Welcome to Prep and Play, where we have conversations
about safer sexual pleasure. This podcast is
dedicated to empowering listeners through open,
honest discussions surrounding keeping our minds,
bodies, and spirits healthy while being sexually
active. My name is Danielle and I am the Rural
Outreach Specialist at AIDS Alabama South. And
today we're going all in talking about anal health
and pleasure with somebody who knows a lot about
it. Dr. Kuttner, could you introduce yourself?
Yes. Hi, I'm Brian Kuttner. I'm a clinical psychologist
and assistant professor at Albert Einstein College
of Medicine in the Bronx in New York. I had the
pleasure of taking a workshop with Brian last
year and I learned a lot about it. Yeah, I guess
let's just jump right in so you can hear a lot
of the stuff that I learned from Brian. First
up, we're going to be talking about pleasure.
And specifically why anal sex can be pleasurable
for all genders. So let's start at the root here.
Why can anal sex be pleasurable for both men
and women? Yes, anatomically speaking. Okay,
great. So the anatomical answer is that there
are sources of pleasure in that region of the
body. And I can give an example of this for your
listeners. If your listeners just take the palm
of their hand and with a finger from another
hand just certainly touch the palm of their hand,
just rub that, and then flip their hand over
and then touch the top of their hand, they may
notice that there's a difference in sensation.
And so one reason that anal pleasure occurs is
because the anus is very densely packed with
nerve endings, like the palm of the hand, but
in a slightly different way. So it's just very
sensitive to touch. So the quote, right kind
of touch from someone that you're aroused by
or attracted to, can feel really pleasurable
that way. And then there are a couple of other
sources of pleasure that are important. So if
someone has a prostate, a prostate is located
about, if you go past the opening of the butt,
the anus, about two inches in and toward the
belly button, you'll be able to feel the prostate
if someone has one of those. It feels a little
spongy. It's about the size of a walnut, but
it's not hard. It's more squishy than that. But
pressure against the prostate also is really
pleasurable. And that's because the sensation
of orgasm in people who have a prostate, that
is what is responsible for the sense of orgasm.
So it's the squeezing of muscles around the prostate.
So you can imagine if you're applying pressure
from the inside of the body against the prostate,
that can be pleasurable. And then another source
of pleasure is that people who have a clitoris,
the clitoris is pretty extensive organ. And it's
also what I've learned is it's the only organ
in the human body whose sole purpose is pleasure.
So it's pretty enviable if you've got one of
those. The clitoris, even though like what I
was taught early on in my life was that the clitoris
is just like what's beneath the hood, just like
a little button there. But actually, that's just
the part that you can see it extends with some
legs and a bulbous part of it, too, that extends
back into the body. And those extensions also
reach back toward the rectum. And in a similar
spot to where the prostate would sit, you can
reach into the rectum a couple of inches, move
toward the belly button with a little bit of
pressure, and you can stimulate a legsiler clitoris
that way. And then the last way, I said there
are two more, but there's actually one more,
which is the sensation of fullness inside of
the rectum some people find pleasurable too.
And you might notice this if you just have a
very like full bowel movement and you release
it, the movement of that going through the rectum,
the sense of fullness can also be pleasurable.
So those are the main anatomical sources that
I've learned about. Awesome, awesome. And so
outside of our... physiological anatomy, what
role do our brains and mindsets play in how we
experience anal pleasure? Yeah, this is a good
one. So, you know, in the same way I asked people
to rub the palm of your hand with your other
hand. Well, you know, I have lived in New York
City for a while, so there's a lot of unwanted
touching that happens in New York City on the
subway, just the people are bumping into one
another. So, you know, you can imagine like you
know, someone on the subway, you don't know,
suddenly rubbing your hand, maybe not so pleasurable.
