Anal fissures: How to get rid of them when they won't go away

Jun 28, 2023

How to Do It is Slate’s sex advice column. Have a question? Send it to Stoya and Rich here. It’s anonymous!

Dear How to Do It,

I am a gay man in my late 20s who almost exclusively bottoms. For the past year, I have had a persistent, painful anal fissure that continues to frequently reopen as a result of bowel movements. This has prevented me from having penetrative sex with my partner as I am often in too much pain and afraid of harming the fissure or bleeding. I have had two consults with colorectal doctors, but they have been relatively dismissive and one was fairly homophobic. They don’t think my case meets the definition of acute bc of the level of pain I am in, but I also think they are not considering why this problem and its persistence is an acute problem for a gay man. Instead, I have made lifestyle changes (more fiber, water, exercise, etc.) and used several prescription creams in various combos but the same fissure reopens again. This has left me frustrated, both medically and sexually to the point of having a hard time feeling sexual enough for non-penetrative sex.

Do you have any advice on additional steps I can take to heal the fissures? Or, despite these two poor experiences, strongly advocate to have my case and its impact on my life seen as acute and worthy of intervention? Also, if I finally heal in a more permanent way, what are some tips for feeling safe, healthy, and sexy during anal sex again? I used to be a proud and satisfied power bottom!

—Tired of Being Torn

Dear Tired of Being Torn,

I feel your frustration. I think every gay man is doing himself a disservice if he doesn’t actively seek gay doctors, particularly for butt stuff. I know this can be a challenge in certain areas (I’m spoiled in NYC by all the experienced MSM who can handle my ass), but it’s worth Googling and/or taking a look at the LGBTQ+ Healthcare Directory. If your search isn’t productive, shoot me an email (richjuz at gmail dot com) and I can ask one of my sources, like J Michael Berry-Lawhorn, clinical professor of medicine and associate director of HPV-related clinical studies at University of California San Francisco’s Anal Neoplasia Clinic, who told me via email that he could refer you, depending on where you live, after I showed him your letter.

Berry-Lawhorn provided me with a checklist of next steps for you. He wrote that anal fissures are occasionally the sign of an STI, so if you haven’t been swabbed anally and had your blood tested for syphilis, get that done right now. Otherwise, the doctor wrote that “LIFELONG attention to keeping bowels soft and moving is mostly the key.” That means fiber/psyllium as well as a high-fiber diet everyday, along with drinking water and stool softeners, as needed. Also keep hygiene in mind. “Some fissures are brought on by aggressive wiping or a sensitivity to a preservative commonly found in wet wipes,” Berry-Lawhorn wrote. “I strongly recommend NO WET WIPES OF ANY KIND.” He says “absolutely no rubbing with toilet paper.” Instead, use a bidet if possible, or also try wiping with Curel Daily Healing lotion applied to the toilet paper “inserted into anus and then wiped off, process continued until clean.” Note that while the doctor hasn’t heard of anyone having an adverse reaction to Curel, it is possible, so keep as much of an eye on that butthole as you can.

Something else that might facilitate healing is heat. You can soak an active fissure in hot water after you poop or apply a hot compress with a washcloth. Berry-Lawhorn also recommended a compound cream of 5 percent lidocaine ointment and 0.3 percent nifedipine, which you’d have to get via prescription.

Once you’re healed, bottom with caution and care. Try using a graduated series of dildos increasing in size until you can take that of your partner. When you do have sex, bottom on top, which will allow you to control the speed and depth. Use lots of lube. Proceed with this all-caps message from Berry-Lawhorn in mind: “SCAR TISSUE TEARS QUICKLY AND STRETCHES SLOWLY.”

I think following Berry-Lawhorn’s advice may help rebuild your confidence—you’ll be taking an active role in your healing, and if you make these changes in the lifelong fashion that Berry-Lawhorn recommends, I hope it gives you peace of mind. Otherwise, you’ll just have to try it and see how it feels. There’s nothing like experience to show you that what once seemed impossible is, in fact, possible. Keep your spirits high and a can-do attitude, and you’ll set yourself up to conquer your fissures.

