S H A M E , S T I G M A, C O L O R E C T A L
H E A L T H
F O R THE B O T T O M S
Receptive anal sex is a valid, affirming, and intimate part of many LGBTQ+ people’s lives. But for bottoms, especially those living with digestive diseases like Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD), or chronic constipation, colorectal health can be layered with shame, stigma, and silence.
Shame, Stigma, and Bottoming
Medical systems often ignore or shame anal sexuality, especially among queer people and the LGBTQ community.
Bottoming is often stigmatized as "unclean" or "risky" as well.
Digestive conditions can involve incontinence, urgency, or gas, which are already stigmatized socially.
Many people grow up being taught that bowel health is "gross" or inappropriate to discuss.
When you combine these factors, bottoms with digestive diseases may feel:
Embarrassed to talk about symptoms.
Scared to bring up sex with their provider.
Ashamed of their body’s functions or changes.
Alone in navigating sex, flare-ups, or pain.
Quality colorectal healthcare requires a deep understanding of the cultural and social background of bottoming to support patients' sexual wellbeing and digestive health.
Bottoming is frequently associated with worries that include:
how to prepare for anal sex ( how to clean the rectum before sex, often via means of water enemas or douching)
concerns about how to cope with pain
anxieties about increased vulnerability to HIV transmission.
Bottoming takes work!
In addition, bottoming has long been associated with a lack of masculinity or submissiveness (not necessarily true, but can definitely be a source of anxiety, shame and insecurity!)
Anxiety and shame are deepened when bottoms experience health concerns, particularly colorectal conditions, such as IBS,IBD, or hemorrhoids, making it difficult to bottom.
Impact of Digestive Disease
Sexual Health
It’s important consider interactions between the biological manifestations of GI conditions (IBS, IBD, hemorrhoids, etc - whatever digestive disease you may have) and the lived experience of being a bottom.
Unfortunately, these intersections and experiences are seldom considered by mainstream healthcare (but it’s improving and this page is trying to fix it!)
Even before anal sex, an individual can become anxious about things associated with bottoming, such as eating specific foods and or using enemas to reinforce a perception of anal hygiene.
Colorectal conditions might affect a person’s ability to bottom due to things we talked about before and here and here.
This includes pain, the fact that bottoming may (may!) worsen existing symptoms and anxieties surrounding anal incontinence.
Self Esteem and Perceptions of Desirability
The effects and impacts of colorectal conditions and/or digestive diseases which may (MAY) impact a bottom’s ability to engage in receptive anal sex,
When this is coupled with body image issues from surgeries and/or scarring, this anxiety may have long-lasting effects on self-esteem, social and sexual lives and can be uniquely detrimental to psychosocial health and wellbeing.
This is why it’s soooooooo important to stay in tune with these things and if you notice it getting bad, don’t hesitate to check in with a trusted friend, mental healthcare professional or healthcare provider or resource for tools on how to stay grounded!
Barriers to Healthcare
Disclosing sexual identity, gender identity, or preferred sexual practices to a healthcare provider, including a primary care provider or GI specialist, remains a challenge for many LGBTQ+ individuals.
Despite changing societal attitudes towards the LGBTQ+ community, homophobia and transphobia still persist in healthcare unfortunately.
Because of this, LGBTQ+ individuals with GI conditions often report experiencing dismissal of symptoms and concerns, or being 'brushed off' as irrelevant or providers change the subject when concerns regarding sexual health arise.
As a result, many LGBTQ+ individuals, including bottoms, may opt to avoid discussing sexual health when seeking colorectal and digestive healthcare, with disclosure positioned as a risk for mistreatment.
While completely understandable, this raises concerns as some sexual practices that may fall under the spectrum of bottoming such as fisting (anal penetration by a hand or fist), rimming, and the use of sex toys may present present unique implications for digestive or colorectal health, such as in the case of recent colorectal surgery or flare, and why providers (and partners!) should be comfortable discussing these topics.
Dealing with Shame and Stigma as a Bottom with GI Disease
Shame around anal health and bottoming doesn't just live in your thoughts, it can take root in your body, your relationships, and how you seek care. But healing is possible!! With time and some coping strategies such as those below, you begin to release stigma and reclaim connection with yourself and your body and identity.
Understand Where Shame Comes From
Shame isn’t yours or your fault. it’s inherited from societal stigma, medical invalidation, or early messages about cleanliness and control.
Recognizing that shame is learned, not natural, helps you begin to question and release it.
Use Kind and Affirming Language
Replace “dirty,” “embarrassing,” or “gross” with words like:
“My body is communicating what I need.”
“These are normal symptoms.”
“I’m deserving of care and comfort.”
How we talk about our bodies shapes how we feel in them.
Build Body Trust
Chronic symptoms can make you feel betrayed by your body.
Practices like breathwork, gentle movement, pelvic floor relaxation, or even masturbation with intention can rebuild a relationship of trust and compassion with your body.
Practice Pleasure Without Pressure!
Pleasure is not all-or-nothing or a zero sum game. On hard days, even:
Warm baths.
Anal self-massage (with consent and comfort).
Erotic media (porn, etc) that reflects your identity.
Partnered cuddling or touch.
Can all be acts of healing!
And if you do these things alongside a partner, it can be just as fulfilling or intimate.
It can really, really be hard to have something that you enjoy or you find important to your identity “taken away” (or the feeling that it is taken away temporarily because of IBD) - don’t get me wrong, this is not underestimating the impact of that! It is hard. But it is important to know that there are other pathways to enjoyment and pleasure that can be just as fun or fulfill what you are seeking while you are getting better.
Find Affirming Providers
You deserve GI and primary care providers who:
Welcome conversations about sex.
Understand LGBTQ+ health and LGBTQ+ bodies.
Validate your pleasure as part of your health
It’s okay to change providers if you feel dismissed or judged.
Here is a page where you can find LGBTQ+ affirming PCPs and GI doctors (you can also ask me, but anyone on the list is good as gold)
Connect With Community!
Talking to others with similar experiences breaks the silence.
Consider:
LGBTQ+ IBD or IBS support groups. here are a list of resources and groups).
LGBTQ+ health communities online. (here are a list of resources that can help you find groups).
Sex-positive therapists who understand chronic illness.
Healing Shame is a Process, and it is not linear! Many bottoms carry emotional and physical scars from invalidation, pain, or isolation. You are not broken. You are worthy of care, sexual expression, and confidence in your body.
Working with affirming GI doctors, pelvic floor therapists, and sex-positive mental health providers can help you rebuild trust in your body and reclaim pleasure.
You Are Not Alone! Thousands of people live at the intersection of queer sex and digestive health. Whether you’re managing flares, pain, or anxiety around sex, there is support.
Healing is possible. Pleasure is possible. Dignity is your right.