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Little research addresses the role of anal sexuality and anal sexual behaviors as a widely practiced but relatively less frequent element of a heterosexual sexual repertoire . However, the importance of anal sex in sexual health is increasingly well-defined by epidemiological and clinical studies . This article reviews existing data on a range of heterosexual anal sex practices and provides conceptual and methodological recommendations for new research .
The Journal of Sex Research (JSR) is a scholarly journal devoted to the publication of articles relevant to the variety of disciplines involved in the scientific study of sexuality . JSR is designed to stimulate research and promote an interdisciplinary understanding .
Building on two centuries' experience, Taylor & Francis has grown rapidlyover the last two decades to become a leading international academic publisher .The Group publishes over 800 journals and over 1,800 new books each year, coveringa wide variety of subject areas and incorporating the journal imprints of Routledge,Carfax, Spon Press, Psychology Press, Martin Dunitz, and Taylor & Francis .Taylor & Francis is fully committed to the publication and dissemination of scholarly information of the highest quality, and today this remains the primary goal .

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The Journal of Sex Research
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Objective To explore expectations, experiences and circumstances of anal sex among young people .
Design Qualitative, longitudinal study using individual and group interviews .
Participants 130 men and women aged 16–18 from diverse social backgrounds .
Setting 3 contrasting sites in England (London, a northern industrial city, rural southwest) .
Results Anal heterosex often appeared to be painful, risky and coercive, particularly for women . Interviewees frequently cited pornography as the ‘explanation’ for anal sex, yet their accounts revealed a complex context with availability of pornography being only one element . Other key elements included competition between men; the claim that ‘people must like it if they do it’ (made alongside the seemingly contradictory expectation that it will be painful for women); and, crucially, normalisation of coercion and ‘accidental’ penetration . It seemed that men were expected to persuade or coerce reluctant partners .
Conclusions Young people's narratives normalised coercive, painful and unsafe anal heterosex . This study suggests an urgent need for harm reduction efforts targeting anal sex to help encourage discussion about mutuality and consent, reduce risky and painful techniques and challenge views that normalise coercion .
Content may be subject to copyright .
Anal heter ose x among y oung people
and implica tions for health pr omotion:
a qualita tiv e s tudy in the UK
this paper is available online .
To explor e expecta tions, experiences and
circums tances of anal sex among young people .
Design: Qualita tive, longitudinal study using individual
Participants: 130 men and women aged 16 – 18 from
Setting: 3 contrasting sites in England (London, a
northern industrial city, rural southwes t) .
Results: Anal heterosex often appeared to be painful,
risky and coercive, particularly for women . Interviewees
frequently cited pornography as the ‘ explana tion ’ for
anal sex, yet their accounts rev ealed a complex context
with availability of pornography being only one
element . Other key elements included competition
between men; the claim that ‘ people must like it if they
do it ’ (made alongside the seemingly contradictory
expecta tion that it will be painful for women); and,
crucially, normalisation of coercion and ‘ accidental ’
penetra tion . It seemed that men were expected to
persuade or coerce reluctant partners .
Conclusions: Young people ’ s narra tives normalised
coerciv e, painful and unsafe anal heterosex . This study
suggests an urgent need for harm reduction efforts
targeting anal sex to help encourage discussion about
mutuality and consent, reduce risky and painful
techniques and challenge views that normalise
Anal sex is incr easingly prevalent among
young people, yet anal intercourse between
men and women — although commonly
depicted in sexually explicit media — is
usually absent from mainstream sexuality
education and seems unmentionable in
Sur vey s suggest that young men and
women — and older adults — ar e engaging in
anal intercourse mor e than ever before .
Sexually explicit me dia depictions ar e often
mentioned as affecting ho w se x is view ed and
course being one of the ‘ high risk ’ pra ctices
thought to be promoted by such media,
although evidence about the in fl uence of
pornography on anal pra ctices is thin .
