Sex and Intimacy

Know Your Baseline: Understanding Your IBD and Sexual Patterns

• Understand your own patterns of flares and remission is important for keeping in touch with not only your sexual health, but IBD health too. Are mornings tougher - would intimacy at night be better? Does food impact urgency - does eating something in particular before intimate moments make your stomach rumble?

• During flares or with active rectal disease (e.g., proctitis, perianal fistulas), you may need to pause or adapt certain sexual activities (and that is okay - we all have our different journeys and timelines : )

• Have honest conversations with your gastroenterologist about how sex impacts your symptoms and vice versa. Many are becoming more LGBTQ+ inclusive, and aren’t listed in directories that say such - but if yours isn’t willing to have these conversations, don’t feel afraid to seek care elsewhere.

• The rectum and lower colon are commonly affected by IBD, which can cause inflammation, bleeding, fissures, pain, or urgency.

• Many people with IBD worry about bottoming due to having fears of discomfort, accidents, or triggering symptoms.

• With stable disease (no active inflammation or pain), bottoming can be safe and pleasurable.

• If you have erectile dysfunction or libido issues caused by IBD medication, the disease itself/inflammation or surgery, talk to your doctor about prescription medications like sildenafil citrate (Revatio, Viagra) or tadalafil (Adcirca, Cialis)

Hot Tip: Keep a private journal or use apps to track your symptoms, stool patterns, and how you feel before and after sex. I like the iPhone notes app - everything from recipes, grocery store lists, how I’m feeling, pre-writing texts, etc… it does it all!

Intimacy with IBD: Anal Sex, Safety, and Confidence

• Anal sex is a meaningful and pleasurable part of intimacy for many people. Living with IBD can add complexity, but it doesn’t mean you have to give up on sex or connection. See more here for detailed information on bottoming and IBD.

• With care, preparation, and open communication, you can enjoy satisfying and safe experiences that respect both your body and your needs.

  Understanding IBD

• IBD is a chronic (or life-long condition) and can affect various parts of the digestive tract, including the rectum, anus, and surrounding tissue.

• Some complications or manifestations of IBD that might impact anal sex include:

  • Perianal disease (fistulas, abscesses, fissures)

  • Rectal inflammation (proctitis)

  • Surgical changes (e.g., J-pouch, ostomy, scar tissue)

  • Non-IBD manifestations such as hemorrhoids

  Important: Always check with your GI provider if you’re unsure about the safety of anal play, especially during a flare, after surgery, or if you have a history of perianal disease.

Before Sex

• Less is more when prepping with IBD.

• Avoid over-cleansing or aggressive douching, especially if you’ve had inflammation or are healing.

• Know your body’s rhythm: Try to “plan” (using that word lightly) intimacy when your GI tract is calm (e.g., after a BM, not during a time of a bad flare, avoid eating things that trigger an upset stomach like popcorn or a super high residue diet)

• Use plenty of lube. Friction can irritate sensitive tissue in the anorectal area, especially if you have recent disease activity. Silicone or water-based lube is generally safe; avoid desensitizing (numbing) agents.

• Warm up slowly. Try toys, fingers, or oral to relax the muscles and build trust with your body. Foreplay is important for relaxing the muscles and blood vessels in your butt so you can actually enjoy bottoming.

• Positioning matters. Positions that give you control (e.g., on your side or riding) may help reduce discomfort and allow you to stop or shift if needed. Missionary can potentially make anodyspareunia (painful anal sex/spasms upon anal penetration) worse in people with IBD, so you may consider switching it up from missionary to another position.

• See below for more information on positions.

• Prep gently. Avoid aggressive douching; if you do rinse, use lukewarm water and stop at the first sign of irritation. Many skip it entirely and rely on a recent bowel movement and good perianal hygeine.

• Mindset Matters: Prep isn't just physical, a lot of sex and prepping is emotional. Give yourself space to feel sexy and loved, not uncomfortable. Light candles, play music, and slow down and be present in the moment.

