Gay and Bisexual Men and Anal Surgery: What You Should Know Before Treatment
Anal surgery can affect sexual function, particularly for gay and bisexual men who engage in receptive anal intercourse.
Procedures for conditions such as haemorrhoids, fissures, and fistulas may impact comfort, healing time, and the ability to resume anal sex. Open discussion with your surgeon about sexual practices, recovery expectations, and timing of return to intercourse is essential for optimal outcomes and quality of life.
Why sexual health should be part of colorectal surgical care
Gay and bisexual men, particularly those who engage in receptive anal intercourse (“bottoming”), commonly present with anorectal conditions such as haemorrhoids, fissures, abscesses and fistulas. While these conditions are not unique to men who have sex with men, anorectal symptoms and disease can have a disproportionate impact on sexual function and wellbeing in this group. Despite this, research shows that sexual practices and their implications are often not discussed as part of surgical care. In research led by Dr Matt Marino, most participants reported that their colorectal surgeon did not enquire about sexual practices and did not explain how surgery might affect sexual function.
How can anal surgery affect receptive anal intercourse?
Changes in sexual function are common.
In the study, half of the participants who regularly practiced receptive anal intercourse were unable to do so in the post operative period, sometimes for months. Many reported concerns regarding pain, scarring, discomfort, changes in appearance and anxiety about when it would be safe to resume sex.
For many gay and bisexual men, sexual identity and well-being are linked to the ability to have receptive anal sex. When the emotional and sexual implications of surgery are not acknowledged, recovery can be confusing, isolating and psychologically distressing.
Should surgeons ask about sexual practices and orientation?
Yes. Almost all survey participants indicated that surgeons should proactively ask about sexual practices, especially because many participants did not feel comfortable raising these questions themselves. If surgeons do not initiate the conversation, important sexual health guidance can often be missed.
How can care be improved for gay and bisexual men undergoing treatment?
Better outcomes can occur with simple changes. These include asking about sexual orientation and practices, explaining how surgery may affect receptive anal sex, giving clear guidance on when it is safe to resume intercourse, and considering the impact of scarring when choosing procedures.
Anal and rectal surgery is not only a physical intervention.
For gay and bisexual men, it can have implications for identity, pleasure, intimacy and relationships. Patients deserve care that recognises this.
Read the full paper here.
How we can help
Dr Matt Marino provides modern colorectal care that incorporates sexual wellbeing. Treatment is tailored to your condition whilst considering function, healing and minimising scarring. Incision-free surgery is promoted where possible. Consultations address relevant sexual practices, the impact of surgery on receptive anal intercourse, and clear guidance on returning to sex. The goal is optimal recovery without compromising quality of life.
If you have an anorectal condition or concern about sexual function, you are welcome to arrange a consultation with Dr Matt Marino. Contact us here or call on 0493 318 188 to book an appointment.
