Does Anal Hurt? Dr. Goldstein’s Tips for Eliminating Pain During Anal Sex

Dr. Evan Goldstein

November 08, 2023

There is a common misconception that anal sex hurts. We can assure you: this isn’t true. If it does, it’s likely you’re doing something wrong (or you didn’t do enough to prepare). While some people use the words “discomfort” and “pain” interchangeably, they are actually quite different. In this blog post, we will dive into the possible causes of pain during anal sex, as well as discuss the nuances between pain (red flag) and discomfort (common).

Does Anal Sex Hurt?

Anal sex is not supposed to hurt, but many people experience pain or soreness. This pain typically happens if your anus muscles are too tense, your anus skin is too tight, and/or if you are not lubricated enough. Discomfort is common, especially when someone is just starting to explore anal play; however, discomfort, which is generally mild and will go away as you continue to explore, is different from pain, which can be the sign of something more serious.

What If I’m Bleeding After Anal Sex?

Much like pain, anal sex should not lead to bleeding. You may experience a spot or two of pink or light red blood, especially if you’re new to bottoming or bottoming for a larger-than-average penis or toy. However, dark red blood or bleeding that’s more than just spotting likely means that an injury has occurred, and you should stop right away and seek medical attention.

Bleeding after anal isn’t typical, and some causes of anal bleeding during sex can include:

  • Hemorrhoids,
  • Anal fissures from friction,
  • Fingernails causing small cuts,
  • Enemas or improper douching
  • And in some cases, STIs, like herpes, gonorrhea, or chlamydia.

A little blood isn’t a cause for alarm, but if you have prolonged pain from the anus, severe abdominal pain or the bleeding does not stop, you should consult a doctor.

What Causes Pain During Anal?

The anus has three sets of muscles that all have to work in tandem in order to create a pleasurable, rather than painful, anal sex experience. These include the external sphincter, superficial sphincter, and internal sphincter (going out to in).

Unfortunately, most people have a difficult time with complete sphincter relaxation. Why? Our anal sphincters are in contract mode nearly the whole day, except when we’re going #2 or engaging in anal play. Just like any other muscle we might work on at the gym, our anal muscles also need regular and frequent exercise to maintain the optimal strength and pliability. Without this, we run the risk of pain and injury during anal. 

That’s why anal dilation training is so important. Untrained (read: tight and tense) skin and muscle, combined with not enough lubrication, make for a very painful experience.

For the unlucky few, there are supplementary issues like hemorrhoids, fissures, and other health-related pathologies that can come between us and anal orgasmic bliss. The good news is that these are all easily addressed. All parties involved in anal play should – and can – experience immense amounts of pleasure from anal, free from pain and even discomfort.

How to Reduce Pain During Anal Sex

The good news is, there are plenty of easy steps that people can incorporate into the daily routine to help minimize the risk of pain and maximize the potential for pleasure during anal. These include:

  • Use the bathroom ahead of time: This can help alleviate concerns that there might be any *surprises* that could pop up during anal sex, which will assist you in being able to more fully relax (the more you relax, the less pain and discomfort you will experience). If you’re looking for an extra boost of confidence, keep reading. Fiber supplements can help keep you regular and ready “down there” as well.

  • Consider prepping with an anal douche: A common prep step before anal sex is anal douching. The skin around your anus is extremely thin, making it important to choose the right solution and apparatus in order to prevent injury and infection. We recommend finding an isotonic, iso-osmolar formula, which means its body-compatible and won’t cause any irritation. 

  • Choose the right lube and use a lot of it: There is no such thing as too much lube when it comes to anal sex. In fact, not using enough lube, not reapplying it often enough, or using ones that aren’t slick enough is one of the biggest culprits of painful sex (along with not practicing anal dilation). There are misconceptions that the anus self lubricates, like the vagina, or that spit can be used in place of real lube. These can be major sources of pain and irritation that can be easily avoided.

  • Use a lubed condom: If you use condoms during anal sex, finding the right lubed condoms, and pairing them with a condom-compatible lube, will help add slickness and safety to your anal play. Not to mention, condoms help with STD prevention. It’s a win-win.

  • Discuss any concerns with your partner: The people I see in my private practice having the best sex are ones that communicate the most with their partners – the good, the bad, and the ugly. Sex is about having fun and getting off, so, if you’re not, you should do something about it. Share with your partner the things you like (and don’t like) so that they can focus on these things. And, if you’re scared and concerned about certain aspects of anal sex, be honest with your partner. Who knows, they may share the same thoughts. The more relaxed your mind and body are, the more you’ll be able to enjoy the moment. And that brings us to the next tip.

  • Take the time to relax before getting intimate: Anal sex requires a lot of things, but high up on the list is relaxation. Sure, sometimes we all crave a quickie (and that’s okay), but lots of foreplay can really set the stage of successful anal sex. When you take the time to explore each others’ bodies, it helps relax both your mind and your hole, which will prime your anus for the penetration that’s to come. One of my best recommendations is rimming or analingus. This is essentially giving oral to your anus by kissing, caressing, and licking the external sphincter and the area around it. This helps relax the muscles, and provide toe curling sensations because of the plethora of nerve endings in the area. Not sure how to get started on rimming? Check out our guide to rim jobs.

  • Prepare with toys or anal dilators: The goal of anal stretching is to train the muscles to be able to easily relax and loosen up when needed (e.g. during anal sex). Anal training and following a dilation protocol is also important for the prevention of anal fissures. If you are unable to fully relax, this could increase your chances of tears and fissures which could lead to pain and a possible need for surgery. Check out our recommended glass anal dilator set to prepare yourself safely today.

