Can you over-douche? How to prep the right way and get back to bottoming

Can you over-douche?

You can absolutely over-douche. While it’s definitely not mandatory, a lot of people only feel comfortable bottoming if they’ve cleaned themselves out by douching first. Prepping your hole can get you ready for sex, but if you douche too much, with too much force, or with irritating products, you’ll do more harm than good.

“You can overdo anything, and douching is definitely one thing you don’t want to overdo,” Todd Baratz, an AASECT-certified sex therapist at #LUBELIFE, tells Out. “Most people fall into this trap because they’re anxious about making a mess, but over-douching can cause irritation and inflammation and ultimately make anal sex more uncomfortable or painful than it needs to be.”

Dr. Michelle Forcier, a clinician for the LGBTQ+ telehealth company FOLX Health, also points out that not only is over-douching bad for you, but “it is not clear that there is any medical benefit to rectal douching and there may be increased medical risk.” Despite that, if douching prior to bottoming makes you feel more confident in your body so that you can relax during sex, you are not alone.

A joint study between Columbia’s Spatial Epidemiology Lab and NYU’s School of Medicine found that between 17 and 53 percent of men who have sex with men “douche prior to anal intercourse,” and 54.3 percent of respondents “used a rectal douche or enema in the preceding three months.”

That tracks with what Dr. Evan Goldstein, owner and lead anal surgeon at Bespoke Surgical, which caters to gay men's sexual health, has seen in his practice. Goldstein says he always tells his patients that “less is more” because of the damage you can do by using “too much liquid, too much pressure, too many rinse cycles, or pushing the water way too far up,” like with a high pressure shower attachment, or a large bulb.

“All of that irritates the rectal lining, throws off the anal microbiome, ramps up mucus production, and over time can even strain or injure the sphincter muscles,” he says. Not only that, but in reality, over-douching can set you up for the exact problem you are trying to avoid: a big mess during anal sex.

“When the liquid travels too high, it loosens stool that you never would have reached, and brings it right down into the rectum, which then elicits a bowel movement,” Goldstein warns. “For everyday play — extra large partners, toys, and fisting is another story — you should really only be cleansing the anal canal and lower rectum. You're not trying to flush out your entire colon. That's just not necessary.”

If you over-douched, how can you fix it?

If you’re feeling “discomfort, irritation, or soreness” or just know you’ve douched too many days in a row because you went on a bottoming marathon, it might be time to take “a break from receptive anal sex and giving your body time to recover,” Baratz says.

Forcier also has a simple solution: “stop douching.” It might not be much fun to implement, but she says giving your body a break from douching and anal sex will allow everything to heal. “Let your body regenerate the microbiome over time,” she says. “Maybe take a little break from receptive anal sex while the lining heals and the biome regenerates. Try other ways to be sexual with your partners. Sex is not just about penetration.”

According to Goldstein, while you’re giving your body a break, you can help the healing process along by using suppositories. “If you find yourself irritated, you can pop in an over-the-counter suppository, like Preparation H, which will help calm everything down,” he says. “I'd also hold off on anal sex or toys while you've got any irritation, pain, bleeding, extra mucus, or other symptoms.”

But if things get worse, don’t ignore your symptoms; seek medical help, Goldstein says. “What you don't want to do is try to fix it with more douching or by putting other products up there,” he says. “If symptoms stick around, get worse, or include real pain or bleeding, see a doctor who actually understands anal health. Once you've recovered, take a hard look at your technique.”

Does over-douching make you more susceptible to STIs?

Not only can over-douching disrupt your rectal lining and cause dryness that leads to micro-tears and fissures, but there is also evidence that it can make you more likely to develop an STI.

“Some research has found an association between rectal douching and higher rates of STIs, but the evidence doesn’t necessarily tell us that douching itself is the cause,” Baratz says. “Practically, regardless, don’t aggressively over-douche. Irritating the rectal lining right before having anal sex is not something you want to be doing.”

Irritation and tearing of the rectal lining — from overdoing it or using harsh douching solutions — can leave you open to STIs, so you want to make sure you’re douching safely. “When you add too much pressure or repeatedly insert a nozzle, you're compounding irritation and increasing your chances of tiny tears,” Goldsteing says. “Once that barrier is compromised, it's easier for an anal injury to occur, as well as an STI to get through during sex.”

In the future, Forcier says we could get rectal microbicide enema for HIV prevention, but we’re not there yet. “Any rectal douching can make someone more susceptible to being exposed and getting an STI,” she says. “There are studies about using douching with HIV preventive medicines and other therapeutics. But so far, douching is likely more STI risk than not.”

Is there a safe way to douche?

