Why I am posting about anal douching on LinkedIn. 💻💦🍑
The anorectal mission
As a medical scientist and bottom I believe anorectal health has been overlooked for too long. Therefore, I am broadcasting this message on Linkedin to not only make you aware of the “bottoms burden” but also to share why I started working on anorectal health and built the Polari Group. A collaboration between scientists who are looking to apply cutting-edge medical technology to overlooked issues within underrepresented communities.
The problem … feaces
From an outsider’s perspective it can appear that sex for gay men is totally carefree and spontaneous. As an insider I can tell you there is one problem with this interpretation: faeces. 70% of gay men spend between 10 mins - 2 hours preparing for anal sex by flushing water through their rectum and then waiting for any trapped liquid to be released in a process known as anal douching (Guide to douching) (Carballo-Diéguez et al., 2018).
To perform this operation, gay men report using several different devices, such as shower attachments, bulb enemas or DIY solutions (e.g., water bottles) (Carballo-Diéguez et al., 2018). Water bottles are particularly popular as they are immediately available with many choosing to opt for an Evian bottle as it has an anal insertion friendly nozzle. Although this may sound reasonably straight forward, the behind-the-scenes process is a mess. It often involves moving back and forth from the toilet to a sink filled with lukewarm water. Temperature is important as to not irritate the lining of the rectum or make the sphincter seize up. Individuals fill a plastic bottle with water inserting this into their anus, and then squeezing water into their rectum. The bottle is then removed, and liquid expelled. They then need to manoeuvre themselves back to the sink to refill the bottle and repeat this ~10 times until the “water runs clear”. Even after this protracted process they are not free from the concern of a faecal accident (meme). This is because the final flushes can dislodge faeces from higher up the gastrointestinal tract which can appear during sex. Additionally, anal douching introduces the possibility of trapped water being released during sex (meme). We have learned that some individuals opt to douche in the shower rather than pivoting between the toilet and the sink. This can be done with a shower head attachment (meme). The problem here is faeces ends up within the bathtub. This can result in people trying to push faeces down the plug hole or transporting faces across the bathroom to the toilet in various receptacles. Dietary fiber supplements designed to condense feces can make it easier to douche or improve the odds of feces-free sex without douching. In more extreme cases people take imodium (bung yourself up) or laxatives (get it all out) to prepare – which both have potential medical consequences and are not advised. See medical experts explain why you should not do this (here, here and here) and instead you can just up your fibre intake.
Speak to gay men…
Me (an expert in Herpes) and Anna Vybornova (a medical device expert and biomedical engineer) started the Polari Group four months ago to try and find a better solution to allow for spontaneous and clean anal sex without anal douching (us). We started by understanding how and why people douche (meme). Having spoken to over 100 people my biggest take-away is that most people are not confident they are doing it correctly. This is likely due to chasmic lack of education / sexual health information on the topic (meme). More broadly we found that the mechanism though which people douche varies widely. Some individuals spend a long time douching to ensure they don’t have an accident. Some people term themselves “douching Jedis” who claim to clean themselves out in 5 mins. We have noticed while gay men are very happy to discuss their sex lives douching is often a sensitive and controversial topic. For example, how long it should take, how it should be done or whether you should do it at all. Our opinion is you should do whatever allows you to confidently enjoy intimacy as long as it is safe. More shocking to us was the number of gay men who reported that douching affects their gut health or exacerbates irritable bowel syndrome (IBS). This affects both their general health and sex life. No studies have ever looked for at the relationship between IBS and douching … despite the fact enemas (medical term for flushing out your bowels) are known to be bad for you gut microflora and likely disrupts the epithelial lining of your rectum (Zhang et al., 2015, Schmelzer et al., 2004, Watanabe et al., 2010). It is clear that gay men with IBS struggled to engage in douching, and this makes their sexual lives significantly harder (see tips on bottoming with IBS – here or Crohn’s disease and colitis - here). While 30% of homosexual couples do not douche before sex, and this can work for a lot of people, it often results in the receptive partner struggling to feel comfortable or enjoy the experience.
Block to spontaneous sex
The biggest issue is anal douching creates a barrier to spontaneous sex. Gay men entering into intercourse face pressure to disappear to the toilet for 30 minutes to prepare themselves (meme). To allow for spontaneity many gay men will engage in “pre-douching”. Essentially this is prophylactically douching before you go on a date or to a venue where you might be sexually active. Although usually by the time the encounter happens, they often will feel they need to douche again. Men also report frustration when they have douched, and intercourse does not happen (meme) (meme). Another jarring experience at the start of a relationship is the first fecal accident with a new partner. While many sexual partners are understanding there are many who are not. Termed toxic tops (top – penetrating partner), they are quoted as saying things such as “do you not know how to douche”, “that is disgusting” and “this has never happened to me before”. Bottoms (the receptive partner) also report anxiety when it comes to having sex outside of their own home. This is because they are away from their own bathroom which is kitted out for preparation. It can be hard enough to navigate the logistics of douching around flatmates let alone in an unfamiliar space. The sad truth is fecal accidents are embarrassing enough in your own home where you have relative control compared to an alien environment where you cannot rapidly move the sheets into the washer (meme). Due to the difficulties surrounding anal sex gay men display extreme behavioral changes such as; dietary restrictions (i.e. avoiding coffee, onions, red meat or spicy food – see bottoms digest), skipping the meal before intercourse, dietary supplements (fiber pills), diarrheal relief pills (imodium) and laxatives. One charismatic bottom told us that – “tops believe bottoms only eat fiber pills and ice cubes”. Gay men will also schedule sex with partners so douching can be quietly accommodated, due to concern about the embarrassment of a potential fecal accident. Remarkably bisexual men have told us that they refrain from engaging in anal sex due to the preparation required or potential mess.