Studies of anal pra ctices, which are generally
might be desired by young men more than
women and may be used to avoid preg-
part of sex for men and women .
one in fi ve 1 6 – 24 year -olds (19% of men and
17% of women) r eported having had anal
intercourse in the past year in a recent
V er y little is known about the detailed cir-
cumstances around or reasons for engaging
in anal sex among under-18-year -olds any-
where, or what implications these might hav e
for health . This s tudy looks in deta il a t anal
pra ctices among young people aged 18 and
under , develops hypotheses for further study
and mak es suggestions for se xual health
Strengths and limitations of this study
▪ This study uses a large qualitativ e sample from
three diverse sites in England and is the first to
capture a wide range of circums tances around
and reasons for engaging in anal sex among
men and women between the ages of 16 and
▪ Analy sis explor es experiences in depth, going
bey ond simplistic explana tions linking motiva-
tions for anal sex with pornography .
▪ The study shows that young people ’ s narra tives
about anal sex contained ideas normalising coer-
cive, painful and unsafe anal sex . These ideas
could be addressed in health promotion work .
▪ This study was conducted in England and further
work is needed to assess the extent to which
similar discourses opera te among young people
Marston C, Lewis R . BMJ Open 2014; 4 :e004996 . doi:10 .1136/bmjopen-2014-004996 1
The narrativ es about anal heterose x presented here
emerged as part of a long itudinal, qualitative mixed
methods study (the ‘ sixteen18 ’ project) which explored
the range and meaning of different sexual activities
among a diverse sample of 130 young people aged 16 –
18 in three contrasting locations in England: London; a
medium-sized northern industrial city and a rural area
in the southwes t . From January 2010, we conducted 9
group inter views and 71 depth inter views (wa ve one: 37
women and 34 men), re-interviewing 43 of the depth
interviewees 1 year later (wa ve two) , unt il June 2011 .
The London School of Hygiene and T r opical Medicine
Resear ch Ethics Committee approv ed the study and all
participants pro vided written con sent .
For the depth inter views, we used pur posive sampling
to maximise variation in social background . Within each
location, we sampled from a range of settings including:
schools/colleges; youth work ser vices targeting young
people not in education or training; youth organisations;
a supported housing project for young people living
independently from their famil ies; and informal net-
works . W e also used ‘ snowball ’ samplin g and, in the rural
southwes t, we approached people directly in a town
centre . The sample was diverse in terms of economic and
social backgr ound, and less diverse in terms of ethnicity
(most participants wer e white British) . See Lewis et al
for further deta ils . W e highlighted in our information
lea fl et and our conversa tions with potential inter view ees
that we wer e keen to speak to any young person, whatever
their experiences . Although participants varied in terms
of the range of activities they had experienced, and the
number and nature of their sexual partners hips, the
majority reported opposite-sex partners only .
In the depth interviews, we asked inter viewees about
what sexual pra ctices they had engaged in, the circum-
s tances of those pra ctices and how they felt about them .
W e deliberately le ft ‘ sexual practices ’ unde fi ned, to allow
for young people ’ s own de fi nitions to emerge . In the
group discussions, we asked gen eral questions about
what pra ctices they had heard of, their attitudes to those
pra ctices and whether the y thought young people their
age would generally engage in particular pra ctices, and
if so, under what circumstances . Many of our intervie-
wees talked about anal sexual pra ctices unprompted
(whether they had engaged in them or not) and so in
wa ve two, we speci fi cally asked all of our participants
about their perception and, if relevant, their experience
of anal pra ctices (about a quarter of our in-depth inter-
view ees r eported anal sexual experiences) . Our aim was
to explor e the ke y discourses surrounding anal sexual
pra ctices among this age group and to elicit detailed
a ccoun ts of speci fi c experiences .
W e recorded and transcribed all inter views . W e used
understanding of the data . This involv ed ‘ coding ’ tran-
and e xtensive discussions between researchers
to come to a shared inte rpreta tion of young people ’ s
accounts of anal se x, taking into consideration our own
chara cteristics (eg, white, middle-class women older
than the inter view ees) and how these may have affected
the data collected . W e made constant comp arisons
acr oss cases and themes, and sought ‘ deviant cases ’ to
challenge our emerging interpreta tions . Throughout the
analysis, we simultaneously engaged with theoretical lit-
era ture to put the work in context .
