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It felt as if that night wouldn't pass. I had a throbbing headache and couldn't stop crying. I don't remember when I slept off. I woke up to find my husband standing in front of my bed with last night's question: "So, what have you decided? Is your answer yes or no?"
I didn't know what to say. I gathered some courage to speak up and mumbled: "Please go to the office, I'll call you by evening and let you know my answer, I promise."
He threatened: "I will call you myself at 4pm. I want the answer and it should be 'yes'. Otherwise be ready to get punished."
By punishment, he meant anal sex. He knew that it was extremely painful for me and he used it as a tool to torture me.
He and his elder sister left for the office. I was now alone and struggling with my thoughts.
After a few hours I gathered the courage to dial my father's number and told him that I couldn't live with my husband anymore.
#HerChoice is a series of true life-stories of 12 Indian women. These accounts challenge and broaden the idea of the "modern Indian woman" - her life choices, aspirations, priorities and desires.
I was afraid that my father would be angry but his response amazed me. "Pack your bags and get out of there," he said.
I took a book, gathered my educational certificates and rushed towards the bus station.
After boarding the bus, I sent a message to my husband. "My answer is 'no' and I am going back home," it said. After that I switched off my mobile phone.
After a few hours, I was home, surrounded by my family. I had left my husband's house after only two months of marriage.
I met my husband, Sahil, when I was in the final year of graduation. He was a jovial man. I liked being around him and with time we fell in love.
We used to go on dates, talk for countless hours on phone. It seemed as if life was almost too kind to me.
But this rosy romance did not continue for long. Gradually I started realising that our relationship lacked equality. It wasn't what I had been looking for.
Our relationship was becoming like my parents' relationship. The only difference; my mother kept silent while I could not stop myself from speaking up.
My father used to scream at my mother for petty things. He would even hit her and the only thing she responded with was tears.
When Sahil and I had an argument, it would often turn into a scuffle. He would use force to get intimate with me and scream at me if I refused.
I remember him once asking me: "Suppose I hit you someday, then what would you do?"
The question stunned me. I controlled my anger with great difficulty and replied, "I would break up with you that very day."
What he said next shocked me even more. He said, "It means you don't love me. Love should be unconditional."
After this, we didn't talk for almost a month.
Our fights became more frequent. Many times I'd try to end our relationship but he would apologise every time. I wanted to get rid of him forever and don't know why I wasn't able to do it.
Meanwhile, I was being pressured into marriage.
I was a teacher now. I'd be in class, teaching children and my parents would call me.
The same conversation would be repeated. "What have you thought about marriage? Why don't you marry Sahil? If not him then let us find a suitable match for you. At least think about your younger sisters…"
If anything went wrong at home, it would be blamed on my staying single.
Mother fell sick because I wasn't getting married. My father's business suffered losses because I wasn't getting married.
I was so frustrated that I finally said yes to marriage. I was still not ready for it and didn't believe Sahil's promise that he would change his attitude.
My fears came true after our wedding. Sahil made me a puppet, dancing to his tunes.
I was fond of poetry and used to my write my poems on Facebook. He forbade me from doing it. He even started dictating what I should wear.
One day he told me that I should finish all my reading and writing work by night. "If you leave me dissatisfied in bed, I will have to go to someone else."
He'd say that I wasn't making him happy and would advise me to watch pornography so I could learn some techniques.
And then he got this obsession with seeking work in Mumbai.
He said: "You stay here, do your job and send me money to support me there, and then you take out a loan so I can buy a house."
This is what he wanted me to say yes to. That night he had pushed me on the bed and forced me into anal sex just for that yes.
A line had been crossed. I left him the morning after.
I was a well-educated woman who could earn and live on her own. Yet, my heart was sinking when I left Sahil's home.
There was a fear of being judged by my own family and society. But even bigger than that was the pain in my heart.
When I reached home, my hair was dishevelled and eyes swollen as I had cried all night.
Newly married women look ravishing when they visit home for the first time after marriage. But my face was pale and the keen eyes of my neighbours guessed why.
People started pouring in. Some would say: "Such a terrible thing has happened to you." Others consoled me that Sahil would come to apologise and take me back.
Then there were a few who thought that a woman should not make such a harsh choice over petty issues.
Everyone had something to say but their opinions could not change my decision.
It has been seven months since I left Sahil's home and now I am choosing my own path. I have received a fellowship; I am doing a job and studying as well.
We have been going to police stations and courts as the legal procedure of divorce is not over yet.
I still wake up with a start at night. I still have nightmares.
I haven't been able to forget what I had to face but I am trying to move on in earnest.
My trust in love and relationships is definitely shaken, but not broken yet. I have decided to take some time for myself. I am proud that I didn't stay silent and got out of this abusive relationship before it was too late.
That is why I believe that my future will be better than my past and present.