I mean, it might be something that you are aroused
by because it's a stranger. But in general, unwanted
touching is not something that people really
enjoy. People want to feel a sense of connection,
even if it's anonymous, a sense of connection
with another person or people. So even though
I've described these anatomical sources of pleasure,
it's not like a button that you press. It's not
like you know, apply pressure and suddenly someone
is incredibly aroused and experiences pleasure
in the same way that, you know, like rubbing
someone's arm or having your arm rubbed by someone
else. It depends on the person or people who
are touching you and your relationship with them
and your level of connection and interest and
arousal and attraction. So the brain or how we
respond emotionally is certainly tied to how
we respond to the stimulation that could be pleasurable.
And the other part of that is that the heart
of a body that we're talking about also responds
to stress and threat. So if people are feeling
anxious or threatened, that part of the body
can tighten up. But if we feel relaxed and welcomed,
warm connection with other people, sexual arousal,
that part of the body starts to relax. And that's
when people can experience pleasure without any
pain in that part of the body. Do you find that
a lack of education or shame around anal sex
interferes with people's ability to fully enjoy
it? Okay, I'm going to say yes, but then I'm
going to pause because you mentioned that you
participated in this workshop last year. I did.
And I've been doing a lot of talking and it's
not really my MO to talk this much in response
to questions. I really want to ask other people.
So I'm just curious from you, if you're willing
to answer this, we can have a little bit of a
dialogue. What do you think? And then we can
go back and forth about it. Yeah, I would say
in general, like I would say shame, I feel like
keeps a lot of people from trying it or being
open to trying it because they're like, oh, that's
not. That's not what that's for. And then I would
say lack of education can affect that in that
a lot of people don't know about that anatomy
wise, especially men will be like, no, there's
nothing supposed to ever go in there. But like,
OK, that's literally what you just explained.
How you experience orgasm is feeling those muscles
contract around the prostate. So obviously stimulating
that would be pleasurable. Or yes, I would say
in those regards, those types of preconceptions
can affect. Yeah. Yeah. I mean, there's a lot
of shame around sex in general. In the United
States, it's not always the same in different
subcultures. It's not the same across the world
that we experience shame related to sex. But
then you take something that's as stigmatized
as anal sex, and people tend to not learn information
because they expect shame about asking questions.
about the things that they want to experience
or curious about experiencing or have experienced
but want to learn more about. And the evolutionary
purpose of shame, at least as I've been taught
and learned, is to protect ourselves from rejection
from other people, which means that then we retreat
from being open with other people about the things
that we want to experience or learn about. What
I've learned from the science of this that I've
done over a number of years is that Most people
who have anal sex or have experimented with it
have learned by trial and error. And they learn
by trial and error because they don't have great
sources of information or resources of people
that they can contact that they think are credible
and reliable and have their best interest at
heart. So most people are learning from pornography,
resources that they can access online now. But
then they encounter all sorts of problems. they
think okay it's supposed to hurt before it's
going to be pleasurable or just have to tolerate
the pain which is not true there's really no
reason to experience physical pain or emotional
pain during anal sex at all can be purely pleasurable
but people don't have that little bit of information
they also don't have knowledgeable credible reliable
sources that are accurate about how to do that
how to approach it in a way that doesn't cause
pain so there's a lot of A lot of reason why
lack of education and shame are linked together
in that question that you asked. Thank you for
that. So next up, let's talk about being clean
and comfortable. Anal sex can bring up a lot
of concerns around cleanliness. So what's a realistic
way to think about that? Yeah, I love this question
too. When I was doing my dissertation work, I
was trying to measure stigma toward anal sex
and then see if it had any public health impact.
And so to measure it, I was interviewing a bunch
of people and then trying to create a scale.