W e use unique identi fi er pseudonyms throughout .
Quota tions are from one-to-one inter views unless other-
wise indicated, with omissio ns marked [ … ] .
Anal pr actices reported usually involved penetra tion or
attempted penetration by the man with his penis or
fi nger and, with one exception, wer e between opposite-
sex partners . Anal pra ctices generally occurred between
young men and women in ‘ boyfriend/girlfriend ’ rela-
tionships . Although a small minority of inter viewees said
anal sex (ie, penetra tion wit h a penis) was e xclusively
‘ gay ’ , it was widely understood as also occur ring between
Initial anal sexual experiences wer e rar ely narrated in
terms of mutual explor ation of sexual pleasure . W omen
As soon as the whole incident happened where he didn ’ t
warn me it just hurt . It was just pain [ laugh ] . It was just
like: no . No one could possibly enjoy that . It was just hor-
rible [ … ] I guess he could hav e used lube, maybe that
would have helped, but I don ’ t know . Apparently if
you ’ re tense it hurts more, I guess, which makes sense
really , but I don ’ t see how you couldn ’ t be tense [ laugh ]
in that kind of situation . (Emma)
Y oung men in our study , while often keen on anal sex
in principle, were somet imes unenthusiastic about the
physical reality: “ I thought it was going to be a lot better
to be honest ” (Ali); “ sometimes it does feel better [than
vaginal sex] but I wouldn ’ t say I preferred it ” (Max) .
From the young people ’ s accounts, it seems that
condoms wer e not often used, and when the y wer e it
was usually for basic hygiene, not sexually transmitted
infection (STI) prev ention: “ so you don ’ t get shit on
your dick ” (Carl ) . Some interviewees incorrectly sta ted
that anal STI tr ansmis sion was impossib le, or less likely
There w ere marked gender differences in how anal
sex was described: its bene fi ts ( pleasure, indicator of
sexual achiev ement) wer e e xpected for men but not
women; its risks — inter view ees rarely mentioned risks of
STIs, focusing ins tead on risk of pain or damaged repu-
tation — w ere expected for women but not men . Our
inter view ees did not describe anal sex as a way to pre-
ser ve virginity or avoid pregnancy .
2 Marston C, Lewis R . BMJ Open 2014; 4 :e004996 . doi:10 .1136/bmjopen-2014-004996
The main reasons given for young people ha ving anal
sex wer e that men wanted to copy what they saw in porn-
ography , and that ‘ it ’ s tighter ’ . The implication was that
‘ tighter ’ was better for men and was somet hing men
wer e said to want, while women wer e expected to fi nd
anal sex painful, particul arly the fi rst time . The ‘ pornog-
raphy ’ explana tion seems partial at best, not least
because young people only seemed to see this as motiv-
a ting men, not women . W e found other important
explana tions and motivations in young people ’ s
a ccoun ts, as we will see below .
Key themes emerged from our inter views that help
explain why the pra ctice continued desp ite narra tives of
women ’ s reluctance, expecta tions of pain for women and
apparent lack of pleasure for women and men: competi-
tion between men; the claim that ‘ people must like it if
they do it ’ (alongside the seemingl y contradictory expect-
a tion that it will be painful for women); and — crucially —
normalisation of coercion and ‘ accidental ’ penetra tion .
While not all young men in the s tudy w anted to have
anal sex (eg, saying it was ‘ not for them ’ ), many men
said they encouraged one another to try the pra ctice,
and men and women said men wanted to tell their
friends that they had had anal sex . Men in a group dis-
cussion said anal sex was ‘ something we do for a compe-
tition ’ , and ‘ every hole ’ s a goal ’ . By contrast, men and
women said women risked their reputa tion for the same
a ct , a se xual double standard familiar from previous
People must like it if they do it
Despite asserting that anal sex is inevitably painful for
women, and despite not usually linking pain to any
sexual pleasur e, men and women often also expr essed
the seemingly contradictory view that anal sex was in fact
Obviously people do enjoy it if they do it . (Naomi)
There ’ s quite a few , a lot of girls enjoy it . But I think
most girls would like, I think they might do, on the quiet .
