I would say that most of the e-mails I’ve received in response to this blog from guys (and a few straight women!) have been regarding the topic of sex. Most of them are concerned if they could do it or not. I would think that they were asking, because it had been brought up with their sexual partner, and they have obviously been researching whether it can be done. Hence, my blog is one of the first that comes up when you search anything about anal sex related to digestive diseases. I like it that way! For those of you who are complete tops, there’s probably not much information you need from this post anyways, and you can continue your topping ways. But I would advise to read it over, in case you come across anyone who’s living with these diseases, or has had the surgeries, so that you can know and be an understanding partner. And those of you who identify as mostly a bottom, I hope that you will find this post extremely helpful, and as a “manual” to your future, yet altered, sex life.

So here in this post, I’m going to lay it all out on the line about what I know from what we can and can’t do in the bedroom. I will again mention that I am NOT a medical professional, so none of this information should be taken officially, but this is all from what I’ve researched (trust me, I did alot!), and also from what I’ve personally experienced (there’s been a lot of research there, as well!). But then I did hear from someone who said his doctor was so nervous about talking about gay sex, he just told the guy to “use more lube” and ran out of the office! So we have to look somewhere in the middle to find information on such a taboo topic, but I’m not afraid to get it out there, so that there isn’t another person as confused and scared as I was. Some might consider this post graphic, so I advise that if you are not willing to read about anal sex, then please continue on to another post.

Pre-Surgical Passions:

Where should I begin? Let’s start with anatomy. For those of you who are pre-surgery, you still have your large intestine (or some of it anyways), and I’m also assuming you still have your rectum. The rectum is the official organ of anal sex. Therefore, receptive anal sex is possible for you folks. But if any of your were like me, you were so sick and there was so much inflammation it would have been far too painful to even think about having sex. Also, you would be going to the bathroom so many times, the thought of any mess or blood would be enough to kill the mood. I remember also just feeling so down about being sick and I was so weak, I don’t think I ever had the energy to be sexually active. It was a very strange time. But if some of you are stabilized or healthy enough to give it a try, I’d say it could be done. But keep in mind, it is very tender in there, and anal sex will most likely cause bleeding. This will need to be discussed with your partner and you also have to keep in mind that the bleeding is a sign that there is more damage. You really want to take your time and not let things get rough. If there are any ulcers or extra inflammation, then there could be some tearing or damaging that could occur, so please be careful. You must ALWAYS be in control and you should be a good judge of what you can and can’t handle. You’re health is on the line.

Post-Surgical Passions- The J-Pouch:

For those of you who are post-surgery, it can get a little more complicated. There are a couple options for procedures, but the most common would be the Ileoanal Anastomosis (“J-Pouch”). I will also talk about the ileorectal anastomosis (“IRA”), because that is the procedure I had, and so I’m quite familiar with it. If you have the J-Pouch, the answer to the anal sex question is unfortunately, NO. As can be seen in the picture, the folded small intestine that creates your J-Pouch is sewn right to the anal canal. This provides almost no room for a penis to pass through, as the small intestine is very narrow. I can’t say the exact size, but it’s certainly not much bigger than the width of a drinking straw, or your pinky finger at most. It is also not as elastic as the rectum, so cannot stretch as freely when an object is inserted. There’s also the concern of the suture site being right there, and any stretching can certainly drastically increase the risk of a tear. If it wouldn’t be the visceral skin that is torn, it could possibly be any suture holding the J-Pouch in place, creating the effect of a rupture in the intestinal lining. I don’t think I need to go any further as to how critical that can be. And after what you went through with that surgery, a tear will only land you back on the operating table. I know this is extremely upsetting news, especially if you are younger and get pleasure out of bottoming. But after all the sickness and disease you’ve already gone through, you shouldn’t put yourself at any further risk. Further down this post, I will provide alternative options for sexual pleasure. If some of you are having touble dealing with this information, I advise that you seek someone to talk to, and if you don’t know anyone, you can always e-mail me (Booties4986@aol.com), and I would be happy to talk with you about it. When I had my first surgery, I thought this was going to be my case and I went through a severe depressive mood, thinking that I was never going to have sex again and that no one would ever want to be with me. Trust me, I’ve been there. I also know what it’s like to think that you’ve lost your “gay identity”, or to feel that the part of what makes you who you are is now taken away. But I always say we have the advances of medicine in our future and perhaps there will be a way someday!

