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  1. Women who have anal sex: Pleasure or pressure? Implications for HIV prevention
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Women who have anal sex: Pleasure or pressure? Implications for HIV prevention

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  • Open source sex 40 anal The interview guide consisted
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Women were recruited through flyers; palm cards; outreach at community based organizations, colleges, and at community events; Internet and print media advertising; referrals through other studies or staff at the community clinic; and word of mouth. Women were initially screened for eligibility over the phone and were invited to participate in the study if they were female; 18 years of age or older; HIV-negative; reported having unprotected receptive anal intercourse in the prior year with a man of unknown or seropositive status; had not participated in another research protocol within the past year; and were comfortable with spoken English.

Eligible and interested participants reported to the clinic for a one-time, face-to-face meeting with a female interviewer. Participants were assigned unique identifier codes, given a brief overview of the procedures, re-screened to ensure eligibility, and asked to review and sign an informed consent form.

The interview guide consisted of open-ended questions and follow-up probes developed by the co-investigators to assess the psychological, social, and cultural factors associated with anal sex, as per the study objectives.

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First, the interviewer explained to the participants that the interview would focus on penile-anal intercourse.

To elicit responses, the interviewer first asked participants open-ended questions such as: The interviewer then followed up with more specific probe questions, when appropriate. The qualitative interviews were tape recorded and transcribed. Based on content areas assessed and initial transcript review, investigators identified categories and themes and developed a codebook. Using the software NVivo, all transcripts were coded independently by staff members who then compared the codes, compared discrepancies, and discussed them until consensus was reached.

Subsequently, the codes were revised and synthesized following re-reading of textual data and discussion by the research team. A grounded theory approach guided the qualitative data analyses 29 , Because participants were not required to answer every question, and because the degree to which each participant responded to a given question varied, it was not appropriate to perform statistical analyses on responses to interview questions.

Instead, when talking about the frequency of certain behaviors, we refer to the percentage of participants who responded affirmatively. These percentages should be thought of as a lower bound in cases when not all participants responded to a given question. Twenty-eight women participated in the study.

In addition to or instead of these racial categories, seven participants also reported Hispanic ethnicity. The mean age of the participants was Women had unprotected anal intercourse with a wide variety of partners, ranging from friends to casual partners, short-term and long-term boyfriends, husbands, strangers met on the Internet, and fathers of their children. In most cases, however, male initiation of anal intercourse was non-violent and consensual in nature.

Although male partners initiated anal sex more often, the women in our sample did not necessarily lack control over the practice; in fact, because they were the ones who had to consent to a specific behavior in order for it to take place, at times women felt that they, not their partners, were the ones who determined the course of a sexual encounter.

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The following participant, when asked if she had been pressured to have anal sex by her non-exclusive partner, distinguished between male initiative and male pressure:.

In other cases, women recognized that permitting or withholding anal intercourse from their male partners allowed them greater power in other areas of their relationships. For example, engaging in an unusual practice with her casual sexual partner made one participant feel more desirable:. I love the attention [from anal intercourse]. Far from being uncomfortable with anal intercourse, as we might expect of an activity that is so often stigmatized 1 , this participant took satisfaction in being the object of male desire and, in doing so, reaffirmed her sense of being a beautiful, desirable woman.

In acting out this part, she did not so much relinquish her power as assume her scripted role as the pursued. See also, San Francisco Chronicle: Sex for money, not love — Violet Blue asks rising adult superstar Lorelei Lee about the differences between sex work and sex not-for-work sfgate. In portraying harmless fantasy, porn often gives us a world that can only ever be that: A good porn film delivers the fantasies well, and we get off with success — wet, sticky, throbbing rapture. However, in the realm of portraying healthy and safe sex, porn often fails. Porn viewers get their fantasies at the price of not seeing how to stay alive and sexually active in the modern era. Non-consensual anal intercourse occurred with a range of partners both familiar and unfamiliar, from former husbands and boyfriends to strangers and men met on the Internet. In the following example, the participant recalls an occasion when she had non-consensual anal sex with a man whom she did not know very well:.