That it ‘ must ’ be enjoyable was typically suggested as
an e xplanation by those who had not engaged in the
W omen experiencing pain were often depic ted as
naive or fl aw ed . Men and women said that women
needed to ‘ relax ’ more, to ‘ get used to it ’ :
I think that the boy enjoys it . I think it ’ sd e fi nitely the
boy that pushes for it from wa tching porn and stuff, they
wanna try it . The girl is scared and thinks it ’ s weird, and
then they tr y it because the boyfriend wants them to .
They normally don ’ t enjoy it because they ’ r e scared and I, I
know that like with anal, if you ’ r e not willing, you don ’ t relax ,
like if you have, you hav e control ov er two of the muscles
that ar e closest to the outside and then inside it ’ s like
involuntary and if you ’ r e scared or you hav en ’ t eased
them off like they stay tight and then you can rip ’ em if
you try and force anal sex . (Mark [our emphasis])
Note that Mark refers, almost casually , to the idea that
a woman might be ‘ scared ’ or ‘ not willin g ’ in a scenario
in which anal sex is possibly taking place, seemingl y
assuming a shared understanding with the inter view er
that this would often be the case . Elsewhere in the inter-
view , he talks about having hurt his partner during an
anal sex ‘ slip ’ (see below), and so his talk about ‘ easing
off ’ ma y r e fl ect his own — perhaps mor e r ecent — under-
standing of how it ‘ should ’ be per formed .
Normalisation of coercion and ‘ accidental ’ penetration
The idea that women would generally not wish to
engage in anal sex, and so would need to be either per-
suaded or coerced, seemed to be taken for granted by
many particip ants . Even in other wise seemingl y commu-
nicativ e and caring partnerships, some men seemed to
push to have anal sex with their reluctant partner
despite believing it likely to hurt her (although it should
also be noted that other men said they av oided anal sex
because they believed it might hurt their partners) .
Persuasion of women was a feature to a greater or lesser
degree of most men ’ s and women ’ s narra tives about
anal sex events, with repea ted, emphatic requests from
W omen seemed to take for gr anted that they would
either acquiesce to or resist their partners ’ repeated
reques ts, rather than being equal partners in sexual
decision-making . Being able to say ‘ no ’ was often cited
by the women as a positive example of their control of
Some men also described taking a ‘ try it and see ’
approa ch, where they anally penetr ated a woman with
their fi ngers or penis and hoped that she would not
Shane told us if a woman said ‘ no ’ when he started
“ putting [his] fi nger in ” , he might keep trying: “ I can be
very persuasive [ … ] . Like sometimes you just keep
going, just k eep goin g till they just get fed up and let
‘ T ry it and see ’ generally either hurt the woman or
was ‘ unsucces sful ’ ( from the man ’ s poin t of view) in the
sense of not penetrating ‘ it just didn ’ t go in really ’ .
( Jack) A verbal ‘ no ’ from the woman did not necessarily
[Interviewer] Had he asked you fi rst or did he just try it?
Marston C, Lewis R . BMJ Open 2014; 4 :e004996 . doi:10 .1136/bmjopen-2014-004996 3
Um, he kept asking me at fi rst . I ’ m like ‘ no ’ , but then he
tried it and I said ‘ no wa y ’ .
In some cases, anal pen etra tion of the woma n — digital
or penile — was described by men and women as having
happened accidentally ( ‘ it slipped ’ ) . For instance, Mark,
mentioned above, told us about a time when he
‘ slipped ’ during a vagina-penis intercourse and pene-
Owing to the nature of the data — we rely on reports at
interview — it is dif fi cult to assess the e xtent to which
events described as ‘ slips ’ wer e genuinely unintentional .
