It’s easy to get so focused on the pleasure sex brings that you don’t think about what comes afterward, but whether it’s cuddling, a warm bath, or pillow talk, aftercare should be part of your post-sex routine — especially if you’re into anal sex.
You may think that aftercare is just for kinky sex, but even the most vanilla among us can benefit, and if you’re regularly topping, you should be putting effort into taking extra care of your partner after anal sex.
The goal of anal aftercare is to return to equilibrium, transition back into the real world after intense sex, and care for a body that may have been put through the wringer.
“Aftercare is what you do in the aftermath of sex to maximize care and wellbeing,” Good Vibes Sexologist Carol Queen tells Out. “There is a solo version of this, but the term is particularly used to refer to checking with a sex/play partner about how they are feeling: seeing if they're doing well, communicating about your scene or date, finding out whether they need anything from you.”
Bottoming on its own can be a particularly vulnerable and physically taxing sex act, so even if you’re not in a Dom/sub relationship or into kinky sex, anal aftercare should become part of your postcoital regimen.
What is anal aftercare?
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In its simplest form, anal aftercare is a term to describe the way you care for your partner after anal sex, especially for the receptive partner. “It’s about what everyone’s mind and body may prefer or need after a round of anal,” says Todd Baratz, an AASECT-certified sex therapist at #LUBELIFE. “It’s really no different from sex aftercare — or any kind of care— it just happens to describe the period specifically after anal sex.”
Just like the kind of aftercare that kinksters have made a required part of BDSM sex, anal aftercare is about looking after your partner’s emotional wellbeing and the impact of any kind of anal play, like “toy play, anal intercourse, digital penetration, fisting, enema play and so on,” Queen says.
“Not all anal play necessarily fits into the kink category, though certainly some does, and there are plenty of people who would view all anal as kinky,” Queen says. “But any anal play comes with taboos that might still be felt by either partner; and additionally, anal, like some forms of BDSM, can result in pain or damage if it isn't done properly and with care. Even when you've had a perfect anal experience, there still might be a history of painful or even abusive or coercive anal behavior, which means emotion and reaction can run high with this kind of sex.”
Why is aftercare important after anal sex?
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Whether you’ve just hooked up for the first time and don’t plan a repeat or you’ve topped a long-term partner, you should still be thinking about anal aftercare and how you can make the experience better for the person you’re sleeping with. Not only will this show your partner that you care about what happens to their body and emotions post sex, but “thinking about your partner's experience and well-being is how you get better at having sex,” Queen says.
“Another function of aftercare is to express caring,” she says. “Even if it's a one-time sexual experience, a person can feel more valued and respected, and is less likely to feel used, with aftercare, where their partner (temporary or long-term) is supportive of them and helps them deal with any aftermath of the experience. It can be equally meaningful for the top, relationally speaking.”
And if you’re not prepared to do that, Queen suggests sticking to solo play and buying a sex doll instead. “Because they're a human being who is due respect and care; they're only a fuckpuppet if you negotiate it,” she says. “A person who doesn't feel the ability to take their partner's experience into account might want to invest in a nice sex doll.”
Baratz agrees and says that taking care of your partner after you’ve penetrated their body during anal sex should be a given. “We could ask, ‘Why is care important?’ and the answer would seem obvious, but for some reason people approach sex as a separate category,” he says. “Sex, cuddling, cooking, walking around together — all of these can be thought about similarly in terms of the care we want to show ourselves and our partners. Sex in particular can be a vulnerable experience physically, emotionally, and relationally, so we need to be intentional about the care we show ourselves and our partners afterward.”
What should you do before you even start having anal sex?
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Before you ever get to the aftercare, there are plenty of things you can do to reduce the physical impact of anal sex and bottoming. Unlike some other forms of sex, anal play can cause pain, discomfort, or even damage, but luckily there is plenty you can do to help prevent this so that your aftercare can be more focused on emotional and physical comfort than dealing with a newly formed anal fissure or other tissue damage.
If you want to reduce any pain and discomfort during or post-anal sex, you’ll need to prep your body first. “Make sure that as a receptive partner you’re paying attention to pain and not trying to push through it,” Baratz says. “Make sure you’re relaxed before receiving penetration. Sometimes it can be helpful to use plugs, dilators, or dildos (also with a lot of lube) before starting to have anal sex. Stop whenever you need to and take breaks. If you’re paying attention to all of this during sex, you’re much more likely to feel good afterward.”