Over-douching can wreak havoc on your hole, but that doesn’t mean you need to avoid it altogether. Baratz recommends keeping things simple. “Plain lukewarm water is generally all you need,” he says. “Use a small amount and low pressure, and you don’t need to repeatedly douche until the water comes out perfectly clear and pristine. There isn’t a medically established number of times you can safely douche per week. Pay attention to how your body feels, and remember that more isn’t necessarily better.”

But Forcier says that if you want to protect your rectal lining while douching, choose an isoosmolar douche that matches the osmotic pressure and pH of the fluids and lining in the rectum. “These types of solution can move across cell membranes without drawing water and electrolytes out of the tissue and changing the rectal micro-organism environment. Normosol-R is one type of isoosmolar rectal douche that has actually been studied for safety,” she says.

This is exactly why Goldstein developed Future Method's Anal Douche Kit, which uses a small douche bulb and a pH-balanced, isotonic, iso-osmolar solution. But according to him, technique matters just as much as the product you use.

“Lube the nozzle, insert it only two to three inches, and squeeze the bulb slowly and gently,” Goldstein explains. “I prefer standing up, with one leg on the edge of the bath or toilet, or lying on your side, which allows gravity to naturally prevent the solution from going too high up. One rinse may be all you need. If not, repeat once or twice, but stop there. If things still aren't running clear, it might be best to take a rain check and reevaluate your fiber intake, diet, hydration, and any food or beverage triggers that might be affecting your douching routine.”

As for how often you can douche, there’s no magic number. “What I tell people is: If you're using a body-safe formula, and only using it before sex, you should be all set,” he says.

How can you prep for bottoming without over-douching?

You want to be physically ready for anal sex, but that doesn’t mean you have to douche every time your butt is involved. The average American doesn’t eat enough fiber, so if you up your fiber intake or take a fiber supplement, your bowel movements will do the work for you because your stool will come out smoothly, without leaving a bunch of residue behind.

“Usually the lower part of the colon, anus, and rectum are empty until you are ready to have a bowel movement,” Forcier says. “Having a high fiber diet with regular bowel movements is usually enough to keep the lower rectum clean. Washing the anus during bathing or with a soft cloth and warm water before sex should be fine for external hygiene.”

If you just can’t imagine bottoming without douching first, Goldstein says you should use a small amount of isotonic and iso-osmolar solution, then do what he calls the "toy test.”

“Insert a lubed toy that's similar in size to your partner or strap-on,” he recommends. “If it comes out clean, you're good to go. If not, do one more gentle rinse instead of flushing over and over until the water runs clear. Then give yourself about 30 to 60 minutes before sex so any leftover liquid has time to come out.”

Baratz also says that if you really want to douche, keep in mind that you don’t have to clean out your entire rectum. “Also, most people are not walking around with a rectum full of stool,” he says. “You don’t need to clean out your entire digestive system to have anal sex. If you want to douche, a small, shallow rinse is generally all you’re trying to accomplish.”

What should you do if a mess happens during anal sex?

People tend to feel so anxious about making a mess during anal sex, but the fact of the matter is bodies are messy, and it’s unlikely you’ll go through life without having it happen at least once.

“If you’re going to have anal sex, I think you have to be a little more lighthearted about the reality of bodies and maybe even have a sense of humor about it,” Baratz says. “If something happens, pause, clean up, and get back to it if you both want to. You don’t need to apologize for having a body that functions.”

Goldstein says that there is so much stigma around the potential for shit to happen during anal sex that it can be hard to relax and enjoy yourself. “If it happens, pause, clean up, and check in with each other. Nobody needs to be shamed or embarrassed,” he says. “Something as simple as ‘No big deal, let's get cleaned up and see how we feel’ is usually all it takes. Keep a dark towel nearby so it's easy to handle.”

After you’ve had an accidentally messy sexual encounter, do a quick debrief and try to figure out what went wrong so that you can avoid it in the future, but don’t stress about it too much. “What did you eat that day? How did you douche, if at all? What positions were you in? Playing it back step-by-step helps you figure out what to adjust for next time,” Goldstein says. “And if accidents keep happening even with a solid routine, come see us at Bespoke Surgical or another GI specialist. Really common issues like IBS or food sensitivities can make prep harder for any of us, and they're worth ruling out so they don't continue to be a pain in the ass.”

Sex is messy in general, so you might as well embrace that and try to let go of the shame. “Whatever parts are going wherever, are a wonderful and potentially fluidy, mucousy, semeny, bloody, poopy mess,” Forcier says. “Kissing is messy, vaginal sex is messy, and anal sex is messy. Sex involving these sites involve fluid exchange, mucous membrane exposure along with movement, friction, and lots of contact. Some people are really sensitive to messiness — they can gear their sex towards reducing messiness if that is what is right for them. But lots of folks enjoy wonderfully messy, intimate, exposed, and free messy sex — and good for them! The key is communicating together as partners, and making a plan that together is right for each other.”