anal masturbation feels good, but then I notice I'm bleeding

[nitrogen]

I like to masturbate by putting either fingers or sex toys up my ass. I'm generally a very careful person about this. I go slowly, use lots of lube, keep my nails trimmed, and wear gloves. I've had a problem recently where I notice blood on my toys or fingers during or after anal masturbation. While I'm masturbating, though, it feels good. If it matters, the blood always seems to be coming from inside my rectum, not from the anus itself. How can I tell whether I'm harming myself if it doesn't hurt or anything? I'm tired of this cycle of having to wait a week after bleeding before I feel safe doing anything anally, enjoying myself again, noticing I'm bleeding, and having to wait a week again.

Also, is waiting a week after bleeding excessive? I'm a trans guy and masturbating anally is one of the few ways that doesn't cause gender dysphoria/does cause gender euphoria, and having to go a week without it each time sucks.

There's never very much blood, and it never lasts after I stop actively masturbating. Am I risking long-term injury by causing repeated minor bleeding?

Thank you!

[Heather]

Hey there, nitrogen. Welcome to the boards.

My best advice would be to check in with a healthcare provider. If you're not experiencing pain, it seems very unlikely it's anything serious, but it could be that you have something like fissures or hemorrhoids that need treatment and/or where you may need to take a break from anal masturbation until they heal.

In terms of what the right amount of time to wait is, I'd say that really depends on the cause of the bleeding: we'd have to know what that is first to say.

Do you have a healthcare provider you feel safe seeing for this?

[nitrogen]

Thank you! I do have a gastroenterologist I saw once who I can ask about this, but I was hoping not to have to (I know that doctors talk about sex stuff all the time, but it's still embarrassing).

Does this mean that I'll have to stop all anal play until I see a doctor? I forgot to mention, but the issue seems limited to when I'm using thrusting motions with a dildo or fingers. Butt plugs have never made me bleed. Do you think it would be generally safe for me to keep using butt plugs until I can ask my doctor about it, or should I refrain altogether? Also, are there any harm reduction tips for if I do choose to continue masturbating anally with plugs while I wait to see a doctor? I want to be as safe as possible even if I'm tempted to do something anally.

[Heather]

Personally -- and I'm sorry, I know this isn't the wanted answer -- I'd wait until I got myself checked out. Any kind of wound (and if there's bleeding, there's some kind of wound) makes you vulnerable to infection. By all means, using gloves and covering your toys makes that less likely, but having some kind of wound makes that risk pretty high, so the barriers only mitigate things so much.

Plus, something like untreated fissures can mean that each time you reopen them, that it becomes harder and harder for them to heal or you might develop some scar tissue, even, which could certainly impede upon the enjoyment you get from that part of your anatomy.

I do think rather than needing to ask someone, you will need to actually be seen. This is just something someone is not going to be able to know what's-what unless they can look at it with a visual exam.

But if you just don't want to wait until then and want some harm reduction tips for this, that'd basically be doing what you are doing, using gloves, and then if using toys, I'd use a condom as a barrier. I'd also suggest washing what you can of your anus and rectum both before and after to help reduce any bacteria in the mix that could cause infection if you have a wound that happens or opens back up.

[nitrogen]

(I tried responding already, but it didn't seem to go through. Sorry if this posts twice.)

Thank you! You're right, that's not the advice I wanted to hear, but that doesn't mean it's not the advice I needed. I'll schedule an appointment for an exam to see if my doctor can help me figure this out.

[Heather]

You're welcome. Like I said, I really doubt it's anything to worry about, but I hope you're alright and that this gets resolved quickly and painlessly for you.

[nitrogen]

I ended up talking to my PCP about this and got a referral for a trans-friendly colorectal doctor. My appointment with her is tomorrow. My PCP said I'll most likely need a rectal exam. Do y'all have any last-minute tips, either about getting through rectal exams or about talking about sex with a new doctor?

