Anilingus
Basic Information
Anilingus is oral/anal contact, often called "rimming", in which the active partner tongues the anus of the receptive partner, often as a prelude to anal sex, oral sex, or sometimes as a sexual act in and of itself. It is engaged in by both heterosexual and gay couples. It is not for everyone and sometimes disagreements arise between partners that cannot be resolved between them. Seeing a health care provider who is knowledgeable about anilingus and nonjudgmental about the sexual activity itself can put both partners at ease once they are armed with the necessary; information about STD and HIV transmission and able to communicate with each other in an atmosphere that is less tension-filled.
If you decide to engage in this activity it is recommended that the passive partner be as clean as possible. Using a Tucks on your anal opening should keep the area clean and should not irritate the anal skin which is sensitive to begin with. It is a good idea not to scrub too hard in case small abrasions or cuts may occur, and soap, if it has an irritant that affects you, should not be used. Using enemas before anilingus may cause liquid to seep out during sex, so if you decide to use an enema or douche it is usually best to use as gentle an enema as possible.
Certain perfumes and oils are not a good idea to use because of possible irritants and because certain oils used to heighten the taste or smell of the anal opening can interfere with the makeup of the condom you may use later if you decide to have anal sex.
HIV transmission is considered to be extremely low or possibly nonexistent with this sexual activity. Though no studies have confirmed HIV transmission via anilingus, still conditions could be right for transmission, such as a possible blood exchange which can occur if there is biting involved. Fingers may also rip the anal skin or cause some damage or irritation to the sphincter muscle. Possible bleeding may occur when fingers are jabbed into the opening. Using fingers is not a recommended way to initiate anilingus. The tongue alone will not injure tissues the same way that fingers will.
Some partners use a barrier for anilingus though for most this barrier interferes dramatically with the taste and feel of the anal opening. Before deciding whether or not to use a barrier (plastic or latex) it is best to discuss the risks involved with your health care professional. Barriers that can be used include:
- dental dam
- plastic wrap
- a condom that has been cut and opened
- tissue or cloth
The greatest documented risk with anilingus is the transmission of virtually any STD excluding AIDS. Hepatitis A and B (and possibly C) as well as gonorrhea, herpes, condyloma and chlamydia can be transmitted via anilingus but in the case of gay males the most common medical problems caused by anilingus are parasitic and bacterial infection. The most common parasitic infections seen in gay males are:
- amebiasis (Entamoeba histolytica)
- giardia (or giardiasis (Giardia lamblia)
Bacterial infections can be caused by the parasites:
- salmonella
- campylobacter
- shigella
Symptoms
Many passive partners will be asymptomatic even if they have hepatitis A or B or parasitic infections. Know your partner. Parasites grow in the colon and can be passed quite unknowingly, especially if the passive partner is symptom free, and quite easily to the active partner via anal/oral contact. Thus you will become infected as well. Certain patients can be asymptomatic carriers, shedding bacteria during bowel movements. When symptoms of amebiasis occur they can include:
- diarrhea, often with blood
- pan in the abdomen
- low-grade fever
Symptoms of giardia (resides in small intestine) include:
- nausea
- diarrhea, which is rarely bloody
- upper abdominal pain
Symptoms from bacterial infections (salmonella, campylobacter and shigella) include:
- cramps in the abdomen
- diarrhea (sometimes with blood)
- vomiting
- fever
Diagnosis/Treatment
If you have any of these symptoms and have been at risk via anilingus for parasites or bacterial infections please see a knowledgeable health care provider to determine if you have been infected. If you have parasites, it increases the likelihood of another possible STD and it is prudent to be tested for such STDs as hepatitis, gonorrhea, herpes and syphilis. Also, a discussion about HIV is important and an HIV test may be indicated.
Diagnosis of amebiasis is made by either (and/or) a blood test for parasite antibodies or feces sample. Giardiasis is diagnosed by laboratory examination of a stool sample. Salmonella, campylobacter and shigella are diagnosed by stool examination as well. Usually bacterial infections resolve on their own as they do in cases of transmission via contaminated foods which occurs quite regularly, especially in urban cities with immigrant populations.
Treatment by antibiotic is indicated in cases of amebiasis and giardia. Usually the antibiotic metronidazole will be successful in eliminating the parasites. However, you must have follow-up visits to your health care provider for re-testing to be sure that the antibiotic has killed the parasites. Even if you have completed one round of antibiotics and are symptom free, you still may harbor some parasites which unchecked can continue to multiply again.
Often symptoms from salmonella, campylobacter and shigella resolve on their own. However, in some cases they do not and an antibiotic is needed. The antibiotic most usually used is ciprofloxacin. Additionally, HIV positive men may also need antibiotics to kill the bacteria.
It is appropriate for you to take a good look at your partner's buttocks and anal area before engaging in anilingus to make sure your partner is clean and does not have any cuts or bleeding, or any mucousy discharge. Also, do not bite your partner's skin as bacteria in your mouth could cause an infection should there be a tear. If an injury from teeth occurs, contact your health care provider who may wish to prescribe antibiotics and instruct you on how to clean the wound (usually with hydrogen peroxide) or if any swelling or pain occurs. Do not be embarrassed to seek medical attention if you have been bitten as it is potentially serious because of bacterial infection from your partner's mouth.
If you have any questions or concerns about anilingus, please see your health care provider.