And as I was interviewing people, I was just
asking them about what they had learned about
anal sex, what their experiences were. And one
person was talking about the shame that some
people experience about cleanliness. People are
concerned about contact with poop. fecal matter,
shit, whatever you want to call it. And the concern
about that is because if something is going inside
of past the anus, the anal opening, and then
into the rectum, which is about five to nine
inches long, they're concerned that they're going
to come in contact with fecal matter. And one
thing that people may not realize is that when
you've got enough fiber in your diet, generally
when you've got enough fiber in your diet, then
poop that enters the rectum, is properly bulky
and full. And when you have that experience of,
I've got to go to the bathroom, that's the sense
that poop has actually entered the rectum. And
then when you release it, it generally all releases
as a whole material or bulky material. And then
there's very little, if anything, left inside
of the rectum. There's some microscopic bits
of fecal matter that can be in there. But in
general, if you were to then insert an object
into the rectum, you wouldn't come in contact
with any visible signs of fecal matter. The problem
is that most of us don't have enough fiber in
our diets. Also, we've got medical conditions,
medications that we take, irritable bowel syndrome
is something that people experience, gluten allergies,
HIV medications themselves sometimes can cause
some Difficulty with bowel movements or just
living with HIV for a long time can also have
an impact on people's bowel movements. So, you
know, I'm describing the ideal, right? But none
of us actually live in the ideal. Many of us
are living with the reality of, like, you know,
our poops are not always so clean. When we wipe
with a piece of toilet paper, usually there's
something left on there which suggests, oh, there's,
you know, something still in there. So that's
the reason why this question keeps popping up.
Okay. It's a long answer to get to it, but you
asked specifically, what can people do about
it? Right. So I asked a realistic way to think
about that. And actually you did, you did kind
of give like a little, and I think the only thing
that I would say I would add to that is that,
you know, In general, sex isn't necessarily the
cleanest activity, right? There are bodily fluids.
And so when we're thinking about anal sex, just
because it's a different area of the body and
different matter that we're coming into contact
with, it's just remembering that we're dealing
with human bodies. Yes. Yes. So I'm so glad that
you said that because you reminded me the reason
I was talking about that dissertation work and
interviews is because there are two things that
people said to me in those interviews that really
are memorable. One is someone said, or when you're
digging for diamonds every once in a while, you're
going to encounter coal. And that was this person's
way of saying, you know, be realistic. It's part
of the body, right? You can experience pleasure,
but you might, you know, you might encounter
something that you didn't want to encounter.
But it doesn't mean that you didn't experience
the pleasure. You can still experience the pleasure,
even if you do encounter that. And a related
story to that is someone telling me he had a
sexual experience with someone and During the
experience he felt like he had a little bit of
an accident and he left some fecal matter on
this person's Penis and he was this guy was mortified
that he had done this just mortified He said
but then his partner Just got up went over to
the kitchen got a paper towel wiped it off came
back and said it's not a problem and then just
continued to enjoy each other's company and he
said it was a very lovely, corrective experience
that he had internalized this message that there's
something wrong if that happens or it's a bad
thing. But as you said, Danielle, like sex is
not always like a, or sex generally is not a
like a clean endeavor. There are body fluids
happening. And actually, in fact, we want body
fluids to happen because you need them in order
to make things fun and lubricate it. So, you
know, you could be realistic about it and accept
it. If you're really concerned about it, then
there are, you know, of course, resources of
other things you can do. And we can talk about
this website we've developed for this project
and where you can learn a little bit more information
about that if you want. Yeah, yeah. And so speaking
of things that you can do, douching, is it necessary?
Well, in a way, we've kind of already answered
it, right? It's not necessary if you feel comfortable
not doing it. But so if people do want to douche,
what are the safest methods and how often should
this be performed? So in answering this question,
I have to preface it by saying there is some
scientific information about the topic of douching.
And in general, when it comes to anal sex, there's
like information we know, information we really
don't know, and then somewhere in between like.
kind of best practices, a little bit of science
there, but we're not completely sure about the
best answer. And douching is one of those. There's
been more research in recent years about douching,
in part because there are HIV scientists who
want to figure out a way to introduce something
like pre -exposure prophylaxis, or even potentially
post -exposure prophylaxis, in douches, so that
people can like prevent HIV. that way. If they're
already douching, then it makes sense to do something
that, as scientists call, is behaviorally congruent.
