Coping Emotionally and

Psychologically With Perianal Symptoms (Abscess, etc)

Even if you aren’t LGBTQ+, having perianal disease is very tolling on one’s mental health and poses a psychological burden that impacts self confidence, self perception, and can have impacts on sexual and romantic relationships as well. If you are someone that prefers RAI/anal sex/bottoming, perianal disease and symptoms can be even more troublesome and tough for you.

Navigating perianal disease in the context of IBD, especially when it affects your sexual health and ability to bottom can be incredibly challenging, both physically and emotionally. You're not alone in feeling grief, frustration, or even shame. But you deserve intimacy, pleasure, and peace, just like anyone else! It’s valid to feel the way you do, ways to emotionally cope, but there are tools to help reclaim a sense of agency and self-compassion in dealing with this challenging condition.

Why Perianal Disease and LGBTQ+ Identity Can Be Challenging

Perianal Disease is Painful, Stigmatized and Underdiscussed

  • That is at least, in popular culture representations of GI disease).

  • Fistulas, abscesses, and chronic discomfort in the anal/rectal area can feel isolating (and not without reason!).

  • These conditions are rarely talked about, we barely talk about IBD (getting better at it), but perianal disease is still quite underrepresented in the realm of things that are discussed and that invisibility can amplify shame or self-criticism.

    Sexual expression is a part of identity for many!

  • This underrepresentation can be quite impactful (in a not good way), especially for people who identify as LGBTQ+, as sexual expression can be deeply tied to identity, empowerment.

  • To be limited physically from the ability to engage in a sexual activity that you enjoy in a way you enjoy it, but your disease forces you to alter the way you engage/what you do - possibly making you switch to things you don’t really enjoy as much can feel like losing a sense of autonomy over your identity. Feeling like you’ve "lost" that can feel like a loss of self and identity.

    Cultural Silence and Internalized Shame

  • There’s little representation of LGBTQ+ people with conditions such as IBD or IBS, or chronic illness in sexual health conversations.

  • That silence may make you feel "broken" or “undesirable,” even though you’re absolutely not!!

    Lack of Control and Unpredictability

  • Flare-ups, leaks, surgical scars, or fistula setons can all make sex feel like something to fear rather than enjoy, making it hard to relax or stay present in the moment.

Coping and Reframing

  • Redefining Intimacy and Pleasure

    Redefining what intimacy and pleasure means for you while you are temporarily dealing with an abscess or fistula is important.

    Bottoming isn't the only way to experience pleasure - while it can definitely be your preferred way, and a desired way for some, there’s other routes as well. While you are healing up in your bottom area, it may be beneficial to explore other options, such as mutual masturbation, rimming, oral, using toys externally, or exploring your top/dom/vers side.

    Pleasure can still be affirming and connective. You're allowed to explore without feeling like you're "settling."

  • Communication

    It’s important to talk to your partner(s) with honesty and trust about how you are feeling. Sharing what’s going on can build intimacy, not diminish it - letting them know why you may not be interest at the moment is important in building trust and understanding. You may start with something like,

    “I want to feel close to you, but I also need to be honest about what my body can and can’t handle right now.”

    If they are dismissive or not understanding and don’t want to respect that, that may be a sign that isn’t the best person for you.

  • Sexual Health and Medical Support

    Exploring sexual health “workarounds” with medical support can be a good idea if you have providers you feel safe and comfortable with asking. A gastroenterologist, colorectal surgeon, or pelvic floor physical therapist can help manage pain, pressure, and healing.

    With medical guidance, some people resume anal play after surgery or treatment ,sometimes even with adapted toys, positions, or lubricants. If you don’t have a healthcare provider you feel comfortable asking, that’s okay too. That’s why this page exists!

  • Be Kind To Yourself!

    Body kindness is important always, but especially important when healing from these things. Soothing baths, gentle touch, supportive undergarments, or skincare around the anus can help reconnect you to your body.

    Avoid dating or sex apps (one that rhymes with “finder” comes to mind here) that make you feel inadequate; and lean into spaces that affirm your beauty (or handsomeness) and humanity.

