Anal Health 101: Caring for Your Anus Without Embarrassment

In my consulting room, the anus is usually the last thing patients mention, after circling around it for a long time. I want to say right at the start: for a doctor, the anus is an organ like the eyes or teeth. Asking about it and examining it is completely normal, and the sooner you come, the easier it is to look after.

Why anal health deserves attention

The anus and rectum have a thin lining with many blood vessels and nerve endings, so they are both very sensitive and easily injured. Problems can happen to anyone, whether from constipation, sitting for long periods, pregnancy or anal sex, which happens in male–female couples, among men who have sex with men (MSM) and among people of every gender.

Common problems

The key point is that rectal gonorrhea and chlamydia often cause no symptoms. If you only test urine, you can miss an anal infection. Read more in 14-pathogen STI PCR testing and Gonorrhea.

Everyday self-care

• Make bowel movements easy. Aim for about 25–30 g of fiber a day (vegetables, fruit, brown rice, beans), drink enough water, don't sit scrolling your phone on the toilet, and don't strain hard.
• Clean gently. Rinse with clean water after a bowel movement and pat dry. Avoid harsh soaps and wet wipes containing alcohol or fragrance.
• Be careful with douching. If you douche, use a small amount of clean, room-temperature water, don't do it too often, and avoid chemical solutions, because frequent douching can irritate the lining and make infection easier.
• Always use lubricant for anal activity. The anus doesn't make its own lubrication. Water- or silicone-based lubes are safe with condoms; oil degrades latex condoms. Read more in Lubricant matters more than you think.
• Go slowly, and stop if it hurts. Pain is a signal that tissue is being injured.
• Sex toys: choose non-porous materials with a flared base so they can't slip inside, clean them every time, and put on a new condom if you share them.

Preventing infections

Condoms together with lubricant reduce the risk of HIV and many STIs. For people at high risk of HIV, pre-exposure prophylaxis is another very effective layer of protection; see PrEP: HIV prevention before exposure.

Vaccines to consider:

• HPV vaccine: protects against anal warts and HPV-related anal cancer. It works best when given before exposure, but adults with ongoing risk may still benefit; discuss it with your doctor individually.
• Hepatitis A and B vaccines: both types of hepatitis can be sexually transmitted, especially hepatitis A through oral–anal contact.

Anal cancer screening: who should be screened?

The 2024 guidelines of the International Anal Neoplasia Society (IANS) recommend screening groups at clearly high risk, such as men who have sex with men and transgender women living with HIV from around age 35, and other people living with HIV from around age 45, as well as organ transplant recipients and some women with a history of vulvar cancer or precancer. Key evidence comes from the ANCHOR study (2022), which found that treating precancerous lesions in people with HIV reduced anal cancer.

There are several screening methods, such as anal cytology (an "anal Pap"), HPV DNA testing, and high-resolution anoscopy when results are abnormal. Details are in Anal cancer screening: anal Pap and HPV DNA.

Also, don't forget colorectal cancer screening for your age, which is a different matter from anal cancer.

When to see a doctor

Book an appointment if you have any of these, and don't keep treating yourself with hemorrhoid cream for a long time without being examined:

• Blood when passing stool, especially if you are over 45, blood mixed into the stool, or bowel habits that have changed for several weeks
• A lump, a sore that hasn't healed in 2–3 weeks, itching, or discharge of pus or mucus
• Weight loss, paleness or fatigue without a clear cause

At Dr. Kris Clinic I offer private, non-judgmental consultations on anal health: STI testing from rectal samples, assessment of warts, advice on HPV and hepatitis A and B vaccines, and referral to a surgeon or for endoscopy when needed. English-speaking consultations are available.