Anal Sex is Not Normal. The anal passage has its biological purpose as part of the body’s waste management system. Nonetheless, its proximity to the genitals, its walls that are tight but allow entry of a finger, penis, or dildo, and its rich network of nerve endings, encourage an auxiliary purpose as an erotic part of the body. For some people, just the knowledge that other people enjoy anal sex produces a “yuck” response. For others, homophobia intensifies their negative reaction because they assume only gay men engage in anal sex.
They also assume that all gay men have anal intercourse. In truth, a large number of people (gay and heterosexual) have at least experimented with anal sex and a significant number do it as a regular part of their sexual life. Let’s take a look at what really goes on.
Heterosexual Anal Sex
Anal sex is common in many countries where it has been seen as a way to have intercourse without risking a pregnancy as well as a way to maintain “technical virginity” in countries and cultures where this is essential for marriageability. It is a common practice throughout Latin America, South America, Southern Europe, the Middle East, and Mexico (Sanders and Reinisch, 1999). Here in the United States, we have done a lot of research on anal sex.
Anal Sex is Not Normal
Not because we are particularly fascinated by this kind of eroticism, but rather because we often take a public health/disease prevention approach to thinking about sexual behavior and we have feared that anal sex carries a higher risk of sexually transmitted infections (STIs), including HIV. While the anal canal can easily accommodate a penis, the anus does not naturally lubricate and abrasions can cause tears in the anal wall meaning that infected semen can more easily enter the bloodstream.
So public health researchers and clinicians want good information about who is doing what to whom. The data, however, are often in conflict with one another. It is an awkward question to ask since many people, even those who have had anal sex, see it as a taboo subject, with some shame attached and don’t want to talk about it.
Laumann et al. (1994) found that 5% of women aged 18–44 found receptive anal sex to be either a “very appealing” or “somewhat appealing” practice. That may sound small but remember 5% of all sexually active women represents approximately 4 million people in the United States.
Other researchers, unimpressed with traditional methodologies and fearing this was an underestimate, made more intrusive inquiry into anal sex habits and got higher numbers. A study by Boiling et al. indicated that 72% of subjects had at least experimented with anal sex and that 23% regularly engaged in anal intercourse.
Boiling’s methodology was studied in a paper by Voeller (1991) who found that Boiling was more persistent than other researchers in terms of following up a first denial of anal sexual behavior. Boiling found at first inquiry that patients commonly denied engaging in anal intercourse and only at the second or third interview would they acknowledge and discuss this sexual act.
Part of the reason for this reticence (or even lying) may have been not wanting to seem at risk for AIDS. And in fact, this underreporting (or denial) may have affected many if not most studies on heterosexual anal sex (Erickson et al., 1995; Laumann et al., 1994; Voeller, 1991; Halperin, 1999).
Newer numbers come from a random sample population survey of 3545 Californians. The survey found 8% of men and 6% of women reported having had heterosexual anal intercourse at least monthly throughout the previous year. Younger respondents and those who were not married were even more likely to report this practice. For example, 13% of males aged 19 and 20 reported anal intercourse at least monthly. Although most respondents who had had anal sex said they did so between 1 and 5 times a month, 10% of those who had had anal sex said they did it between 6 and 30 times per month (Bogart et al., 2005).
Anal Sex is Not Normal
Another study of Californians concluded that about 1 in 14 heterosexual people in the state regularly engaged in anal sex (Erickson et al., 1995; Halperin, 1999). The most recent nationally representative data comes from the National Survey of Sexual Health and Behavior (NSSHB) which was published in 2010. It found that 5% of men aged 16–19, 11% of men aged 20–24, more than 20% of men aged 25–49, and 11% of men aged 50 and older had had insensitive anal sex in the last year. The numbers for women are remarkably similar with 4% of women aged 14–17, 18% of women aged 18–19, more than 20% of women aged 20–39, and 4% of women aged 50 and older reporting anal sex in the past year (Herbenick et al., 2010).
The lifetime numbers are also similar with 40% of men aged 25–49 and 40% of women aged 20–49 reporting having engaged in anal sex at some point (Herbenick et al., 2010). Other studies have also looked at lifetime incidence of anal sex and found that 35% of women and 40% of men aged 25–44 in the United States have had anal sex at some point (Baldwin and Baldwin, 2000).