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Dear How to Do It,

My boyfriend and I are going on an end-of-summer vacation with my immediate and extended family for about two weeks and I’m trying to think of a creative way for us to enjoy extracurricular activities while still being discreet. Any ideas for ways to sneak around and things we can do? We’ll be staying in a big house with everyone and will be sharing a room with other family members. Any fun ideas are appreciated!

—Vacation Vibes

Dear Vacation Vibes,

Well, if you’re staying in San Francisco, you can look into a self-driving car—apparently, having sex in them is all the rage, or so says this trend piece. Watch out though, as that could get you in trouble for public sex. That’s the issue here—sometimes the outdoors presents itself as the perfect sex forum, but there’s always the risk of getting caught. Undeniably some people get a thrill out of that.

Otherwise, you’ll have to act like kids living under their parents’ roof, sneaking around and keeping extremely quiet. Spending time together in the bathroom under the guise of “getting ready” for the next activity could work. Taking some time for yourselves and going on duo adventures might make it easier to find a quiet place (you could always hit up a hotel). If you feel like you need to provide an excuse, offer to run an errand for the house (like grabbing groceries) and, uh, take your time, if you know what I mean. You can also just wait it out. Two weeks isn’t that long. That’s not the fun answer, but it’s reality.

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Dear How to Do It,

My partner (39, NB, they/them) and I have been together for over two years. We are extremely sexually compatible and two years later it still feels like a match made in heaven. There’s just one thing that’s kind of a downer.

My partner struggles to ejaculate with anyone. They usually have to bring themself to orgasm with their hand, which is totally hot, but they have shared with me how discouraged they are about this. They say they’ve masturbated many times per day for many years and that the nerves in their phallus are shot. They were also aggressively circumcised as an infant and the “stretch” of skin over their erection can cause numbness. They tend to have the most sensation when they are flaccid or half-erect, but those states inevitably lead to full erections.

I am multi-orgasmic and my partner satisfies me in so many ways, but I want to make them feel good, too. They insist they get a lot of pleasure out of pleasuring me, but it’s not the same for me. They have tried going many days without masturbating and only trying to ejaculate when we are together. But it’s not really helping.

Is this common for AMAB people? Is there any hope of bringing back their sensation? Are we fighting a losing battle? What can we do?

—Looking for Help

Dear Looking for Help,

It’s not uncommon to encounter what you have with your partner—it’s typically referred to as “idiosyncratic masturbatory style,” as coined by sex therapist Michael Perelman, and described in detail in Ian Kerner’s So Tell Me About The Last Time You Had Sex. Generally what’s recommended is a short break from masturbation or doing it with the non-dominant hand in the interest of re-sensitization. (Note: Your partner’s nerves aren’t “shot,” it’s more likely that they’re just habituated to particular sensations.)

I think your partner may need a longer break than they’ve been doing. Tell them to try that, and to have some patience. Patience would serve you well, also. Putting pressure on this situation will almost surely not produce the results that you want—most of us can’t come on command and penises are very sensitive things. You could also explore other paths to pleasure that are well worth doing even if they don’t end in orgasm—things like massage, internal and external buttplay, and sensation play. We hear a lot from people who are fixated on their and their partner’s orgasm, and that’s understandable, but there’s way more to enjoying sex than that.

Ultimately, you may have to settle for taking your partner’s word for it, that they get pleasure from pleasuring you. That’s not just plausible, it’s a great thing, and a sign of a generous partner. You’re striving for perfection when in fact, you have it pretty damn great. Appreciate it.

—Rich

I am curious to go somewhere to anonymously watch other people have sex. Like, to be in an audience, or sit at a table with a drink like you would at a strip club. I don’t want to meet people or hook up. I don’t want to arrange a personal show in real life with a particular couple I find online. I just want to drive to a venue or club, go inside, drink a beer and watch live sex. How do I find opportunities like that that are legal where I live, and which will admit a single male unaccompanied by a partner?