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Affiliation
1 Academic Medical Center of the University of Amsterdam and Amsterdam Institute for Global Health and Development, PO Box 22700, 1100 DE Amsterdam, The Netherlands. n.veldhuijzen@amc-cpcd.org
Nienke J Veldhuijzen et al. Sex Health. 2011 Jun.
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1 Academic Medical Center of the University of Amsterdam and Amsterdam Institute for Global Health and Development, PO Box 22700, 1100 DE Amsterdam, The Netherlands. n.veldhuijzen@amc-cpcd.org
Introduction: Epidemiological and HIV prevention studies in sub-Saharan Africa have almost exclusively focussed on vaginal transmission of HIV, the primary mode of transmission in the region. Little is known about the prevalence of heterosexual anal intercourse (AI), its correlates and its role in the spread of HIV. Prevention messaging seldom, if ever, includes AI.
Methods: Sexual and other risk behaviours (including frequency of AI) were assessed in two cross-sectional surveys of female sex workers (FSW) in Kigali, Rwanda (n=800) and Mombasa, Kenya (n=820). In addition, a subset of FSW surveyed in Kigali attended seven focus group discussions and four in-depth interviews.
Results: AI was reported by 5.5% and 4.3% of FSW in the cross-sectional surveys, in Kigali and Mombasa, respectively. FSW practising AI reported multiple risk factors for HIV transmission: inconsistent condom use (odds ratio (OR) Kigali 5.9 (95% CI 1.4-24.7); OR Mombasa 2.1 (1.1-4.2)); more than five sexual partners in the past week (OR Kigali 4.3 (1.5-12.4); OR Mombasa 2.2 (1.1-4.3)); alcohol use before sex (OR Kigali 2.8 (1.4-5.8)); more than 5 years of female sex work (OR Mombasa 2.4 (1.2-4.9)); and history of genital symptoms in the past year (OR Mombasa 3.6 (1.7-7.9)). AI was, however, not associated with HIV prevalence (OR Kigali 0.9 (0.5-1.9); OR Mombasa 0.5 (0.2-1.2)). Negative connotations and stigma associated with AI were expressed during qualitative interviews.
Conclusions: AI was associated with several indicators of sexual risk behaviour. Prevalence of AI was probably underreported due to social desirability bias. Stigma associated with AI poses methodological challenges in obtaining valid data.
Morris CN, Morris SR, Ferguson AG. Morris CN, et al. AIDS Behav. 2009 Oct;13(5):860-5. doi: 10.1007/s10461-008-9431-z. Epub 2008 Jul 30. AIDS Behav. 2009. PMID: 18665445
Okal J, Luchters S, Geibel S, Chersich MF, Lango D, Temmerman M. Okal J, et al. Cult Health Sex. 2009 Nov;11(8):811-26. doi: 10.1080/13691050902906488. Cult Health Sex. 2009. PMID: 19484638
Owen BN, M-Giroux M, Matse S, Mnisi Z, Baral S, Ketende SC, Baggaley RF, Boily MC. Owen BN, et al. PLoS One. 2020 Feb 11;15(2):e0228849. doi: 10.1371/journal.pone.0228849. eCollection 2020. PLoS One. 2020. PMID: 32045444 Free PMC article.
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Owen BN, Baggaley RF, Elmes J, Harvey A, Shubber Z, Butler AR, Silhol R, Anton P, Shacklett B, van der Straten A, Boily MC. Owen BN, et al. AIDS Behav. 2020 Mar;24(3):697-713. doi: 10.1007/s10461-019-02477-w. AIDS Behav. 2020. PMID: 30953304 Free PMC article.
Chen J, Ren Y, Daharsh L, Liu L, Kang G, Li Q, Wei Q, Wan Y, Xu J. Chen J, et al. Front Microbiol. 2018 Mar 29;9:557. doi: 10.3389/fmicb.2018.00557. eCollection 2018. Front Microbiol. 2018. PMID: 29651274 Free PMC article.
Mazeingia YT, Olijjira L, Dessie Y. Mazeingia YT, et al. Glob Health Res Policy. 2017 Sep 8;2:27. doi: 10.1186/s41256-017-0047-6. eCollection 2017. Glob Health Res Policy. 2017. PMID: 29202095 Free PMC article.
Maheu-Giroux M, Baral S, Vesga JF, Diouf D, Diabaté S, Alary M, Abo K, Boily MC. Maheu-Giroux M, et al. Am J Epidemiol. 2018 Feb 1;187(2):287-297. doi: 10.1093/aje/kwx244. Am J Epidemiol. 2018. PMID: 28633387 Free PMC article.