Tips:

• Use a bulb syringe with warm water, no soap or additives

• Keep cleansing gentle and avoid repeated flushing (using it over and over)

• If you’re concerned about accidents, speak to your provider about Imodium (loperamide) ahead of time.

• Consider gentle, minimal prep: a warm water rinse may help if you have rectal urgency, but avoid harsh douching, which can cause microtears or irritation, especially burdensome in IBD.

• If you're concerned about urgency or mild leakage, speak with your GI about using Imodium (loperamide) sparingly. Only use with medical clearance, as it can worsen inflammation in flares or if you have infectious diarrhea.

• Check with your provider if you are comfortable discussing such about whether you’re in a safe window for anal play (no active proctitis, bleeding, or severe rectal pain).

  Positions

• Certain positions may feel better than others, especially if in a flare/recently coming out a flare, due to how they put pressure on the abdomen.

• If you have any bloating, tenderness, or distention, avoiding positions with belly pressure is helpful.

• If you have joint pain/arthralgia or fatigue, you can also try to opt for positions that require less muscle engagement.

• Missionary may cause pain upon penetration anodyspareunia (painful anal sex/spasms upon anal penetration) worse in people with IBD, so you may consider switching it up from missionary to another position.

  Side-Lying (Spooning or Modified Saddle Spoon)

• How it helps: takes pressure off the abdomen and joints, easy to stop or adjust and puts less pressure on your abdomen and pelvic floor

• Good for if you are fatigued or tired, post-flare, or feeling vulnerable and want something more low key.

• Also allows for closeness, intimacy, emotional safety, slow pacing and gentle rhythm which is great for when you want emotional connection and bonding.

  Modified Doggy (Supported Forward Lean)

• How it helps: Less strain on hips/lower back if you lean on a pillow or bed and you can adjust the angles, and allows for a gentle depth with full control.

• This position is a good one if you have perianal disease since it reduces strain and pressure on the pelvic floor.

• Be mindful if you have rectal inflammation! gentle entry and lots of lube are key.

  Modified Doggy with Arm/Chest Support

  How it helps: Deep penetration is supported and comfortable with hip/knee support, and can be preferred if you have arthralgia or pain in the joints of your hips and knees.

• You can control how much you arch your back or open your legs.

• Not great for active perianal inflammation or perianal abscesses, you may want to skip this one when that is flaring up and try when you're feeling well.

  Face-down with Pillows (Pillow Stack Position/Prone)

• How it helps: You control the angle and can cushion pressure points.

• Avoid if you have painful abdominal tenderness or ostomy that is sore or recent abdominal surgery surgery/recent ostomy surgery.

  On Your Back with Legs Elevated By Pillow (e.g., Missionary with Support)

• How it helps: Offers easy access for your partner while letting you fully relax.

• May not be ideal if you’re bloated or have lower abdominal pain.

  Missionary with A Pelvic Tilt (On Your Back with Hips Elevated)

• How it helps: A nice relaxed and receptive, with easy communication.

• Tip: Use a wedge pillow under hips to control angle rather than a feather pillow.

• This position can feel uncomfortable though if you are bloated or having pouch pressure.

  For the Tops (can’t forget about y’all!)

  Seated Positions (e.g., receiving partner on top)

• How it helps: Minimal energy required, great for flares or a high fatigue day.

• There are also hands-free possibilities for exploring touch or toys.

  Standing from Behind (Leaning Over Counter or Bed)

• How it helps:Easy to shift pressure off your body and control thrust depth.

• Be mindful of energy levels if you are fatigued, use pillows for stability if needed.

  Straddled Lap (Partner Sitting, You on Top)

• How it helps: You set the pace and depth.

• Excellent if you’re healing from fissures/fistulas and want full control.

• May also work for people with short bowel or rectal sensitivity.

  Lying Side-by-Side Facing Each Other

• How it helps: Intimate and adaptable, good for mutual stimulation or shallow thrusting.

• also has a the plus of eye contact, kissing, emotional connection and we love that!

  Pro tips for anyone - bottom, top, etc.

