Dear Dr Laura,
I like being fisted but I was wondering how dangerous it was for the person being fisted? I’ve heard some guys get real long-term damage to their arses? Is this true? Many thanks.
Fisting, performed carefully, can be very pleasurable but I wouldn’t be a doctor if I didn’t start with the risks! As you mention, an important risk is physical damage or trauma to the anus and rectum. This can range from small tears in the anus or the skin/tissue surrounding the anus (which can be very painful but will heal), to major tears or even perforation (holes) in your bowel – this is less common but can cause very serious infection; there have been cases where people have ended up on intensive care and even some deaths.
There aren’t many scientific studies on the topic; a recently published one stated as many 1 in 5 people receiving anal fisting get some sort of injury, although the authors do admit that the figures may be unreliable. The risk of injury is unsurprisingly much higher if the fisting is non-consensual (i.e. someone is forced into it). A survey of men who have sex with men attending a sexual health clinic in the US showed that 1 in 6 had ever tried fisting, and 1 in 25 had fisted in the last 3 months. Since fisting is relatively common, and serious injury uncommon, we can assume most fisting takes place without injury.
To reduce the risk of physical damage use PLENTY of lubricant and take things slowly: the fister should insert one straight finger at a time, keeping their thumb close to the palm of their hand and then gently curl their fingers to form a fist once their hand is inside you. People who are ‘warmed up’ and experienced at fisting may go straight in with a curled fist (known as, amongst other terms, punch fucking). As much care should be taken when taking their fist out. The person doing the fisting should have short nails and no jewellery on!
The feelings of fisting may be intense, but should not be very painful; if you get any deep sharp pains or anything more than very small amounts of blood your partner should stop, if you and your partner are experienced at fisting then you’ll know this already. Many people use drugs while fisting but these can mask pain so avoid if you can, especially when you’re new to fisting.
Fisting increases the risk of sexually transmitted infections (STIs), including hepatitis C; using gloves can reduce this risk. Avoid using of saliva as a lubricant – it’s not very effective and is also an important way of transmitting STIs, especially gonorrhoea.
If you’re fisting as part of group sex be particularly careful about infections; new gloves should be used for each partner. Shared lube can increase the risk of infections so try to use individual sachets – also make sure the lube you use is safe with latex gloves and remember if you’ve used lube for fisting then have anal sex afterwards the lube can affect condoms too. Most oil-based lubes will damage latex (making the gloves/condoms ineffective) – water-based lubes are safe (most will say on the instructions if they can be used with latex) if you’re not sure you can use non-latex products.
Make sure you and your partner are up to date with you your sexual health check-ups, including HIV; not all clinics offer routine hepatitis C testing so do ask and, if you’ve had a recent risk then ask them to do a hepatitis C antigen or viral load as that detects infection sooner than the more traditional antibody test.
So, though fisting can be risky, if you take it slow, with lots of lube applied repeatedly, and stop if you get more than a twinge of pain it can be safe and fun.
The Boyz Doc is Dr Laura Waters, an HIV and sexual health consultant at the Mortimer Market Centre in central London. Dr Laura answers your questions every week in Boyz. If you have a question for Dr Laura please email her at firstname.lastname@example.org