I love butts. They’re gorgeous in summer shorts, frolicking at Pride. They have an incredible biological and social history (see: Butts: A Backstory by Heather Radke, which is where I learned that our butt muscles evolved to allow us to run). We’re all capable of experiencing Anal Pleasure and Health, as the classic guide from Jack Morin puts it.

That said, if you’ve ever searched for decent health information about exploring anal pleasure, you might’ve come across some myths—about STIs, hygiene, and the aesthetics of a sexy hole. If you’ve ever imagined a pristine, hairless, infinitely stretchy asshole, one that just takes a fist on the first try, that never shows even a speck of shit, that has never experienced a pimple or a wart or chlamydia—well, this is not how most human holes work. Assholes come in all kinds of visual varieties, it generally takes sustained practice to work up to larger penetration, we do use our butts to poop so we’re likely to see some shit on occasion, and irritation and infections are just a part of life.

In order to help you set more realistic expectations—and to bust some common butt health myths—I reached out to sex educator Abbey Ferguson, executive director of the Halifax Sexual Health Centre, and physician Kevin Woodward, MD, FRCPC, executive and medical director of HQ Toronto, a sexual health clinic for queer and trans men. 
 

Claim: Tops don't ever get rectal infections.

You don’t need a dick or hand or toy in your ass to end up with an anal STI.

“Sex is messy, fluids can get in and around the rectum and tops can certainly get infections inside their butts,” says Dr. Woodward. “We often see rectal chlamydia or gonorrhea in individuals who say they only top and never bottom.”
 

“If there’s anyone playing around your butthole in any capacity, including oral sex, it’s smart to always do a rectal swab, just in case,” says Ferguson, “especially in a Canadian context where you’re not paying per swab.”
 

Claim: Butt health is all about STIs.

Alongside routine STI screening and treatment, Woodward says the most common butt health concerns he sees are anal fissures and hemorrhoids, which can affect anyone, whether or not they have receptive anal sex. If your butt hurts and you’re not sure why, one of these might be the culprit.

Anal fissures are small tears in or around your asshole, and they really hurt. “Stretching or taking a penetrative sexual activity a little too hard, too fast causes fissures with irritation and bleeding,” says Ferguson.
 

To prevent fissures, Woodward suggests using lots of lube during penetration. He also recommends a fiber-heavy diet, which can help prevent straining on the toilet. “As for treatment, there are multiple options including topical vitamin E ointment,” he says. “Anal fissures can be diagnosed by having someone—trained, not from Grindr— take a look at your butt.”

As for hemorrhoids—swollen veins in or around your anus, which can cause irritation and bleeding—those can happen when you sit too long on the toilet. “If you’re spending 10-15 minutes sitting on the loo, all that blood flowing around your unsupported hole can lead to hemorrhoid formation,” says Woodward. Hemorrhoids are typically treated with fiber, topical hydrocortisone, sitz baths, and pain relievers.
 

At the end of the day, your doctor should be willing to field your questions about anal health, whether or not they have to do with STIs. “If you have questions about butt health, STBBIs or anything like that, talk to your local STI clinic or PrEP clinic,” says Woodward.
 

Claim: Using wet wipes on your butt disrupts your microbiome.

Woodward says the jury is still out on this one. The many roles of the microbiome in both health and disease is an active area of research. For example, researchers have found that changes in the gut microbiome precede HIV infection. And yet myths about the microbiome abound. One of these is that when you use wet wipes on your butt, you destroy the “good bacteria” on your anal skin, which leads to irritation and infections.

The problem is that we have no peer-reviewed evidence for this claim. Research on the anal skin microbiome is just beginning, and to date it’s been focused on perianal abscesses, anal fistulas, and perianal eczema.
 

The closest peer-reviewed research for our purposes focuses on babies: randomized controlled trials comparing wet wipes to water in infants show no difference in skin hydration or pH. Another randomized controlled trial found no difference in the occurrence of diaper dermatitis when comparing water vs. water and diaper cream vs. water and diaper cream and wet wipes. And while this doesn’t refer to anal skin microorganisms, research shows no difference in microorganisms around the urethra in infants when comparing wet wipes vs. water.

Bottom line: the science just doesn’t exist yet for this one.
 

Claim: Wipes are harmless.

Even though we don’t have any evidence that wet wipes disrupt your microbiome, experts still don’t recommend you use them. The reason why can be summed up in one word: irritation.

“Soap and water is your friend, but using wet wipes regularly can lead to skin irritation,” says Woodward. 
 

“You can have an impact on the skin from the overuse of wipes, especially scented or astringent wipes,”  Ferguson adds.

If you notice skin irritation, stop using wipes and let your skin heal. Repeated friction and moisture causes chafing—that’s why you see marathon runners applying anti-chafe creams during training. Wiping with wet wipes or toilet paper aggressively can end up rubbing your skin raw.  
 

In the medical literature, allergic contact dermatitis—skin irritation from contact with an allergen—is commonly associated with wet wipes, primarily due to preservatives like methylisothiazolinone (MI) and methylchloroisothiazolinone (MCI) and fragrances. If any part of your skin is severely irritated, you’re more likely to have microtears that allow fungi, bacteria and viruses to enter your skin. So irritation will not cause infection, but it can make you more susceptible. 
 

As such, using lots of your favourite lube during sex or solo play will also help to prevent irritation and reduce susceptibility to infection, especially when you use it alongside barrier methods like condoms and gloves.
 

If you do want to try wipes on your hole, choose ones with ingredients that feel good on your skin. Wipe gently, and dry completely after. Most importantly, listen to your body. If you notice any skin irritation, put the wipes down.
 

Claim: Douching is always required and makes you spotless for sex.

If you enjoy receptive anal sex, there’s nothing like the pleasure of the dick or hand or toy of choice sliding into your lubed up, ready hole, then coming all the way back out drenched in nothing but lube.

“If you have a healthy gut, you don’t always need to douche before anal sex. Usually the poop is higher up in your colon,” says Woodward.
 

That said, most of us don’t have spotless buttholes all the time. Douching or no douching, we will inevitably come across some shit.

What you eat is much more of a driver than douching, Woodward says. “Fibre is your friend! A high-fibre diet can help you keep the inside clean as a whistle and just a shower and soap and water on the outside does wonders.”  
 

While we don’t have data to show that wipes disrupt our microbiomes, there is more and more research that shows rectal douching can do just that. If you do douche regularly, you might want to consider reducing the frequency.
 

And when you do choose to douche, there are some best practices for doing it safely. “Go slowly, use lube for whatever you insert inside and, if you can, use saline (salt water) instead of just tap water,” says Woodward.
 

The most important principle is to listen to your body. “Generally speaking, you want to trust your butt when things hurt,” Ferguson says. “Or if you get to a point where you try to douche over and over again, it just may not be the time in your bowel’s cycle.”
 

Claim: There is a universal, attainable aesthetic standard for a sexy hole.

People come in all shapes and sizes—and so do our holes. 

You don’t need to bleach your ass, pay for laser hair removal, get botox, or hire someone to stretch your hole to be "normal" or lovable or fuckable or desirable.
 
The most important person to please with your hole is you. That’s why Jack Morin, in Anal Pleasure and Health, emphasizes solo exploration so much in the first part of the book. As you make peace with your own body as it is—and gently learn what you like and don’t—you’re more able to show up compassionately and confidently with both yourself and others.