[KierC]

Hi Nitrogen,

I’m glad to hear you spoke to your PCP and got a good referral! We can certainly talk through what to expect with a rectal exam, and how to talk with a new doctor about sex.

Rectal exams
During a rectal exam (also called a digital rectal exam), the doctor will gently insert one gloved and lubricated finger into the rectum and gently palpate to feel for any wounds or abnormalities. You don’t need to do anything physically to prepare for the exam, aside from bringing your ID and insurance/payment card, and a list of questions (more on that later), but if there’s anything you do to help yourself relax, like any breathing or relaxing exercises, that’d be a good way to ease any discomfort you might feel during the exam. In terms of the exam itself, it shouldn’t be painful, either, and if it becomes painful you can let your doctor know to stop. They don’t want to hurt you or make any wound worse, so it should be a gentle exam. How does hearing that make you feel about the exam?

Talking to a new doctor:
We have an article that might be a great start here: Dealing with Doctors: Taking Control of Your Healthcare Destiny. I’d start from the section “Preparing for your Appointment,” it goes through some tips to collect the info your doctor might need, and walks you through how the appointment may go.

Talking to a new doctor, or any doctor, about sex can be difficult — not many doctors are trained in sexuality or know how to talk about gender and sexuality; but it sounds like the referral you got is for someone who might know a bit more about this. So I can get a better idea of how you might be able to approach your doctor with questions about sex, what questions do you think you’d like to ask her?

[Jacob]

Whoop! Very pleased you got a referral!

When I'm nervous before an appointment I like to write down things down which I want to communicate before the appointment, and look over my notes in the waiting room. Getting there early, having some water etc can also help you settle if your concerned about going in flustered.

They'll probably ask you some variation of "What seems to be the problem" to which you can tell them pretty much what you've told us here, the way you told us here.

It depends on the doctor themselves and what their process is whether they'll book a follow up, but they might offer to examine you right there and then, so I would bear in mind that that it is a possibility.

I also think it's a good thing to tell them if you're feeling nervous... that alone can break the ice, like "I'm glad we're getting this sorted, but I'm nervous about the rectal exam"

[nitrogen]

Hello,
Thank you all for your responses! I didn't get a chance to reply to them before my appointment, but I did read both of them and find them helpful, especially the tip about writing down questions.

The exam itself wasn't anywhere near as bad as I was afraid it would be! It was definitely unpleasant, but it didn't hurt at all. The doctor explained exactly what she was going to do and how it would feel at every step, which was useful. I also got to meet and talk to her about my symptoms in a separate room before the exam itself, which did a lot to help my anxiety. She was completely unfazed by talking about sex, which makes sense for a colorectal doctor but was something I was unsure about beforehand. My PCP's recommendation was a good one.

The next paragraph will be possibly extraneous/TMI details about my diagnosis and methods of dealing with it, but overall: there's probably nothing seriously wrong with me and I should be okay continuing anal masturbation with some minor changes!

[My diagnosis ended up being probable bleeding internal hemorrhoids caused by chronic constipation . The diagnosis is probable and not certain because the doctor didn't see any active bleeding on the exam, but my symptoms match up. With some lifestyle changes (increased water intake and fiber supplementation) and specific changes in how I masturbate (no more curved dildos, because those seem to hit my hemorrhoids directly), I'm cleared to resume anal masturbation! I will need a follow-up appointment in a few months or if the lifestyle changes don't help, but I'm confident that I'm in good hands with this doctor.]

Thank you for your advice throughout this process - I really didn't know where to go when I started having these issues, and I'm glad that y'all advised me to get a doctor and get this figured out. It's great to know how I can safely enjoy anal masturbation again without the anxiety that I'll start bleeding. Even though I hopefully won't need future advice in this area now that I have a doctor who handles it, I wanted to update y'all and let you know that the advice was helpful.

[Heather]

I'm so glad we could help, and so glad that your diagnosis isn't anything serious and is also something that's usually easy to solve for!