Written by Dr John Dean, specialist in sexual medicine, and Dr David Delvin, GP and family planning specialist
What is it?
Anal sex means sexual activity involving the bottom – in particular, the type of intercourse in which the penis goes into the anus. It is often referred to as ‘rectal sex’. Anal sex does carry some health risks, so please read our advice carefully.
Our impression is that anal sex has become rather more common in heterosexual couples, partly because they have watched ‘blue movies’ in which this activity so often occurs.
One small study carried out in 2009 suggested that 30 per cent of pornographic DVDs which are on sale in the UK feature rectal intercourse. Often, it is presented as something that is both routine and painless for women. In real life, this is not the case.
Other types of sexual activity which involve the anus include:
- ‘postillionage’ – which means putting a finger into the partner’s bottom.
- insertion of ‘butt plugs’ – which are sex toys that dilate the anal opening and create a sensation of fullness.
- use of vibrators on or in the anus (please see cautionary note below).
- ‘rimming’ – which is oral-anal contact; this carries a significant risk of infection.
- ‘fisting’ – which means putting the hand into the rectum; this activity is rare among heterosexual couples.
Taboos and infection
There are taboos surrounding the various types of anal sex – and particularly anal intercourse.
These may arouse strong feelings of moral indignation, guilt and anxiety.
It is important to remember that while some people find these activities repugnant, others may find them stimulating, exciting, and a normal part of their sexual intimacy.
Research shows that, whether we like it or not, the anal area is equipped with many erotic nerve endings – in both men and women. So it is not surprising that many couples (including a lot of heterosexual ones) derive pleasure from some form of ‘bottom stimulation’.
What about infection? Most sexual activities carry a risk of transmission of sexually transmitted diseases (STDs) from gonorrhoea and herpes to hepatitis B and HIV. There is evidence that anal intercourse carries a higher transmission risk than almost any other sexual activity. Information about these risks is given below.
The key issues are legality and consent. In the UK, anal intercourse is a legal activity between consenting men and women aged 16 and over, in both heterosexual and homosexual relationships, except in Northern Ireland where it’s 17 and over.
In some countries it is still a criminal offence punishable by long custodial sentences, corporal or even capital punishment. It remains forbidden in some states of the USA, and in some former colonies of Britain.
Consent freely given by both partners is an essential feature of sexual activity in a loving relationship. Many individuals, both men and women, may have secret fantasies involving anal intercourse but feel unable to discuss them with their partner.
Some may try and pressurise their partner to have anal intercourse, even though the partner does not share their interest. Some partners will reluctantly acquiesce, others may be pressured or even physically forced to allow it.
Forcing or pressurising a partner to submit to an activity that they find distasteful or degrading is completely unacceptable behaviour.
Intoxication with drugs or alcohol is associated with lowering inhibitions and experimentation with unusual or unsafe sexual behaviour – and can lead to serious consequences.
It should be remembered that in the absence of freely given consent, the very serious criminal offences of assault and rape are committed. Therefore, it is essential that both partners agree that they wish to try anal sex as a part of their sexual repertoire and that they are sure of the legal position on anal intercourse in the country that they are in.
Who does it?
There is a common misconception that anal sex is practised almost exclusively by gay men. This is certainly not the case. An estimated one third of gay couples do not include anal intercourse in their lovemaking. About one third of heterosexual couples try it from time to time.
It is thought that about 10 per cent of heterosexual couples have anal intercourse as a more regular feature of their lovemaking. In absolute numbers, more heterosexual couples have anal sex than homosexual couples, because more people are heterosexual.
Is it safe?
Anal sex, if practised with care, is possible for most couples. It does, however, carry additional health risks and there are safer sexual practices that couples can enjoy. The main health risks, which affect both heterosexual and homosexual couples, are described below.
Human immunodeficiency virus (HIV): there is no doubt that anal intercourse carries a greater risk of transmission of HIV – the virus that can cause acquired immunodeficiency syndrome (AIDS) – than other sexual activities, particularly for the receptive partner.
Human papilloma virus (HPV, wart virus): this can be transmitted during anal intercourse and lead to anal warts, which in turn could perhaps predispose infected individuals to cancer of the anal canal.
Hepatitis A (infectious hepatitis): this is a viral infection that can cause jaundice and abdominal pain. Hepatitis A is not usually a life-threatening illness, although sufferers can feel quite ill. It can be transmitted by oral-anal contact.
Hepatitis C: is a cause of progressive and sometimes fatal chronic liver disease. Hepatitis C may be transmitted by anal intercourse, although this seems to be a rare occurrence. Sharing of equipment for intravenous drug use is a far more important risk for transmission.
Escherichia coli (E. coli): may sometimes cause mild to severe, or even (rarely) fatal, gastroenteritis. It is one of many viruses and bacteria that can be transmitted by oral-anal contact. Some E. coli strains (uropathic E. coli) can also cause urinary tract infections (UTIs), ranging from cystitis to pyelonephritis – a serious kidney infection. E. coli very readily crosses the short distance between the female anus and the female urinary opening, so causing a urinary infection. Anal intercourse can facilitate this ‘transfer’ – particularly if it is immediately followed by vaginal intercourse.
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