Among the seven women who experienced non-consensual anal intercourse, two of them also reported having had anal intercourse during transactional sex on at least one occasion, suggesting, for these women, a history of limited sexual agency.

Among those women who had experienced non-consensual anal intercourse in the past, more than one participant also reported engaging in anal intercourse of her own accord, for non-transactional purposes, on other occasions.


Open source sex 40 anal Coercion and violence notwithstanding, many participants reported other sensations of pain and discomfort arising from anal intercourse, including emotional distress.

Mild intestinal discomfort was also experienced as an aftereffect of anal intercourse, such as in disrupted bowel movements. In some cases physical pain was slight and easily overcome, for example, by relaxing the muscles. Given the frequent mentions of pain during consensual anal intercourse, we were interested in understanding why and how women engaged in anal sex in spite of these unpleasant sensations. In cases where women expected anal sex to be painful, they listed various reasons for engaging in the practice anyway: Indeed, some participants experienced pain during anal sex as enhancing their sexual pleasure.

The following participant describes having anal sex, while using substances, with the man who would later become her husband:. I let him do it. And we did it in the big recliner chair. It hurt and it felt good at the same time.

That some participants experienced anal intercourse as simultaneously pleasurable and painful supports our view that anal intercourse usually occurred as a complex emotional and physiological event for our participants, and cannot be easily categorized as entirely pleasurable or entirely painful, even for the same individual.

For all but one participant, the last occasions of anal intercourse occurred alongside other forms of sexual activity, such as oral sex and vaginal intercourse. Viewed as a complementary form of sexual expression, anal intercourse took on meaning not only as a site of negotiation and pressure, but as a source of sexual pleasure and eroticism for the women in our study. In considering the motivations for women to engage in high-risk sexual behaviors such as unprotected anal intercourse, it is important not to overlook female desire 24 , 31 , Among our participants, pleasure-seeking behavior, encompassing both physical arousal and emotional desire, emerged as a factor associated with a greater willingness to both engage in and request anal intercourse from male partners.

Regardless of who initiated it, many women in our study reported enjoying anal intercourse and the physical sensations related to the practice, such as this participant:. If I have anal sex, I have orgasms. My body likes it. It feels like vaginal but almost a little better, it seems like. And it feels good. However, just as the sensation of physical pleasure during anal intercourse varied among participants, so did the importance that participants placed on physical pleasure alone as a motivating factor for engaging in anal intercourse.

Participants often cited the desire for intimacy or closeness to their partners as either the motivation for anal intercourse, or as the necessary preconditions for anal intercourse to occur. Just [for] something different. And I just found a new part of my body I can enjoy.

In the following example, the participant talks about the first time she had anal sex, with a man that she met on the Internet for the purpose of having sex:. In this sense, anal intercourse was sought not only for the physical pleasure that it afforded women, but also valued as a marker for exceptional sex.

By equating exceptional sex with exceptional relationships, women sought to express their love, commitment, and openness towards theirpartners through their willingness to have anal intercourse, as this woman did with her husband:.

This notion of sexuality does not so much uphold the masculine model of the autonomous sexual actor seeking his own satisfaction, but instead identifies women--and by extension, their male partners--as sexual beings by virtue of their relational stance towards others.

Infrequent condom use during anal activity was to be expected among participants, given the eligibility requirements. Eighty-two percent of the sample indicated that they had not used condoms during the first occasion of anal intercourse and the same proportion though not necessarily the same participants reported no condom use during the last occasion of anal intercourse.

Reasons for not using a condom during anal sex were varied, including: In the following example, the participant was asked if she had used condoms with her boyfriend the last time they had had anal intercourse:. No, [we did not use condoms]. The reason is that we mostly used the condoms in order not to get pregnant. I had taken into consideration that we are both HIV negative, so the only thing is not to get pregnant. On the other hand, those participants who had used a condom during anal intercourse listed the following reasons for doing so: When describing discrete occasions of anal intercourse, on eight occasions participants reported that they had used a condom for vaginal sex to prevent pregnancy, but had removed the condom prior to anal sex.