This is a true life-story of a woman who lives in western India as told to BBC reporter Sindhuvasini Tripathi, produced by Divya Arya. The woman's identity has been kept anonymous on request.
BBC 100 Women names 100 influential and inspirational women around the world every year and shares their stories. Find us on Facebook , Instagram and Twitter and use #100Women
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Young women and anal sex
BMJ
2022 ;
378
doi: https://doi.org/10.1136/bmj.o1975
(Published 11 August 2022)
Cite this as: BMJ 2022;378:o1975
Tabitha Gana , ST8 general and colorectal surgery , Lesley M Hunt , consultant surgeon Author affiliations Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK Correspondence to: L M Hunt lesley.hunt3@nhs.net
Faustino MJ . “It’s time to ease your fears—and your sphincter”: gender and power in contemporary media discourses of heterosexual anal sex . Gend Issues 2020 ; 37 : 241 - 60 doi: 10.1007/s12147-020-09250-7 .
Rosewarne L . School of shock: film, television and anal education . Sex Educ 2015 ; 15 : 553 - 65 doi: 10.1080/14681811.2015.1023285 .
Lewis R , Tanton C , Mercer CH , et al . Heterosexual practices among young people in Britain: evidence from three national surveys of sexual attitudes and lifestyles . J Adolesc Health 2017 ; 61 : 694 - 702 . doi: 10.1016/j.jadohealth.2017.07.004 pmid: 29169520
Hess KL , DiNenno E , Sionean C , Ivy W , Paz-Bailey G , NHBS Study Group . Prevalence and correlates of heterosexual anal intercourse among men and women, 20 US cities . AIDS Behav 2016 ; 20 : 2966 - 75 . doi: 10.1007/s10461-016-1295-z pmid: 26781872
Reynolds GL , Fisher DG , Rogala B . Why women engage in anal intercourse: results from a qualitative study . Arch Sex Behav 2015 ; 44 : 983 - 95 . doi: 10.1007/s10508-014-0367-2 pmid: 25378264
Fahs B , Gonzalez J . The front lines of the “back door”: navigating (dis)engagement, coercion, and pleasure in women’s anal sex experiences . Fem Psychol 2014 ; 24 : 500 - 20 doi: 10.1177/0959353514539648 .
Maynard E , Carballo-Diéguez A , Ventuneac A , Exner T , Mayer K . Women’s experiences with anal sex: motivations and implications for STD prevention . Perspect Sex Reprod Health 2009 ; 41 : 142 - 9 . doi: 10.1363/4114209 pmid: 19740231
Hutton HE , McCaul ME , Chander G , et al . Alcohol use, anal sex, and other risky sexual behaviors among HIV-infected women and men . AIDS Behav 2013 ; 17 : 1694 - 704 . doi: 10.1007/s10461-012-0191-4 pmid: 22566077
McBride KR , Fortenberry JD . Heterosexual anal sexuality and anal sex behaviors: a review . J Sex Res 2010 ; 47 : 123 - 36 . doi: 10.1080/00224490903402538 pmid: 20358456
Reynolds GL , Fisher DG , Rogala B . Why women engage in anal intercourse: results from a qualitative study . Arch Sex Behav 2015 ; 44 : 983 - 95 . doi: 10.1007/s10508-014-0367-2 pmid: 25378264
Štulhofer A , Ajduković D . Should we take anodyspareunia seriously? A descriptive analysis of pain during receptive anal intercourse in young heterosexual women . J Sex Marital Ther 2011 ; 37 : 346 - 58 . doi: 10.1080/0092623X.2011.607039 pmid: 21961443
Markland AD , Dunivan GC , Vaughan CP , Rogers RG . Anal intercourse and fecal incontinence: evidence from the 2009-2010 National Health and Nutrition Examination Survey . Am J Gastroenterol 2016 ; 111 : 269 - 74 . doi: 10.1038/ajg.2015.419 pmid: 26753893
Reginelli A , Mandato Y , Cavaliere C , et al . Three-dimensional anal endosonography in depicting anal-canal anatomy . Radiol Med 2012 ; 117 : 759 - 71 . doi: 10.1007/s11547-011-0768-4 pmid: 22228126
Brook G , Church H , Evans C , et al . 2019 UK national guideline for consultations requiring sexual history taking: clinical effectiveness group British Association for Sexual Health and HIV . Int J STD AIDS 2020 ; 31 : 920 - 38 . doi: 10.1177/0956462420941708 pmid: 32718268
Hebert LE , Newton SL , Webb ME . “Never anything about anal sex whatsoever”: young women’s reflections on sources of information about anal sex . Contraception (Stoneham) 2017 ; 96 : 303 doi: 10.1016/j.contraception.2017.07.151 .
