The Ultimate Guide to Anal Sex for Women (28 page)

As in chapter 6, I will use the following terms and corresponding definitions, each of which assumes the unprotected form of sex (i.e., no safer sex barrier).

 

RUBBING: manual external stimulation with fingers, without penetration, without a glove.

 

FINGERING: anal penetration with a finger or fingers without a glove.

 

LICKING: analingus or rimming without a barrier.

 

ANAL INTERCOURSE: anal penetration with a penis, without a condom, with or without ejaculation.

 

SHARING SEX TOYS: transferring a sex toy from an infected person’s orifice to another person’s orifice without putting a condom on it or disinfecting it first.

There are more than one hundred types of the human papillomavirus (HPV), and more than thirty different strains affect the genitals, including the ass. HPV is a virus most closely associated with genital or anal warts, although not all forms of HPV cause warts. Some of the strains are potentially cancerous including several that have been directly linked to cervical cancer. It is estimated that as many as one in ten people in the United States has HPV. You can spread HPV through anal intercourse, rubbing, fingering, licking, or sharing sex toys.

HPV often manifests itself as genital warts; however, in many cases, there are no external symptoms at all. Anal warts begin as small pink bumps that look like cauliflower florets around the anus and in the anal canal; they tend to spread rapidly, forming clumps of bumps that may be itchy. The bumps could be painful if they are irritated. Their incubation period is usually one to six months, but they can grow more rapidly if you are pregnant or have a compromised immune system.

HPV in the vagina can cause precancerous lesions on the cervix that can be detected through a pelvic exam and PAP test. If you have HPV in your ass, it’s less common to have treatable precancerous lesions present since there is no cervix or cervix-like place for them to develop, though it’s still possible to have pre-cancerous cells. If you have anal warts, a physician will be able to see them during a rectal exam with an anoscope. Anal warts are treated by removing them from the skin either through applying chemicals to them (usually acids), burning them with an electric needle (electrocautery), freezing them with liquid nitrogen (cryotherapy), or with laser treatment. Even after visible warts are removed, HPV remains in your body, and the anal warts can recur.

To test for the presence of HPV in the ass when there are no warts, a physician takes a swab of the rectum and sends it for laboratory analysis (similar to a vaginal PAP test). If you regularly engage in unprotected anal
penetration and think you have been exposed to HPV, you can request a rectal exam and an anal papilloma screening (also known as an anal PAP test). The test can identify if there is HPV in and around the anus and anal canal; some people with HPV will never develop any symptoms, others may show precancerous cells which precede rectal cancer. You can spread HPV from your anus to your vagina and vice versa, so if it has been discovered in one place, it’s advisable to get the other place checked. People diagnosed with HPV should have regular exams to monitor recurrences and prevent complications.

More than forty-five million people in the United States have been diagnosed with genital herpes. Most often genital herpes is caused by herpes simplex virus type 2 (HSV-2), as opposed to herpes simplex virus type 1 (HSV-1), the virus that causes oral herpes. Genital herpes is transmitted through sexual contact, including licking, anal intercourse, and, less commonly, rubbing or fingering with cuts in the skin and sharing sex toys.

Within a week of exposure, people with herpes usually first experience a tingly or burning sensation in the genital area; then they develop bumps, blisters, or open sores in the affected area, which can be itchy, sore, and/or painful. Women can also experience flu-like symptoms, swollen glands or lymph nodes, a vaginal discharge or yeast infection, and painful urination. Initial sores usually heal in one to three weeks without treatment.

There is no cure for herpes, and symptoms can recur during outbreaks. These outbreaks can be brought on by stress, a compromised immune system, or prolonged exposure to the sun; they can last for up to three weeks. Although a person is most contagious during an outbreak, transmission of the virus can happen during nonactive periods as well (especially the two weeks after an outbreak) and with or without visible blisters or other symptoms. Doctors prescribe medications like acyclovir, famiciclovir, or valacyclovir to both treat and prevent outbreaks, but there is no cure for genital herpes.
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Chlamydia is a sexually transmitted bacterial infection and the most common STD in the United States. Seventy-five percent of women and fifty percent of men with chlamydia have no symptoms. It can be spread through anal intercourse, more rarely through sharing sex toys, rubbing or fingering if there are cuts in the skin, and very rarely (if ever) from licking. Common symptoms—if they do occur—can begin anywhere from five days to a few weeks after infection, and may include painful anal penetration, bowel movement discomfort, anal burning, soreness, and discharge; women may also experience swelling and soreness of the lymph nodes and rectal bleeding. Chlamydia is diagnosed through a rectal exam and treated with antibiotics like doxycycline and azithromycin.
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Rectal gonorrhea is a bacterial infection transmitted through different types of sexual contact including anal intercourse and licking, and less frequently, sharing sex toys, and rubbing or fingering if there are cuts in the skin. Symptoms appear within three to seven days of exposure and include soreness or burning during bowel movements and an anal discharge. Gonorrhea affects about 650,000 Americans every year. Up to 80 percent of women and about 10 percent of men who have gonorrhea have no symptoms; for women, this is even more true in cases of rectal gonorrhea than in those of vaginal gonorrhea. Rectal gonorrhea is treated with antibiotics, including penicillin, tetracycline, and ceftriaxone.

