Receptive Anal Sex Practices and Risks

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Receptive anal sex is when someone is rectally penetrated during anal intercourse. A person who practices unprotected receptive anal intercourse may be at higher risk of certain STDs than the person who penetrates them. However, the insertive partner is not without risk.

In gay relationships, the person who is penetrated during anal sex is often known as the bottom. The person who penetrates is known as the top.

Receptive Anal Intercourse and STD Risk

Receptive anal intercourse is associated with a high risk of numerous STDs. (Although that is primarily true for unprotected anal sex. Using condoms for anal sex greatly reduces STD risk.) The best-known risk associated with anal sex is HIV. However, unprotected anal sex also puts people at risk for a number of other infections. These include both the low-risk HPV associated with anal warts and the high-risk HPV associated with anal cancer

Interestingly, research has shown that the high HIV risk associated with anal intercourse isn't the only reason gay men are at high risk of HIV. Instead, one of the major factors is role switching. Most men who like anal sex tend to practice either insertive or receptive anal sex. That increases the spread of the virus more than staying with a single role. (It's worth noting that not all gay men like anal sex. Liking anal sex is not a requirement of having sex with men.) 

On the Lookout for Anal Cancer

Doctors have started to understand the importance of anal STD testing. This is, in part, because of the growing prevalence of anal cancers associated with HPV. Early anal cancers can be detected using an anal Pap smear. Such tests are directly analogous to the Pap smears used to detect cervical cancer. However, they're less frequently performed. 

If you have receptive anal sex, tell your doctor. If you don't, they may not be aware that you are at risk of anal STDs. If they don't know you're at risk, they're less likely to test you appropriately. While in an ideal world, doctors would ask if you had anal sex, this world isn't ideal. Many doctors are just as uncomfortable talking about sex as lay people. Therefore, people often have to take their sexual health into their own hands. That means actively talking about risk and asking for testing. After all, you can't assume that testing will happen at your annual exam. 

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