We have often waxed poetically about the marvel of invention, that is the human penis. But, no less impressive is the male anus. It took millions of years of evolution to develop its distinctive size, shape, and function. And no one appreciates all of Mother Mature’s hard work as much as we gay males.

Our relationship with the anus is special and unique. We defy religious and societal mores and find pleasure in a body part we are expected to shun and be disgusted by. We know the joy this muscle can provide our sexual partners and us. With abandon, we celebrate the anus and its functions.

Unfortunately, many of us are not as well educated about our anus as we should be. In this article, we provide you with the information you need to have a healthy and positive relationship with your hole and the anus’ of the men you sexually encounter.

So, join us in exploring inside the gay male butthole!

Biology lesson

The anus is the opening where the gastrointestinal tract ends and exits the body. The anus starts at the bottom of the rectum, the last portion of the colon (large intestine). The anorectal line separates the anus from the rectum. It’s coated with muscles that the body uses to hold in gas or feces until they are ready to be expelled. Think of the anus as the doorway to the rectum. A ring of muscles called the anal sphincter keeps your anus closed until you go to the toilet.

The rectum is usually empty because stool is stored in the large intestine. When the intestine gets full, the stool passes into the rectum, and you feel like you need to go to the toilet.

Two sphincters control the exit of feces from the body during an act of defecation. These are the internal anal sphincter and the external anal sphincter, which are circular muscles that normally maintain constriction of the orifice and which relax as required by normal physiological functioning. The inner sphincter is involuntary, and the outer is voluntary. It is located behind the perineum, which is located behind the scrotum.

How big is it?

Medical websites and Google will tell you that the rectum is 6-8 inches long and 2.5 inches at its widest point. But that’s misleading: The rectum is designed to hold varying amounts of fecal matter, so the tissue is stretchy.

Emergency room doctors can give us a ballpark idea of how spacious that cavity can be. A doctor writing under the pen name Mona Moore wrote that doctors have retrieved a “12-inch long and 8-inch wide salami” from a patient’s rectum, among other surprisingly large objects such as bedposts, doorknobs, glass bottles, aluminum tubes, and a 20-inch-long live eel.

Scientists have tried to assess just how roomy the rectum can get, ostensibly not because of what they do in their time off but rather to understand the conditions that can lead to incontinence. To understand the volume and pressure situations, they use imaging techniques like ultrasounds or CT scans to insert a balloon into the rectum and inflate it. But these techniques don’t take into account things like rectal-wall thickness and variations in the mechanics of different facets of the tissue, so the results vary too much among patients to give a solid estimate, according to one 2007 study.

The anus has an amazing ability to stretch itself to accommodate waste existing the rectum as well as a penis, finger, dildo, or even fist seeking to enter it. With much practice and lubrication, the anus is able to expand and subsequently contract with surprising ease.

But, anal stretching or fisting poses a more serious threat of damage due to the deliberate stretching of the anal and rectal tissues; its injuries include anal sphincter lacerations and rectal and sigmoid colon (rectosigmoid) perforation, which might result in death.

Extreme care should be taken when attempting to stretch the anus!

Why does touching it feel so good?

The anus has a relatively high concentration of nerve endings and can be an erogenous zone, which can make anal intercourse pleasurable if performed properly. The pudendal nerve that branches to supply the external anal sphincter also branches to the dorsal nerve of the penis.

The abundance of nerve endings in the anal region and rectum can make anal sex pleasurable. The internal and external sphincter muscles control the opening and closing of the anus; these muscles, which are sensitive membranes made up of many nerve endings, facilitate pleasure or pain during anal sex.

Human Sexuality: An Encyclopedia states that “the inner third of the anal canal is less sensitive to touch than the outer two-thirds, but is more sensitive to pressure” and that “the rectum is a curved tube about eight or nine inches long and has the capacity, like the anus, to expand.”

In addition to nerve endings, pleasure from anal intercourse may be aided by the close proximity between the anus and the prostate. For a male insertive partner, the tightness of the anus can be a source of pleasure via the tactile pressure on the penis. Pleasure from the anus can also be achieved through anal masturbation, fingering, facesitting, anilingus, and other penetrative and non-penetrative acts.

Your sensitive anus

An anal pain could actually originate anywhere within the perianal area, including your anus, anal canal, and rectum. Your perianal area contains numerous nerve endings, which can easily become irritated and inflamed. The tissues in that area can also tear or ulcerate, which may cause bleeding.

If you notice anal bleeding and are also in pain, you may worry that you have anal or colon cancer. Most of the time, anal pain is caused by benign — not malignant — conditions. However, contact a medical provider immediately if you see blood in your stool or have anal pain accompanied by a fever.

Below are a few of the most common causes of anal pain.

