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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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Young women and anal sex

Should covid-19 vaccines and drugs be “not for profit”?
Copyright © 2022 BMJ Publishing Group Ltd
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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Gwyneth Paltrow has imparted her unsolicited advice on many things – from vagina steaming to ex-purging bra-burning – and now she's decided to tell us what she's learned about anal sex.
In the Sex Issue of Goop , Paltrow's lifestyle site, readers are told that if "anal turns you on, you are definitely not alone".
"First it was shocking, then it was having a cultural moment, now it's practically standard in the modern bedroom repertoire – or so a quick scan of any media, from porn to HBO, will tell you,' says Goop. "But the reality about anal is not, actually, that everyone's doing it."
The piece points out that while "somewhere near half" of homosexual men practise anal sex, the number of heterosexual men and women who've tried it "vacillates between 30 and 40 percent".
The piece then offers question-and-answer-based advice from the research psychoanalyst and author Paul Joannides , who has published a book on sexuality called The Guide To Getting It On!
He goes on to explain the health risks of anal sex, how to modify the anal sex seen in porn, how to make sure your anal experience is a positive one and what should we be telling our children about anal intercourse.
So there we have the completely unprompted Gwyneth Paltrow guide to anal sex. You're welcome.

Posted on January 29, 2016
- By
Meg Butler

Comment Disclaimer: Comments that contain profane or derogatory language, video links or exceed 200 words will require approval by a moderator before appearing in the comment section. XOXO-MN

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We never would have guessed in a million years that anal play was quite so popular behind closed doors in Hollywood. But we would have been wrong on several counts if we would have assumed it wasn’t true. These celebrities were very upfront about what they like out back. And all of our jaws are still on the floor. You’ll never believe which red carpet regulars like backdoor action — and how comfortable they are with telling people what they really like in the bedroom.
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He wouldn’t mind eating hers, likes his munched on, and isn’t afraid to give all of the hilarious details about how it goes down.
We’ll just leave this quote from 2009 right here:
“I like fu–ing a–! Ain’t nothin’ like the butthole. The a– is a delicacy, goddamn it. I’d put hot sauce on it. When you eat the brown hole, that’s when her toes do this.” [Sticks legs out and curls toes]
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