These may be underestimates because there is still a real stigma attached to anal sex which can make honest answers hard to get. A study that investigated the underreporting of sensitive behaviors, with a particular interest in abortion, found that participants were more willing to admit to having an abortion than to engaging in anal intercourse (Smith et al., 1999).
Heterosexual Anal Sex Among Specific Populations
As it is hard to get an overall picture as to how many heterosexual Americans have anal sex, it can be helpful to look at specific populations that may have higher rates of anal sex.
Much of the research on anal sex has focused on AIDS transmission and as such much of it has concentrated on populations uniquely at risk. In a study of sexual behavior among 146 partnered male intravenous drug users, 38% reported engaging in anal sex. In another national survey of 1368 women intravenous drug users, 37% reported practicing anal intercourse within the previous year.
Other studies of drug users in the United States have identified rates of anal sex ranging from 30 to 74% (Lewis et al., 1990; Rosenblum et al., 1992; Voeller, 1991; Erickson et al., 1995; Forquera and Truax, 1997; Halperin, 1999). Adolescents and college students have also been the subject of many studies on anal sex because they too are considered to be “at risk.” Again, however, the results are all over the map. As mentioned earlier, the NSSHB found that only 5% of adolescents (14–19) had had anal intercourse (Herbenick et al., 2010).
Anal Sex is Not Normal
A study of 793 adolescents aged 13–21 conducted at a New York City clinic revealed that 26% of female clients had already engaged in anal sex. A self administered anonymous questionnaire survey of female adolescents in a northern California rural area found that 12% of Hispanic and 10% of white young women reported a history of anal intercourse. Using a similar methodology, a New York City study of predominately Hispanic and African American female adolescents found that 9% of the 13-to 15-year-olds, 25% of 16-to 18-year-olds, and 38% of 19-to 21-year-old young women had engaged in anal sex. Moreover, 68% of the adolescents who had anal sex had done so at least once in the preceding 3 months (Hein et al., 1995; Kegeles et al.,1990; Jaffe et al., 1988; Halperin, 1999).
Not surprisingly, college students are having anal sex as well. Surveys at North American college campuses have identified fairly high prevalence rates for anal sex. Of 3400 undergraduate students surveyed at the University of Maryland, for example, 25% reported having practiced heterosexual anal intercourse (Kotloff et al., 1991; MacDonald et al., 1990; Gilbert and Alexander, 1998; Halperin, 1999).
A survey in the early 1990s at a Midwestern university found that 17% of male and 18% of female students reported having anal sex (Reinisch et al., 1995; Halperin, 1999).
There is also some research to suggest higher rates of anal sex among Hispanics than non-Hispanics in the United States, though these numbers are somewhat confusing because far more men than women say they engaged in heterosexual anal sex. In the University of Chicago survey, 34% of Hispanic men said they had practiced heterosexual anal intercourse in their lifetime — twice what was reported by Hispanic women. When asked just about the last year, 19% of Hispanic men reported anal sex compared with 12% of Hispanic women.
Anal Sex is Not Normal
In addition to Latino cultural patterns where men are more likely to have anal (and other types of) sex with secondary or tertiary partners, part of this gender discrepancy may be due to Hispanic women being less likely to report, even in an anonymous telephone interview, this form of sexual activity.
Others have also suggested that some Hispanic males may be having anal sex with male partners but reporting it as heterosexual for fear of being labeled gay (Erickson et al., 1995; Laumann et al., 1994; Voeller, 1991; Brody, 1995; Halperin, 1999).
Anal Sex Among Gay Men
Though anal sex may be automatically associated with gay men, it is important to remember that not all men who have anal sex are gay (they may identify as bisexual or even heterosexual but occasionally have sex with another man) and not all gay men have anal sex.
Research indicates that 2–10% of males in the United States have had a samesex adult sexual experience, but only a small minority regularly engages in receptive anal intercourse (Binson et al., 1996; Fay et al., 1989; Halperin, 1999).
It is estimated that approximately half to at most two-thirds of sexually active men who have sex with men in the United States regularly engage in receptive anal intercourse (Edward Laumann, Eric Rofes, personal communications, September 1999). For example, according to an unpublished 1996–1998 study of sexual behavior in the four large urban centers (New York City, San Francisco, Los Angeles, Chicago), 51% of men who have sex with men reported having receptive anal intercourse during the previous 12 months (Lance M. Pollack, personal communication, September 1999).