• Use pillows to reduce joint strain and support the abdomen.

• Communicate frequently and check in before, during, and after.

• Warm up with toys, fingers, or oral to ease anxiety and reduce muscle tension.

• Stop anytime, no position is worth pain or getting hurt!

• Aftercare is important: Hydrate, rest, and connect emotionally, especially important for people with chronic illnesses like IBD!

  During Sex:

• Use generous amounts of lube!! If you love it, lube it.

• Water- or silicone-based lubes reduce friction and prevent tears.

• Reapply often, especially if you're using condoms (it can get dry).

• Go Slow and Be Present.

• Start with fingers or toys.

• Use verbal check-ins, asking “How’s this pace?”or “Is this okay?”. Some people come up with a safe word to use just in case.

• Deep breathing and mindfulness can help ease tension before and during so you aren’t tensed up and stressed/not able to relax your muscles and enjoy.

• Protect Yourself and Your Partner!

• Use condoms or barriers to prevent STIs and bacterial infections if unsure of STI status.

• If using toys, clean them thoroughly between uses.

• Adapt Positions for Comfort!

• Positions like spooning, lying on your side, or straddling can reduce abdominal pressure and improve control.

• Take breaks if needed; stop if there's sharp pain, cramping, or discomfort.

• Use plenty of water-based or silicone lube!!! IBD can make rectal tissue fragile and prone to tearing, and lube is important to keep things smooth.

• Go slow, communicate with your partner, and stop if you feel sharp pain, pressure, or cramping.

• Condoms and barrier methods protect against STIs and help reduce risk of transmission of bacteria that may complicate IBD or recovery from surgeries (especially if you have a pouch or stoma).

  After Sex

  Physical Aftercare

• Rinse gently with warm water or fragrance-free wipes (or a bidet, the attachments are ~$40 on Amazon)

• Use a sitz bath or apply a barrier cream (like zinc-based ointment) if irritated.

• Avoid strenuous activity afterwards if you are sore or tired and take it easy. Sex is technically physical exercise (see here at the bottom of the page) so you got a work out in!

• Watch for new or concerning symptoms (e.g., bleeding, new urgency, persistent pain)

• Gentle clean-up with fragrance-free wipes or water is ideal.

• Avoid scrubbing or using soap inside the anus, as this can irritate and dry out the mucosa/tissue and won’t really benefit you at all over using water and a gentle soap.

• If you notice new pain, bleeding, or changes in bowel movements after sex, contact your provider!!

Emotional Aftercare

• Normalize talking about how things felt physically and emotionally.

• Address any accidents or discomfort with compassion, not shame or stigma! Talk it out :)

• Cuddling, affirming words, or simply lying together can strengthen connection and are nice and fun and cute too :)

Emotional Safety and Navigating Negative Thoughts/Shame

• Living with IBD often often means dealing with body-related shame (it doesn’t have to, though!) anxiety about accidents, and vulnerability, especially in the context of bottoming.

• This may be particularly compounded for LGBTQ+ people who may already carry messaging that their bodies or desires are "too much" or "not right."

  • You are not dirty or broken for needing more prep or having IBD.

  • Accidents, while not ideal, can happen to anyone.

  • Emotional connection and trust deepen when we allow ourselves to be fully seen, bodily functions and all!

  Hot Tip: Find partners who are kind, affirming, and comfortable having real conversations about sex and health. You deserve that and nothing less.

  Zinc

  • Zinc deficiency is actually associated with poor clinical outcomes in IBD, so staying on top of your zinc intake is a good idea (no pun intended)

  • IBD patients with serum zinc deficiency are more likely to have adverse disease-specific outcomes (IBD-related hospitalizations, IBD-related surgeries (surgical resection with or without creation of a stoma or ileoanal pouch) or IBD-related complications (including malnutrition, dehydration, anemia, hemorrhage, intestinal obstruction, fistula, abscess, and colonic stricture and these outcomes improve with normalization of zinc.