One man, how ever , describe d a ‘ slip ’ at the fi rst inter-
view , which he said to the inter view er — and said he had
told his girlfriend — was an accident, an account which
he amended at the second inter view:
[Interviewer] I think you said [ … ] in the fi rst inter view
that ther e had been a time where [ … ] you said it [his
W ell I, I tried, and I said it slipped .
[Interviewer] So it hadn ’ t actually slipped? It wasn ’ ta n
No, no, no it wasn ’ t an accident . ( Jack)
Describing events as ‘ slips ’ , then, may enable men and
women to gloss over the possibility that penetra tion was
The narr atives suggested little expecta tion that young
women themselves would want anal sex . Many young
men, on the other hand, clearly described wanting to
penetra te a woman anally . This mismatch may help
explain why ‘ slips ’ and ‘ persuasion ’ of the woman wer e
common featur es of the narrativ es about anal sex .
Among those who had had anal sexual experiences, few
of the men and only one woman among this young age
group referred to physical pleasure in their accounts .
Alicia, the only woman narra ting pleasurable anal pene-
tra tion, exempli fi es some of the complexities involved in
women ’ s naviga ting (and narrating) anal sexual pra c-
tices . She described a fairly common pattern: her
partner asked for anal sex, which she fi rs t refused but
later agreed to . She found it painful, and also had a
second experience where her consent to anal penetra-
tion was questionable ( ‘ it just kind of slipped in ’ ) . She
was atypical, how ever , in that she related the story in a
positive wa y emphasising her own agency ( ‘ I was curious
about it ’ ) and described how she had subsequen tly
enjoyed anal sex, sugge sting that they had found a mutu-
ally satisfa ctor y way to engage in the practice .
Her partner had had anal sex before . The fi rst time
she had anal sex with him was ‘ really painful ’ :
I didn ’ t wanna try it [anal sex] initially , well I was unsure
about it initially . But I kind of, he didn ’ t, he said ‘ that ’ s
fi ne ’ , but I still wanted to try it for him because I was
interes ted . I think I was interes ted to why he was inter -
ested . I was curious about it [ … ] So I think that ’ s[ … ]I
just sort of tried it for him .
She described the second occasion they had anal se x
differently in the fi rst and second inter views:
[First inter view] W e wer e having [vaginal ] se x another
time and it [his penis] just kind of slipped in [into her
[Second inter view] He just sort of slipped in [ … ] I think
he thought it would make it less painful for me . And I
think he thought he can make me like it like that .
At the fi rst inter vie w , Alicia was ambiguous about what
happened, narra ting the event as though it w ere a cci-
dental ( ‘ it just kind of slipped in ’ ), perhaps reluctant to
dra w a ttention to not having been involv ed in the deci-
sion . At the second inter view , she was clearer tha t he
had delibera tely penetrated her (she may also hav e
spoken to her partner about it between inter views) . She
presents it in a somewha t positive way ( ‘ he thought he
can make me like it ’ ) but he r consent remains unclear .
At both inter views, she emphasised how much she
enjoyed subsequent anal sex with the same man, and
that either of them might initiate it . Alicia was the only
woman we inter view ed who described experiencing
pleasure, including orgasm, from anal sex .
Y eah . I quite like it because I think I quite like the
feeling of him against my bum, like against the meat of
your bum, like it ’ s kind of cushiony . So yeah, I think
that ’ s what I like about it, I ’ m not sure .
Alicia ’ s case w as also unusual in how she presented
herself in relation to her partner as more sexually
driven: “ I ’ m not saying that I ’ m like wanting sex [all
pra ctices, not only anal sex] all the time, but I ’ ds a yIg o
for it more . I ’ d initiate it more ” .
In a previous work, we hav e shown how interpretations
of apparently coercive events can change ov er time
and it is possible that better , later e xperiences in the
context of a continuing rela tionship had allowed her to
incorpora te the initial, less enjoyable ones into a narra-
tive of personal sexual growth within a stable rela tion-
ship, particularly as she came to enjoy the practices that
she had found painful at fi rst .
Despite being generally positive, Alicia ’ s a ccoun t also
contains indications of reluctance ( “ I didn ’ t wanna try it
[ . . .] I was unsure ” ) . It
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