Anal Douching

By Finley Baker

Last Updated March 19, 2025

Image Description [Vignette style illustration with teal, green, and blue color palette. The frame of the vignette features a teal enema bulbs with water droplets and two intersecting male gender symbols. Within the vignette, a Black trans man with tattoos, ear piercings, and top surgery scars is holding an enema bulb and balancing himself on a front-wheeled walker. One of his feet is propped up on a Squatty Potty stool and he is standing slightly bent forward in front of the toilet. The light teal background includes a sink counter with a pump bottle labelled "lube," a mirror, a "Men who love men" gay pride flag, and a shelf above the toilet with a plant, glass jar, and picture frame.]

Image Description [Infographic with several illustrations in six sections and a light blue background. Heading text reads "Anal Douching: AKA Enemas" with the subtitle "a common practice to clean poop from your rectum before anal sex." The first section reads "Lube: Always lube up the tip of the device. May need to start by manually massaging your butthole. Water: Lukewarm, no additives. A soda can's worth of water or less - too much increases risk of fissures. Douche until water runs clear. Position: Bent torso relaxes rectum. 1 foot up on toilet/stool or side-lying on bathroom floor." The second section is titled "Bulb Enema" with a green dot and illustration of an enema bulb. Text reads "Safer option! Able to refill multiple times, commonly sold. Short stem, requires grasp to squeeze." The third section is titled "Bag with Shut Off Clamp" with a green dot and illustration of a hanging bag with shut off clamp tubing and tip. Text reads "Safer option! Best if you can't make it from where you are douching to the toilet quickly - stop/start clamp." The fourth section is titled "Shower Nozzle" with a yellow dot and illustration of a shower head with thin metal nozzle attached. Text reads "Use with caution! Can easily overload rectum due to high water pressure - hard to judge volume. Easier clean up." The fifth section is titled "Fleet Enema" with a red dot and illustration of a bottle with a long tip that is labelled "FLEET." Text reads "Not safe! Only meant for constipation, salt water irritates colon - not helpful before sex." The final section is titled "Vaginal Douche" with a red dot and illustration of a uterus with a scared face with a vaginal douche bulb inserted. Text reads "Not safe for vaginas or butts!" There is a QR code with a link to this webpage and the caption "Scan for more."]

Anal Douching

Basics

Douching is not required before receptive anal sex (alone or with partner(s)), but it reduces the chance that fecal matter will appear during play.
Healthy rectums should not be full of poop for the first 8-12 in, because there is a sphincter between the colon and the rectum. Eating regular fiber and being well hydrated increases the chances of a healthy rectum overall. This may not be the case for people with disabilities if there are other issues with the gastrointestinal tract - douching or receptive anal sex is not recommended if you have hemorrhoids (McGowen, 2020).
Douching more than once per day and more than 3 times per week can create inflammation because the natural mucus layer that protects the rectum is removed.

Process

Always use lube on the tip of anything you are inserting into the rectum, as tissues are easily damaged.
Bent at the waist helps relax rectum (side-lying on bathroom floor or hinged at the hips while standing).
8 to 12 ounces (can of Coke) is a safe volume of water, too much water can create fissures - any additional openings to your bloodstream increases risk of contracting STIs.
Use lukewarm water with no additives. If you are immunocompromised, use filtered or bottled water (not well water).
- Additives typically irritate the rectum, which is undesirable if you are planning to have anal sex.
Douche until the water goes clear, which may take 2 to 3 times. Hold the water in for 10-30 seconds, if possible, before expelling (Carballo-Diéguez et al., 2017).
Wait 15-30 minutes after douching before engaging in receptive anal sex (McGowen, 2020).

Options

All options require the ability to reach your own anus and have the dexterity to insert a tip into a tight sphincter. This is made more complicated by the possibility of immediate expulsion of water/fecal matter from the anus - meaning that being near the toilet is more convenient. Since some people choose to lie down on the floor or on a nearby bed to insert the enema, there may also be the requirement of standing up and walking quickly to get the toilet.