And you can never have enough lube, according to Baratz, who says, “If you’re worried about making a mess, put down a towel, a tarp, whatever you need, but nothing should limit the amount of lube you use. It’s for both safety and pleasure.”
Leading anal surgeon Dr. Evan Goldstein, who owns Bespoke Surgical and now has his own line of anal sex prep products available at CVS, says that not over-douching, stretching your body slowly with a dilator set when you’re on your own, and focusing on foreplay and pre-dilation with your partner during sex will all help you avoid injury. “All it takes is one mishap to potentially lead you down the road toward a chronic anal issue,” he says. “Bottoming is a sport, and practice makes perfect. I always say you can be submissive and still be in control. That control comes from the preparatory routines above.”
You also don’t want to overdo it when it comes to the number of times you bottom back to back. “My partner, also a sexologist, and I were once talking to his anal doc and he told us almost all the rectal tears they saw at the hospital nearest the Castro were people who tried to play all weekend,” Queen warns. “Overdoing it with anal can not only cause pain, it can cause life-threatening injury.”
10 anal aftercare tips
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Anal aftercare is going to look different depending on the person you slept with and what their needs are post hook-up, but the experts have some tried and true tips to help you take care of your partner’s emotional and physical wellbeing after any kind of anal play.
1. Talk about aftercare beforehand
According to Baratz, the best time to have a conversation about what you want aftercare to look like should start before you have sex so that you can “talk about sexual preferences, including your wishes for aftercare. Discuss what that includes or could include.”
2. Pillow talk
When you both are coming down from an intense sexual experience, take the time to talk openly with your partner. “What I often try educating my clients about is aftercare isn't just physical – my happiest and healthiest patients also check in mentally, not only with themselves, but also their partners,” Goldstein says. “Something as simple as asking how they're feeling, what worked, what didn’t, etc. This tells them you're paying attention, and it also gives soreness a chance to get addressed early so that you can set yourself up for success next time.”
Baratz agrees and says you should consider this time to do a sexual recap. Sexual recap and ask your partner, “What felt good? What did you like? What would you want to try next time?”
3. Cuddle time
Physical touch can be incredibly helpful for everyone’s emotional well-being after anal sex, but especially for whoever bottomed. “Stay in contact with your partner physically—hold them or touch them—as they ‘come down’ from the experience,” Queen says.
And don’t rush the process, try to stay present with your partner “Physically, staying close also helps — cuddling, a warm shower together, just quiet time before jumping back into the rest of the day,” Goldstein says. “The nervous system needs time to come down off that level of tension, and having a partner who isn't rushing that process makes a real difference.”
4. How does your body feel?
Don’t forget to advocate for yourself. It may make you feel vulnerable, but it’s important to tell your partner what you need from them. “Pay attention to your body and what you need, while also asking your partner if they need anything. And share if there’s something you want or need,” Baratz says.
5. Ask what they need
After anal sex, your partner will need to hydrate, maybe have a snack, or take a warm Epsom salt bath. This is something you can discuss ahead of time and then get it prepared so that they don’t have to think about it. “Ask them what they need: water, a bit of food, a warm washcloth, bath or shower,” Queen says. “Get or prepare that for them.”
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6. Keep an eye on bleeding
After anal sex, you’re going to want to monitor any bleeding that occurs, especially for more intense acts like anal fisting. ”Make sure any bleeding is minor or temporary,” Queen says. “That means it isn't copious and continuing to bleed, but stops shortly after play. If blood continues to drip and doesn't stop, accompany them to urgent care or the ER.”
7. Help clean up
While your partner is resting, it’s a good time to take care of any mess that the two of you made. “If you were playing with toys, gather them up and get them ready to clean,” Queen says.
8. Don’t leave right away
Even if this is a one-night stand or a quick hookup, don’t sneak out. Stick around to provide aftercare and don’t ditch them until they’re feeling emotionally stable. “Don’t leave before they're ready to be left alone — that is, if you don't live with them or have plans to stay,” Queen says.
