MI Science Staff: August 2016

Anal sex is currently a “hot topic” of discussion for it is increasingly prevalent among young men and women, and older adults.1 In 2007, a study based on the National Survey of Family Growth (NSFG), found that one-third of U.S. men and women had experienced heterosexual anal sex.2 In the study, starting from the age 15, the percentage of participants reporting heterosexual anal sex increased with age, was significantly higher among 20-24 year olds and peaked among 30 to 34 year olds. Another study conducted by the University of Indiana asked questions on heterosexual anal sex and found that the percentage having anal intercourse within the past year demonstrated a similar age breakdown as that of the NSFG.3

Adolescents are also practicing heterosexual anal sex; and again, the prevalence increases with age. Only 5% of females ages 16-17 reported receptive anal intercourse over the past year, while 18% of females aged 18-19 years reported the same activity.3 A smaller study sample from a 2007 study looking at “main” and “casual” sexual relations among urban minority adolescent females found that teen girls with “casual” partners and those with a “main” partner had a similar percentage experiencing anal intercourse (12% and 16% respectively). The frequency of heterosexual anal intercourse increased in teens with “main” partners.4

Are there health concerns regarding heterosexual anal intercourse? Of course – as with all types of sexual activity – there are both emotional and physical pitfalls. People need to be educated about the dangers of anal intercourse, so they can make an informed decision about whether or not to participate in the activity. Heterosexual anal intercourse predominantly impacts the health of young females as compared to young males. These same risks can affect women of any age. Some examples follow:

A) A small Guttmacher Institute study (28 women) from 2009 reports that 25% of the women interviewed had been forced into having anal intercourse at least once. It goes on to say, “Coercion and violence notwithstanding, many participants reported pain and discomfort, including emotional distress, during anal intercourse.” 5 Furthermore, a qualitative study from the United Kingdom concludes, “Young people’s narratives normalized 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 normalize coercion.” 1 It is the woman who is being coerced and feels the pain.

B) Anal intercourse can eventually lead to fecal incontinence. A February 2016 study concludes: “The findings support the assessment of anal intercourse as a factor contributing to fecal incontinence in adults, especially among men.” 6 In the case of heterosexual anal intercourse it is the woman who is at risk to develop fecal incontinence.

C) The American Cancer Society reports, “Receptive anal intercourse also increases the risk of anal cancer in both men and women, particularly in those younger than 30.” 7 HPV (human papillomavirus) is the main cause of anal cancer; but apparently, anal intercourse in particular increases the likelihood that the virus will attack the anus or rectum. Multiple sexual partners is also listed as a risk factor for anal cancer. Again, it is the woman experiencing heterosexual anal intercourse who is at risk.

D) The Center for Disease Control and Prevention (CDC) just released (August 2016) a new fact sheet on “Anal Sex and HIV Risk”. The first statement on the page says, “Anal sex is the riskiest sexual behavior for getting and transmitting HIV for men and women.” It goes on to say that receptive anal sex is 13 times more risky than insertive anal sex for acquiring HIV infection.8 In heterosexual anal intercourse, it is the woman who is always experiencing the highest sexual risk for the transmission of HIV, receptive anal intercourse. Furthermore, receptive anal intercourse carries a risk 17 times greater than receptive vaginal intercourse. Moreover, receptive anal intercourse even carries a risk 2 times greater than that of needle-sharing during injection drug use.9

In August 2016 the CDC also reported that using condoms consistently reduced the risk of acquiring HIV on an average of 63% for insertive anal intercourse and 72% for receptive anal intercourse with an HIV-positive partner. Because “condoms are not 100% effective” the CDC advises that one “consider using other prevention methods to further reduce your risk.” That would require taking a medication, pre-exposure prophylaxis (PrEP), which has to be taken consistently. Obviously, protecting oneself against acquiring HIV when practicing anal sex is complex. Therefore, heterosexual anal sex is obviously very high risk to the woman, 8 especially in locations where HIV prevalence is high. (At best, HIV remains a serious chronic disease requiring a lifetime of treatment and medical follow up; at worst it can result in mortality.)

E) The CDC reports that in addition to the same sexually transmitted infections that are passed through vaginal sex (gonorrhea, etc.), anal sex can also expose participants to hepatitis A, B and C; parasites like Giardia and intestinal amoebas; bacteria like Shigella, Salmonella, Campylobacter, and E. coli.8

There is a lot of misinformation on the internet on heterosexual anal intercourse. As a result the Medical Institute is concerned that the public in general, and adolescents and young adults in particular, are not receiving the whole truth about heterosexual anal sex. Therefore, MI would like to encourage sex educators, health providers, counselors, youth workers and parents to include specific information about anal sex in their communication with adolescents and young adults. (Receptive anal sex carries the same risks for both men and women). For women there appears to be a high degree of coercion and emotional distress associated with heterosexual anal intercourse; this aspect should be included in healthy and unhealthy relationship education.

In summary, the information provided shows receptive anal intercourse to be a very high-risk sexual activity for women as well as men: fecal incontinence, anal cancer, HIV infection, etc. Awareness of these substantial health risks can enable women of all ages to emphatically say no to anal intercourse.

References:

1. Marston C and Lewis R, “Anal heterosex among young people and implications for health promotion: a qualitative study in the UK., BMJ Open, 2014 http://bmjopen.bmj.com/content/4/8/e004996.full

2. Leichliter JS, Chandra A, Liddon N, et al, “Prevalence and Correlates of Heterosexual Anal and Oral Sex in Adolescents and Adults in the United States,” Journal of Infec Dis (2007) 196 (12):1852-1859.

3. Herbenick D, Reece M, Schick V, et al, “Sexual Behavior in the United States: Results from a National Probability Sample of Men and Women Ages 14-94,” The Journal of Sexual Medicine October 2010, Vol. 7, Supple 5, pages 255-265.

4. Houston AM, Fang J, Husman C and Peralta L, “More than just vaginal intercourse. Anal intercourse and condom use patterns in the context of “main” and “casual” sexual relations among urban minority adolescent females,” Journal of Pediatric and Adolescent Gynecology, 20, 299-304 (2007).

5. Maynard E, Carballo-Dieguez A, Ventuneac A, et al, “Women’s Experiences with Anal Sex: Motivations and Implications for STD Prevention,” Perspec Sex Reprod Health Volume 41, Issue 3, September 2009, Pages 142-149

6. Markland AD, Dunivan GC, Vaughan CP and Rogers RG, “Anal Intercourse and Fecal Incontinence: Evidence from the 2009-2010 National Health and Nutrition Examination Survey,” The American Journal of Gastroenterology 111, 269-274 (February 2016) http://www.nature.com/ajg/journal/v111/n2/full/ajg2015419a.html

7. American Cancer Society, “What are the Risk Factors for Anal Cancer?” http://www.cancer.org/cancer/analcancer/detailedguide/anal-cancer-risk-factors

8. Centers for Disease Control and Prevention, “Anal Sex and HIV Risk,” http://www.cdc.gov/hiv/risk/analsex.html

9. Centers for Disease Control and Prevention, “HIV Risk Behaviors,” http://www.cdc.gov/hiv/policies/law/risk.html