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.

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!

Bottoming 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.

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

  Understanding IBD

• IBD can affect various parts of the digestive tract, including the rectum, anus, and surrounding tissue. Some complications that might impact anal sex include:

  • Perianal disease (fistulas, abscesses, fissures)

  • Rectal inflammation (proctitis)

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

  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 flare).

• Use plenty of lube. Friction can irritate sensitive tissue. 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.

• 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.

• 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 BM and hygiene.

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.

• 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.

• 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 about whether you’re in a safe window for anal play (no active proctitis, bleeding, or severe rectal pain).

During Sex:

• Use generous amounts of lube!!

• 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: “How’s this pace?” “Is this okay?”

• Deep breathing and mindfulness can help ease tension

• 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.

  Physical Aftercare

• Rinse gently with warm water or fragrance-free wipes.

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

• Avoid strenuous activity if you are sore or tired.

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

Emotional Aftercare

• Normalize talking about how things felt physically and emotionally.

• Address any accidents or discomfort with compassion, not shame or stigma!

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

• Use plenty of water-based or silicone lube!!!

• IBD can make rectal tissue fragile and prone to tearing.

• 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).

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

• Avoid scrubbing or using soap inside the anus.

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

Emotional Safety and Navigating Negative Thoughts/Shame

• Living with IBD often means dealing with body-related shame, 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.

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.

• 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.

• IBD can come with a few scars - from things like G tubes, to stomas to laparoscopic surgery scars - these can all impact our body image and confidence.

• 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!

Consent, Communication, and Confidence

• Be clear with partners if they are long term (if it is a fling or one night stand, 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 talk all count.

Intimacy Beyond Penetration

• Anal sex can be a wonderful part of intimacy, but it’s not the only path to pleasure, connection, or affirmation. When living with IBD, especially during flares 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

  • Mutual masturbation: being turned on together can be deeply connecting, even without penetration.

  • Rimming (oral-anal play) (with safe hygiene): if both partners are comfortable and have discussed hygiene and boundaries.

  • Toys and external stimulation

  • Kissing, cuddling, erotic massage: especially around the pelvis, thighs, and lower back, which can be healing and sensual

  • Erotic talk and fantasy-sharing (sexting, etc): power dynamics, dirty talk, or role play can offer sexual exploration even without touch

  • Exploring non-sexual touch like holding hands, cuddling, skin-to-skin contact.

  • Using toys for external stimulation, prostate massage (when safe), or mutual exploration.

  • Intimacy is not defined by penetration, it’s defined by 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!

Emotional Health, Body Image, and IBD

• Fatigue, scars, stool unpredictability, and body changes can shake your confidence. That’s valid and okay! I have quite 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.

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

• Use lube generously.

• 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.

• 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.