Talking to Your Provider AND Partner

Your gastroenterologist/IBD doctor/colorectal surgeon can be very important in helping you find ways post-fistula or abscess to explore safe, pain-free, and affirming ways to engage in sex, especially as a receptive partner (bottoming), while managing perianal IBD complications.

Medical History/History of Present Illness (HPI)

  • If you are seeing a new doctor or it’s a follow up visit after these things have just appeared (like, you didn’t have a fistula last appointment) you can start with a brief overview of what’s going on.

  • For example: You are diagnosed with: IBD (specify Crohn’s or UC), with perianal involvement (fistulas, abscesses, etc.)

  • What are your current symptoms? (e.g., drainage, pain, discomfort, uncomfortable seton placement, scarring causing issues)

  • Past surgeries or interventions: (e.g., fistulotomy, seton placement, abscess drainage)

  • Current treatments: (biologics, antibiotics like cipro/flagyl wound care, etc.)

Concerns - What You Want To Address

  • Describe what your main concern is about; pain, infection, or trauma, pain or concerns from and about receptive anal sex (bottoming)

  • Do you have worries or concerns about hygiene, leakage, or drainage during intimacy?

  • Questions about desire to explore safe ways to reintroduce intimacy with partner and how perianal disease impacts that?

  • Where to find medical and other support in discussing what is/isn’t safe for my body when perianal symptoms are flaring?

  • Ways to avoid long-term disconnection from my sexual identity and pleasure caused by perianal disease impacting bottoming/sex life?

    Questions For The Healthcare Provider

  • Is anal penetration/anal sex/RAI/bottoming safe for me at this time?

  • What signs should I look for that indicate increased risk of damage or infection?

  • Are there stretches, therapies, or medications (e.g., dicyclomine, lidocaine gel, pelvic PT) that could make bottoming more comfortable?

  • What about hygiene; are enemas or anal douching safe for someone with perianal disease?

  • Is there a colorectal surgeon or pelvic floor PT I should be referred to?

  • If sex isn’t safe now, what benchmarks or healing signs would indicate when it could be?

Potential Goals

  • Building a realistic timeline and set of guidelines around returning to sexual activity!

  • To reduce fear, stigma, and self-blame around perianal disease and sex.

  • To have affirming, LGBTQ and trauma -informed care that supports my sexual well-being!

    Talking and Communicating With Your Partner(s)

  • Its important talk honestly about how perianal IBD is affecting your body and sexuality, while keeping the door open to intimacy, support, and mutual growth.

    Opening the conversation

  • This can start with something frank and a little scripted like,

  • “There’s something I want to talk about because I care about you and I want to keep feeling close to you. My IBD has been affecting me in ways that aren’t just physical. It’s also been hard on me emotionally and sexually.”

    Talking About the Impact

  • “Right now, bottoming isn’t safe or comfortable for me because of ongoing symptoms and healing.”

  • “I’m grieving the parts of sex I used to enjoy. It’s been hard to feel attractive or desirable.”

  • “I’m scared sometimes that you’ll stop wanting me, and I know that’s not fair to assume, but it’s a fear I carry.”

    Saying What You Need Emotionally

  • Reassurance that your value isn’t tied to one sex act (bottoming, or whatever you may like to do that is impacted by perianal disease)

  • Space to be vulnerable about your changing relationship with your body.

  • Patience as you figure out what feels good again.

  • Willingness to explore intimacy in new ways.

    Saying What You Might Be Open To Exploring

  • Non-penetrative sex: oral, mutual masturbation, toys, massage, etc.

  • Topping or being more dominant, if that feels empowering to you.

  • Scheduled check-ins about your emotional and physical comfort (i.e, every so often taking a breather and checking in mentally and physically to make sure nothing hurts, and you aren’t getting psychologically uncomfortable). Establishing a safe word may be a good idea too.

  • Counseling or support groups if either of you wants more tools.

    Reassurance :)

  • You’re doing a brave and beautiful thing by advocating for your pleasure, health, and wholeness - it can be really hard and I am proud of you!

  • It might take time and you’ll have to work as a team as you figure out how to feel safe and good in your body again. You still deserve pleasure, closeness, and love, it just may take time to find that in while recovering from perianal disease.