Savage Love: Down There

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Q: Background: I, a 21-year-old male, enjoy receptive fisting. I’ve also had constipation problems all my life. Question: I saw my doctor recently, and he tried to link my enjoyment of anal sex to my constipation. (Granted, I didn’t tell him EVERYTHING I do down there.) My understanding was that there was no causal relationship, assuming no serious injuries occur. Is there something I don’t know? Was my doctor just trying to be helpful?
– Fearing Inner Sanctum Tarnished

“There are many myths about anal sex, but this is the first time I’ve heard this one,” said Dr. Peter Shalit, a physician in Seattle and a member of the Gay and Lesbian Medical Association.

It’s also the first time I’ve heard anyone associate fisting with constipation—typically when fisting is mentioned in the same sentence as constipation, FIST, it’s as a cure. But it’s a myth that fisting cures constipation, of course, along with anal sex being inherently dangerous.

“Fisting is a safe activity, provided that both the top and bottom are sober at the time,” said Dr. Shalit. “It does not cause damage or constipation or any other type of bowel problem. The same applies to other anal sexual activities including anal receptive intercourse (getting fucked) and use of toys (dildos, vibrators, etc.) for anal stimulation—again assuming this is voluntary on the part of the bottom and that both partners are not under the influence of mind-altering drugs during sexual activity.” (For safety’s sake, of course, buttfuckers should use condoms and gay and bi men get should get on PrEP.)

While many people engage in anal play while under the influence of drugs or alcohol, and most emerge unscathed, uninfected, and un-constipated, FIST, getting fucked up before fisting is not a butt sex best practice. A fucked-up top can quickly become an out-of-control top, and a fucked-up bottom can be numb to feelings of discomfort that mean “slow down,” “stop and add more lube,” or “stop altogether.”



Despite the fact that millions of people safely engage in anal play, many people believe that anal play does irreparable harm to the anus—or the soul—and that sadly includes many doctors.

“There is a misconception that these activities can cause damage by stretching or tearing the tissue, when actually the anus is very elastic and much of the ‘permission to enter’ actually involves intentional relaxation of the muscles by the bottom” and not force applied by the top, Dr. Shalit affirmed. (The top applies gentle pressure, the bottom breathes, relaxes, and opens up.)

“If a person suffers from constipation, that should be addressed as its own problem and not blamed on any type of anal sexual activity,” said Dr. Shalit. “In addition: For obvious reasons, it’s not fun to bottom if you’re constipated, so it would be good to have this problem evaluated and treated by a nonjudgmental health-care provider who understands that anal penetration—by fist, penis, or dildo—does not cause constipation.”

Finally, FIST, your doctor was misinformed, which is not helpful. If you don’t feel comfortable telling your doctor EVERYTHING you’re doing “down there,” you can find a new doctor—one you can breathe, relax, and open up to (in a different way)—under “find a provider” at GLMA.org.

Q: My boyfriend and I just got back from Berlin, and we had a great time—until the last night. There was a dark room in the basement of this gay bar, and my boyfriend wanted to check it out and I did not. We are monogamous for now—I’m open to opening things up down the road—and I didn’t see the point of going down there. I told him that drunk in a gay bar at 3 a.m. wasn’t the right time to open up our relationship, and he angrily insisted he wasn’t trying to do that. But if we’re monogamous and want to stay monogamous, why go into a dark room at all?
– Dude Into Monogamy

If it was your boyfriend’s intent to reopen negotiations about monogamy while horny men circled you in a dark room, DIM, that wouldn’t be okay. But it is possible for monogamous couples to enter sexually charged environments like dark rooms, sex parties, or swingers clubs and emerge with their monogamous commitments intact. It’s advisable even—or at least I’ve advised monogamous couples who want to keep things hot to visit those kinds of spaces. Go in for the erotic charge, soak it up, and plow that energy into each other. So next time, go down there. You might have to bat a few hands away, but once the other guys realize you two aren’t there for anyone else, they’ll turn their attentions to others who are.