That anal sex remains taboo may explain why
a study
about anodyspareunia – that is, pain during anal penetration – received
little attention when it was published in the Journal of Sex &
Marital Therapy. The study should have turned heads: It was the first
research on anodyspareunia among women; it was conducted by a
well-respected scientist (Dr. Aleksander Stulhofer from the University
of Zagreb); and it was centered on young women and sex. That’s often the
kind of research that attracts media attention (Young women sext! They
get pregnant! They give oral sex! You get the picture …). However, anal
sex remains such a strong taboo that this otherwise important study
barely turned a head.
Except it did turn mine. Here’s why. In an
incredibly short period of time, anal sex has become a common part of
Americans’ sex lives. As of the 1990s, only about one-quarter to
one-third of young women and men in the U.S. had tried anal sex at least
once. Less than 20 years later, my research team’s
2009 National Survey of Sexual Health and Behavior
found that as many as 40-45 percent of women and men in some age groups
had tried anal sex. With its rising prevalence, I felt it was important
to devote a chapter of my first book, “Because It Feels Good,” to anal
health and pleasure — only to find that a magazine editor wouldn’t
review it because the topic of anal sex was “not in the best interest of
our readership.” Even though nearly half of American women in some age
groups have done it! She added, “In the correct circles, I personally
will be suggesting the book to those with whom I can share such a
resource.”
Hmm.
The correct circles. Which ones would
those be? The ones where scores and scores of women openly sit around
talking about anal sex between glasses of wine?
So taboos persist
and anal sex remains hush-hush even though more people are doing it.
What changed to make it more common, anyway? It’s not entirely clear –
after all, rates of masturbation, vaginal sex, oral sex and other sexual
practices don’t seem to have changed too much. However, it’s commonly
thought that the widespread access to porn played a role.
Some research has found that anal sex was shown in 56 percent of sex scenes studied even though
national data of real people’s sex lives show that fewer than 5 percent of Americans had anal sex during their most recent sexual experience.
Honest,
evidence-based answers to questions about anal sex are difficult to
come by. You’d think we would know more about a behavior that’s become a
common part of Americans’ sex lives – one that, for all its potential
pleasures, remains among the riskiest sex acts when it comes to
spreading sexually transmissible infections (STI) including HIV. Yet
there is strikingly little scientific research on anal sex. The list of
what we don’t know about anal sex is far longer than the list of what we
do. This makes it difficult for sex educators to feel truly confident
in answering people’s very real and important questions.
This is
also what made the recent University of Zagreb study so valuable. They
surveyed more than 2,000 women ages 18 to 30 about their experiences
with anal sex. Building on limited early research about anal pain among
men who have sex with men, the researchers asked about women’s
experiences with pain. This was critical because, as much as we often
talk about anal sex possibly hurting, and lubricant possibly minimizing
pain or discomfort during anal sex, there is almost no research on
women’s experiences of anal sex. One exception is a study that I
conducted with my research team at Indiana University in which we gave
six different lubricants to more than 2,400 women and asked them to use
them during their masturbation, vaginal sex and/or anal sex activities.
Among our interests was whether using a lubricant helped to make sex –
including anal sex – more pleasurable, more satisfying and less painful
(it did).
The Zagreb team found that about half of women (49
percent) stopped their first experience of anal intercourse because it
was too painful to continue – not surprising considering 52 percent of
women report not even using lubricant when they first had anal sex! An
additional 17 percent of women also experienced pain or discomfort
during their first anal sex, but didn’t stop their partner. Only about
one-quarter of women said their first experience with anal sex was
pleasant.
That said, nearly two-thirds tried anal sex again
(hopefully this time with lubricant), continuing on another occasion.
Those women who found it positive, pleasurable and pain-free were more
likely to try it again. About 9 percent of women who had anal sex at
least twice in the past year said that they experienced pain every
single time. Based on what I know about women who experience
pain during vaginal intercourse,
my guess is that chronic pain during anal sex is even more common –
perhaps hovering in the 10-15 percent range – once the women who
actively avoid it because it always hurts are taken into account.
This
9 percent figure is important. It tells us that a similar proportion of
women experience pain consistently during anal sex as experience pain
consistently during vaginal penetration. That’s right: Somewhere around
10 percent of women experience pain during vaginal intercourse or even
during daily activities like sitting down or riding in the car. The 9
percent number is also close to the 10-14 percent range that’s been
identified as the proportion of men who have sex with men who experience
pain during anal sex. And though the Zagreb study asked women what
sense they made of their pain (most blamed themselves or their sexual
practices, suggesting their pain was linked to not feeling fully
relaxed, inadequate anal foreplay, or not using sufficient lubricant),
the fact is that we still don’t know clinically what’s causing their
pain.
It may be that, like the vagina and vulva, the anuses of
some women and men respond to touch or penetration in painful ways and
for unknown reasons. It may be that some of these women and men have
skin disorders, such as
lichen sclerosus,
which can affect genital skin (including anal skin), increasing the
likelihood of discomfort, pain or tearing. Certainly lack of information
and education is at the root of some people’s pain, but it’s probably
not the primary cause for everyone. Some women and men do everything
“right” – they use gobs of lubricant, they start out slowly, relax,
communicate well with their partner, avoid desensitizing or numbing
gels/creams – and yet it still hurts. Do they have an underlying medical
condition that’s contributing to the pain? Wonky nerve receptors that
scream in pain rather than perceive penetration as neutral or
pleasurable? We don’t know.
In case you’re wondering, we also
don’t know much about the long-term effects of anal intercourse.
Certainly enough people have been having anal sex over enough
generations that if anything were seriously dangerous about anal sex, we
would know it by now. But as for questions about how regular anal sex,
rough anal sex or insufficiently lubricated anal sex might ultimately
affect the likelihood of a woman experiencing rectal prolapse or of a
woman or man experiencing various anal or rectal health issues, we don’t
know because no one has studied these kinds of things. It’s 2012 and
pretty much all we know about anal sex is that lots of people have tried
it, there’s a higher degree of risk for STI/HIV transmission (compared
to vaginal sex or oral sex), many people have found it painful on
occasion, many people also find it pleasurable sometimes, and about one
in 10 women and men experience pain during anal sex on a regular basis.
Much of the research
involving HPV and anal cancer is focused on men who have sex with men –
which is needed — even though more women in the U.S. have received anal
sex than the number of men who have received anal sex. That’s not to
say that anal cancer isn’t important to study among men – it very much
is the case – but women get anal cancer, too, and we need to know more
about risk and protective factors (related: check out
this I Have Butt What? blog by a brave anal cancer survivor named Michelle).
Knowledge gap, anyone?
Even
though most people who have had anal sex engage in it only
occasionally, anal sex is a fairly common practice. And if people are
going to engage in sexual behavior, then they deserve enough information
to help make that behavior as safe, pleasurable and satisfying as
possible. To do so, science has to catch up and taboos have to dissipate
enough so that more people feel comfortable talking about it and
sharing their experiences.