9. Take constructive criticism
When you’re having your post anal sex check in, take what you partner says to heart and incorporate it next time so you can really rock their world. “Some partners will welcome a chance to share feedback about the play itself; this can help you learn more about your partner and about how to give better anal pleasure,” Queen says.
10. Check in later
Anal aftercare doesn’t end when you say goodbye. Touch base a couple days later to make sure they aren’t having any lingering pain or need anything from you emotionally. “A day or so later, call or meet to check in and see how they're doing,” Queen says.
What kind of anal aftercare should you do for yourself?
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If you slept with a selfish partner who didn’t stick around after their orgasm — we’ve all been there — or you just like to provide yourself a little self-care, there are things you can do to take care of your own bottom after bottoming.
Right after, skip the scented wipes and instead use a gentle external wash to help remove lube so you don’t irritate already-sensitive tissue, and don’t feel like you have to douche. “If there's soreness or swelling, a nice, warm Epsom salt bath does a lot of work relaxing the pelvic floor and the skin,” Goldstein says. “A lightweight, quick-drying cream or a calming suppository can help too, and ibuprofen is fine for inflammation. I'd steer people away from numbing agents like lidocaine — they mask the problem instead of helping it, and they can also inflame the tissue further.”
Over the course of the next few days, you’ll want to support your body’s natural ability to heal by staying hydrated and taking a daily fiber supplement and synbiotic to keep your stool soft so you don’t strain, since “straining is one of the most common things that turns mild soreness into something worse like a fissure or a hemorrhoid,” Goldstein says.
“Breathe normally during bowel movements instead of holding your breath,” he recommends. “And give the area a break — that means holding off on more sex until soreness has fully resolved. If sessions were longer or more intense, that recovery window should stretch out too. Watch for warning signs — worsening pain, swelling, discharge, bleeding beyond light spotting, fever — that's when I recommend booking an appointment to see your doctor."
Although the internet is full of information about bottoming — from prep tips to advice on fiber intake to techniques for loosening up — it can be hard to know what information is worth your time and what isn’t.
And because U.S. sex education definitely failed to prepare anyone for anal sex, it certainly didn’t cover what to do if you’re a bottom and also have irritable bowel syndrome (IBS).
For people struggling with IBS, things can be a lot more complicated — and messy — if you don’t know what you’re doing.
IBS is a chronic condition of the stomach and intestines that affects 5 to 10% of the global population and causes “cramping, belly pain, bloating, gas, and diarrhea or constipation, or both,” according to the Mayo Clinic. These symptoms can make bottoming more challenging, but not impossible.
So don’t let IBS get you down or ruin your sex life because we gathered together a group of anal health experts with tips for changing your diet, prepping effectively, and making bottoming more pleasurable, all while dealing with IBS.
If you have IBS, how do you prep for bottoming?
If you have IBS, how do you prep for bottoming?
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Before you think about douching or diet changes, the first step is to make an appointment with a health care provider, says Dr. Carmen Fong, a colorectal surgeon and the chief medical officer at Bummed, a telehealth platform that makes prescription creams to treat hemorrhoids and anal fissures.
“If you're self-diagnosed with IBS, get an official diagnosis from a medical provider,” Fong tells Out. “This means ruling out other possible etiologies. IBS is a criteria-based diagnosis, but other conditions such as IBD, bacterial infections, and STIs should be ruled out through stool studies, colonoscopy, and bloodwork.”
Many people feel more comfortable and confident bottoming if they’ve douched beforehand. If you fall into that camp, you’ll want to avoid overdoing it, according to Dr. Evan Goldstein, a leading anal health expert who founded Future Method, a sexual wellness brand dedicated to revolutionizing anal sex prep.
Goldstein also recommends “gentle anal dilation exercises” with a dilator set because it will not only help with a tight pelvic floor that often accompanies IBS, but it’s also a way to check if you’re actually cleaned out. “Not only are they great for training the muscles and skin, but they also help you figure out if you’re ready or not to bottom that day,” he says. “In the end, the goal is to find a prep routine that works with your body. This may take some trial and error, but it’ll be so helpful in the long run.”
What else can you do to get ready?
Rather than risk irritation by douching frequently, Dr. Carl Streed, the research director for the GenderCare Center at Boston Medical Center and associate professor of medicine at Boston University, says it’s “best to stay ready than have to get ready.”
