Surgeons have warned that clinicians’ reluctance to discuss the possible harms of anal sex is letting down a generation of young women who are unaware of the risks.
New research from the UK’s Sheffield Teaching Hospitals NHS Foundation Trust, published August 11th in The BMJ, has found that as anal intercourse becomes more common amongst heterosexual couples, failure to discuss it exposes women to missed diagnoses, futile treatments, and further harm arising from a lack of medical advice.
In Britain, the National Survey of Sexual Attitudes and Lifestyle showed that participation in heterosexual anal intercourse among 16- to 24-year-olds, rose from 12.5% to 28.5% over the last few decades, with similar trends seen in the US where 30-44% of men and women reported having anal sex.
Authors and surgeons, Dr Tabitha Gana and Dr Lesley Hunt, said that 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-judgemental conversations to ensure that all women have the information they need to make informed choices about sex.”
Anal intercourse is generally considered a risky sexual behaviour because of its association with alcohol, drug use and multiple sex partners, 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 (STDs) and anal malignancy. Anal pain, bleeding, and fissures also occur as a result of anal intercourse,” Dr Hunt said.
“[Similarly], increased rates of faecal incontinence and anal sphincter injury have been reported in women who have anal intercourse, and women are also at a higher risk of incontinence than men, due to their different anatomy.
“The pain and bleeding women report after anal sex is indicative of trauma, and risks may be increased if anal sex is coerced.”
Young women cited pleasure, curiosity, pleasing the male partners and coercion as factors, with up to 25% of women with experience of anal sex said that they have been pressured into it at least once.
The researchers highlighted that effective management of anorectal disorders requires understanding of the underlying risk factors, and ‘good history taking is key’ – yet clinicians may shy away from these discussions, influenced by society’s taboo.
“It may not be just avoidance or stigma that prevents health professionals talking to young women about the risks of anal sex,” Dr Hunt said.
“There is genuine concern that the message may be seen as judgmental or even misconstrued as homophobic.”
The issue is compounded in the UK by the fact that NHS patient information on anal sex only considers STIs, making no mention of anal trauma, incontinence, or the psychological aftermath of the coercion young women report in relation to this activity.
“However, by avoiding these discussions, we may be failing a generation of young women, who are unaware of the risks,” the authors concluded.
“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.”