Bulb Enema: Most common option. It will be empty when bought, requires the ability to twist open the tip from the bulb to refill with tap water. Also requires a strong, swift squeeze of the bulb to push water up into the rectum.
Bag with shut off clamp: Safer option. Can be inserted in another room with the clamp in the "off" position, and if it can remain in the person's rectum while they get to the bathroom, it can then be pushed into the "on" position to fill the rectum with water.
Shower nozzle attachment: Use with caution. Can easily overload the rectum with more water than recommended due to high water pressure and difficulty with judging volume. More convenient because everything that is expelled stays in the shower and it is reusable. Usually the device remains installed in the shower, so it requires labor to set up and may be difficult for renters.
Fleet enema: Risky. These are pre-filled with salt water, single use enemas. They are meant to help with constipation and designed to irritate the colon enough to expelled compacted fecal matter. This increased irritation means it is not a good choice before anal sex.

Vaginal Douches

NOT RECOMMENDED - there is an abundance of evidence that vaginal douches should not be used if you were born with a vagina due to disruption of the natural microbiome (Martino, 2002; Wireko et al., 2024). An exception is for trans women with healed vaginoplasties experiencing unwanted symptoms, as recommended by the doctor (Meltzer, 2016; Women's College Hospital, 2022).
The term "anal douching" is confusing because vaginal douching is often referred to as just "douching." The term "anal douching" actually refers to enemas.

Resources & References

Queer Health Pod: Douching - Podcast episode (35:48), features queer clinicians and people with lived experience, primary resource for this article

Anal douching safety tips: San Francisco AIDS Foundation

Douchie’s Guide to Butt Health: San Francisco AIDS Foundation - Lots of great, approachable articles about anal sex

Do you have to use an enema or anal douche before you have anal sex?: Planned Parenthood

Carballo-Diéguez, A., Lentz, C., Giguere, R., Fuchs, E. J., & Hendrix, C. W. (2017). Rectal douching associated with receptive anal intercourse: A literature review. AIDS and Behavior, 22(4), 1288–1294. https://doi.org/10.1007/s10461-017-1959-3 (PubMed)

Literature review about anal douching for prevention of STIs.

Chu, Z. X., Shen, G., Hu, Q., Wang, H., Zhang, J., Dong, W., Jiang, Y., Geng, W., Shang, H., & Xu, J. (2021). The use of inappropriate anal douching tool associates with increased HIV infection among men who have sex with men: A cross-sectional study in Shenyang, China. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-10276-z (PubMed)

Recommends caution with shower nozzle douching, as inappropriate use can increase risk of HIV infection

Martino, J. L. (2002). Vaginal douching: Evidence for risks or benefits to women’s health. Epidemiologic Reviews, 24(2), 109–124. https://doi.org/10.1093/epirev/mxf004 (PubMed)

Concludes that there are no benefits to vaginal douching, and only risk of harm. Vaginal douching should be discouraged for people with vaginas.

McGowan, E. (2020, June 29). A sex educator explains the sexist history of vaginal douching. Bustle. https://www.bustle.com/wellness/colorectal-cancer-is-on-the-rise-in-young-women-heres-what-you-need-to-know

Meltzer, T. (2016, June 17). Vaginoplasty procedures, complications and aftercare. UCSF Transgender Care. https://transcare.ucsf.edu/guidelines/vaginoplasty#:~:text=Insert%20the%20dilator%20into%20the,the%20vaginal%20packing%20is%20removed

Wireko, S., Ofosu, M., Agyemang, F., Dankluvi, H. E., & Cobbina, A. E. (2024). Vaginal douching and health risks among young women. Health Science Reports, 7(2). Portico. https://doi.org/10.1002/hsr2.1882

Further evidence for discouraging vaginal douching

Women's College Hospital. (2022). Post-operative vaginoplasty guide to the first year. https://www.womenscollegehospital.ca/wp-content/uploads/2022/09/PatientHandoverDocument.pdf

For providers, not a perfect resource, but a good overview