Post-Surgical Passions- The IRA:

For those of us with the IRA (represent!), we have a slight advantage, but even more care and concern. People with an IRA have all or at least some of their rectum. The rectum is the main organ invovled in anal sex, as it is the only place that the penis goes. It is generally eight to ten inches long, if you have the whole thing. Since I have my entire rectum, I am still able to have sex, but I also use extreme caution. It is similar to being pre-surgery, except there is no pain and disease, but the sex drive is normal. At least it is for me. For one, if you have inflammation of the rectum (proctitis), it happens to be more painful and something you’d want to avoid so that further inflammation or damage doesn’t occur. I came down with mild proctitis recently and it was easily helped with rectal suppositories (mentioned in a previous post). The best way to have intercourse would be to get in the “riding” position. This allows full control to be in your hands. You can let it enter at your own pace, and if it becomes too painful, just get back up. Then you can also control the speed and depth of the thrusting, to make it the most comforatble for you. Also keep in mind that your rectum is now the storage area for all of your bowel movements, since the large intestine is no longer there to do that. They can’t be stored in your small intestine like they previously were in the colon, so you have to be very conscious of what’s going on down there before having sex. Make sure that you have gone to the bathroom and if I can provide a bit of advice that has been extremely useful to me…. douche. I went online and found an anal douche for only about $10, and it works wonders in clearing everything out. Of course it would need to be done right before the sexual act, otherwise time will just bring more bowels into the rectum and you’re back at square one. Another concern for post-IRA people would be the size of you sexual partner. We should always be concerned with girth, but it’s the length that is key here. As I mentioned before, you have a limited amout of space. What once would have passed your rectum and gone into the large intestine, can now no longer fit in the small intestine. It would bring up the same risks as people with the J-Pouch (tearing, bleeding, ruptures, etc), and should be avoided at all costs. Therefore you should cap the length of your sexual partner at 7.5 inches (all us men lie anyways, it shouldn’t be that hard to find!), unless you know the exact measurement of your rectum from your doctor. You should also avoid any sexual position that is out of your control, or where he would be deepest inside.

Heterosexual Anal Sex:

For women, all of the previous information is of course true. The anal anatomy would all be the same depending on what type of surgery you’ve had, but I would say that your rectums would probably be smaller. So something to consider, depending on the size of your partner. Men have prostates, which is what gives us the pleasurable feeling of anal sex, but women however may derive their own form of pleasure from it, or do it to please their sexual partners. I would advise that your partner be aware of your surgical history, and hopefully he will lose his desire for anal sex and stick with vaginal intercourse, to avoid any damage to you. If not, then in my opinion, he’s not a worthy man to keep around. But if anal intercourse is actually something that you get pleasure out of as well, and seek to explore, then read below for the alternatives, as it would be the same for you ladies as well.

How To Prepare:

If you are pre-surgery, or post-surgery with an IRA, then there is unfortunately almost always going to be a preparation process. It doesn’t look like anal sex is ever going to be this random quickie thing for you again. If you’re at all like me, you’re most likely going to plan your day around whether you think you’re going to have sex or not and might get paranoid about making sure everything is going to go okay. As I mentioned before, the one thing that shot up my confidence was buying an anal douche. I was extremely paranoid because some of the times I was experimenting with sex after my surgeries, I would have a little bit of a mess. Thankfully, I had some understanding partners, but I think there is only so much a person can take. I would eventually just avoid having sex, and on extreme days, I prevented myself eating the whole day, so that by the time I was ready to be intimate at night, there shouldn’t be anything to pass through. Please don’t choose that option, because trust me, stuff passes through whether you eat or not. It’s all part of the body’s natural peristalsis. An anal douche is similar to using an enema, except you don’t have the intense bathroom-usage side effect, and it’s just basically washing your rectum. People who still have their colons might consider an actual enema. I fill mine up with lukewarm water and do two washes to clean things out, right before having sex. The cleaner the water that comes back out, the cleaner you know it is up there. You might even “feel” cleaner and therefore it would increase your confidence, and I’m sure that’s something your partner will notice and enjoy.

Another option is to pay attention to any medications, supplements, or food you eat that day. I always be sure take the full amount of pills needed, and my last dose of Lomotil right before having sex. That medication slows down some of the working of the intestines, so it can slow down the process of food needing to come out. I use that in the hope of preventing any last-minute digestion while I’m in the bedroom. I also eat a Metamucil fiber cookie about an hour or two before anything, because then things can bulk up and prevent any loose, watery stools that would unfortunately be there no matter what douching does. And of course, eating any bulky food that day will also help and eating it in small amounts, at a decent time before, depending on how fast your digestive process is. For instance, I feel as though my digestive process is about 5 to 6 hours. So anything I eat in a day, will generally be coming out 5 to 6 hours later. It’s all about timing. I also be sure to avoid anything that doesn’t fully digest. For example, lettuce, raw vegetables, or anything with seeds in it. Since they won’t digest for us anymore, and they can easily get stuck in the tract and not be able to be douched out, they can sometimes appear at the wrong time. This is definitely something you would want to avoid. The last thing you need is to have little bits of broccoli or lettuce involved in your sex!

