Every few weeks, Dr. Joe DeOrio, a urologist in Chicago, tackles questions about male sexuality here on EMandLO.com. To ask Dr. Joe your own question, click here.

Dear Dr. Joe,

Is it safe for me to enjoy receiving anal play if I have hemorrhoids?

— Backdoor Bob

Dear B.B.,

I guess the pertinent words here are “safe” and “enjoy.” If your definition of a safe and enjoyable sexual experience involves potential pain and bleeding, then we might be in business.

Okay, okay…maybe I’m exaggerating a bit, so let’s get into it. Surrounding the anal canal are plexuses of veins. In addition to performing the normal function of veins (returning blood to the heart), these plexuses may also contribute to fecal continence. A hemorrhoid is simply an abnormal dilation, or varicosity, of one of these veins. Since there are veins located both within the anal canal and at the level of the anus itself, one can develop both internal and external hemorrhoids.

Internal hemorrhoids are usually painless, and you might not even know that they are there. With irritation, however, they may bleed. Occasionally, they can prolapse, or stick out from the anus. Besides being a little unsightly, prolapsed hemorrhoids may become strangulated and lose their blood supply, which can be painful. External hemorrhoids, on the other hand, are often visible, appearing like a bulge at the anal verge. They are sometimes painful, they frequently itch or cause irritation, and they often bleed.

So what causes these little bundles of joy? Truth is, we don’t really know for sure. Hemorrhoids are associated with chronic constipation, occupations that involve prolonged sitting or standing, pregnancy, obesity, chronic diarrhea, and the abuse of laxatives — in essence, conditions that produce straining or increased intra-abdominal pressure or conditions that cause chronic irritation to the anal canal.

Does anal sex cause hemorrhoids? The jury is still out on that one. Undoubtedly, anal sex can increase anal pressure and cause some spasm. And it can also cause irritation, especially if you don’t use enough lubrication. Despite these facts, however, I suspect that anal sex, properly performed, will not result in hemorrhoids. In the presence of pre-existing hemorrhoids, however, anal sex can certainly irritate, inflame, or disrupt them, which can lead to pain, bleeding, and prolapse.

My recommendation? If you know you have hemorrhoids, treat them properly before attempting anal sex. Going to a professional proctologist is the best thing you can do to help you eliminate the problems caused by a hemorrhoid. Oftentimes, hemorrhoids will spontaneously resolve by increasing dietary fiber, maintaining good hydration, and moving about a bit during the workday. If that doesn’t do the trick, see a surgeon. There are a multitude of treatments that he or she can offer.

If you don’t know that you have hemorrhoids, if you are ignoring my advice and attempting anal sex anyway, or if you are just looking to prevent hemorrhoids, follow the common recommendations for healthy anal play: use plenty of lubrication, go slowly, and do not do anything painful. And don’t forget that the risk for acquiring STDs is higher with anal sex, so be safe.

— Dr. Joe

Want more tips for exploring the back roads?
“A Beginner’s Guide to Anal Sex”

Dr. Joe earned his undergraduate degree in Molecular Biology from Princeton University. After attending the Loyola University Stritch School of Medicine, he completed his residency training in urological surgery at the Los Angeles County Medical Center. He lives and works in Chicago, IL.