“This means addressing symptoms proactively,” he says. “It may be boring, but we must continue to talk about fiber (soluble NOT insoluble); so psyllium husk is a mainstay of reducing symptoms and is excellent for helping cleaning before bottoming.”
According to Fong, a “well-formed stool leaves much less residue in the rectum, which makes bottoming more comfortable,” so shoot for “a daily soft, formed stool, ideally a Bristol Stool Scale Type 4."
Should you change your diet or lifestyle?
Should you change your diet or lifestyle?
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Everyone’s IBS symptoms are a little different, and what diet works for one person may not work for another. Figuring out what foods trigger your IBS symptoms is going to be your best bet if you want the option to bottom frequently. “Keeping a food and symptom journal can help identify foods, drinks, or even stressful situations that lead to flare-ups,” Goldstein says. “If you know you're planning to bottom, it's a good idea to avoid your known triggers in the day or two leading up to sex whenever possible.”
Streed also recommends following the Cleveland Clinic’s low-FODMAP diet (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), which involves avoiding a specific class of carbohydrates. “Peppermint oil has also been found to reduce GI symptoms (including spasms) and there are prescription medications for GI symptoms to reduce severity and frequency of symptoms,” he says.
Beyond changing your diet, if you want more consistent bowel movements, you need to prioritize regular exercise, staying hydrated, getting enough sleep, and incorporating a fiber supplement when appropriate for your IBS type. “The more predictable your bowel movements are, the more confident you'll feel bottoming,” Fong says.
How can you make bottoming with IBS more comfortable?
How can you make bottoming with IBS more comfortable?
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Streed advises using more lube than you think you need and loosening up your muscles with foreplay that can include rimming, gentle fingering, and toys. “Most importantly, communicate with your partner about what feels good (or doesn't) and provide feedback,” he says. “Ensuring you're getting what you want out of the experience is key.”
It’s going to take some trial and error, but you can absolutely plan when you’re going to bottom around your IBS flare-ups. "Comfort starts with listening to your body,” Goldstein says. "If your IBS is flaring or you're experiencing pain, diarrhea, or significant discomfort, bottoming should be off the table. It's absolutely okay to wait until your symptoms are under better control. In fact, it’s better.”
And if you need a break from bottoming, take a page out of the side’s handbook and switch to frotting, oral sex, and handjobs when you’re having a flare-up. “Pain during bottoming is not something that comes with the territory, nor is it something you should simply push through,” Goldstein says. “It’s your body's way of telling you something isn't right, and if you’ve tried to address it without success, I recommend seeing a specialist who can help you find the root of the issue.”
Will IBS stop you from bottoming as often as you want?
Will IBS stop you from bottoming as often as you want?
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As long as your symptoms are well managed, there is no reason why you can’t bottom as frequently as someone without the condition, Goldstein says. “IBS affects everyone differently — and everyone has a different appetite for sex regardless if they have IBS or not — so there's no universal rule for how frequently someone can engage in receptive anal sex,” he explains.
According to Goldstein, “there's no reason you can't have regular, spontaneous sex” once you’ve learned what your triggers are, have made changes to your diet and lifestyle, and figured out how to clean yourself out beforehand without aggravating your symptoms.
“On the other hand, if you're experiencing an active flare-up with pain, diarrhea, or significant discomfort, it's best to give your body time to recover before bottoming,” he recommends.
Are people with IBS more likely to get anal fissures or hemorrhoids from bottoming?
Are people with IBS more likely to get anal fissures or hemorrhoids from bottoming?
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People with IBS are more likely to get anal fissures or hemorrhoids, but bottoming itself is not to blame. The constipation and diarrhea caused by IBS are the real culprit.
“This comes down to frequency: more trips to the bathroom, more wiping, and alternating between watery stools during diarrhea and hard stools during constipation, all of which increase irritation and trauma to the area,” Fong says.
Once you have an anal fissure or hemorrhoid, you’re going to need to take a hiatus from bottoming until you heal. “If you already have a fissure or a painful hemorrhoid, receptive anal intercourse can worsen symptoms or delay healing, so it's important to let those conditions resolve before bottoming,” Goldstein says. “Keeping bowel movements regular, avoiding excessive friction, and using adequate lubrication during sex can all help reduce your risk. If you're experiencing persistent pain or bleeding, it's worth seeing a specialist to identify and treat the underlying issue before resuming anal sex.”
