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 about how to 'prepare' for anal sex (that is, how to clean the rectum before sex, often via means of water enemas known as 'douching'), concerns about how to cope with pain, or anxieties about increased vulnerability to HIV transmission.

  • Bottoming takes work!

  • In addition, the bottom sexual position has long been associated with a lack of masculinity or submissiveness, revealing complex gender intersections which bottoms inhabit.

  • 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 the interactions between the biological manifestations of an illness (IBS, IBD, hemorrhoids, etc - whatever digestive disease you may have) and the

    specific lived experience of a bottom, with symptoms being experienced in ways seldom considered by mainstream healthcare.

  • Even before anal sex, an individual can become anxious about rituals 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 pain, the fact that bottoming may worsen existing symptoms, and due to anxieties surrounding anal incontinence.

  • When seeking healthcare, for individuals with GI conditions who bottom on receptive anal report increased stigma towards anal sexuality in healthcare, a

    general lack of guidance on non-heterosexual sexual activity, making it even harder for

    gay and bisexual MSM (men who have sex with men) to navigate this adjustment in their sex lives without a roadmap to do so.

  • Individuals also report that 'when sexual well-being was addressed by [healthcare

    professionals], it is often a "one-size-fits-all approach" that was "geared

    up for straight men", with little, if any, psychosexual support offered to cope with the

    impact on gay sexuality and relationships.

    Self Esteem and Perceptions of Desirability

  • The effects and impacts of a colorectal condition and digestive disease, which may impact a bottom’s ability to engage in receptive anal sex, may have profound impacts on self-perceptions of sexual desirability (self esteem regarding sex).

  • When this is coupled with body image issues from surgeries and/or scarring, this anxiety may have long-lasting effects on a bottom’s self-esteem.

  • These conditions have unique effects on bottoms’ social and sexual lives and can be uniquely detrimental to psychosocial health and wellbeing.

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 sexual minorities, homophobic attitudes are

    still perceived to linger in some healthcare settings, where individuals report experiencing dismissal of symptoms and concerns, or being 'brushed off' as irrelevant or briskly

    change the subject when concerns regarding sexual health arise.

  • As a result, many LGBTQ+ individuals, including bottoms, may opt to avoid disclosure of

    their sexual practices when seeking colorectal and digestive healthcare, 'motivated by "fear of rejection", "reservations as to whether health care providers are accepting or not", not wanting to be "lectured" [...] and being "too embarrassed" - 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), 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 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. On hard days, even:

  • Warm baths.

  • Anal self-massage (with consent and comfort).

  • Erotic media that reflects your identity.

  • Partnered cuddling or touch.

  • Can be acts of healing.

  • And if you do these things alongside a partner, it can be just as fulfilling or intimate.

    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).

  • Queer 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.