  • Zinc supplementation actually reduced inflammation in Ulcerative Colitis as well and plays an important role in intestinal barrier integrity and function in both Crohn’s disease and Ulcerative Colitis.

  • It’s important that you don’t take TOO MUCH zinc though. Too much of anything can be a bad thing, and excess zinc intake can cause issues neurologically, and can cause nausea, dizziness, headaches, gastric distress, vomiting, and loss of appetite. If used too much, it can interfere with copper absorption (which can cause low copper status), reduce immune function, and lower HDL cholesterol levels

  • Very high doses of zinc from supplements (142 mg/day) might also interfere with magnesium absorption and disrupt magnesium balance.

  • Long story short: zinc deficiency is bad, but too much zinc can cause neurological issues, tummy issues, and copper deficiency.

  • Social media has made zinc supplementation for sexual health very popular due to it (anecdotally) increasing ejaculate volume, as zinc is a vital mineral and cofactor for sperm production and erectile function

  • Zinc improves sexual performance and erectile function by preventing penile oxidative injury/oxidative stress and upregulating circulating testosterone

  • Zinc is an important cofactor/coenzyme for the body to produce testosterone and is important for prostate and sexual health. It also acts as an antibacterial in the urea system.

  • Low levels of zinc can of course be associated with poor outcomes in IBD, but also poor sexual health! Like said here, good health correlates with good sex, and good sex correlates with good health.

  • The overall consensus is that zinc improves sexual function, testosterone production, and sexual health - including cisgender men, postmenopausal women and pre-menopausal cisgender women.

STIs, HIV, and IBD: What to Know

• Having IBD does not increase your risk of HIV or STIs directly, but some IBD meds (like biologics or immunosuppressants) may slightly affect immune function.

• Regular HIV/STI testing (every 3–6 months) is recommended if you're sexually active with new or multiple partners.

• PrEP (Pre-exposure prophylaxis) is safe to take alongside IBD treatments, and many gastroenterologists are familiar with PrEP and can co-manage care.

• Be mindful that antibiotics for STIs can disrupt gut flora, so let your GI know if you’re treated for something like gonorrhea or chlamydia. It may be helpful to eat yogurt or take a probiotic during this time when you are taking antibiotics (personally, I chose yogurt and the literature backs me up)

  Surgeries, Stomas, and Scars: Sex After IBD Procedures

• People with ostomies, J-pouches, or rectal surgeries can and do have satisfying sex lives - see information here for navigating sexual health and bottoming/anal with colorectal surgery in IBD!

• Communication, creativity, and the right tools (like stoma covers or different positions) can help restore intimacy.

• If you’ve had anal or pelvic surgery, get guidance from your surgeon or a pelvic floor physical therapist trained in LGBTQ+ health before resuming anal sex if you are unsure.

• IBD can come with a few scars, from things like G tubes, to stomas to laparoscopic surgery scars and these can all impact our body image and confidence, but don’t let it get you down!

• You aren’t alone in this - I have a G tube scar myself! But the most important thing is that the person you are connecting with doesn’t see your scars as something to be ashamed of - as you shouldn’t either. Having scars means you overcame and survived something big, and that’s important and should be celebrated!

Emotional Health, Body Image, and IBD

• Fatigue, scars, stool unpredictability, and body changes can shake your confidence. That’s valid and okay! I have a few random scars, and if someone doesn’t accept you for you as a whole, they aren’t the person for you.

• Queer and trans folks with IBD often feel double stigma, compounded from their diagnosis and from body or sexual expectations in LGBTQ+ spaces.

• Therapy, support groups, and sexual health coaching with LGBTQ+-affirming providers can help rebuild pleasure, agency, and self-worth.

Consent, Communication, and Confidence

• Be clear with partners if they are long term (if it is a fling or one night thing, you probably don’t have to share or feel the need to) but if it is someone you are going to be with for a while, you may want to let them know you have a chronic digestive disease, so sometimes you need more prep or a slower pace, and you will let them know what feels good.