You're already doing it. It's congruent with
what you're already doing. Then let's see if
there's a way to help you do that and prevent
HIV, too. So there's a little bit of research
on that. So what I have learned from that is
that, in general, if you're going to introduce
a liquid into the body, it should be just water
that's body temperature. You don't need to add
anything to it. Just introduce that water into
the body. It should be about the size of like
a, you know, like a small bottle of water that
you get at a store. Yeah, like that. Thank you.
Yeah, I couldn't remember the number of it. Thank
you. So about that size, you hold in the body
for a little bit. You let it evacuate. You can
do that two more times. That's generally the
rule of thumb that I've learned from people who've
been studying. rectal douches in the context
of trying to come up with what we call microbicides,
something that could prevent HIV in the future.
But we don't have a lot of great data on that.
This is just from those studies that have been
conducted so far. Awesome. Awesome. I didn't
even know that they were attempting to put microbicides
and douches. Learn something new today. Yeah,
it's been a long, long effort to do that. So
to make those available and In this context around
science these days, we don't know what's going
to happen to that research or if it's going to
continue. But there have been a lot of people
who have done a lot of great work on that front.
I want to talk a little bit about lubrication,
toys, and protection. But just to bridge between
the conversation about douching and this other
conversation, what are some things that people
should avoid putting in or around the anus? Yes.
I'm going to make a plug. I'm going to make a
plug for a podcast that was done a couple years
ago, maybe just a year ago. It's on our website
and it's by the Queer Health podcast. Just because
it says Queer Health doesn't mean you have to
be queer to listen to it. It's just a very thorough
discussion about douching and very accessible.
It's got resources and links to things too. So
we can talk about that. I think maybe in your
show notes we can link to that specific podcast
or to our website. So what you do not want to
introduce are things that have a lot of sugars
or salts in them. You want to just introduce
something that's neutral. It's just water. Because
if you introduce sugars and salts, it draws out
the water that's already in the rectal lining
and then can compromise that rectal lining. So
this is like high school science that I'm not
sure I'm going to remember perfectly, but the
term is osmosis. So the water is going to pass
through a porous membrane and move into the more
concentrated area. So it depletes in some studies
that have sown at least with lubricants, that
if you introduce a lubricant that's high in sugars
or salts, then it can draw out that liquid and
then compromise the lining. So we don't want
to do that, is the idea. Some people have concerns
about the amount of liquid that they introduce.
So I mentioned that the rectum is five to nine
inches long. And when I say five to nine inches,
I don't mean like it goes from five to nine inches
in an individual person and expands. I mean like
there's this human variability and diversity.
So in some people it's five inches, in some people
it's nine inches, in some people it's shorter,
some people it's longer. The reason why we were
talking about this 12 ounces is because that's
about how much you can hold inside of the rectum.
So you want to put in as much as you feel like
is comfortable for you to hold, but don't feel
like you have to push the entire bottle in. The
more liquid that you introduce, the more likely
you are to go past the rectum and into what we
call the sigmoid colon, which is a little S curve
that's up above the rectum. And then that is
where there's more likely to be fecal matter.
waiting to enter the rectum. So we generally
want to avoid washing that into the rectum because
then you're introducing more fecal matter rather
than washing out anything that might be in the
rectum. You talked a little bit about lubes with
sugars and salt and lube can be very, very good
for anal play. So can you walk us through the
types of lube like water -based, silicone, oil
-based and how to choose the right one? You said
it can be very good and for many people it's
absolutely essential. because the rectum doesn't
really produce a lot of natural lubrication.
There's some mucus that it produces, but generally
not enough for the friction of stimulation of
an object going in and out of the rectum. So
people generally then apply some kind of lubricant.
And there are naturally occurring lubricants,
for example, saliva, spit. If people are not
using a barrier method. Pre -ejaculate also can
be a source of lubrication. And if people are
having vaginal sex and anal sex, it's possible
if there's natural lubrication in the vagina,
then that can help lubricate inside of the rectum
as well. I'm not saying that this is what we
recommend and these are best practices. I'm saying
this is realistically what people do. One note
on that about vaginal and anal sex is that the
bacteria that live in the vagina and the bacteria
that naturally live in the rectum. You don't
want to introduce bacteria from the rectum into
the vagina, because you can create UTIs and other
issues. The vagina doesn't like to live with
the bacteria of the rectum. So basically, in
the same way that you would wipe after peeing,
you go front to back rather than back to front.
