Sexual Health and IBD

Frequently asked questions about sex and IBD as an LGBTQ+ person, navigating sexual activities and life with perianal/rectal IBD or fissures/fistulas/setons 

‘Bottoming’ or having anoreceptive intercourse (anal) while in an active flare/perianal disease - what to do?
  • Using Fleet/saline enemas - are these okay?
  • Amyl nitrate/’poppers’ - can I use these?

Bottoming and IBD

Prep for bottoming often involves using things like loperamide (Immodium), enemas, eating a high fiber dietwhich can be a big no-no in IBD (every person is different!), so be sure to double-check with a trusted care team member if taking things like Immodium and other prep tools such as anal douches is safe for you.

  • If you notice pain, bleeding, or unusual soreness/weeping when prepping or bottoming (engaging in anoreceptive intercourse) pause what you are doing - you may need to recollect, try a gentler approach, or have a check-in with your physician. This applies for everyone - not just IBD-ers - sex shouldn't hurt and you shouldn't bleed!
  • You won’t have an enjoyable time if you are suffering through or in pain- but there is one piece of advice for bottoming/anal sex that is most important of all - I  cannot stress enough -

LISTEN to your body and COMMUNICATE with your partner!

If there is significant inflammation in your anorectal area, anoreceptive intercourse increases the risk for trauma to the area and can increase pain.

  • IBD is often associated with being on immunosuppressive medication (biologics, etc). Protection is important as well as being proactive about testing for STIs. If applicable, you may consider talking to your doctor about starting PrEP. 

  • If you begin to notice blood or experience pain - it may be time to take a break from bottoming/anoreceptive intercourse
  • ‘Douching’ too frequently and using products with excessive additives in areas of pre-existing inflammation can lead to bleeding and irritation

  • Amyl nitrite/’poppers’ act as a vasodilator and can have  harmful side effects, such as methemoglobenemia, and can lower your blood pressure precipitously and cause a rapid spike in heart rate. Be very careful when using and make sure someone is with you.

  • Lubricant is your friend! 

  • Be aware of what base your lubricant is made of though - silicone, water,  oil, etc. Silicone-based lubricants can damage silicone products but are safe to use with condoms. Oil-based lubricants/oil-based lube will lead to condom breakdown! This can lead to an increased risk of STIs. 

  • ALWAYS use a flared base for anything going in behind - this applies for everyone, not just if you have IBD!

Condoms and What to Not Mix

  • Water Based Lube - Compatible with Latex Condoms

    Water Based Lubcriant is the best option!

    KY water based- lubricating jelly/lube

  • Silicone Based Lubricant - Will Degrade Latex Condoms

    Avoid using silicone lubricant with latex condoms as condom breakdown can lead to increased risk of infection.

  • Petroleum Jelly

    Same principle as silicone based lubricant - will degrade the latex in the condom.

  • Mineral Oil

    Contact with mineral oil greatly decreases condom strength and integrity. Stick to water-based lubricant!

Safe Practices

How to live your best life without compromising your bowel health!

Always, always, always listen to your body - if something doesn’t feel right or feels off - pause and reevaluate!

Have honest and open communication with your partner - in a flare, let them know you have more limitations and may need to change what you do (go slower, no bottoming, etc)

Before using amyl nitrate/’poppers’, talk to your physician or a healthcare professional - these can have seriously harmful side effects and be very dangerous if you have an underlying cardiac condition, and are generally unsafe even if you have no health conditions

Poppers may seem harmless, but when living with IBD we have to be careful with things hat may hurt our heart. Please be careful and try not to use these.

You are your own best advocate - advocate for what is best for you/works best for you, and communicate about what is painful or uncomfortable

If having anoreceptive intercourse (bottoming/anal) during/right after a flare, take it very easy - the swelling and inflammation in the area can cause things to be much different from how they 'normally' are. The tissue in the area may be more sensitive as you are recovering, so it's important to take it easy.

Be mindful of what lubricant you use - oil-based lubricant will lead to degradation of latex condoms, which can lead to an increased risk of STIs

As mentioned before, IBD is an autoimmune disease and predisposes you to infection. In addition to already practicing safe sex (condoms always!), consider talking to your doctor about PrEP (if applicable)

If you start to notice blood, pain, or unusual discomfort, stop and reassess. If you have perianal Crohn's or Ulcerative Colitis active in the anorectal area, bottoming may not be a great idea until the inflammation is decreased.

I know it may seem really boring, and no fun at all, but your health in the long run is the most important, and it may mean not bottoming for a little bit until your IBD is better.

Take care of yourself before and after!

Be kind to your butt! Aftercare is important for everyone, especially if you have IBD. Wash with gentle unscented soaps (Cetaphil, etc) but never use soap INSIDE your rectum/anal area - only on the outside!! This can dry out and irritate the re