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When You Have Crohn’s But Love to Take It in the Ass

How to safely have anal sex when there’s always going to be a little splash risk

Welcome friends and lovers to another enlightenment-seeking installment of the same column that brought you such philosophical explorations as “should I deep-fry ground beef into the shape of a hand?” and “what happens when pancakes and Mountain Dew collide?” This week: The splash risk you face when performing anal sex on a person who has a chronic gastrointestinal illness.

Probably no one wants to talk about that. In fact, probably someone will demand that I formally apologize to Geoffrey Chaucer for using the English language to place the terms “splash risk” and “anal sex” in a single unholy sentence. But that’s the problem. Anal sex and chronic gastrointestinal illness are both unmentionable in polite company, even in this relatively liberated day and age. A layperson who partakes of neither might not think of either item as shameful, exactly — more just unsuitable for casual conversation.

Hey, I get it. I have Crohn’s disease myself, and I have never been able to make myself have a frank conversation with my gastroenterologist about anal sex. She’s a polite woman who wears a little gold crucifix. It’s hard to fold the erotic functions of the anus into medical conversation with a person who refers to diarrhea as “going to the bathroom.” I know she spends most days elbow-deep in B-hole, but something about anal sex doesn’t seem like it’s her business. So instead, I consulted Kaveh Hoda, a gastroenterologist and hepatologist as well as the host of the medical podcast The House of Pod. I needed someone who will never be elbow-deep in my particular B-hole to give me some answers about how safely one can receive anal sex when one has GI problems that will never go away.

First, some definitions of terms: Crohn’s disease is one of two conditions (the other being ulcerative colitis) that comprise the umbrella term “inflammatory bowel disease,” or IBD. Crohn’s disease can strike anywhere in the GI tract, while ulcerative colitis is confined to the colon. Though the acronym IBD looks like that of IBS, or irritable bowel syndrome, Hoda clarifies that the two are distinct. “IBD is when you have inflammation or ulcers in your GI tract, and IBS is a functional disorder with chronic abdominal discomfort and altered bowel movements,” he tells me. “Unlike IBD, IBS appears normal on a colonoscopy.” The difference is the inflammation and the risks it carries if left untreated: Crohn’s disease and ulcerative colitis can put patients at risk for colon cancer; IBS does not.

All these illnesses can also be psychologically ruinous. You know the anxiety you feel when you need to take a shit right the fuck now and aren’t sure when you’ll get to a toilet? That anxiety is the stuff of day-to-day life for those of us with chronic GI illnesses. Before I was able to get treatment for my Crohn’s disease, it’s no exaggeration to say that I lived in fear — fear of leaving my house, fear of the cool little bars my friends all loved that only had one single-stall bathroom, fear of hearing the shower turn on and knowing I was exiled from the bathroom for some unknowable stretch of time. Worse, the fear was totally warranted. This was no “what if everyone who loves me actually hates me” anxiety. The consequences of ignoring this fear were vile and humiliating. Thus, I was its servant for ages.

Fortunately, I began taking medication that put my illness into remission, allowing me to say goodbye to the anxiety that had ruled my life. But just because the illness was in check didn’t mean it was gone. I didn’t know what all I could start doing normally again — could I resume eating foods that had once been triggers for flare-ups? Could I take NSAIDs for my migraines even though NSAIDs, too, often caused flare-ups? Most importantly, could I have anal sex again?

A lot of my questions had straightforward answers, but again, I was uncomfortable asking that last one of a doctor I knew I’d have to keep seeing regularly for years. For all the talk about how medical doctors absolutely don’t judge and should get the same frank conversation out of us that we might prefer to reserve for our therapists or priests, we all know it’s not true. Doctors are susceptible to prejudices like the rest of us, and I’d heard plenty of anecdotal talk of doctors neglecting the needs of “difficult” patients, be they overweight patients with conditions that couldn’t be resolved no matter how many diets they tried or women begging to no avail for anesthesia during IUD insertions. These stories filled me with a whole new batch of fears.

I mean, I was too loath to mention my Crohn’s disease in public to even consult friends on the matter (a sex ed practice that has long supplemented the pitiful health classes we all took in middle school). So I very much worried that once I became the “anal sex patient,” I might get a pesky and impossible-to-remove Note™ added to my chart. Should such a note be included, any future manifestations of Crohn’s disease could become attributable to the anal sex my doctor would know I was having. I, of course, didn’t know for certain that my doctor was prudish or judgmental. But that was the problem: I didn’t know. My doctor might not judge me, or she might. When you have a chronic illness, you quickly learn how much of your future relies on the whims and opinions of a person who’s supposed to be impartial. Why rock the boat, no matter how much I missed getting my boat rocked?

So, do we butt-sex lovers have anything to fear when it comes to medical persecution? “I would certainly hope the answer is no,” Hoda responds. “Patients shouldn’t be concerned that having anal sex will bring them judgment from a gastroenterologist. It’s 2021, for Christ’s sake! Whatever you’re afraid of sharing with us, we’ve probably already seen it.”

There are caveats of sorts, though. “This doesn’t mean that a doctor will always tell you what you want to hear,” Hoda clarifies. “They may recommend things you don’t want to do, and they may tell you that certain sexual practices are risky. But you should never feel judged. If you do, get yourself a new doc.”

As for my other big question — getting pounded in the ass Chuck Tingle-style: yea or nay? — Hoda assures me that I have no need to worry about accidentally triggering a Crohn’s flare-up via a dick in my ass. “For either IBD or IBS, receptive anal sex should be fine as long as you’re not having any active symptoms,” he explains. “I’m not aware of any literature or research that suggests that receptive anal sex will trigger symptoms. In a case of active inflammation, however, I would recommend caution with receptive anal sex, as that does increase the risk of bleeding or trauma.” (I transcribed that quote from memory because I’ve been gleefully reciting it to my boyfriend all week as sex talk.)

I buried my questions about anal sex for a long time, and I didn’t even get to bury them in the fun way — deep in someone’s ass. Happily, though, in recent years, the reputation of Good Sir Colorectal Inflammation and Lady Diarrhea has seen some much-needed rehabilitation at the hands of — who else? — hot girls.

This is the dawning of a new and magical era! I’m not the only beautiful, busty woman afflicted with the Shitting Death. This is hot girl business now! Because I’ve been relatively open about my illness for a while, friends and acquaintances often come to me with the concerns they have about their own variants. This has left me with the impression that all the hot babes do indeed have gastrointestinal tracts that are held together with binder clips and prayer. So I hope this piece is a beacon to anyone who has an ass that just won’t quit: You are not alone, and that troublesome ass will find romance again someday.

Happy hot bowel disease summer!

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