Thanks for your question. It is difficult to know if your girlfriend could be pregnant or whether she is having “serious” stomach issues due to a complication of anal sex or something else. If you are using condoms every time you and she have intercourse and never have vaginal penetration, it is unlikely that she is pregnant; however, the vagina and anus are located very close together and without a condom, even a little semen (fluid containing sperm) can find is way inside your partner’s vagina and ultimately to an egg and cause pregnancy. The other fact you should be aware of: although very rare, anal penetration can puncture a hole in the “recipient’s” colon (the person who is receiving penetration by a penis, finger, or sex toy). The symptoms usually start after anal sex and include abdominal pain and heavy bleeding from the rectum. This is an emergency situation and requires immediate medical care, usually a trip to an emergency department. With that being said, your partner’s “stomach pains” may be caused from something entirely different such as a viral or bacterial infection, constipation, or food intolerance. It’s a good idea for her to be checked by her health care provider (HCP) so she can get treated if needed. It’s important to be honest with the HCP. Remember, what she or you tell to the HCP is confidential.

Anal sex for the most part is safe if you follow these guidelines:

1. Use a water-based lubricant– A person’s anus doesn’t naturally make lubrication like the vagina.
2. Always use condoms– Condoms help to protect you and your partner from STIs and bacterial infections that can be caused from contact with poop. Since bacteria naturally live in poop and the rectal lining is very thin, a tear can sometimes happen and bacteria can enter the skin and cause an infection.
3. Change condoms when going from anal to vaginal sex– This will lessen the chance of your partner getting a vaginal infection and/or irritation from the bacteria in the poop.
4. Use condoms but do not use additional spermicide creams/gels during anal sex, as these products can cause the recipient to have anal irritation.
5. Enter your partner slowly and STOP if your partner complains of pain or discomfort– The anus has a muscle that is there to hold poop in. Therefore, the muscle can be tight, making penetration painful. Anal penetration can be pleasurable, but it isn’t always comfortable for the receiver.

Check in with your partner and make sure they are not in pain and want to continue, as anal sex isn’t for everyone.

Although more and more people are having anal sex, it is still considered one of the riskiest forms of sexual activity. As long as you and your partner both agree to having anal sex, and you practice “safe anal sex”, and follow the guidelines above, you should be okay.