Stewart J , Douglas G , O’Rourke T , Gammel C . Promoting safer sex in the context of heterosexual anal intercourse: a scoping review . J Clin Nurs 2021 ; 30 : 2111 - 30 . doi: 10.1111/jocn.15628 pmid: 33377555
Scottish Parliament. To ask the Scottish Government who designed the questionnaire for the Health and Wellbeing Census for schools in 2021-22. Question S6W-04881. 2021. https://www.parliament.scot/chamber-and-committees/written-questions-and-answers/question?ref=S6W-04881
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Tabitha Gana ST8 general and colorectal surgery , Lesley M Hunt consultant surgeon
Gana T , Hunt L M .
Young women and anal sex
BMJ 2022; 378 :o1975
doi:10.1136/bmj.o1975
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Intended for healthcare professionals
Clinicians’ reluctance to discuss possible harms is letting down a generation of women
Anal intercourse is becoming more common among heterosexual couples. Within popular culture it has moved from the world of pornography to mainstream media. 1 It is no longer considered an extreme behaviour but increasingly portrayed as a prized and pleasurable experience. 2 In Britain, the National Survey of Sexual Attitudes and Lifestyle shows participation in heterosexual anal intercourse among 16 to 24 year olds rose from 12.5% to 28.5% over the past few decades. 3 Similar trends are seen in the US, where 30-44% of men and women report experience of anal sex. 4
Individual motivation varies. Young women cite pleasure, curiosity, pleasing male partners, and coercion as factors. 5 6 Up to 25% of women with experience of anal sex report they have been pressured into it at least once. 7 Hit television shows such as Sex and the City and Fleabag may unwittingly add to the pressure, as they seem to normalise anal sex in heterosexual relationships or make it appear racy and daring.
Anal intercourse is considered a risky sexual behaviour because of its association with alcohol, drug use, and multiple sex partners. 8 But it is also associated with specific health concerns. The absence of vaginal secretions, increased traumatic abrasions, and less common use of condoms increase the risk of sexually transmitted disease and anal malignancy. 9 Anal pain, bleeding, and fissures also occur as a result of anal intercourse. 10 11
Increased rates of faecal incontinence and anal sphincter injury have been reported in women who have anal intercourse. 12 Women are at a higher risk of incontinence than men because of their different anatomy and the effects of hormones, pregnancy, and childbirth on the pelvic floor. Women have less robust anal sphincters and lower anal canal pressures than men, 13 and damage caused by anal penetration is therefore more consequential. The pain and bleeding women report after anal sex is indicative of trauma, and risks may be increased if anal sex is coerced.
Effective management of anorectal disorders requires understanding of the underlying risk factors, and good history taking is key. Without it, patients are likely to present repeatedly with the same symptoms. Asking about anal sex is standard practice in genitourinary medicine clinics 14 but less common in general practice and colorectal clinics. Clinicians may shy away from these discussions, influenced by society’s taboos. However, with such a high proportion of young women now having anal sex, failure to discuss it when they present with anorectal symptoms exposes women to missed diagnoses, futile treatments, and further harm arising from a lack of medical advice.
More widely, public health education is lacking. 15 16 NHS patient information on anal sex considers only sexually transmitted diseases, making no mention of anal trauma, incontinence, or the psychological aftermath of the coercion young women report in relation to this activity. 17 A plethora of non-medical or pseudomedical websites fill the health information void. Rather than helping young women make informed decisions, some sites may increase societal pressure to try anal sex.
It may not be just avoidance or stigma that prevents health professionals talking to young women about the risks of anal sex. There is genuine concern that the message may be seen as judgmental or even misconstrued as homophobic. However, by avoiding these discussions, we may be failing a generation of young women, who are unaware of the risks. With better information, women who want anal sex would be able to protect themselves more effectively from possible harm, and those who agree to anal sex reluctantly to meet society’s expectations or please partners, may feel better empowered to say no.
Reluctance to discuss anal sex is not confined to healthcare. The Scottish government attracted criticism for proposing that questions about it should be included in the schools’ health and wellbeing census, prompting first minister Nicola Sturgeon to respond: “ Either we can bury our heads in the sand and pretend that young people are not exposed to the issues or the pressures that we know they are exposed to. Or we can seek to properly understand the reality that young people face and provide them with the guidance, the advice, and the services they need to make safe, healthy, and positive decisions.” 18
Healthcare professionals, particularly those in general practice, gastroenterology, and colorectal surgery, have a duty to acknowledge changes in society around anal sex in young women, and to meet these changes with open neutral and non-judgmental conversations to ensure that all women have the information they need to make informed choices about sex.
Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare no other interests. Further details of The BMJ policy on financial interests are here: https://www.bmj.com/sites/default/files/attachments/resources/2016/03/16-current-bmj-education-coi-form.pdf .
Provenance and peer review: Not commissioned; externally peer reviewed.
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