ANAL DOUCHING- The Good, The Bad, and The Ugly
The Rectum is the Jan Brady of the sexual organs (for those of you that are too young to know who that is, think Khloe Kardashian)- by this I mean it doesn’t get a lot of attention. In fact, up until recently even though you can get gonorrhea, chlamydia, HPV, and syphilis in your rectum, people were rarely if ever checked for any of these. Additionally, there has been very little research done on the rectum as a sexual organ and what health-related consequences exist for those that do use it sexually. It is known, that up to 60% of MSM (men who have sex with men) that have receptive anal intercourse (“take it in the ass”) douche to, “clean out.” Yeah, of course they do because most people find having feces make an appearance during sex to be a mood killer. If you aren’t one of those people and have a partner who also doesn’t care, this post isn’t for you…
Let’s start with an evolutionary perspective, while anal sex is without question natural; bonobos (a type of chimpanzee) have anal sex. They don’t however douche. Regular anal douching is something that hasn’t been a part of our evolution, and so we don’t know how well our bodies are set up to adapt to our doing it frequently. Thus, we don’t know very much about what, if any, health impact may come from excessive or prolonged anal douching. So before getting to the “how to”, let’s be clear- since we aren’t sure about potential negative consequences don’t get carried away and do it more than is necessary to have an enjoyable and rewarding sex life.
Now, let’s talk about the known and theoretical risks of douching- It's known that anal douching seems to increase the risk of acquiring anal gonorrhea and chlamydia. This is likely to be because it cleans out not only the unwanted boner-killing poop-but also some of the good bacteria that line your rectum and large intestine leaving the place lonely for bacteria of any kind including some of those unsavory sorts you’ll hit up, on Grindr at 2 AM. So, if you are douching often, you should also be getting tested for anal GC/Chlamydia regularly. This is especially important as anal GC/Chlamydia can often be asymptomatic (meaning you have no idea that shit is there). (see what I did there? Yes I know, my comedic skills are wasted in medicine.)
Additional possible risks come from using regular tap water for douching. This could be a problem for two reasons. Firstly, your intestine acts like a dialysis membrane. When we put fresh water in our colon, it leaches the electrolytes (salts) from our body’s water. For the most part, the volume of water used for douching and the amounts of electrolytes in your system make this loss negligible, and there are not any health consequences. Yet, for some people that douche with vast amounts of tap water or that have health conditions where they have low levels of electrolytes (like sodium/potassium) this presents a potentially dangerous health risk. How much is too much for a healthy person? We don’t know for sure, so err on the side of caution and make sure your health care provider knows if you are douching very frequently and especially if you have a known electrolyte imbalance. Ideally you should douche with the smallest amount of fluid possible and if you can, use bottled saline from the drug store or homemade biological saline out of tap water. We can discuss this during a visit if you’d like. Doing this will help maintain your electrolyte balance and reduce the risk of any problems. It will also most likely reduce the amount of liquid required to clean up as non-physiologic saline can stimulate your colon to start moving things along creating more work for you. Sadly, carting huge bottles of saline around isn’t a feasible solution for many, but without question douching with physiological saline from the drug store is the safest way to go! Using bottled saline also protects you from the second and more insidious risk of tap water douching. Which is related to what’s in that tap water? If you are on a well water system, it’s possible the water could be contaminated with parasites or bacteria that could cause infection. Water contamination is unlikely in most municipal water supplies but if you’re camping in Yosemite, think twice before douching with stream water. Lastly, you could also be exposing yourself to toxic contaminants in the tap water. When we drink with our mouths, our livers are given a chance to eliminate a lot of pollutants from the water before it gets dispersed in our bloodstream and throughout our body. When you stick things directly in your ass (think booty bump), it goes straight into your blood with no filtering. This puts you at risk for exposure to toxins and contaminants. So, you may not want to douche with tap water on your vacation trip to Flynt, Michigan, for example.
If you often douche at home and have the option of using filtered water there, go for it, or consider getting your water tested. At least look at water quality reports in your area if there is any doubt about the safety of your water. Think about this when you travel as well. Lastly, think about what and how you’re using your douche. There is no question, it is possible to damage your rectal tissue if you are jamming a fire hose in your ass and blasting it, so don't. It’s also possible to transmit infection via an anal douche. I have had multiple patients who without question acquired Hepatitis C via sharing a douche nozzle. Soak your douche nozzle in a 10% bleach/water solution for 30 minutes and rinse it thoroughly for an extended period of time if it's shared or better yet never share it with anyone else.
Ok, so if I haven’t scared you out of douching with all the what if’s? (cause let’s face it you’re likely going to do it anyway)- Here’s a reader’s digest “how to” guide….
Firstly, douching when you have loose or runny stool can feel like trying to bail a sinking ship with a teaspoon (this can also lead to using a lot of water and all the risks described above). If your stool is very loose and you have no medical contraindications (check with your health care provider), you can consider taking a single, loperamide (OTC antidiarrheal) a few hours before. This will help slow down the movement of the feces through your colon and make it so you don’t accidentally stimulate your colon into pushing everything towards the exit, setting you up for a considerable investment in time. Taking loperamide also makes what’s there a little more solid and dry so that it comes out in a nice lump instead of like a lot of chocolate milk. Use small volumes of preferably sterile biological saline but alternatively clean water, preferably at body temperature and administer it with a slow flow rate, using a lubricated nozzle that you either never share or that has been sterilized with bleach. Hold the water in there for about 30 seconds before letting it expel into the toilet. Keep doing this until the water runs clear or has only yellowish mucus present. Once done, give yourself about 30-60 minutes for your body to reabsorb any remaining water and to make sure there aren’t any late comers to the party. If someone does arrive late, you may be back to the drawing board for a few more rinses but take heart the end is probably in sight. If the process is taking you a considerable amount of water or an exorbitantly long time be careful. If you start to feel dizzy, or lightheaded, stop, the anal sex gods are telling you it’s all not in the cards for you that day.
References
· Sexually Transmitted Infections, "Association between rectal douching and HIV acquisition among men who have sex with men: a systematic review and meta-analysis," 2021.
· BMC Public Health, "The use of inappropriate anal douching tools associates with rectal mucosal damage among men who have sex with men," 2021.
· International Journal of STD & AIDS, "Lubricants and rectal douching: associations with rectal gonorrhea, chlamydia, and syphilis diagnoses among men who have sex with men," 2020.
· Open Forum Infectious Diseases, "Douching and Rectal Inflammation in Sexual Minority Men," 2019.
· Sexually Transmitted Infections, "Rectal douching practices among men who have sex with men in Paris: implications for HIV/STI risk behaviors and rectal microbicide development," 2017.
· Sexually Transmitted Infections, "Effect of rectal douching/enema on rectal gonorrhoea and chlamydia diagnoses among men who have sex with men," 2019.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6586483/?utm_source=chatgpt.com
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