The risks of anal insertions for the receptive person from physical trauma and tearing alone include the following (there may be more). Note that many of these issues are associated with others. For example, a fissure can become an abscess; an abscess may lead to incontinence and/or become a fistula. Incontinence can also result directly from trauma. Moreover, multiple developments can occur as a result of a single instance of trauma.
The rectal mucosa is particularly prone to tearing and trauma, as the mucosal lining is not capable of dealing with abrasive friction (especially if the mucous on the epithelium is removed by an enema). Significant damage that occurs may lead to deep rectal abscesses and bacterial sepsis, and the rectum is
generally insensitive to pain.
Abscess, Bleeding, Fissure, Fistula, Hemorrhoid, Incontinence, Proctitis, Rectal Perforation (life-threatening risk from extreme insertions), Rectal Prolapse, Sentinel Pile, Sepsis (infection), Skin Tag, Stenosis, and Stricture
BOOK REFERENCES [ Title (Year) - Page ]: These can be looked up using
http://books.google.com/ -- Enter a phrase or phrases from one page of a specific book into the search box, surrounding each phrase by double quotes.
Example: "prevalent sexual practice" "studies report"
Prevalencehttp://abcnews.go.com/Health/story?id=6428003Study Reports Anal Sex on Rise Among Teens (Dec. 10, 2008)
Lack of Sex Education, Virginity Pledges, Ignorance Contribute to Risky Behavior
http://www.msnbc.msn.com/id/17285757/The last lovemaking taboo lifted? (March 1, 2007)
More straight couples experimenting with anal sex
"Anal intercourse continues as a prevalent sexual practice in both homosexual and heterosexual populations. Studies report that up to 43% of adult women have participated in anal intercourse."
Current Diagnosis & Treatment of Sexually Transmitted Diseases (2007) - Page 52
Hemorrhoid & Skin Tag"... a lack of relaxation with anal play can cause a break in the anal cushions, padded areas that protect the muscles and blood vessels from the stress of evacuation (passing stool). If the cushions become disturbed, they can puff up and split, allowing blood vessels to pop through either internally (internal hemorrhoids) or externally (external hemorrhoids). These blood vessels can then break (a bleeding hemorrhoid); clot (a painful purple hemorrhoid); or regress, leaving a small skin tag."
http://www.awomanstouchonline.com/dr_myrtle.php?articleID=3011"Traumatic complications of rectal intercourse include prolapsed hemorrhoids, anal fistulas and fissures, perirectal abscesses, rectal ulcers, and anal tears."
Primary Care Medicine (2006) - Page 491
These also include anal intercourse as a risk factor for hemorrhoids:
http://digestive.niddk.nih.gov/ddiseases/pubs/hemorrhoids/index.htmhttp://emedicine.medscape.com/article/775407-overviewhttp://www.patient.co.uk/showdoc/40000290/Fissure & Sentinel Pile"Anal fissures are common among male homosexuals, presumably as a consequence of traumatic anal intercourse."
Colon and Rectal Surgery (2005) - Page 274
"Anal intercourse is potentially physically harmful. It can cause anal fissures (cracks), thereby allowing the quick transfer of blood born diseases such as hepatitis and HIV... Also, different people have different levels of susceptibility to anal problems such as fissures."
http://hemorrhoid.net/analsex.php"Quite often, the anal papilla immediately above the fissure becomes swollen due to inflammation and edema. This so-called sentinel pile may resolve or fibrose and persist as a skin tag."
http://www.emedmag.com/html/pre/fea/features/011504.aspAbscess & Fistula"An anorectal abscess is a collection of pus in the anal or rectal region. It may be caused by infection of an anal fissure, sexually transmitted infections or blocked anal glands."
http://www.patient.co.uk/showdoc/40000238/"An abscess can cause substantial damage to nearby tissues and may lead to fecal incontinence... Even with proper treatment, in about two thirds of people, an abscess leads to the formation of an abnormal channel from the anus or rectum to the skin (anorectal fistula)."
http://www.merck.com/mmhe/sec09/ch130/ch130d.html"Treatment of anorectal abscesses involves early surgical drainage of the purulent collection. Primary antibiotic therapy alone is ineffective in resolving the underlying infection and simply postpones surgical intervention. Any delay in surgical drainage of anorectal abscesses prolongs infection, augments tissue damage, and may impair sphincter continence function, as well as promote stricture and/or fistula formation."
http://emedicine.medscape.com/article/191975-treatmentStenosis & Stricture"[Anal stenosis is an] abnormal narrowing of the anal opening and/or anal canal... The most common form of anal stenosis arises from trauma, such as hemorrhoid operations [or] recurrent and persistent trauma in connection with anal sex... Strictures may develop in relation to a chronic anal fissure... Most patients are asymptomatic."