What should you do if you’re bottoming and a mess happens?
What should you do if you’re bottoming and a mess happens?
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First of all, don’t panic. This happens to everyone at least once, even without IBS being an issue. “Someone once told me, if you stick your hand down enough rabbit holes, eventually you’re going to find a rabbit,” Goldstein jokes. “We’re all adults here and there's no reason to feel embarrassed or ashamed.”
So clean up, move on, and remember that knowing your body and communicating your needs means this will be a rarity. “If you're having an IBS flare-up or experiencing diarrhea, it's usually a sign that your body isn't in the right place for receptive anal sex that day,” Goldstein says. “Having open communication with your partner and approaching the situation with a sense of maturity and compassion is what we should all be doing. Sex should never feel stressful, so if it means taking a rain check, do it.”
When sex gets a little messy, Streed says your best bet is to be an adult and talk it out. “Communicate when it happens, clean up, and decide how you want to proceed; don't let anyone shame you. Shit happens,” he says.
Fong’s recommendation is simple: “Laugh it off, say ‘I have IBS,’ and clean it up.”
Sources cited:
Dr. Carmen Fong is a colorectal surgeon and the chief medical officer at Bummed.
Dr. Carl Streed is the research director for the GenderCare Center at Boston Medical Center and an associate professor of medicine at Boston University.
Getting ready to start testosterone can be an exciting time in any transmasculine person’s life. That said, like literally any medication, HRT can sometimes come with unintended side effects. Feeling pre-T anxiety, including around hair loss, is common for transmasculine people and trans men starting testosterone-based hormone replacement therapy (HRT).
Many who are considering starting testosterone-based HRT will post online about their concerns, often attributing their main hesitation for scheduling an endocrinology appointment at their local LGBTQ+ health clinic to their fear of losing hair. This inevitably sparks discourse about working through internalized beauty standards about hair, age, and transness, but that is a topic for another day. If you’re considering starting T and worried about your hair, this is the guide for you.
Androgenic alopecia, the medical term for baldness triggered by a genetic predisposition to androgen sensitivity in the hair follicles that shrinks them over time, impacts 80% of cisgender men by the age of 70. When transmasculine people start testosterone-based HRT, it can trigger this kind of hair thinning and loss over time for some people.
According to a 2021 study in The Journal of Pediatric Dermatology, 33% of trans people on testosterone-based HRT experience some level of androgenic hair thinning or loss, though it is important to note that research on HRT-related baldness is limited. Though the exact cause of balding can vary from person to person, this largely occurs due to genetic predisposition to high levels of dihydrotestosterone (DHT), which can cause hair follicles to become lighter and smaller over time.
It’s important to note that many trans men experience little to no change in their hairline when they start HRT. Also, let’s be clear: balding and hair loss are not inherently negative effects of HRT. For many transmasc people, a changing hairline can help us feel more confident, hot, and secure. That said, it’s impossible to deny that hair loss is a common deterrent for others who otherwise want to start T, frequently dotting the pages of Reddit’s r/FTM, YouTube, TikTok, and other online forums where trans people seek answers and advice from each other. And for some people, losing hair doesn’t just impact their confidence; it can activate gender dysphoria.
But before you panic, know that this doesn’t mean HRT needs to be off the table if you want to preserve your hairline. Scientific experts and everyday transmasc people and trans men alike have found solutions to address and prevent androgenic alopecia triggered by starting HRT. Below are some options for people experiencing testosterone-related hair loss, from topical medication to transplants.
Minoxidil
This FDA-approved hair loss treatment, known to many as the generic form of Rogaine, can be prescribed as a topical treatment, like a liquid or foam, applied directly to the affected hair follicles. Originally developed to treat high blood pressure, it is now a common way many people treat their hair loss. A 2026 study published in theJournal of the American Academy of Dermatology found that it was specifically effective at treating hair loss for trans people on testosterone.
When you apply it to your scalp, it stimulates additional blood flow to the area, which can help extend the growth phase of your hair follicles. (It’s also been anecdotally used by some trans men and masc people to help facial hair growth, though this is not clinically proven and not approved by the FDA for this purpose.)
