As a sex educator, one of the topics I get asked about most often is anal sex. Given how curious people seem to be about this activity, I thought it would be worth putting together a brief guide that addresses some of the most common questions people have about anal sex. So, here goes:

1.) Anal sex is a very popular sexual activity in the United States today, with CDC research suggesting that close to one-half of men and about one-third of women have had anal intercourse before.

2.) Of course, anal intercourse is just one of many forms of anal stimulation that people might engage in. For instance, some practice oral-anal stimulation (rimming), some use their hands (fingering and, in some cases, fisting when the entire hand is used), and yet others use sex toys (such as when a woman performs anal sex on a man while wearing a strap-on, an activity known as pegging). We don’t have good data on how common these other anal activities are because researchers don’t routinely ask about them in national sex surveys.

3.) Although a lot of people are engaging in the activities noted above, not everyone considers anal stimulation to be a form of sex. While people largely agree that anal intercourse constitutes sex, they’re much more split about whether the other kinds of anal activities “count.”

4.) While anal intercourse is the sexual activity people most commonly associate with gay men, research actually finds that men who have sex with men engage in other activities—like oral sex and mutual masturbation—far more frequently.

5.) Research finds that people engage in anal intercourse for a wide range of reasons and their attitudes toward it vary widely. For example, while some truly desire this activity and find it very pleasurable, others do it primarily to please a partner and find the experience to be physically uncomfortable.

6.) There are several things you can do if you want to try and make anal intercourse more pleasurable, including: relaxation, slow and gentle penetration, lubrication, and frequent communication. For more information on safe and pleasurable anal sex, see here.

7.) These guidelines won’t work for everyone, though, because studies suggest that around 10-15% of people report severe pain every time they’re on the receiving end of anal intercourse. We don’t fully understand why, but it may be because certain people are just more sensitive down there, or perhaps because some people have medical or health conditions that make this activity very uncomfortable.

8.) Some research has linked anal intercourse to a very high likelihood of orgasm for both men and women (higher than for other sexual activities). However, the thing that’s unclear about this research is whether anal sex actually increases the odds of orgasm, or whether the odds of orgasm are simply higher due to the fact that people who practice anal sex tend to have the most variety in their sexual activities.

9.) A lot of people are worried about whether receiving anal sex is harmful to their health (beyond the obvious risk for STIs). However, research suggests that the vast majority of people who do it don’t seem to report any issues with their anal health or functioning. However, for those who practice more extreme anal acts—things like double penetration and fisting—the potential for complications and injury is higher.

10.) If you’re going to engage in anal activities, take precautions to protect yourself from STIs and other infections. For instance, if practicing rimming, consider using a dental dam to decrease infection risk (intestinal infections can be passed along through this activity). If practicing manual stimulation, remove jewelry, keep fingernails short, and consider using latex gloves. And if practicing anal intercourse, use condoms. Of course, PrEP can also help if you want to further reduce your risk of HIV—however, remember that PrEP doesn’t protect you from other STIs, so condoms are still needed for maximum protection.

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