ANAL SEX: PAIN OR PLEASURE?

I AM A 23-YEAR OLD FEMALE AND I LOVE MY BOYFRIEND DEARLY. WE HAVE SEX EVERY CHANCE WE CAN MEET, AT LEAST 2-3 TIMES A WEEK, WHICH WE BOTH ENJOY. HOWEVER, RECENTLY, MY BOYFRIEND HAS BEEN ASKING ME TO ENGAGE IN ANAL SEX. IS THERE ANY HARM OR DANGER THIS CAN CAUSE ME?

Anal sex is a practice that is surprisingly more common among women, the statistics being 37.3% in women and 4.5%. in men[1] There are several reasons couples would engage in anal sex:

  1. For women who do not want to lose their virginity, anal sex provides the intimacy and possibly the sexual pleasure without having to break the hymen.[2] It .gives men pleasure on their organ from the tightness of the sphincter muscles.
  2. Women who have their period or have a vaginal discharge may resort to anal sex as a substitute for vaginal sex. [3]
  3. Couples who are not or don’t want to use contraceptives feel that this is an alternative method to sex that will not lead to pregnancy.
  4. In a sample of sample of 1,893 women aged 18-60 years, 58% of them who continued to practice anal intercourse (58.1%) reported it to be very arousing and pleasurable. [4] In fact, some women who cannot achieve orgasm by vaginal sex claim to have orgasms with anal sex.[5]
  5. Some women experience positive emotional experiences with anal sex, especially if they do it to please a partner desirous of anal sex. Many women feel that it is more intimate than vaginal sex and that it is something that they reserved only for special partners.3
  6. Many women also claimed they had anal sex because they were on drugs, and because they were given drugs or money in exchange for anal sex.2
  7. Some women engage in it because they are just downright curious about it or because of the heat of the moment, which may increase the risk-taking behavior. The very taboo of anal sex makes it sexually appealing for some women.

What harm can anal sex do? Before engaging in it, here’s what you need to consider.

The vagina was designed by nature for sex. During sexual arousal, the vagina lubricates due to the increased blood flow to the genitals, causing the vaginal tissue to become engorged with blood, and lubrication to be produced. the vagina expands by lengthening (called vaginal tenting and widening in shape (called ballooning). This results in the cervix being drawn higher into the pelvis, creating more space.[6] 

  1. In contrast, the anus has no built-in mechanism for lubrication so lubricants have to be used in order to prevent tearing and bleeding.
  2. The anus is made up of two sphincters, the function of which is to prevent the feces from exiting until the time is right. The internal sphincter muscle is involuntary, meaning it is automatically controlled just like respiration. The external sphincter is a voluntary muscle but it takes practice to deliberately relax this when poked for sex. Both these muscles have to relax during anal sex to avoid tears and bleeding.
  3. Many women report pain, discomfort and emotional stress with anal sex. Mild intestinal discomfort and disrupted bowel movements have also been reported as an after effect of anal intercourse.1
  4. Tearing of the sphincter muscles during anal sex can cause anal fissures that may lead to pain, bleeding and fecal incontinence. This refers to the involuntary as leakage of mucus, liquid, and/or solid stools at least once monthly.[7] Damage to the internal and external muscle sphincters can lead to lower atrophy of the muscle and damage to the nerves leading to sensory deficits as evidenced by lower resting pressure of the sphincters, thus, leading to fecal incontinence.[8]
  5. Because the tissue inside the anus is thinner, delicate, and more likely to tear and bleed as a result of penetration, compared to the vagina, anal sex increases the likelihood of passing infections, viruses, or bacteria between partners. Anal intercourse is associated with higher rates of heterosexual HIV transmission than vaginal intercourse.[9] Researchers found that HIV negative women who practiced anal intercourse in addition to vaginal and/or oral intercourse with HIV positive male partners were approximately four times as likely to acquire HIV than women who did not practice anal intercourse.[10]
  6. Even if neither partner has a sexually transmitted disease, bacteria can be passed between each other through tears in the skin. The bacteria that is responsible for about 90 percent of uncomplicated UTIs is commonly found in the gastrointestinal (GI) tractand known as Escherichia coli, or E. coli. This makes unprotected anal sex a common cause of UTI after sex. It is therefore advised that when engaging in anal sex, a condom should be used because of the bacteria present in the rectum which can cause urinary tract infections both in males and in females . This is especially true if no change in condom or if no condom at all is used for vaginal sex immediately after anal sex.
  7. Having said that, the condom is not entirely reliable for protection against HIV and other infections during anal sex. The US Food and Drug Administration has only cleared condoms for use during vaginal intercourse and has warned against the use of condoms during anal intercourse.[11]Because the anatomy of the anus differs from the vagina and there are differences in the friction and compression between anal intercourse and vaginal intercourse, condoms can possibly rupture with anal intercourse.  Behaviors associated with condom breakage were unrolling the condom before fitting to the penis, longer penis length, absence of additional lubricant, the use of inappropriate lubricant, and longer duration of intercourse.[12]

To have safe anal sex and optimize the sexual experience, remember the following:

  1. Communication is key. Research shows that about one in four had anal sex without being consulted or agreed upon and this happened whether the partner was new or not.[13] Some men may not imagine how painful or uncomfortable the experience may be. Psychological preparation and trust in the partner to insure relaxation is key to relaxing the anal sphincters. An unexpected sabotage from the rear will cause you to defend her behind by constricting your anus and if your partner insists on ramming his organ, this can lead to tear and bleeding
  2. Psychological pressure must be discussed – You must be given autonomy to consent or withraw your consent without being shamed for refusing. Some men can get pushy and selfish in insisting the woman should give in to him as an expression of her love. No one should ever be obliged or forced into anal sex. Mutual consent is important for both of you to enjoy the experience. If you’ve tried it and absolutely dislike it, do not feel pressured to give in.
  3. Have a safe word. Agree on a word to mean “STOP” while engaging in anal sex when it gets too uncomfortable or downright painful. There has to be teamwork and cooperation and it should not be a one-sided martyr-like activity.
  4. Plan ahead. It’s best to prepare yourself for the activity by avoiding certain food that increase the chances of gas and passing gas: beans, onions, dairy, eggs, wheat and whole grains and cabbage. Emptying your rectum, and cleaning yourself to minimize slip-ups can give you the confidence that can promote the relaxation necessary for you not to constrict the sphincters. But even with preparation, expect that there can be some poop that can come out and cause some mess. As long as you’re both fine with that, it should not diminish your pleasure.
  5. Condoms must be used. Because of the increased risk for infections, especially the spread of HIV and sexually transmitted diseases, as well as the pathogenic bacteria that reside in the rectum, condoms can be protective both for you and your partner. The condom must be changed and you both should wash before shifting to vaginal intercourse or oral sex.
  6. Lotsa lube. Lubrication is essential since the rectum does not have a build-in mechanism for lubrication. A non-allergenic lubricating jelly is a must and a generous helping will help make the sensation less painful. A water-based lubricant minimizes the risk of breaking the condom.
  7. Go slow. Jumping straight into anal penetration can be a recipe for disaster and trauma. Women usually need around 20 min for foreplay to stimulate arousal. Start with one finger anal penetration followed by two fingers or a sexual toy before full-blown anal penetration. You might want to take time to get used to the rectal pressure by just holding each other for a while until you to get used to the sensation of his organ on your behind before he actually thrusts. This will give you ample time to allow your rectal sphincter to relax.
  8. Find your most comfortable position. For some women, placing a pillow on their belly in doggy style exposes the anus best with minimal discomfort. For some women, the missionary position works better. A side-lying position may also be comfortable and offers the additional advantage of being hugged and caressed at the same time. Find whatever position gives you the best sensation with the least discomfort.

In the absence of coercion, you and your partner can create the best conditions for mutual pleasure. Some couples find that it adds another armamentarium to the sexual repertoire to take sex to a different level of intimacy not shared with anybody else. As long as safety and mutual pleasure is achieved, the boundaries for sex are what you set it to be.

1.  Markland AD, Dunivan GC, Vaughan CP, Rogers RG. Anal Intercourse and Fecal Incontinence: Evidence from the 2009-2010 National Health and Nutrition Examination Survey. Am J Gastroenterol. 2016;111(2):269-274. doi:10.1038/ajg.2015.419

2. Goldstone SE, Welton ML. Anorectal sexually transmitted infections in men who have sex with men–special considerations for clinicians. Clin Colon Rectal Surg. 2004;17(4):235-239. doi:10.1055/s-2004-836944

3.  Reynolds GL, Fisher DG, Rogala B. Why women engage in anal intercourse: results from a qualitative study. Arch Sex Behav. 2015 May;44(4):983-95. doi: 10.1007/s10508-014-0367-2. Epub 2014 Nov 7. PMID: 25378264; PMCID: PMC4379393.

4. Stulhofer A, Ajduković D. A mixed-methods exploration of women’s experiences of anal intercourse: meanings related to pain and pleasure. Arch Sex Behav. 2013 Aug;42(6):1053-62. doi: 10.1007/s10508-012-0068-7. Epub 2013 Mar 22. PMID: 23519588.

5.  https://medium.com/moments-of-passion/the-anatomy-of-anal-sex-71ee58646823

6]. Levin RJ. Recreation and procreation: A critical view of sex in the human female. Clin Anat. 2015 Apr;28(3):339-54.

7.  Rockwood TH, Church JM, Fleshman JW, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum. 1999;42:1525–32. [PubMed] [Google Scholar]

8.  Mitrani C, Chun A, Desautels S, et al. Anorectal manometric characteristics in men and women with idiopathic fecal incontinence. J Clin Gastroenterol. 1998;26:175–8. [PubMed] [Google Scholar]

9.   Leynaert B, Downs AM, de Vincenzi I. Heterosexual transmission of human immunodeficiencyvirus: Variability of infectivity throughout the course of infection. American Journal of Epidemiology. 1998;148(1):88–96.

10.  Guimarães MDC, et al. HIV-infection among female partners of seropositive men in Brazil. American Journal of Epidemiology. 1995;142(5):538–547. [PubMed] [Google Scholar]

11.  Kim M, McKenney J, Khosropour CM, et al. Factors Associated With Condom Breakage During Anal Intercourse: A Cross-Sectional Study of Men Who Have Sex With Men Recruited in an Online Survey. JMIR Public Health Surveill. 2016;2(1):e7. Published 2016 Feb 22. doi:10.2196/publichealth.5298

12.  Golombok S, Harding R, Sheldon J. An evaluation of a thicker versus a standard condom with gay men. AIDS. 2001 Jan 26;15(2):245-50. doi: 10.1097/00002030-200101260-00015. PMID: 11216934.

13.  Maynard E, Carballo-Diéguez A, Ventuneac A, Exner T, Mayer K. Women’s experiences with anal sex: motivations and implications for STD prevention. Perspect Sex Reprod Health. 2009;41(3):142-149. doi:10.1363/4114209

 
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