Safety of Anal Sex After Fistulotomy for Low Transsphincteric Fistula
You must completely and permanently avoid receptive anal intercourse after your fistulotomy, as the mechanical trauma will cause wound breakdown, recurrent infection, progressive sphincter damage, and potentially permanent fecal incontinence. 1
Why Anal Sex Is Contraindicated
The American Society of Colon and Rectal Surgeons explicitly states that receptive anal intercourse should be avoided indefinitely after fistulotomy for low transsphincteric fistulas. 1 Here's the reasoning:
- Mechanical trauma from penetration will likely cause wound dehiscence, converting your successfully healed surgical site back into an open wound 1
- Substantial risk of introducing infection into the healing wound, which could trigger abscess formation and require additional surgeries 1
- Progressive sphincter damage from repeated trauma could necessitate multiple operations, each carrying significant incontinence risk 1
- Even though you currently have no incontinence and less than 30% EAS involvement, any additional sphincter injury from anal sex could push you into the 10-20% risk category for continence disturbances 2, 3
Minimum Waiting Period (If Considering Future Activity)
If you are considering any future resumption of anal sexual activity:
- Complete cessation is required for at least 12 months post-fistulotomy to allow complete wound healing and scar maturation 1
- A graduated approach to resumption is mandatory, not immediate return to full activity 1
- Prophylactic topical calcium channel blockers should be maintained before and after any activity to reduce sphincter hypertonicity 1
Critical Next Steps
You need immediate referral to a colorectal surgeon with sphincter preservation expertise for: 1
- Anorectal manometry to objectively measure your sphincter pressures and function
- Endoanal ultrasound to visualize the sphincter anatomy and assess for any occult damage
These tests will provide objective data about your sphincter integrity, which is essential given your sexual practices and the need to preserve continence long-term.
Common Pitfall to Avoid
The most dangerous assumption is thinking "the fistula is healed and I have no symptoms, so I'm safe to resume normal activities." Your sphincter has been surgically divided and reconstructed—it is permanently weaker than before surgery, even if you feel completely normal. 4, 5 The 10-20% risk of continence disturbances from fistulotomy alone 2, 3 becomes functionally devastating when combined with receptive anal intercourse, which makes any degree of incontinence far more impactful on quality of life. 3