AIDS and Behavior

, Volume 22, Issue 4, pp 1288–1294 | Cite as

Rectal Douching Associated with Receptive Anal Intercourse: A Literature Review

  • Alex Carballo-Diéguez
  • Cody Lentz
  • Rebecca Giguere
  • Edward J. Fuchs
  • Craig W. Hendrix
Substantive Review


To inform the development of HIV-prevention rectal douches, we reviewed the scientific literature and online instructional videos on rectal douching associated with receptive anal intercourse (RAI). Up to 88% of men who practice RAI ever have douched, while 43–64% have douched recently. Of them, 87–97% douche before RAI and 13–48% afterwards. Water, occasionally mixed with soap or salt, is used most often, although up to 31% of men use commercial products. Douching is more common among individuals reporting substance use, sexually transmitted infections, or being HIV-infected. Scant literature is available on women’s rectal douching practices, but it is apparently less frequent than among men (32 vs. 70%). Videos advise using 2–3 doses of liquid and retaining it for 10–30 s before expelling. These findings can inform the development of a safe and acceptable rectal douche for HIV prevention.


Rectal douche HIV prevention Men who have sex with men Microbicides Enema 


Para contribuir al proceso de desarrollo de duchas rectales para la prevención del VIH, revisamos la literatura científica y los videos de enseñanza disponibles en el Web sobre el uso de duchas rectales en asociación con el sexo anal receptivo (SAR). Hasta el 88% de los hombres que practican SAR se han administrado alguna vez una ducha rectal, mientras que el 43-64% lo han hecho recientemente. De ellos, 87-97% se administran la ducha antes del SAR y 13-48% después. Agua, a veces mezclada con jabón o sal, es lo que se usa con mayor frecuencia, aunque hasta un 31% de los hombres usan productos comerciales. El uso de duchas rectales es más común entre los individuos que reportan el uso de sustancias, haber tenido infecciones de transmisión sexual, o estar infectados con el VIH. Hay poca literatura disponible sobre el uso de las duchas rectales entre mujeres, pero parece ser menos frecuente que entre los hombres (32% vs. 70%). Los videos aconsejan usar 2 a 3 dosis de líquido y retenerlo por 10-30 segundos antes de expulsarlo. Estos resultados pueden informar el desarrollo de una ducha rectal segura y aceptable para la prevención del VIH.