Textbook of Anal Diseases (1998) - Page 140
"Anal stenosis represents a technical challenge in terms of surgical management. It is a rare but serious complication of anorectal surgery, most commonly seen after surgical hemorrhoidectomy. However, stenosis can also occur in the absence of an anorectal surgical history... Anal stenosis may be anatomic (stricture) or functional (muscular)."
http://www.ncbi.nlm.nih.gov/pubmed/10875995"More commonly, stenosis develops as a result of scarring from a tiny fissure, or crack, in the anal canal."
http://www.bbc.co.uk/health/ask_the_doctor/analstenosis.shtmlProctitis & Sepsis"Trauma to your anus or rectum, in which the anal and rectal linings stretch and tear, can be a potential cause of proctitis. Health care providers usually see such trauma in people who introduce any foreign object into their rectum. Foreign objects include a penis during anal intercourse or sex toys... People with anorectal trauma also may have an accompanying infection as a result of high-risk sexual behavior."
http://www.emedicinehealth.com/proctitis/page3_em.htm"Proctitis is an acute or chronic inflammation of the rectal mucosa. The prognosis is good unless massive bleeding occurs... This condition occurs with high frequency among homosexual men and women who engage in anal intercourse."
Disease Management for Nurse Practitioners (2001) - Page 438
"This retrospective study details the findings and outcome in 34 homosexual men, out of a total of 177 patients, who underwent surgery for non-condylomatous perianal disease over a 2-year period. Of 34 homosexuals 20 presented with anorectal sepsis compared with 11 of 79 heterosexual male patients... These findings suggest that the prevalence of anorectal sepsis in homosexual men is high..."
http://www3.interscience.wiley.com/journal/112185258/abstract"Anal intercourse may cause mucosal damage that introduces sepsis beneath that layer with subsequent fistula formation."
Immunology for Surgeons (2002) - Page 80
Rectal Prolapse"The main cause [of rectal prolapse] is thought to be straining to defecate, but penetrative anal sex may also be the reason in younger patients."
Essential Revision Notes in Surgery for Medical Students (2008) - Page 139
"Occasionally, large hemorrhoids (large, swollen veins inside the rectum) may predispose the rectum to prolapse... Hemorrhoids occur commonly, but they rarely cause rectal prolapse."
http://www.emedicinehealth.com/rectal_prolapse/article_em.htmIncontinence"Although the threat of fecal incontinence from anal sex is small, it can occur from repeated injury to the internal sphincter. This occurs when a penis is repeatedly inserted through a contracted internal sphincter. Over time the muscle may be unable to properly seal tightly, resulting in fecal incontinence. Rates increase with fisting and insertion of large sex toys into the anus."
http://healthydevil.studentaffairs.duke.edu/health_info/Anal Stimulation and Intercourse.html
"... surgical insult or trauma can also lead to incontinence. It is important to recognize that causes of trauma include sexual abuse and anal intercourse."
http://www.mssm.edu/msjournal/67/page096_105.pdf"There is a case report of 'multiple ruptures' of the internal anal sphincter with resultant fecal incontinence after nonconsensual anal penetration with a penis and fist."
Clinical Forensic Medicine: A Physician's Guide (2005) - Page 108
Rectal Perforationhttp://www.ncbi.nlm.nih.gov/pubmed/17726499Vibrator-induced fatal rectal perforation.
Rectal Anatomy"The rectal epithelium is an absorptive tissue with a delicate simple columnar epithelium. In sharp contrast, the human vagina is lined by a multilayered stratified squamous epithelium designed for the strain that can occur during sexual intercourse and childbirth."
http://www.stdjournal.com/pt/re/std/fulltext.00007435-200406000-00005.htm"Simple columnar epithelia consist of elongated cells, including mucus-secreting cells (in the lining of the stomach and cervical tract) and absorptive cells (in the lining of the small intestine)... Stratified squamous (nonkeratinized) epithelia line surfaces such as the mouth and vagina; these linings resist abrasion and generally do not participate in the absorption or secretion of materials into or out of the cavity."
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mcb.figgrp.1389"The [rectal] mucosa is a delicate tissue that can be damaged by such relatively benign action as oral cathartics [laxatives], enemas, or hard stools. Thus endoscopic examination and anal sex are likely to cause some degree of trauma. With trauma the secreted layer of mucin is depleted, as are the tall columnar cells of the crypts, and blood cells proliferate. Damage may consist of congestion and hemorrhage in the lamina propria, and may sometimes include detached epithelium and inflammatory cell infiltration."
http://img.thebody.com/amfar/pdfs/rectal_microbicides.pdf 
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