• Discussing accidents, discomfort, or prep upfront may feel vulnerable, but it builds trust and better sex!

• Explore alternative intimacy if you’re flaring: mutual masturbation, oral sex, cuddling, and dirty (not that there is anything dirty about it!) talk all count. See below for more information about non-penetrative modes of finding intimacy.

Intimacy Beyond Penetration

• Anal sex can be a wonderful and fun part of intimacy, but it’s not the only path to pleasure, connection, or affirmation.

• When living with IBD, especially during flares, bouts of perianal disease or abcess, or recovery, it’s empowering to know that intimacy doesn’t begin or end with penetration

• Even when anal sex isn’t possible or preferred, which can be the situation if you are dealing with perianal disease or in a bad flare intimacy can still be desirable, affirming, and connective.

  You can potentially try:

  • Oral sex (stimulating the genitals with your mouth) : Generally fine 99% of the time, if you have oral thrush, I would hesitate and explore other options. See here for more info on oral and IBD!

  • Mutual masturbation: Kind of self explanatory of what it is, but masturbating is generally always safe and fine to do, IBD flare or not, and actually beneficial for your health! Being turned on together can be deeply connecting, even without penetration.

  • Fun fact: Masturbation actually more effective than Kegels in strengthening the pelvic floor! (Penis-root masturbation)

  • Rimming (oral-anal play) (with good hygiene): if both partners are comfortable and have discussed hygiene and boundaries. See here for more information on oral-anal play in IBD, but it can be an alternative to anoreceptive intercourse.

  • Intercrural sex: A type of non-penetrative sex in which the penis is placed between the partner's thighs and thrusts to achieve pleasure and/or an orgasm. Friction can feel amazing against a penis no matter where that friction is coming from, and the thighs offer a unique type of friction that can feel exciting for those who are accustomed to receiving friction from other body parts, like the butt. If you are having a flare-up and don’t feel comfortable being the receptive partner, there’s no risk of poop or hurting anything in your perianal region with intercrural.

  • Toys and external stimulation: this can scratch that itch if you will, without direct penetration and you can still connect and find intimacy. Consider erogenous zones as well. See here for more information on using toys after flares or fissures.

  • Kissing, cuddling, skin-skin contact, erotic massage: especially around the pelvis, thighs, and lower back (erogenous zones), which can be healing and sensual without penetration of areas that IBD is affecting.

  • Erotic talk and fantasy/kink sharing, power dynamics,(sexting, etc. “dirty” talk (a bit of a loaded term, as there isn’t anything inherently dirty about intimacy or talking about it), or role play can offer sexual exploration even without touch as well.

  • Prostate massage and/or perineal area massage/stimulation (if you feel comfortable with that), or mutual exploration. The prostate and perineal area are both erogenous zones (areas of the body outside of the usual “sexual zones” that are sensitive to touch and can stimulate sexual arousal.

  • The perineum is a sensitive patch of skin that is between the scrotum and the anus and the prostate is a little walnut-sized gland at the internal root of the penis.

  • At the end of the day, intimacy isn’t solely defined by penetration, it’s how you and your person of interest find pleasure, mutual care, and presence and it’s important to recognize that, especially in IBD!

  • Intimacy is about safety, trust, and creative connection and doesn’t have to be solely defined by bottoming. In IBD, having to take a pause from certain things can feel like the end of the world, but there are always other things!

TL;DR: Safe, Hot, and Empowered - The Toolkit for Better Sex with IBD

• Use lube generously. If you love it, lube it!

• Communicate with your partner(s)

• Prep only as much as needed and avoid over-cleansing.

• Talk to your provider about flares, fistulas, and medication interactions.

• Celebrate your body’s capacity for pleasure - every body is beautiful and it is amazing that it carries you through this world!

• You are worthy of joyful, safe, and affirming sex!

• Sometimes you may want to or need to think outside of the box with intimacy!

• Living with IBD doesn’t mean giving up intimacy. With the right preparation, knowledge, and support, you can have fulfilling sexual experiences that honor both your desires and your health.