The consensus of most researchers is that roughly 1% to at most 1.5% of adult males (or approximately 1 million men in the United States) regularly practices receptive anal sex (Edward Laumann, Eric Rofes, personal communications, September 1999). This is decidedly lower than the estimate of women’s anal sex behavior (Erickson et al., 1995; Laumann et al., 1994; Turner et al., 1995; Catania et al., 1992; Holmberg, 1996; Binson et al., 1996; Halperin, 1999).
Anal Sex is Not Normal
Is Virginity the Motive?
As we have mentioned, preservation of virginity is the motivation for large numbers of women who have anal intercourse, especially in places where virginity is highly prized or even required (Sanders and Reinisch, 1999). This question has come up here in the United States many times, especially during the rise of the abstinence-only-until-marriage movement when many students were taught that the ultimate goal was to remain a virgin until your wedding night. Researchers and educators wondered if this emphasis on virginity pushed young people toward alternative behaviors such as oral sex.
Sanders and Reinisch found that 19% of their sample of college students did not consider anal intercourse to be “sex.” This would allow for an individual who engages in anal intercourse but abstains from vaginal sex to still label herself a “virgin.”
Few published studies explore virginity as a motivating factor for anal sex; however, a study of urban high school students in grades 9 through 12 who identified as virgins found that 1% of the sample had engaged in heterosexual anal intercourse during the previous year (Schuster et al., 1996).
A review of several studies concluded that “virginity” may have a role in the occurrence of anal intercourse among adolescents (McBride and Fortenberry, 2010Halperin, 1999).
In general, however, there are few data to support the idea that young people are having anal sex to preserve their virginity as few adolescents have anal sex (or even oral sex for that matter) before they have vaginal sex.
Anal Sex is Not Normal
Do We Like It?
Recently, it seems that more people are talking about anal sex — television shows from Sex And the City, to Entourage, to Girls have depicted characters discussing it, worrying about, and even trying it. But the question still looms, do people (especially women) really like it?
Research shows that men find it more pleasurable than women do (Pinkerton et al., 2003, Wilson and Medora, 1990), but is mixed on what percentage of women find it pleasurable. A study of college students found that 45% of women said that they had engaged in anal receptive penetration with a finger or sex toy (e.g., butt-plug, dildo, or vibrator), and the authors felt the motivation for these activities was seeking pleasure (McBride and Fortenberry, 2010).
But another study found that the majority of the 47% of a female sample who had anal sex reported it as a negative experience (Rogala and Tyden, 2003). Some of this negative reaction may be due to the fact that in some of these instances coercion, violence, or roughness may have occurred (McBride and Fortenberry, 2010).
We know even less about the context and pleasure of receptive anal sex of men whose female partners use dildos to penetrate them. Studies document receptive anal sex behaviors, both oral–anal and manual–anal contact, occurring in heterosexual men who report having only had female sexual partners but don’t determine how much the men enjoyed these activities (McBride and Reece, 2008; McBride et al., 2008).
We should not discount pleasure or the possibility of pleasure during anal sex. The fact that many people are engaging in this act regularly suggests that it has the potential to be extremely pleasurable. As with everything, we suggest that people who are interested talk with their partner and experiment. Possibly starting slow — say inserting a finger a few times before trying a dildo or a penis — can alleviate fear and increase pleasure.
Lubrication is also very important for anal play because the skin around the anus is very sensitive and does not lubricate itself at all. And, of course, we’d be remiss if we didn’t remind our readers that anal sex carries the risk of STIs — a risk that can increase if there is any tearing — which makes lubrication more important and condoms very important as well.
For people who are interested in experimenting with anal sex, there are a number of books — such as Anal Pleasure and Health: A Guide for Men, Women and Couples by Jack Morin or The Guide to Getting it On by Paul Joannides — that can help you get ideas on how to have the best and most pleasurable experience. There are also books written specifically for women, lesbian women, and gay men. We suggest finding a guide that you like so that you (and your partner) can decide if anal sex works for you.
Thanks for Reading — Anal Sex is Not Normal
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