The last thing that’s smart to take notice of is the environment. If you’re more comfortable in your own place, or have all the previous preparations readily available there, try to veer the act in your own domain. Not only would this increase your confidence, but you would have anything you need close by and are able to use them if required. Also, you can control other aspects of the sexual environment. For instance, if a certain smell is of concern to you, be sure to light scented candles in the bedroom. Not only will this provide romantic lighting, but it will also make the bedroom smell great and hopefully get rid of any concerning odors. There’s also the option of flavored lubricant. The brand, Wet, makes a strawberry kiwi that tastes nice and also gives off a very fruity smell that takes over the room. This is sure to mask any smell, and if he says something about it, just say it’s the only lube you have left. Also, controlling the lighting is another key. If there’s going to be a little mess and you sometimes can’t control it, then it would be better to keep the lights off. No one needs to see any of that, and I’m sure it will increase your confidence. I avoid daytime sex, because I’m just not sure enough how things are going to be and instead of worrying about it, I just keep the lights off, lay a towel down, and enjoy what I can. It should also be noted that having white, or light colored sheets might not be the smartest thing either. I go with the policy of making sure sure I’m as comfortable as can be, and he’s as clueless as can be!

Other Risks & Factors:

As with any sexual act, there are always risk factors involved. And if you couple that with having a chronic disease that may have involved the removal of key body organs, then you have to assume that the risks increase substantially. For those of you living pre-surgery, you most likely have inflammation, ulcers, or sores that are just asking for diseases to attack. It makes you extremely susceptible to contracting an STD, or other types of infection or bacteria that shouldn’t be there. It could easily put both you and your partner at risk. There’s also the risk of further damaging the frail tissue in that area, and from what I remember it was a long struggle just to heal that tissue, and I couldn’t imagine wanting to damage it for one sexual act.

For those of you living post-surgery with the IRA, it’s the same story with the STDs and infections. Most of us will basically always have the inflammation, and if not, then some of you may have scar tissue as well. This all creates a more shrunken environment than is usual. And a smaller environment down there, means it’s tighter and it’s more painful to take, and that pain just leads to slight tearing and bleeding, which can then lead to increased risk of contracting something or causing more scar tissue. It’s an unfortunate cycle.

However, these do not mean that those of you living pre-surgery, or post-surgery with an IRA can’t have sex, it just means that you should be VERY cautious. And it should allow those of you living post-surgery with a J-Pouch feel better about not even having to deal with having sex! It can be more work than it’s worth!

One of the last things I bring up, and it’s definitely a “risk” in my book, is abandonment and rejection. This can happen for ALL of us, whether you are pre- or post-surgery and whether you have a J-Pouch or an IRA. We are different. Just say it to yourself: “I am different”. Different, however, should not be viewed as bad, but just as something other than what society calls “normal”. But being gay, we should all already know the experience of being different and be proud of it! Franky, I think normal is pretty boring. I compare the words “normal”, “common”, and “frequent” with the words “different”, “rare” and “unique”. I’d much rather be the latter. Now that you realize that, you have to realize we are also different within our own community. We are gay men who are living with something that gets in the way of us leading a regular sex life. And because of that, we are more apt to be abandoned by those we love, or rejected by those we hope to love. There are a lot of people out there who don’t understand us and don’t understand what we went through. Some (mostly bottoms) probabaly aren’t going to mind as it might not affect them much. But the tops might not understand why we have to take precautions during sex, and they might lose interest in that. I can speak from personal experience that it’s very hard to get someone to accept your insecurities, your preparations, and sometimes even your scars. I was in the middle of a three year relationship when I got sick, and he was with me through pretty much all of it. I had decided to go through with the surgery, because I knew I wanted to be with him forever anyways, and we had talked it through. So I had the surgery, then he called me and ended our partnership before I even made it back home from my first surgery. Needless to say, I felt naive. But it was a learning experience into the risks of living post-surgery. And each date, or sexual encounter after that has still been a learning experience. I always say to look at it like a “filter”. We are biologically living with something that allows us to “filter out” the unworthy men in our lives, therefore saving much heartache later on.

Alternatives To Anal Sex:

Alas, we come to the topic of alternative ways to get sexual pleasure. The majority of these options work for both pre- and post-surgery patients, so they can be generalized, unless I have specified otherwise. One of the basic options is to just change the type of sex you’re having. If you had mostly, or exclusively, bottomed before getting sick, then consider switching roles. Discuss with your partner whether or not he would be willing to be the bottom from now on. This should also be something that you are willing to do. Some of us may not be comfortable switching roles, or may be bitter about the fact that the opportunity was taken from us, but it’s this or other less thrilling options. And frankly, I’d rather still have sex! If topping and bottoming isn’t how you classify your sex life, and you rely more on domination or submissiveness, then it wouldn’t matter what role you were in. If you were used to being more submissive, therefore leading you to bottom more frequently, then you can learn to be a submissive top. For instance, being thrown onto your back and ridden is just as dominating as being thrown onto your stomach and… well, there’s not exactly a decent word for it, haha. There are always ways to work around sex to make it comfortable for you, and your partner should be willing to do so, as long as he is comfortable as well. I find myself to be a little more submissive, so if I’m going to top, I’m much more comfortable having someone ride me, because then I can still feel like they are in control and like they are on “top”.