To apply, your scalp and hair should be completely dry so that it can adhere and sink into your skin. Once you have your prescribed dose ready to go, massage the product into your scalp, starting from the center and extending outward, and let it sit on your head for four hours before you consider shampooing. As with other topical medications, make sure to wash your hands thoroughly afterwards to avoid spreading it around. The most common side effects to look out for are itchiness and skin irritation.
Finasteride
Unlike Minoxidil, which promotes hair growth by directly stimulating the follicles when applied, Finasteride is usually prescribed as an oral medication used to prevent baldness before it occurs by blocking dihydrotestosterone (DHT). It is FDA-approved to increase head hair growth, but because it blocks DHT, there are other reported side effects that can come with it, such as slowing or stopping bottom growth, limiting facial hair and body hair growth, and anecdotally causing period spotting for some trans people.
A 2025 study published in the Journal of Medical Case Reports found that finasteride is an effective way to treat androgenic alopecia in trans people taking testosterone;however, there were some reported impacts on the effectiveness of HRT. Sometimes, doctors may prescribe Minoxidil and Finasteride in tandem to treat hair loss or balding.
Hair Transplant
Modern medicine is an amazing thing! There have been developments in recent years that make hair transplants more effective and accessible. They work by taking thick and healthy hair follicles from a fuller part of your head and transplanting some to the area you have experienced thinning in that you would like to treat. That means they can be a great way to address concerns about your hairline that you haven’t been able to treat with medication. Some trans men have even used transplant technology to grow facial hair when HRT wasn’t enough.
Embrace it!
This isn’t exactly a treatment, but hair loss doesn’t have to be a bad thing. For some transmasc people, it can be an affirming and desired part of the process of transition. Others might feel ambivalent. And ultimately, it’s important to remember that all bodies change as they age. For many cis men, this means balding or hair thinning. Ultimately, there are ways to treat hair loss if it isn’t something you want, which is why it’s always good to consult a healthcare professional about your transition goals.
Done correctly and safely, bottoming should be a pleasurable experience for everyone involved. But why do some people feel sick afterward?
If you’ve ever felt feverish or had flu-like symptoms after a particularly vigorous round of sex, you may have been experiencing “bottoming fever,” a collection of symptoms attributed to inflammation from receptive anal intercourse.
Gay urologist and medical influencer Dr. Joshua Gonzalez went viral on TikTok earlier this month for a video he made on this colloquial term for bottoms who feel crummy after sex.
“There’s something called bottoming fever,” Gonzalez says in his video. “You can have flu-like symptoms, like chills or low-grade fever after intense anal sex. This is an inflammatory response to micro-trauma to your rectal lining.”
🤒 Yes, "bottoming fever" is a real thing. After intense anal sex, some people can experience chills, body aches, or a low-grade fever for a short period of time. In many cases, it's simply your body's inflammatory response to minor irritation and microtrauma of the rectal lining. 💧 Rest, hydrate, and give your body time to recover. Symptoms often resolve within 24 hours. 🚨 But if the fever lasts longer than a day, gets worse, or is accompanied by significant pain, bleeding, or discharge, don't ignore it. That could be a sign of proctitis or an infection that needs medical attention. Your body talks to you after sex too. Listen to what it's saying. #doctor #sexualhealth #didyouknow
To find out whether “bottoming fever” is a real condition and if it’s something you need to be worried about, Out talked to LGBTQ+ health experts who could answer all of our burning questions.
What is bottoming fever?
What is bottoming fever?
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The lining of the rectum is delicate and sensitive, which means that if it gets irritated because you spent last night having very enthusiastic sex, you could end up feeling like you’re coming down with the flu, according to Gonzalez.
But is this a real condition? The answer is more complicated than a simple yes or no.
“I find this question to be reminiscent of the obsolete and pejorative ‘gay bowel disease’ that was coined in the 1970s,” says Dr. Carl Streed, an LGBTQ+ health specialist and assistant professor of medicine at Boston University, referring to the outdated and homophobic medical term for STI infections and gastrointestinal issues in men who have sex with men.
Streed tells Out that he questions putting any stock in a term that seems to have been coined by a medical influencer. “While the physiology of this purported ‘bottoming fever’ sounds legitimate coming from a medical influencer, there is no research to back up its existence or suggest it is distinct from other anogenital issues related to receptive anal intercourse,” he says.
