By Jonathan R. Baker, PA · @RectalRockstar
Pain with anal sex is NOT normal, and it’s usually fixable. Use this one page to work through it with your care team. Check things off, jot notes, and bring it to your visit.
Before your visit: know your pattern
When does it hurt? ☐ At insertion ☐ Deeper, with thrusting ☐ Afterward ☐ Only in certain positions ☐ With bowel movements too
How long has this been going on? ______________
☐ Consistently ☐ At times ☐ Getting better ☐ Getting worse
Also noticing: ☐ Bleeding ☐ Discharge ☐ A lump or bump ☐ Itching ☐ Fever ☐ Mucus or diarrhea that won’t quit ☐ Urinary symptoms ☐ Tailbone or low back pain ☐ Worse around my period ☐ Other:________________
What I use: Lube ____________
Condoms ____________
Toys ____________
☐ I use numbing products (tell your provider)
Cleaning out before sex: How often? ________ How? ________ (bulb, enema, shower)
How long does it usually take? ________ How many times do I pass the water? ________
Bowels: How often? ________ Time on the toilet: ______ min
How do I clean after? ________ (toilet paper, bidet, wet wipes)
How often do I fee the need to push or strain with bowel movements? ________
Last STI testing: ____________ Included a rectal swab? ☐ Yes ☐ No
Start the basics now
☐ 25 to 38 grams of fiber a day (food plus a supplement like psyllium, methylcellulose, or dextrin) and lots of water
☐ Limit to 1-2 minutes on the toilet without pushing or straining
☐ Gentle wiping, no wet wipes
☐ If you clean out: small bulb syringe, about half a cup of tap water, 2 to 3 rounds, and just release it (don’t push)
☐ Skip numbing agents.
☐ Stop if the pain is sharp
☐ Match your products: no oil-based lube with latex or polyisoprene condoms, no silicone lube with silicone toys
Ask your care team
☐ Exam of the anus and surrounding skin (hemorrhoids, fissure, dermatitis, abscess or fistula)
☐ Rectal swab for gonorrhea and chlamydia (a urine test won’t catch a rectal infection)
☐ Syphilis blood test
☐ HSV and MPOX swabs (PCR) if there is a sore or active symptoms
☐ Is my sphincter or pelvic floor tense? Would pelvic floor PT help?
☐ If I have blood, mucus, or ongoing diarrhea: could this be proctitis or IBD?
☐ If symptoms follow my period: should gynecology check for endometriosis?
☐ If I have urinary symptoms or deep pain: should my prostate be checked?
☐ Once other causes are ruled out, is it OK to try the dilation protocol?
☐ Who do I follow up with, and when?
Don’t wait if you have:
Fever, a swollen or hard lump, ongoing drainage, blood or mucus, unexplained weight loss, or pain that’s getting worse or hanging on after a few weeks of the basics. Don’t sit on it, see a licensed provider.
Last reviewed by Jonathan Baker, MPAS, PA-C, DFAAPA 11/08/2026