Keep Factually independent
Whether you agree or disagree with our analysis, these conversations matter for democracy. We don't take money from political groups - even a $5 donation helps us keep it that way.
Does consensual receptive anal sex increase risk of anal sphincter weakening or incontinence over decades?
Executive summary
Available reporting shows a mixed picture: large‑scale survey analysis links receptive anal intercourse with higher odds of fecal incontinence in both sexes (e.g., 34% higher risk in women and 119% in men in one report), but case reports and reviews emphasize that severe sphincter disruption from consensual anal sex is rare and often associated with trauma, lack of lubrication, alcohol/drug use, or assault [1] [2] [3]. Overall, studies note associations and plausible mechanisms (stretching, lower resting pressures) but also stress limited and imperfect evidence about long‑term risk from consensual, careful activity [2] [1] [4].
1. What the large survey evidence shows — a statistical association, not proven causation
A nationally representative analysis using NHANES data found that people who reported receptive anal intercourse had higher rates of fecal incontinence; authors quantified a 34% increased risk for women and a 119% increased risk for men in some summaries of that paper [1] [2]. Reporting on that study emphasizes the association but explicitly cautions that this does not establish that anal sex by itself causes incontinence, because fecal incontinence has many other causes and the survey data cannot prove causality [2] [5].
2. Mechanisms proposed by clinicians — stretching, nerve or muscle change, lowered resting pressure
Clinical and opinion pieces explain plausible mechanisms: repeated stretching could reduce resting anal sphincter pressure or damage sensory nerves, leading over time to reduced control [1] [6]. Small clinical series report lower manometry pressures in those who receive anal sex, and authors hypothesize dilation/stretching of the internal sphincter or nerve injury as plausible pathways [2] [1].
3. Case reports and surgical literature — severe structural injury is uncommon but possible
Surgical case reports describe complete anal sphincter disruptions after intercourse, but these accounts are described as uncommon and often involve additional risk factors such as alcohol use, rough penetration, assault, or foreign objects [3] [7]. Reviews of traumatic or unwanted anal penetration document permanent structural damage in some victims, underscoring that forceful or non‑consensual events carry clear risk [8] [9].
4. Surveys and narrative reviews — mixed self‑report data and limitations
Narrative reviews and surveys report varying prevalences of symptoms among people who engage in anal sex — for example, one survey found that around 28% of women reporting recent anal intercourse also reported fecal incontinence, but these studies commonly lack longitudinal follow‑up and control for confounders such as childbirth, prior sphincter tears, chronic bowel disease, or other exposures [4]. Authors of reviews note the dearth of long‑term prospective research to isolate the effect of consensual anal sex over decades [4].
5. Practical perspectives and harm‑reduction advice from clinicians and sex educators
Clinicians and sex‑health commentators generally advise that consensual anal sex done slowly, with generous lubrication, relaxation, condoms, and attention to pain is far less likely to cause tearing or acute injury; pelvic‑floor or anal sphincter exercises may help preserve tone and treat symptoms if they develop [10] [5] [11]. Popular articles argue the “loose butthole” idea is largely a myth for careful adults, while still acknowledging that repeated injury or ignoring pain can harm muscles [11] [10].
6. Key limitations across the literature — why uncertainty persists
Available sources repeatedly flag major limitations: much evidence is cross‑sectional or from small series, manometry differences do not prove future clinical incontinence, self‑report surveys may conflate temporary leakage or preparation issues with true sphincter damage, and important confounders (childbirth, prior surgical or medical conditions, assault, object use, alcohol) are variably measured [2] [4] [3]. Several authors explicitly call for longitudinal studies to determine whether consensual, careful anal intercourse causes progressive weakening over decades [4] [2].
7. Bottom line — balanced takeaways and what to do if you’re concerned
Evidence shows an association between receptive anal intercourse and higher reported fecal incontinence in population data, and mechanisms (stretch/nerve effects, lower resting pressure) are plausible; however, severe structural injury from consensual, careful activity appears uncommon in case reports and reviews [2] [1] [3]. If you engage in anal sex and are worried, harm‑reduction steps supported across sources include use of lubrication and condoms, avoiding force or intoxication, stopping if there is pain or bleeding, and seeking medical evaluation for persistent leakage or new symptoms — pelvic‑floor rehabilitation may help treat fecal incontinence [10] [5] [12].
If you want, I can extract the exact NHANES figures and the study citation text, summarize the surgical case reports in more detail, or list concrete pelvic‑floor exercises and when to see a clinician, all drawn from the sources above.