If you’re adament about not switching roles, there is a whole array of foreplay to explore. When I was diagnosed and didn’t have sex, my partner and I relied mostly on foreplay. After all, it doesn’t have to ALWAYS be about sex. Making out can become more passionate when it’s not just a time-passer between getting undressed and having sex. We are all (hopefully) equiped with two hands that can come in very handy all over the body. A simple back massage could work it’s way down to hand jobs, fingering (I’ll discuss later), or just an all-over massage that can relax the muscles and increase bloodflow, therefore leading to a more intense orgasm. I personally enjoy oral sex and find it to be satisfying enough for the majority of the time. Just like intercourse, this can involve a series of positions to promote sexual gratification. For gay men, 69 is the perfect equilibrium sexual activity. Both parties get the same satisfaction at the same time, there’s no risk of damaging anyone, and there’s a much smaller chance of transferring STD’s or infections (if done safely). For those of us who have more sexual receptors in the back end, there is of course the option of oral sex back there. This act provides no risk of damage to your surgery site, yet provides an intense stimulation. And from what I’ve experienced, the people that like to do it, REALLY like to do it and won’t mind. Of course, the preparations listed a few sections above should most definitely be taken into account, as you wouldn’t want to give yourself a reputation!

For the second round of foreplay, let’s consider options that involve forms of penetration. Of course these all need to be considered very carefully. One of the most basic forms is, of course, the finger. You should first explore it alone during masturbation. Try inserting one finger (very lubricated) in to get a feel for it and see how comfortable you would be. You should be able to feel the area and get an idea of what you have going on down there, because you’ll want to know when your with someone else. If you don’t notice much discomfort and feel like you can explore a second one, go ahead and try it. I would not advise going beyond two fingers. You might notice, because it will be tighter anyways, and you wouldn’t feel comfortable with anything bigger. Keep in mind, even if your fingers feel okay, it doesn’t mean a penis would. After you get to know it, try it with a partner if they are comfortable doing so. Express that they should start with one finger and keep it slow so you can get adjusted to it. This should provide a pretty safe form of anal stimulation and hopefully keep you from any harm. Other options include sex toys. Please don’t go overboard and keep these to a small size, and simple form. You don’t want anything too big, nor do you want anything with ridges, bumps, spikes, etc. This is a sure way of bringing on damage. At sex stores I’ve been to, I’ve seen really small dildos and other miscellaneous toys meant to be small enough, yet they still provide the stimulation. You may find that many of these toys are meant for use by women, but can easily be used by a man as well.

One of my favorite toys that I always talk about is The Bullet. This can come in many sizes, shapes, and colors, but is generally a small, silver bullet-shaped toy that is attached to a cord and remote. The objective is to insert it into your anus and use the switch on the remote to control the vibrations it makes. They generally range from slow to fast. Please be sure to buy the smallest version of The Bullet you can find and don’t use the high speed unless you’ve used the slow speed often and are comfortable with it. Too many vibrations might increase your chance of damaging something. If it’s too tight and The Bullet doesn’t fit all the way in, keeping it on the opening of the anus, with slight pressure, will still create an amazing feeling. Also, I should mention that if you are topping and you have The Bullet inside yourself, your penis will vibrate slightly. This should create yet another great feeling for both you and your partner!

For those of you who are post-surgery, with an IRA, if you notice some tightness when trying to have sex, there is yet another toy you should try. It’s a Rectal Dilator Kit. It usually comes with three to four buttplugs, in varying sizes. The point is that you start with the smaller one, and work your way up to the larger one, or whereever you feel comfortable stopping. This can help relax the muscles of the rectum and allow you to be more prepared for sex without the discomfort. But be VERY cautious with this, as some of the kits have the largest being so big, it’s alsmost impossible. I would generally stick with the first two sizes and this is ONLY if you have a rectum leftover (The J-Pouchers should not try this). There are plenty of things for you to explore at your local sex shop. Other items include anal beads, finger toys, dildo ice-cube makers, straps, handcuffs, feathers, costumes, poppers, and of course food. I highly recommend you try out these options, as the only thing it can do is make your sex life more interesting, and if you are worried about not being able to bottom, then these will surely pass the time between the sheets!