Young women and anal sex - The BMJ

Within popular culture it has moved from the world of pornography to mainstream media.1 It is no longer considered an extreme behaviour but increasingly portrayed as a prized and pleasurable experience.2 In Britain, the National Survey of Sexual Attitudes and Lifestyle shows participation in heterosexual anal intercourse among 16 to 24 year olds rose from 12.5% to 28.5% over the past few decades.3 Similar trends are seen in the US, where 30-44% of men and women report experience of anal sex.4.

Young women cite pleasure, curiosity, pleasing male partners, and coercion as factors.56 Up to 25% of women with experience of anal sex report they have been pressured into it at least once.7 Hit television shows such as Sex and the City and Fleabag may unwittingly add to the pressure, as they seem to normalise anal sex in heterosexual relationships or make it appear racy and daring.

The pain and bleeding women report after anal sex is indicative of trauma, and risks may be increased if anal sex is coerced.

However, with such a high proportion of young women now having anal sex, failure to discuss it when they present with anorectal symptoms exposes women to missed diagnoses, futile treatments, and further harm arising from a lack of medical advice.

More widely, public health education is lacking.1516 NHS patient information on anal sex considers only sexually transmitted diseases, making no mention of anal trauma, incontinence, or the psychological aftermath of the coercion young women report in relation to this activity.17 A plethora of non-medical or pseudomedical websites fill the health information void.

Rather than helping young women make informed decisions, some sites may increase societal pressure to try anal sex.

It may not be just avoidance or stigma that prevents health professionals talking to young women about the risks of anal sex.

Healthcare professionals, particularly those in general practice, gastroenterology, and colorectal surgery, have a duty to acknowledge changes in society around anal sex in young women, and to meet these changes with open neutral and non-judgmental conversations to ensure that all women have the information they need to make informed choices about sex.