What is 'bottoming fever'? Experts weigh in

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?

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 Carl Streed, an LGBTQ+ health specialist and assistant professor of medicine at Boston University, referring to the outdated and homophobic medical term for STI infections and gastrointestinal issues in men who have sex with men.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?

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?

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?

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?

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,