Anal Sex and Sexual Function Satisfaction: A Comprehensive (and Critical) Review of Current Medical Literature

Abstract

ABSTRACT Introduction Anal sex is practiced by people of all sexualities, genders and bodies. Despite common practice, there is relatively little in the clinical literature about anal sex from a more sex-positive “sexual health” perspective. Objective To review the medical literature related to anal intercourse, with attention to the fraction that focuses on the sex positive aspects of anal sex to address and support the sex-based questions and concerns of adults who practice it. Methods A comprehensive literature review was conducted in accordance with PRISMA guidelines, using PubMed. For our search, we generated a comprehensive list of synonyms for anal intercourse and combined them with synonyms for sex positivity (sexual satisfaction, erogenous, pleasure, and orgasm). Results We identified a total of 149 articles from the search terms. Of these articles, 59 abstracts were relevant to include and were reviewed. Among these abstracts, 23 manuscripts were reviewed in full and only 20 of these were acceptable for inclusion in this review. Twelve of the twenty papers included in our review were primarily sexual health focused, while the other eight primarily pathology focused. Men who have sex with men (MSM) is the population most considered within the discussion of anal sex. There was a trend towards identifying the influence of external factors on the sexual outcomes of anal sex in MSM, such as condom use, lubricant use, prostate cancer, and drug use. Among women who have sex with men (WSM), 28.4% described the first experience as pleasant and 62.3% continued to practice anal sex. However, almost half of WSM found their first experience to be too painful to continue. Women who have sex with women (WSW) were missing from the discussion of anal sex and sexual health. Conclusions Though the medical literature contains an abundance of studies of “sexual pleasure” and “sexual function” these are commonly hetero-normative and focus on penile-vaginal intercourse, and very rarely include anal stimulation/sex. Given that anal sex is widely practiced, the dearth of sex-positive literature focused on anal sex suggests both that patient's practices of anal sex is less commonly queried by providers, and, that there is a need for medical literature to help inform providers and patients about how to make anal sex safer and more satisfactory. Second to the general U.S. population, other small but important subgroups for whom this is relevant include cancer survivors working to recover their sexual health, and transgender women awaiting gender affirming genital surgery. There is a need for more investigation into the sex positive nature of anal sex. Disclosure No