Clinicians’ reluctance to discuss possible harms of anal sex may be letting down a generation of young women who are unaware of the risks, two researchers from the UK write in an opinion article published today in The BMJ.
Failure to discuss the subject “exposes women to missed diagnoses, futile treatments, and further harm arising from a lack of medical advice,” write Tabitha Gana, MD, and Lesley Hunt, MD, with Sheffield Teaching Hospitals NHS Foundation Trust and Northern General Hospital, Sheffield, United Kingdom.
In their opinion, 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.”
Asking about anal sex is standard practice in genitourinary medicine clinics, but it’s less common in general practice and colorectal clinics, they point out.
No Longer Taboo
Anal intercourse is becoming more common among young heterosexual couples. In the UK, participation in heterosexual anal intercourse among people aged 16-24 years rose from about 13% to 29% over the last few decades, according to national survey data.
The same thing is happening in the United States, where research suggests 30%-44% of men and women report having anal sex.
Individual motivation for anal sex varies. Young women cite pleasure, curiosity, pleasing the male partners, and coercion as factors. Up to 25% of women with experience of anal sex report they have been pressured into it at least once, Gana and Hunt say.
However, because of its association with alcohol, drug use, and multiple sex partners, anal intercourse is considered a risky sexual behavior.
It’s also associated with specific health concerns, Gana and Hunt point out. These include fecal incontinence and anal sphincter injury, which have been reported in women who engage in anal intercourse. When it comes to incontinence, women are at higher risk 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, and damage caused by anal penetration is therefore more consequential,” Gana and Hunt point out.
“The pain and bleeding women report after anal sex is indicative of trauma, and risks may be increased if anal sex is coerced,” they add.
Knowledge of the underlying risk factors and taking a good history are key to effective management of anorectal disorders, they say.
Gana and Hunt worry that clinicians may shy away from talking about anal sex, influenced by society’s taboos.
Currently, NHS patient information on anal sex considers only sexually transmitted infections, making no mention of anal trauma, incontinence, or the psychological aftermath of being coerced into anal sex.
“It may not be just avoidance or stigma that prevents health professionals [from] 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,” Gana and Hunt write.
“However, by avoiding these discussions, we may be failing a generation of young women, who are unaware of the risks,” they add.
“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,” Gana and Hunt say.
This research had no specific funding. Gana and Hunt report no relevant financial relationships.
BMJ. Published online August 11, 2022. Editorial