Among those who reported using a condom during anal intercourse, on three occasions participants used the same condom for both vaginal and anal intercourse; on another three occasions participants used separate condoms for vaginal and anal intercourse; and on four occasions participants used condoms for anal intercourse but not vaginal intercourse, citing concern about hygiene or pregnancy as motivations.

It was with my significant other. He never had done it before. Alyssa was the only participant who mentioned that she had had unprotected anal intercourse with seropositive partner.

However, another participant Valeria, 41, Hispanic said that she regularly had anal sex with a man whose other partner was HIV-positive. Although nearly all of the participants were aware that unprotected anal intercourse might put them at risk for sexually transmitted infections, this knowledge apparently did not translate into behavioral change, as evidenced by the participant who had unprotected anal intercourse with her HIV-positive partner.

To avoid sounding confrontational, our interviewer did not ask participants why they continued to practice unprotected anal intercourse with partners of unknown or positive HIV status, despite the risks involved. Because our participants tended to follow traditional gender roles when it came to initiating anal intercourse, and because anal intercourse emerged in our interviews as a sexual behavior that complemented vaginal and oral sex, it may be useful to view heterosexual anal intercourse not so much as a deviant behavior, but as an intensified example of how sexual decisions are negotiated between men and women.

Following this line of reasoning, at first glance the pattern of male initiative over anal intercourse suggests that women might engage in anal intercourse under pressure, coercion, or persuasion from male partners. Taking sexual scripting theory into account, however, a more complex story emerges from the data. In this context, male initiative alone may not necessarily indicate a lack of female agency, but rather serve as a marker for the presence of a strong sexual script that dictates male pursuit and female acquiescence or rejection of male desire.

Although researchers have documented the relationship between pleasure-seeking behavior and sexual risk-taking in men who have sex with men 36 — 38 , it is not yet clear how pleasure-seeking may be related to sexual risk-taking among women. Nevertheless, as we did not survey a control group of women who engaged in low-risk, protected anal intercourse, it may be difficult to draw conclusions about the relationship between sexual risk-taking and pleasure-seeking behaviors from our sample alone.

Future research is needed to elucidate such relationships. When taken together, unprotected anal intercourse seemed to offer women a way to please their partners, to please themselves, and to avoid pregnancy.

As long as some women view anal sex as a way to bypass pregnancy concerns while maintaining intimacy and sexual pleasure, the failure to educate this population on HIV and STI prevention may lead to increased infection. A similar dynamic may be at work among women who engage in unprotected anal intercourse in order to achieve a greater degree of intimacy with their male partners, as in the case of some of our participants.

Interventions to promote safer anal sex must find a way to increase the use of barrier methods without decreasing perceived intimacy between sexual partners. This may be done by emphasizing the intimate nature of anal intercourse, even when accompanied by condom use. Too often, note Gupta and Weiss 40 , interventions to address high-risk sexual practices collude with existing hierarchies, rather than challenge the underlying structures that contribute to economic and sexual marginalization.

Therefore, if part of what makes a woman feel like a woman is being desired by her male partner, vaginal and rectal microbicides should be marketed to women as products that will enhance their sexual desirability. On the other hand, HIV and STI interventions geared towards women who have unprotected anal intercourse must not lose sight of societal factors that disadvantage women. Indeed, even in our small sample, the subgroup of women who had experienced non-consensual anal sex tended to report lower annual incomes than those who had not, though we did not test for statistical significance.

Future studies should seek to identify the specific factors that put women at risk for non-consensual, unprotected anal intercourse. To be successful, interventions must take into account the ways in which violence directed towards women can impact their ability to negotiate safe vaginal and anal sex. Given that the need for female-controlled alternatives to condoms encompasses products that can be used intrarectally as well as vaginally, rectal microbicides should be marketed to women as well as to MSM.