So you don't introduce bacteria from the rectum
into the vagina, right? I would like to repeat
that because a lot of people engaging in these
activities don't seem to understand. You can
penetrate the vagina and then subsequently penetrate
the anus. Penetrating the anus and subsequently
penetrating the vagina is not good unless you
are washing after or in between. Yes, yes, yes.
Gold star to this explanation. Thank you for
saying it again. So those are some natural sources
of lubrication, the sense of like they're in
your bodies already and people tend to use them.
But they may not be sufficient to be able to
have anal play in a way that feels really like
relaxed and comfortable because may not be enough
natural lubrication in that way. So then people
introduce lubricants and there are three general
types of them. Some people know this already,
but some people really haven't heard this. So
there are water -based lubricants, They get pretty
well absorbed into the body pretty quickly. So
if you're going to use a water -based lubricant
for anal sex or anal play, then you need to keep
repeating the addition of more lubricant, more
lubricant, more lubricant. Because it will eventually
get, the water will get absorbed into the body
and then it'll stop having as much of a fluid
lubricating effect. It's a little sticky too.
Yeah, exactly. And it can get a little bit sticky
too. And then there are silicone -based lubricants.
And silicone -based lubricants are really just
tiny, tiny, tiny beads that you can't see and
that, as far as we know, don't get absorbed into
the body, too. And those little beads just rub
up against one another and roll around with one
another. But because they're not absorbed into
the body, they stay lubricating. So you don't
really need to keep adding a lot of silicone
-based lubricant. which is why generally people
recommend a silicone -based lubricant if you're
going to engage in anal play. And then the third
option would be an oil -based lubricant. And
generally, they're not recommended for anal play
because oil can also collect bacteria, and so
that may cause some issues in the rectum. But
there are some oils that are naturally antibiotic,
like coconut oil, so that may be able to be used
in anal play. without any particular concerns.
Remember what I said about, like, there's the
stuff that we know for sure, the stuff we definitely
don't know, and then there's the stuff in the
middle. This is kind of the stuff in the middle.
People certainly have been using oil -based lubricants
for anal play. You have to experiment and see
what works for you. But there are some words
of caution about each of these different options.
So if it's water -based lubricant, then you got
to be sure that you're continuing to add it repeatedly.
because it will start to wear off its lubricating
effect. So using silicone -based lubricants,
there are two things. One is it can stain your
sheets. And also, if you're using any kind of
silicone -based toy, then you can't use a silicone
-based lubricant because it will wear away at
the toy and cause it to wear down and fall apart.
And then if you're using oil -based lubricants,
then if you use a latex condom or glove or some
kind of barrier, then oil will wear down on the
latex. So you'd want to use water or silicone
instead of that. And then you did mention the
concerns with water -based. And this is specifically
something I've seen a lot with the sugars and
salt going into the anus. A lot of water -based
lubricant contains glycerin, which is essentially
the sugar. And that is one of those things that
you said can cause that osmosis effect and dry
out the anus. Exactly. So in the limited studies
that have been done about lubricants, it's the
ones that are high in sugars and salts that tend
to wear out the lining, right? So exactly what
you just said. And the only thing I'm going to
add to it, which you may already know yourself
too, is that lubricants for sex are not regulated
by the Food and Drug Administration. So it's
not like they have to go through extensive testing
before they've been introduced to the market.
And that also means that a formula, let's say
you use IDLube, which is a brand of lube. This
year, their ingredients could differ from what
they had two years ago inside of them because
they're not regulated by the Food and Drug Administration.
So that's another area where we don't know some
things, but what we do know is exactly what you
said. All right. Well, that's all the time we
have for today's episode. We will continue this
conversation on our next episode of Prep and
Play. See you next time.