Much less common today than in the past—there are less than forty thousand reported cases in the United States—syphilis is a bacterial infection. Syphilis is transmitted by touching a sore on an infected person; sores can be on someone’s mouth, penis, vagina, anus, or skin. You can spread it through anal intercourse, licking, rubbing or fingering (especially but not exclusively if there are cuts in the skin), and very rarely, sharing sex toys. Syphilis can have an incubation period of two to eight weeks. Ten to ninety days after exposure, people with syphilis experience the primary stage of the virus. A round ulcer (called a chancre) erupts in the affected area. The area in and around the chancre may ache or burn—or not. People may also have swollen lymph nodes. After the chancre hardens, heals, and disappears, the secondary stage begins. The secondary stage is marked by a general skin rash of sores the size of pennies that may be itchy and painful. You may also experience fever, swollen glands, aching joints, headaches, nausea, and/or constipation. This stage is when people are most contagious. The third and fourth stages, latent and tertiary, are very serious and can be deadly if untreated. Syphilis is treated with antibiotics, usually penicillin, doxycycline, or tetracycline.

Hepatitis A is an inflammation of the liver caused by the hepatitis A virus (HAV); the virus is transmitted when infected fecal matter gets into the mouth. A person who practices unprotected oral-anal sex
with an infected person and comes into contact with that person’s fecal matter
is at risk. There are conflicting studies about how many cases of HAV are spread through sexual contact.

On average, the incubation period is thirty days, but can be anywhere from fourteen to sixty days. An individual is most infectious two weeks before and one week after he or she develops symptoms. Symptoms include fatigue, nausea, vomiting, abdominal pain, dark urine, light stools, fever, and jaundice (yellowing of the skin and eyes). You may become ill with several of these symptoms suddenly. Doctors can diagnose hepatitis A with a blood test. There is no treatment for hepatitis A, and it usually clears up on its own in weeks or months, depending on a person’s immune system; the liver repairs itself and there is no permanent damage. Once you’ve had it, you develop antibodies for it and cannot have it again. In
the United States, nearly one-hundred thousand new people contract HAV every year; there is a vaccine for the virus.
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The type of hepatitis most likely to be sexually transmitted is hepatitis B, an inflammatory liver disease caused by the hepatitis B virus (HBV). The virus is present in all bodily fluids of an infected person, including semen, saliva, vaginal secretions, blood, feces, menstrual blood, and sweat, although it can only be transmitted through blood, semen, and possibly saliva. It can be spread through anal intercourse and licking, and manual penetration if there is a cut on the skin and a tear in rectal tissue or rectal bleeding.
HBV is one hundred times easier to transmit sexually than HIV.
About eighty thousand Americans become infected with HBV each year. One out of twenty people in the United States will become infected with HBV sometime during their lives. Most of these infections occur among people who are twenty to forty-nine years old. There is an HBV vaccine to prevent hepatitis B that is given in multiple scheduled doses over four to six months.

About 50 percent of adults with HBV never have symptoms. When symptoms do occur, they appear between six weeks and six months after infection and may mimic flu symptoms: fatigue, nausea, vomiting, loss of appetite, headache, fever, tenderness and pain in the lower abdomen or joints, and possibly jaundice; more severe symptoms could be hives, severe abdominal pain, dark urine, and pale-colored bowel movements. Hepatitis B is diagnosed by a blood test.

About 95 percent of adults with hepatitis B develop antibodies to the virus and recover within two to six months without medication or treatment. While their blood will always test positive to the virus, they are immune and not infectious. The other 5 percent become chronically infected. They may or may not continue to show symptoms, but they will always be a carrier of the virus and can infect other people; they are at risk of developing cirrhosis, liver failure, and liver cancer. There are about 1.25 million HBV carriers in the United States. There is no treatment or cure for acute hepatitis B, but people with chronic hepatitis are prescribed different medications to eradicate or suppress the replication of the virus.
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Hepatitis C, also an inflammation of the liver, is caused by the hepatitis C virus (HCV). It is passed from person to person through direct contact with an infected person’s blood. It is primarily spread through unsafe IV drug use, including sharing needles. Researchers disagree on the number of cases transmitted through sexual contact, and some studies “failed to detect the presence of HCV in either saliva, semen, or urine of HCVINFECTED people—except when those body fluids have been contaminated by the person’s blood.”
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It may be spread through anal intercourse, but only when there are tears in the rectum or rectal bleeding and through finger-fucking with rectal bleeding
and
cuts on the skin of the finger. HCV is more likely to be spread during sex if either of the sex partners also has HIV or another sexually transmitted disease.

Most infected people are asymptomatic or may have mild symptoms that resemble the flu: nausea, fatigue, loss of appetite, fever, headaches, and abdominal pain. Doctors do blood tests to determine if someone has HCV. Twenty to thirty percent of people can become disease-free with medication that contains the viral activity and reproduction and decreases inflammation in the liver. About 70-80 percent of people have chronic hepatitis C, and many of this group develop cirrhosis (scarring of the liver) or liver failure. There is no vaccine for HCV.
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HIV, the virus that causes AIDS, is carried in and transmitted through bodily fluids and most concentrated in blood, semen, menstrual blood, breast milk, and vaginal secretions. HIV is transmitted in several ways: through unprotected sexual contact with the bodily fluids of an infected person, by sharing needles with an infected person (through intravenous drug use), by receiving infected blood (through a transfusion), or from mother to baby via amniotic fluid, during delivery or breast-feeding. It’s easier for women to get AIDS from men through sexual intercourse than vice versa. The tissue of the vagina is more susceptible than the tissue of the penis to trauma, tears, and minute sores, which provide infected semen a direct route to the bloodstream. This is even more true of the tissue of the rectum, which is more delicate than that of the vagina. Plus, semen has a higher viral load than vaginal fluid, so infected semen is more infectious than infected vaginal secretions. Women and men can get the virus from anal intercourse,
licking, and sharing toys, as well as from rubbing and fingering if there are cuts on the skin and in rectal tissue.