Have you talked to your patients about safer sex lately? If so: Here’s hoping you didn’t skip the “taboo topic” of anal intercourse. Because it’s increasingly important to women’s health – even outside of gynecological practices.
In August, an editorial in the BMJ generated quite a fuzz: Surgeons Tabitha Gana and Lesley Hunt called out fellow healthcare professionals for ignoring a looming women’s health problem. Their claim: Young women are being let down by doctors due to their reluctance to discuss anal sex.
Although often still perceived as a topic concerning mainly homosexual men, anal intercourse is becoming increasingly common amongst heterosexual couples as well. Gana and Hunt point to the results of the National Survey of Sexual Attitudes and Lifestyles (NATSAL), which provides national-level data on sexual and reproductive health in the UK. Over the years, it found a marked increase in women who have partaken in anal penile intercourse (API): In the very first NATSAL-1 (1990–1991) only 13.5 % of women aged 16–44 years reported having anal intercourse, whereas that amount grew to 35 % in the last survey in 2012. The current NATSAL is still underway; results are expected around 2024.
More recent studies from other countries demonstrate that this trend is in no way limited to the UK. A 2019 US-survey reported 35.1 % of the included women have had anal sex; a 2021 study by the French Institute of Public Opinion on behalf of The Poken Company, representative of the female population aged 18 and over residing in Italy, Spain, France, Germany and the UK, suggests even higher percentages, setting the European average at 44 % with France being the front-runner (51 %). All this to say: Heterosexual API is apparently no longer considered niche or extreme among younger people. The practice has become increasingly normalized due to media depiction not only in pornography, but also in popular shows or movies, as well as open discourse surrounding the topic on social media platforms.
Well, to each their own, one might think – why should physicians care? The problem is that many of the people engaging in API are not well informed about its possible harms, as API is indeed connected with specific health risks. Gana and Hunt explain that the absence of vaginal secretions, the increased occurrence of traumatic abrasions together with reduced condom use increase the risk for sexually transmitted diseases (STDs). Further consequences can be anal pain, bleeding and fissures. API can generally lead to fecal incontinence and injuries of the sphincter, but due to their different anatomy women find themselves at an elevated risk compared to men. The authors also point out: “Risks may be increased if anal sex is coerced” – which is not uncommon unfortunately, as about one in four women who has partaken in API reports being pressured into it and common narratives among young people normalize coercive, painful and unsafe API.
Reliable information on how to circumvent these harms is not that easy to come by for these young women – at least not from official, reputable sources. As an example, the authors point to the NHS website: While information on API does stress the increased risk for STDs, it does not mention the possible traumata that might occur and require certain preparation. It’s similar for the German equivalent, the Federal Agency for Health Education, whose internet portals directed at teens and young adults do mention STD risks, but no other health concerns. However, not every country fails in that regard: The French Agency for Public Health sets a positive example. Its website for sex education communicates that injuries may occur during API and actually gives tips on how to circumvent them. In other countries, though, this information gap is filled by a bunch of non- or pseudomedical websites, as Gana and Hunt criticize. Obviously, good information is still out there, but how can inexperienced patients be expected to spot misinformation and untrustworthy sources by themselves?
Therefore, if young women are not to be left alone to acquire some dodgy semi-knowledge, doctors need to step up. “With better information, women who want anal sex would be able to protect themselves more effectively from possible harm, and those who agree to anal sex reluctantly to meet society’s expectations or please partners, may feel better empowered to say no,” Gana and Hunt conclude.
A healthcare professional’s job does not end with comprehensive educational efforts alone. If young women present with anorectal disorders, doctors – and not only gynecologists – need to assess their history with API, as effective disease management requires understanding of the underlying risk factors. Although this should be obvious, Gana and Hunt fear that clinicians may shy away from these discussions, influenced by society’s taboos. “Failure to discuss anal sex when young women present with anorectal symptoms exposes women to missed diagnoses, futile treatments and further harm arising from a lack of medical advice”, the surgeons rightfully point out.
If these problems are already reflected in clinical practice is hard to say. So, DocCheck News asked German gynecologist Dr. Petra Brandt whether she already noticed an increase in disorders due to anal sex among her patients. While she agrees that API among heterosexual couples and the possible health consequences are increasingly being reported in the Anglo-American-speaking world, the topic is still rather the exception in her own gynecological practice. “But it should always be considered in the case of anorectal complaints and then also addressed sensitively. So that the patient may swiftly present in a proctological or urogynecological special consultation and that the patient can be adequately helped.”
Image source: Ben White, unsplash