  • Go slowly: Most people think you can just ram it in. Maybe that’s because porn has taught us that. But that’s the perfect recipe for painful anal sex, and even injury. The best thing you can do is take your time to slowly relax and open up the three sets of anal sphincters. When you consider your sphincters spend most of the day clenched, it should make sense that when you’re first starting out, you need to go slow. Then, once everyone feels comfortable and relaxed, you can increase the speed, intensity, and depth of penetration.

  • Try different positions: Everyone’s bodies are different not only on the outside, but on the inside, too, with differences in the lengths of our anal canals and the angles of our pelvic floors. All this means that doggy style can be pure bliss for some, and cause excruciating pain for others, and the same for any other position. That’s why I’m a huge proponent of self exploration with toys and dilators. It allows you to see what you like and don’t like without feeling the pressure to perform or get your partner off. You’ll learn different positions that feel best for you and which ones you should avoid when the time comes to bring your partner(s) into the mix.

Do numbing creams help with pain?

People ask me all the time: can I use numbing creams and/or poppers to help ease the pain of anal sex? The first problem with this question is that it assumes anal sex has to be painful. The second problem is that if you do experience pain during anal sex, it’s actually your body saying: stop, something isn’t right. Oftentimes, this happens when the skin has torn, also known as an anal fissure, which could lead to medical issues. Learn more about anal fissures and treatment of anal fissures today.

So, while these substances do mask the pain, they are allowing potentially more damage and injury to happen since now you don’t know that something is wrong. Instead, you should get to the root of what’s causing you the pain in the first place, whether that’s not dilating enough, not using enough lube, or perhaps another underlying issue that should be addressed by an anal specialist or pelvic floor therapist.

Our Favorite Positions for Comfortable Anal Sex

When it comes to comfortable anal sex, not all holes are the same. However, there are general rules that we’ve discussed so far, and now we’ll get into positions that I find are the best for beginners or those still learning the ropes. Once you’ve tried these, check out our guide to the best anal sex positions to get creative.

Cowabunga (Cowboy or Cowgirl):

Without a doubt, I always recommend bottoms start out on top, facing their partner who is lying on their back. This allows the bottom to be in control of the speed and depth of penetration. It also provides direct eye contact to gauge facial cues (things like wincing or smiling) and open lines of communication. It’s also common for penises and toys to either jut straight out or curve upward, and this position allows easier access to the prostate or A-spot, which usually results in pleasure rather than pain.


Although this gives the top more control of the situation, for anal sex in particular, there are ways for the bottom to control the depth of penetration by adjusting the angle of their pelvis and the placement of their legs. The lower the angle of the pelvis, hips, and legs, the shallower the top will be able to thrust into the bottom. However, the higher you lift your legs (as far up as resting on the shoulders of the top), the deeper the top can penetrate the bottom.

Spooning or Side-by-side:

While the top and bottom are facing away from each other, which limits the ability to read facial cues, this position, like missionary, can be as sensual and slow or as deep and fast as you’re both comfortable with. What’s great about this position is that by increasing and decreasing how much the bottom is crouched will adjust the pelvis and help maximize pleasure and minimize discomfort for both parties.

Anal Sex FAQs

What kind of lube should I use for anal sex?

Silicone lube is the best lube for anal sex due to its unmatched slickness and endurance. Water-based lubes tend to dry out very quickly, get sticky, and require frequent reapplication. These are best used to supplement the natural lubrication of the vagina. Oils also provide superior lubrication; however, they are not compatible with condoms and have not been tested for use in the anus.

Will anal sex be messy?

It doesn’t have to be. It’s a myth that you will always encounter feces during anal sex. Yes, it’s possible, but with the right preparatory measures – going to the bathroom beforehand, listening to your body and not bottoming if you’re currently experiencing digestive issues, and even using an anal douche – it’s unlikely you’re going to have a mess on your hands (or penis or toy).

Does anal sex impact bowel movements?

No. Anal sex only takes place in the anal canal and rectum, which is free of any stool, except when you feel the immediate need to go #2.

What kind of protection should I use for anal?

Condoms are a great way to protect yourself from STDs and HIV transmission when engaging in anal sex. It’s important to make sure the lube you’re using is compatible with your condoms of choice, otherwise you run the risk of the condom breaking during sex.

Can anal sex result in severe injuries?

Anything is possible if the proper precautions aren’t taken; however, it’s unlikely in a situation where the sex is consensual, both parties are sober, and common-sense measures were taken (like using lube, not using blunt objects, etc.). If anything doesn’t feel right, don’t be ashamed to stop, take a breather, and try again. If things still aren’t feeling right, call it a day and seek professional help if you’re experiencing bleeding and/or pain.

In Conclusion

In the end, I want everyone to come away with the assurance that anal sex doesn’t have to be – and shouldn’t be – painful.

When someone is interested in trying out anal sex, unlike what movies and porn might lead you to believe, it’s not something you can just dive into on a whim. It takes practice (with anal dilation exercises), patience (with a trusted partner), open lines of communication (sharing what feels good and what doesn’t), and a hell of a lot of lube (preferably silicone).

For those of you who have vulvas, we have a guide on how to enjoy anal play through the a-spot, for those of you who want to learn everything about anal sex, I recommend checking out our full guide from top to bottom, and for those just looking for incredible tips on anal foreplay, we have you covered, too. Anal sex should be fun and I promise you that with the proper education and tools, you’ll be on the right path to maximizing pleasure and minimizing pain.

About the author

Dr. Evan Goldstein is the Co-Founder of Future Method and the Founder and CEO of Bespoke Surgical, the leading private practice in health and wellness for gay men. He received his MD from the University of Medicine and Dentistry School of Osteopathic Medicine. Dr. Goldstein is the go-to butt and bottoming expert, having been published in Huffington Post, Men’s Health, Healthline, and more. Learn about Dr. Goldstein by visiting his practice,


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