The study was funded by a U19 Grant under the Integrated Preclinical-Clinical Program for HIV Topical Microbicides (IPCP-HTM), Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH) (AI113127). This work was also supported by a Center Grant from the NIMH to the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University (P30-MH43520; PI: Remien, PhD). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Herbenick D, Reece M, Schick V, Sanders SA, Dodge B, Fortenberry JD. Sexual behavior in the United States: results from a national probability sample of men and women ages 14–94. J Sex Med. 2010;7(Suppl 5):255–65.CrossRefPubMedGoogle Scholar
  2. 2.
    Noor SW, Simon Rosser BR. Enema use among men who have sex with men: a behavioral epidemiologic study with implications for HIV/STI prevention. Arch Sex Behav. 2014;43(4):755–69.CrossRefPubMedGoogle Scholar
  3. 3.
    Galea JT, Kinsler JJ, McLean S, Calvo G, Sánchez H, Leon SR, et al. Rectal douching prevalence and practices among Peruvian men who have sex with men and transwomen: implications for rectal microbicides. AIDS Behav. 2016;20(11):2555–64.CrossRefPubMedGoogle Scholar
  4. 4.
    Schilder AJ, Orchard TR, Buchner CS, Strathdee SA, Hogg RS. Insert discourse: rectal douching among young HIV-positive and HIV-negative men who have sex with men in Vancouver, Canada. Sex Cult. 2010;14(4):327–43.CrossRefGoogle Scholar
  5. 5.
    How to give yourself an enema/douche/clean inside your butt.
  6. 6.
    Schmelzer M, Schiller LR, Meyer R, Rugari SM, Case P. Safety and effectiveness of large-volume enema solutions. Appl Nurs Res. 2004;17(4):265–74.PubMedGoogle Scholar
  7. 7.
    Calabrese SK, Rosenberger JG, Schick VR, Novak DS, Reece M. An event-level comparison of risk-related sexual practices between Black and other-race men who have sex with men: condoms, semen, lubricant, and rectal douching. AIDS Patient Care STDS. 2013;27(2):77–84.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    National Institutes of Health Group: Development of a Rectal Enema as Microbicide (DREAM). 2015. Cited 3 May 2017.
  9. 9.
    Javanbakht M, Stahlman S, Pickett J, Leblanc M-A, Gorbach PM. Prevalence and types of rectal douches used for anal intercourse: results from an international survey. BMC Infect Dis. 2014;14:1–8.CrossRefGoogle Scholar
  10. 10.
    Carballo-Diéguez A, Bauermeister JJ, Ventuneac A, Dolezal C, Mayer K. Why rectal douches may be acceptable rectal-microbicide delivery vehicles for men who have sex with men. Sex Transm Dis. 2010;37(4):228–33.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Carballo-Diéguez A, Bauermeister JA, Ventuneac A, Dolezal C, Balan I, Remien RH. The use of rectal douches among HIV-uninfected and infected men who have unprotected receptive anal intercourse: implications for rectal microbicides. AIDS Behav. 2008;12(6):860–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Achterbergh RCA, van der Helm JJ, van den Boom W, Heijman T, Stolte IG, van Rooijen MS, et al. Is rectal douching and sharing douching equipment associated with anorectal chlamydia and gonorrhoea? A cross-sectional study among men who have sex with men. Sex Transm Infect. 2017. Scholar
  13. 13.
    Galea JT, Kinsler JJ, Imrie J, Nureña CR, Sánchez J, Cunningham WE. Rectal douching and implications for rectal microbicides among populations vulnerable to HIV in South America: a qualitative study. Sex Transm Infect. 2014;90(1):33–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Mitchell JW, Sophus AI, Lee J-Y, Petroll AE. Anal douche practices and willingness to use a rectal microbicide enema for HIV prevention and associated factors among an Internet sample of HIV-negative and HIV-discordant male couples in the US. AIDS Behav. 2016;20(11):2578–87.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Leyva FJ, Bakshi RP, Fuchs EJ, Li L, Caffo BS, Goldsmith AJ, et al. Isoosmolar enemas demonstrate preferential gastrointestinal distribution, safety, and acceptability compared with hyperosmolar and hypoosmolar enemas as a potential delivery vehicle for rectal microbicides. AIDS Res Hum Retrovir. 2013;29(11):1487–95.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kinsler JJ, Galea JT, Lama JR, Segura P, Peinado J, Casapia M, et al. Rectal douching among Peruvian men who have sex with men, and acceptability of a douche-formulated rectal microbicide to prevent HIV infection. Sex Transm Infect. 2013;89(1):62.CrossRefPubMedGoogle Scholar
  17. 17.
  18. 18.
    Cleaning out—for anal sex.
  19. 19.
    Coates R, Calzavara L, Read S, Fanning M, Shpherd F, Klein M, et al. Risk factors for HIV infection in male sexual contacts of men with AIDS or an AIDS-related condition. Am J Epidemiol. 1988;128(4):729–39.CrossRefPubMedGoogle Scholar
  20. 20.
    Moss AR, Osmond D, Bacchetti P, Chermann JC, Barre-Sinoussi F, Carlson J. Risk factors for AIDS and HIV seropositivity in homosexual men. Am J Epidemiol. 1987;125(6):1035–47.CrossRefPubMedGoogle Scholar
  21. 21.
    Carballo-Diéguez A, Stein Z, Sáez H, Dolezal C, Nieves-Rosa L, Díaz F. Frequent use of lubricants for anal sex among men who have sex with men: the HIV prevention potential of a microbicidal gel. Am J Public Health. 2000;90(7):1117–21.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Gorbach PM, Weiss RE, Fuchs E, Jeffries RA, Hezerah M, Brown S, et al. The slippery slope: lubricant use and rectal sexually transmitted infections: a newly identified risk. Sex Transm Dis. 2012;39(1):59–64.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Dezzutti CS, Brown ER, Moncla B, Russo J, Cost M, Wang L, et al. Is wetter better? An evaluation of over-the-counter personal lubricants for safety and anti-HIV-1 activity. PLoS ONE. 2012;7(11):e48328.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Alex Carballo-Diéguez
    • 1
  • Cody Lentz
    • 1
  • Rebecca Giguere
    • 1
  • Edward J. Fuchs
    • 2
  • Craig W. Hendrix
    • 2
  1. 1.HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Institute and Columbia UniversityNew YorkUSA
  2. 2.Division of Clinical PharmacologyJohns Hopkins UniversityBaltimoreUSA

Personalised recommendations