7 Women Share The Reasons They’ve Cried During Sex
Pretty much any emotion can turn on the waterworks.
When you imagine having sex that you're totally into, crying probably isn't part of the picture. But sometimes when you're in the middle of doing the deed, your emotions take over and you suddenly find tears leaking out of your eyes. You might feel surprised depending on the situation, but being overcome with feelings during the act is actually pretty normal, even when you actively want to have sex. Here, 7 women show as much by sharing the reasons they've cried during sex. Some are heartbreaking while others are incredibly sweet, but all of them prove that there's absolutely nothing wrong with getting emotional during sex. Sometimes, you've just got to let it out.
1. Because of confusing anal sex-induced feelings.
"I was having anal sex with my boyfriend of two years. We were slightly tipsy after a few glasses of wine, and it was only the second or third time we’d tried it. A few minutes in, I burst into tears, and not from pain. I started crying because I wasn’t sure if I felt degraded or not, and if I did feel degraded, then I was actually enjoying it. It was a strange feeling, and I was shocked by my own tears. My boyfriend immediately wrapped me in his arms and asked if I was OK. I said yes and started laughing, so he joined in. Needless to say, the mood was somewhat ruined, but I can confirm there have been no tears since." —Thea C., 21
"One morning, a woman slid into my Instagram DMs and told me she and my 'boyfriend'—I use that term loosely—had been sleeping together and dating each other for a couple months. I didn't sleep with him for over a month after I found out, and the first time I did,I began to cry shortly after we began. I was thinking about him with the other woman and the qualities she had that I didn't. We broke up about a week after that incident. The crying made me realize this guy hurt me to my core. I'd wondered throughout our year-long courtship whether or not he really cared for me. At the moment I started crying, I said to myself, 'Nope he doesn't.'" —Talisha H., 28
"I've only cried once during sex. It wasn't because it was beautiful, although he was the hottest guy friend I had, like an Abercrombie model. But it also meant I'd slept with almost my entire group of guy friends in a two-year period. There's nothing inherently wrong with having sex with as many people as you want, but I was young and so ashamed of myself. Shortly after college, though, I met the love of my life, and we got married in 2013!" —Maria P., 31
"It was senior year of college, and my then-boyfriend and I hadn't talked about graduation at all. He was walking me to a meeting I was attending, andall of a sudden he told me he wasn't sure if he loved me enough to date me forever. I had no idea he had doubts, and I started uncontrollably sobbing in the middle of the meeting. Later on, he came over to my place and started kissing my breasts, clearly wanting to have sex, and I started crying again. I knew we weren't going to be together, and I loved him so much. At some point, I stopped crying, and we finished having sex. It's OK now, though. I'm so not attracted to him, I'd rather get intimate with a comforter." —Monica T., 25
5. Because of physical pain and emotional frustration.
"I suffer from vaginismus, a condition where penetrative intercourse is painful. I was having sex with my boyfriend and experiencing pain and discomfort when I started crying. Not from the physical pain, but from the complications and frustrations that came along with the experience that was supposed to be magical and pleasant. While my partner was experiencing those very feelings, I was simultaneously conflicted, in pain, and unhappy. I couldn't help killing the mood with some tears. When he noticed, he was alarmed and rushed to comfort me, trying his best to understand what it was I was feeling. This, to me, felt most intimate of all." —Sarah L., 23
6. Because it was really, truly over.
"A year after my ex and I mutually broke up, we were having sex. We did everything we used to do, but we knew it would be the last time. I broke up into tears. It was pretty obvious from my side—I have always been touchy with emotional stuff. He asked me for the reason behind my tears, but I was silent. He asked again, and I kept on with my closed lips. He then understood my silence and broke into tears himself." —Anukriti S.
7. Because it was time to go back to long-distance dating.
"My boyfriend and I are in a long-distance relationship, and we had just gotten back home from our first trip abroad. The vacation really cemented how head over heels I was for him, and being together for over a week was like a dream. When we landed in my Midwest city, we were going to spend one last night together before he headed back to the West Coast and we wouldn't see each other for weeks. As we had sex, I was honestly overwhelmed by how much I loved him and how much I didn't want him to leave, so I started crying. I tried to keep it subtle, but he realized. At first he was scared he hurt me, but when I explained, he wiped my tears away and comforted me. Then we continued on having amazing sex. Swoon." —Kimberly C.
Quotes have been edited for length and clarity.
Zahra Barnes joined SELF in November 2015, working on the Culture and Health teams before eventually becoming Executive Editor. She has spent her career as a reporter and editor covering people's lives with a focus on wellness. Zahra specializes in sexual, reproductive, and mental health, all with the goal of destigmatizing... Read more
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