Broadly the topic of anal douching is largely stigmatized and overlooked but deeply important as many gay couples report this can cause tension within romantic relationships. When sex becomes a friction point it can be emotionally traumatic for both partners and end relationships. Despite the clear problems that anal douching causes it is chronically understudied. There is currently far more literature available on shark attacks affecting ~57 people per year, compared to anal douching which inconveniences ~1.1 billon (Javanbakht et al., 2014, Naylor, 2022).
Medical bodies and douching
Medical bodies widely do not provide guidance on anal douching apart from – “don’t do it” or lists of reasons it is bad for you. As a gay man I can tell you - the motivation to douche is to feel confident during sex that you will not have a faecal accident. Therefore, the community will not stop douching as it is plain as day faecal accidents are an incredibly strong motivator. The problem is anal douching is known to cause medical issues. For example, it increases the spread of most sexually transmitted infections (HIV, chlamydia, gonorrhea, syphilis, human papillomavirus, hepatitis B virus and hepatitis C virus) by roughly 3-fold (Li et al., 2019). This is likely because the intestinal lining is disrupted during the douching process, either by mechanical abrasion or due to pure water triggering an osmotic shock within the rectum. Aside from this there are many horror stories when it comes to douching related ailments. For instance, persistent hemorrhoids, rectal bleeding, burns triggered by shower douches due to inconsistent water pressure and travelers who contract gastrointestinal parasites after douching with unclean water (meme) (meme). This is why medical experts are sheepish about offering advice on douching and individuals that do strap – “this is not medical advice” - across their channels for fear of medical liability. Therefore, on this topic there is a vast chasm between patients' practices and medical advice. The only relief appearing in breakaway doctors who talk openly about douching and LGBTQIA+ charities that provide guidelines (see the bottom of the article for resources). From our point of view the reason medical science has largely overlooked this shit show is likely the stigma surrounding anal sex, being viewed as unnatural by many and so not medically important. Anal douching does clearly cause health problems, but no medical alternatives currently exist.
The fact medical bodies don’t provide guidelines is a real problem for young people and those engaging in anal sex for the first time who often turn to YouTube or advice delivered by porn stars. We will dig into the consequences of the lack of LGBTQAI+ sex ed and misinformation in a future article but oddly enough a friend of mine reminded me that when I first came out as gay I explained to him the process of anal douching, on the ferry to the Isle of Wight. He was horrified … likely the people around us were too. I had no clue what I was talking about. Despite this I distinctly remember feeling disappointed I could not be as sexually spontaneous as my heterosexual peers and that my sexual experiences would involve a constant effort to dodge turds.
When it comes to anal douching I believe – “for the love of Jennifer Coleridge there must be a better way”. So, me and Anna Vybornova have made a product that allows spontaneous feces free sex while also avoiding the medical concerns associated with douching.
Ps - It's not just a homo-thing
If at first glance this appears to be a homosexual issue – you could not be more wrong. ~12-fold more anal sex acts are committed by heterosexuals within the UK per week. 30% of straight couples engage in anal sex twice a month and 32% of women who engage in anal sex anally douche before the event (Hess et al., 2016, Javanbakht et al., 2014). So, ditch the stigma, we want spontaneous sex for everyone that wants it (meme).
Disclaimer
This article does not provide medical advice. When it comes to anal douching neither will medical bodies. Below is a list of top-notch resources published by organisations and individuals willing to give advice at their own risk.
Resources
How to douche
● San Francisco AIDS foundation
Douching with IBS or Crohn’s disease or colitis
- IBS
Clinical influencers
Influencers
References
HESS, K. L., DINENNO, E., SIONEAN, C., IVY, W. & PAZ-BAILEY, G. 2016. Prevalence and Correlates of Heterosexual Anal Intercourse Among Men and Women, 20 U.S. Cities. AIDS Behav, 20, 2966-2975.
JAVANBAKHT, M., STAHLMAN, S., PICKETT, J., LEBLANC, M.-A. & GORBACH, P. M. 2014. Prevalence and types of rectal douches used for anal intercourse: results from an international survey. BMC Infectious Diseases, 14, 95.
LI, P., YUAN, T., FITZPATRICK, T., SMITH, K., ZHAO, J., WU, G., OUYANG, L., WANG, Y., ZHANG, K., ZHOU, Y., LI, M., CHEN, D., LI, L., CAI, W., CAI, Y. & ZOU, H. 2019. Association between rectal douching and HIV and other sexually transmitted infections among men who have sex with men: a systematic review and meta-analysis. Sex Transm Infect, 95, 428-436.
NAYLOR, G. 2022. The ISAF 2022 shark attack report [Online]. Florida Meuseum. [Accessed].
SCHMELZER, M., SCHILLER, L. R., MEYER, R., RUGARI, S. M. & CASE, P. 2004. Safety and effectiveness of large-volume enema solutions. Appl Nurs Res, 17, 265-74.
WATANABE, M., MURAKAMI, M., NAKAO, K., ASAHARA, T., NOMOTO, K. & TSUNODA, A. 2010. Randomized clinical trial of the influence of mechanical bowel preparation on faecal microflora in patients undergoing colonic cancer resection. Br J Surg, 97, 1791-7.
ZHANG, F., LI, X., XU, X., CAI, D. & ZHANG, J. 2015. Relationship between the pH of enema solutions and intestinal damage in rabbits. Biol Res Nurs, 17, 78-86.