Hemorrhoids

Hemorrhoids are swollen veins in your anus or rectum. Try adding more fresh vegetables and fruits to your diet and drinking more water to loosen your stool. Also, relax when you defecate rather than straining and pushing, which worsens hemorrhoids.

Skin conditions

Conditions that affect other areas of your skin, such as psoriasis, can also affect your anal skin. If you have a tendency to develop warts, you could have passed them to your anus. Anal warts might also be a type of sexually transmitted disease (STD) caused by an infection with the human papillomavirus (HPV).

Anal fissure

A fissure is a small tear in your skin or other tissues. It can be extremely painful, like a paper cut, but it will heal.

Anal abscess with fistula  

An anal abscess is an infected cavity within your anus that’s caused by blocked anal glands. A fistula is a small tunnel that runs from the abscess to a small opening in the skin around your anus. Your doctor can treat the infection and heal the abscess.

STD or other infection

A fungal or bacterial infection can cause anal pain. Your specialist prescribes antibiotics or antivirals to eliminate or control the infection.

Trauma

Anal sex, constipation, and diarrhea can all irritate and tear the linings of your rectum and the skin around your anus. The tears are painful, but the pain will diminish as they heal.

Inflammatory bowel diseases (IBD)

Digestive diseases such as Crohn’s disease and ulcerative colitis can cause pain throughout your digestive tract, including your anus. These diseases can be controlled but not cured.

Muscle problems

Pelvic floor muscles that can’t fully relax can make bowel movements painful. You might also have levator ani syndrome, in which the muscles around your anus spasm. Pelvic floor muscles can be retrained with physical therapy.

Treating anal pain

If you have anal pain and you also have a fever or blood in your stool, you should contact a medical provider immediately.

If your anal pain is new, and you don’t have a fever or bloody stool, try:

  • Over-the-counter pain medication
  • Sitz baths (i.e. soaking in hot water)
  • High-fiber diet
  • Stool softener

Anal pain that persists for more than a couple of days could be a sign of a serious condition, including anal cancer. Benign pain, too, might need specialized treatment, including repairing traumatized tissues or removing diseased veins.

I want it to be pretty!!!

To the complete surprise of no one reading this article, anal cosmetic surgery is big business. No matter the state of your cavity, there is a way to make it camera ready as long as you are willing to pay for it.

Dr. Evan Goldstein is a Manhattan surgeon who has pioneered the practice of making buttholes beautiful and more sexually compatible through Botox, tightening, and loosening procedures.

He opened his Bespoke Surgical practice on East 12th Street in 2010, where he offers medical services to treat hemorrhoids, skin tags and fissures, as well as cosmetic procedures like Botox, dilating and tightening services that run from $5,000 to $25,000 depending on the severity of the case.

“Anal reconstruction is a type of plastic surgery that focuses on restoring the form, function, and cosmetic appearance of the anus. These reconstruction services may also help tighten the sphincter muscles that are too elastic and beyond recoil. There are a few different names for anal reconstruction, including anal plastic surgery, depending on the purpose of the operation. Anal reconstruction will revitalize the anus’s aesthetic look and functionality, increasing the patient’s quality of life.”

The procedures offered by Dr. Goldstein include:

ANAL TIGHTENING

We provide anal tightening surgery for loss of control, lessened sensation during penetration, or just that added “pucker” to the aesthetics.

ANAL RELAXATION

If you have difficulty with defecation and/or penetration, we provide relaxation services with scar revision.

ANAL BOTOX

We provide botox injections for primary healing of secondary procedures and assisting in the relaxation of both native skin and muscle.

SCAR REVISION

To fully rejuvenate your anal area, we provide external skin and scar revision with both excision and laser/cautery application for a clean look.

Another anal cosmetic procedure that is popular is anal bleaching. This procedure can be accomplished through a trained medical provider or over-the-counter creams. DIY bleaching can last up to six months.

Bleaching of the skin, in general, can come with irritation and inflammation. It could be as minimal as dermatitis or increased acne but, in rare cases, could cause a darker bluish-black pigmentation on the skin as well, according to 2016 research.

Beware of severe itching, burning, and stinging during and after treatment. Skin irritation is common when you use lightening creams, and it is even more likely to develop when you treat sensitive areas like perianal skin.

If you experience any adverse effects in response to a product, stop using it immediately, thoroughly wash the affected area with a gentle cleanser, and apply a petroleum-based moisturizer, such as Vaseline, to form a protective seal over the skin.

Some spas, salons, and plastic surgeons offer the service for about $125 per session, according to Cindy Barshop, CEO and founder of VSpot Medi-Spa in New York City. Others, like the Unisex Intimate Bleaching Peel, cost up to $1,000 for three 30-minute treatments scheduled two weeks apart, says licensed aesthetician Graceanne Svendsen. You could see results after one session, but it will likely take several sessions to get the skin color you want, and you often need to apply lightening products at home between sessions. Like DIY bleaching, the results can last up to six months, Svendsen says.