Our findings must be interpreted within the limitations of this study. Although the sample was ethnically and racially diverse, participation was limited to English-speaking women, and more low-income women were interviewed than middle- and upper-income women.

Additionally, as the participants included only those women who were willing to be interviewed about a highly-stigmatized practice, we know little about the experiences of women who may feel uncomfortable discussing anal intercourse with a stranger In terms of the generalizability of our discussion on condom use and HIV and STI prevention, we must emphasize that our sample only consisted of women who had recently engaged in unprotected anal intercourse with a partner of unknown or seropositive HIV status.

There are undoubtedly numerous women who practice anal intercourse with minimal risk e. Future studies should seek to quantitatively assess HIV and STI risk among a larger and more representative sample of women who engage in anal intercourse. Furthermore, notwithstanding that this may have been a highly-motivated group of women who welcomed the opportunity to talk about their anal sex experiences, it is important not to overlook how social constraints or norms about what is socially appropriate situated within the interview itself may have influenced how and what may have been discussed during the course of the interview.

Despite the limitations of the study, the findings presented here have important implications for HIV interventions aimed at heterosexual women. National Center for Biotechnology Information , U. Perspect Sex Reprod Health. Author manuscript; available in PMC Sep 7. Exner , 1 and Kenneth H. Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at Perspect Sex Reprod Health.

However, since the industry is self-regulating in all aspects of testing and condom use, safer-sex risk assessment ultimately falls into the hands of the performers. AIM Healthcare serves over clients a month and is making plans to expand. Since its inception, the organization has successfully lowered the spread of HIV in the porn industry, and has certainly increased awareness among performers. There are many kinds of HIV tests. That antibody can take up to six months to show up in detectable levels in the blood of a healthy person.

The PCR polymerase chain reaction test looks for the virus itself. So far, AIM has reported only two false positives and no false negatives. There is currently a trendy fetish for ass-to-mouth contact, using everything from penises and fingers to sex toys, and there are even a few porn series specifically devoted to showing the practice. Ass-to-mouth contact puts the recipient at great risk for contracting Hepatitis A, which can be treated but not cured.

The penetrator is at no risk in this situation. Hepatitis A comes from getting fecal matter in the mouth, and many starlets reduce their chances by taking multiple enemas before anal sex scenes, though this is not a foolproof measure. Anal-to-vaginal penetration is another sex act fetish, which by bringing E coli bacteria from the anus to the vagina causes a severe bacterial infection.

Again, enemas are used beforehand, but this is not a reliable safeguard. Sometimes there is anal penetration with objects or sex toys that do not have a flared end, which is unsafe because the flared end prevents them from being pulled into the anal canal by the involuntary sphincter muscle.

Performers are at risk every time they shove something like this up their asses, all covered in slippery lube and difficult to hang onto, because an item lodged in the lower colon is a major health emergency. Similarly, starlets seem to be able to just take a toy, penis or huge object in their asses without any warm-up. They never show you that the performers spend lots of time off-camera relaxing their anuses with lubed fingers and toys, and some will even prepare the night before a shoot.

To insert anything without preparation and sufficient lube can seriously damage the dry, thin tissues of the anus, and can even result in fatal injury. As if by magic, the penis or sex toy slides right in the vagina or anus, or a little licking will precede a fast penetration. Lubrication is used in shooting porn videos, but it is very rarely shown to the audience. Condom use in porn is hotly debated by everyone involved.

And in the manner that condoms are generally used with the exception of smarties like Ed Powers of Dirty Debutantes fame there is much room for error. Ejaculation in the eyes and nose are other unsafe practices engaged in by porn performers. Ejaculation in the eyes and nose can transmit herpes, chlamydia, syphilis and gonorrhea, and the latter three viruses cause conjunctivitis when contracted via the eye.

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