This week in Savage Love: Brownie points

I’m a cis bi woman, and I mainly have sex with people with penises. I have a really gross problem, sorry. It’s been an issue for as long as I’ve been sexually active—but in the past few years, it seems to have gotten worse. If I am being penetrated vaginally, especially if it’s vigorous (which I prefer), and I orgasm, sometimes I poop accidentally. If I try to clench up to keep this from happening, it doesn’t work and I can’t orgasm. This used to happen once in a blue moon, only with particularly intense orgasms, but now it happens more frequently. One person I’ve been seeing really likes anal, and that makes the problem even worse. To be clear: I have no desire for poop in my sex life. It’s gross, it’s embarrassing, and my partners do not enjoy it. Nor do I. I’ve tried going to the bathroom before sex, but I can never seem to fully empty out. I even went to a doctor to talk about it, but all I got was a big shrug and no useful suggestions. I’ve looked online and found discussions of this happening to other people and them being understandably horrified, but nobody mentions it being a regular occurrence. This really sucks! Do you have any suggestions? Other than “give up sex completely,” which I would prefer not to do.
Necessary Objective: Soothe Her Intestinal Tract

“I’ve absolutely heard of this before, and as NOSHIT already knows from internet searches, she’s not alone and needs help,” said Dr. Debby Herbenick. “And a ‘big shrug’ doesn’t sound like a helpful response from a physician who you’re asking for help in figuring out a complicated and extremely under-researched and therefore tricky sexual issue.”

Dr. Herbenick is a professor at the Indiana University School Of Public Health and author of Because It Feels Good: A Woman’s Guide To Sexual Pleasure And Satisfaction and numerous other books. And what you’re going to need, according to Dr. Herbenick, is a doctor who’s actually prepared to help you. So that awkward conversation you had with your last doctor? A conversation you no doubt dreaded having? You’re going to have to have that conversation again, NOSHIT, maybe more than once, with other doctors. I know, I know: Talking with your doctor about a sexual issue—particularly a messy one—is difficult. And when we finally work up the nerve to speak with a doctor about something like this and that doctor isn’t helpful, our understandable desire to avoid having that conversation ever again can lead us to conclude that talking to doctors is a waste of time. But it isn’t, so long as you’re talking to the right doctor.

“The letter writer should ask her health-care provider for a referral to an urogynecologist,” said Dr. Herbenick, “especially one who likes to get to the bottom (no pun intended) of challenging cases.”

If this happens to you at other times—if you poop yourself when you fart or sneeze—be sure to share that information with the specialist.

“There are lots of tests that health-care providers can use to examine her rectal function,” said Dr. Herbenick. “These tests can include a digital rectal exam, a sigmoidoscopy (insertion of a tiny tube with a camera to look for issues such as inflammation), an X-ray, an anal ultrasound, a colonoscopy, or other tests. In other words, there are things other than a big and completely useless shrug that can be done. And depending on what they find, they may suggest biofeedback, surgery, physical therapy/pelvic-floor exercises, supplements, and so on.”

But with all that said, NOSHIT, doctors aren’t all-powerful, and some problems can only be managed and not solved.

“The fact is, our bodies don’t last forever in the ways we want them to,” said Dr. Herbenick. “And some research does point toward more frequent anal intercourse being associated with fecal incontinence.” (Aging, childbirth, and hormone-replacement therapy are very strongly associated with fecal incontinence.) Only a small percentage of women who regularly engaged in anal intercourse reported higher levels of fecal incontinence, NOSHIT, so if this isn’t a problem for you generally—if this is only a problem during sex due to some tragically star-crossed neural wiring—you might want to steal a move from the squeaky clean gay bottoms out there. Instead of just “going to the bathroom” before sex and hoping you’re empty, treat yourself to an anal douche to make sure you’re empty. (Alexander Cheves wrote a great guide for receptive anal intercourse, “17 Tips For Happier, Healthier Bottoming” for the Advocate. Google it.)

“But finding a health-care provider who’s willing to listen to what’s important to her in her sex life is the first step,” said Dr. Herbenick. “A sex-positive health-care provider—probably a urogynecologist or a proctologist—who’s willing to hear her out can help her figure out some good ways forward. It’s about listening to what quality of life means to her. That seems to include an active, pleasurable sex life involving vaginal and/or anal sex with orgasm, and without pooping, or at least not nearly so often.”

Follow Dr. Herbenick on Twitter @DebbyHerbenick.

You aren’t obligated to have sex with your husband—you aren’t obligated to have sex with anyone, ever. But I assume you don’t want to be left any more than you want to leave, SHAM. And if you refuse to fuck your husband because he broke the deal you made a decade ago—and because you’re pissed about nine years of sexual neglect (legit grounds)—he might decide to leave you. So while you don’t have to fuck this ash-hole, you might want to fuck this ash-hole. But until he quits smoking, you could reasonably refuse to kiss him or sleep in the same room with him. (Smokers don’t realize how bad it smells—how bad they smell—and just how thoroughly they can stink up a room, even one they never light up in.)

One follow-up question: Did your husband always know this about himself—did he know he was turned on by the thought of you being with other dudes—or did he realize it only after you started fucking this other dude? If he knew it all along, and his encouragement to get your “needs met elsewhere” was a dishonest and manipulative attempt to force his kink on you, SHAM, you have even more right to be pissed. But if he realized this turned him on only after you started fucking other dudes—if he was as surprised by how you getting a boyfriend uncorked his libido as you were both surprised and annoyed by it—you might want to forgive him.