What about Anal Cancer?

Anal cancer is a disease in which malignant (cancer) cells form in the tissues of the anus. Most anal cancers are related to human papillomavirus (HPV) infection. Signs of anal cancer include bleeding from the anus or rectum or a lump near the anus.

Anal HPV is present in approximately 65% of HIV-negative MSMs and 95% of MSMs who are HIV-positive. Although HAART (highly active antiretroviral therapy) has decreased overall mortality from HIV, it has not reduced the incidence of anal squamous cell carcinoma. And, since it is spread through sexual skin-to-skin contact, condom use only partially reduces the risk of transmission. 

In the general population, anal cancer is a rare disease. Among men who have sex with men (MSM), the incidence of anal cancer is significantly more prevalent and increasing annually. However, the majority of MSM’s know little about the disease, have never been tested for it, nor know that screening tests exist. Healthcare professionals, too, remain divided on how and whether to screen for it. In fact, a standardized screening protocol for anal cancer does not yet exist.

Each year anal cancer is diagnosed in about 2 out of every 100,000 people in the general population. Current estimates are that HIV-negative MSMs are 20 times more likely to be diagnosed with anal cancer. Their rate is about 40 cases per 100,000. HIV-positive MSMs are up to 40 times more likely to be diagnosed with the disease, resulting in a rate of 80 anal cancer cases per 100,000 people.

Risk factors for anal cancer include the following:

Signs of anal cancer include bleeding from the anus or rectum or a lump near the anus.

These and other signs and symptoms may be caused by anal cancer or by other conditions. Check with your doctor if you have any of the following:

  • Bleeding from the anus or rectum.
  • A lump near the anus.
  • Pain or pressure in the area around the anus.
  • Itching or discharge from the anus.
  • A change in bowel habits.

Anal cancer is an increasing health threat to MSMs, especially those who are HIV+. There is no professional consensus about whether to vaccinate against it, screen for cell changes, or treat positive results on an anal pap smear. More research is needed, and both the consumer and provider communities need to be educated.

Most health care providers are not offering anal cancer screening to their patients, either because they are unaware of the risk factors for anal cancer, do not inquire about their patients’ high-risk sexual practices, and/or do not know how to perform an anal pap smear. Some providers are knowledgeable but do not believe that routine screening of this population is warranted.

In order for healthcare providers to offer anal cancer screening to their patients who warrant it, it is critical that MSMs talk to their medical providers about their sexual orientation, HIV status and sexual practices. This does not happen often enough. The NYC Dept of Health found that nearly 40% of MSMs do not come out to their providers. Those that are open about their sexual orientation often do not know enough about anal cancer to request a screening.

It is critical that the gay community be educated, both HIV-negative and HIV-positive MSMs, about HPV, anal cancer risk factors, and the options available for screening and treatment. Then individuals can make an informed decision about whether to be screened and seek out a provider who is familiar with the options. 

Did you know?

Your lips and anus are both made of the same type of skin, called the mucosa

The anus doesn’t require soap to stay clean, just water and wiping. In fact, soaps and shampoos can irritate and dry out the sensitive skin of the anus

Scientist believe humans have hair around the anus because we simply haven’t evolved away from hair there. It doesn’t get in the way of elimination or procreation. It helps conduct scents that our ancient selves relied upon for reproductive purposes. It helps prevent irritation or chafing in that sensitive tissue

Many forward-thinking people believe that the anus is a powerful source of primal instinct. Wiccans call this area of the body a “cone of power”

No two buttholes smell or taste, the same. That’s because each of us secretes certain pheromones through an anal gland

The “anal sphincter” is actually two valves. The internal sphincter is involuntary, meaning you can’t squeeze it open. You can consciously hold closed or open, the external, voluntary sphincter if you have to

Once a year, you should have a professional look at your anus. Lots of abnormalities that people live with can be treated, such as fissures, hemorrhoids, and even cancer

Sitting on the toilet for more than five minutes can increase your chances of developing hemroids

In the land of ancient Egypt, caring for the sacred anus of the pharaoh was a privilege. These were the first proctologists, also called the Neru Phuyt, which literally translates as ‘guardian of the anus or Shepherd of the anus’

Before you go…

Society has taught us that the anus is a dirty part of the body. Some cultures have developed rituals around which hand (the left one) is allowed to touch it after defecation. Hopefully, by now, you understand that the anus is an important part of your body and your sexual health. Treated properly, it can be a source of great joy and pleasure for you and your partners.

Now, go out and play in your butthole or, preferably, someone else’s!

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