But Dr. Evan Goldstein, a leading anal health expert who founded Future Method, a sexual wellness brand dedicated to revolutionizing anal sex prep, says that while “bottoming fever” isn’t an official medical term, people may experience these symptoms after “intense anal sex, but it can also occur from douching, as well as micro and macro-tearing (anal fissures) as well."
What are the symptoms of bottoming fever?
What are the symptoms of bottoming fever?
Jelena Stanojkovic
Chills, fatigue, a low-grade fever, muscle aches, and other flu-like symptoms have been attributed to “bottoming fever” and should resolve within 24 hours.
“The symptoms are normal per se for what the body does in the situation of an inflammatory cascade,” Goldstein says. “The wall of the rectum – from many rounds of douching (using plain water or enemas, large bulbs, shower hoses, and plain ol’ overdouching) and certain forms of anal play – get stripped and are basically raw, leading to microscopic tearing, irritation, and what’s called bacteremia or the alteration of the microbiome. The body detects these changes and compensates, which manifests as bottoming fever.”
But Streed cuts right through what he sees as misinformation and says, “It is hard to say what symptoms are normal of a made-up condition.”
What should you do if you get bottoming fever?
What should you do if you get bottoming fever?
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In his TikTok video, Gonzalez says these symptoms are “nothing to worry about” and suggests you should “rest, hydrate, and it should resolve on its own within 24 hours.”
Basically, your body needs time to recover. It’s telling you to take a break. Listen to it.
If you find yourself suffering from “bottoming fever,” Goldstein insists you don’t need to worry because the symptoms should pass quickly. “Rest. Hydration is key. You can even take Advil or Motrin to assist. And then just let the wave pass,” he suggests.
Streed doesn’t buy into the diagnosis but says if you are having the kinds of symptoms Gonzalez has attributed to “bottoming fever,” you should “try to avoid or minimize overly aggressive or prolonged sessions if you're prone to symptoms,” get regularly tested for STIs, and “maintain general good health through adequate sleep, balanced nutrition, and exercise, all which help maintain your physical health (especially your immune system).”
How can you avoid getting bottoming fever in the future?
How can you avoid getting bottoming fever in the future?
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Minimizing altering your rectal microbiome is key, says Goldstein, who recommends calibrating down on how much you douche (or skipping it altogether), optimizing your diet, taking fiber supplements, using lube shooters, and trying anal-specific dilators to thicken the anal walls over time.
“We can help minimize the risk of bottoming fever by either skipping douching entirely or refining your pre-sex routine,” he says. “This includes using supplements designed for bottoming, implementing better lubrication techniques, and incorporating toy-work practice before bottoming and on your off days.”
Streed says he doesn’t have any advice for avoiding “something that sounds made up to garner likes, clicks, and shares,” but he does think that safe bottoming techniques are an important part of your sexual health.
He recommends eating fiber, staying hydrated, using a gentle rinse instead of “harsh or frequent douching, which can irritate tissue and worsen symptoms,” taking things slowly, and using a lot of water or silicone-based lube, and maintaining open and honest communication with your partner because “saying what hurts and what feels good improves the experience for everyone.”
When should you get medical help?
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Goldstein says that if your symptoms persist beyond 24 hours or your fever goes above 101 degrees Fahrenheit, you should seek medical help.
“Also, there may be some mucus discharge from the act of bottoming itself, but that should not persist,” he says. “If it does, a full STD panel should be obtained. And if anything out of the ordinary for you happens, then seek medical attention. Earlier intervention is always better.”
Streed agrees and also says you should get medical help from “a trained professional, not a medical influencer” if you have abdominal or rectal pain, significant rectal bleeding, pus or unusual discharge, painful urination, sores, a rash, or “symptoms that keep recurring with every bottoming episode.”
He continues, “These all could be signs of an infection or injury that require medical attention and care.”
Sources cited:
Dr. Carl Streed is an LGBTQ+ health specialist and assistant professor of medicine at Boston University.
Dr. Evan Goldstein is a leading anal health expert who founded Future Method, a sexual wellness brand dedicated to revolutionizing anal sex prep,
