Anal Sexual Activity Research Articles

Pelvic Floor Disorders Due to Anal Sexual Activity in Men and Women: A Narrative Review.

Recent evidence shows that consensual anal penetrative intercourse has become more prevalent, not only limited to gay, bisexual, and other men who have sex with men but also for women who are in a sexual relationship with men. The aim of this review was to study the influence of consensual anal intercourse on pelvic floor function and the role of pelvic floor physical therapy treatment in preventing or treating consensual anal intercourse-induced anodyspareunia and/or fecal incontinence. We reviewed 68 references that showed that anal penetrative intercourse is a risk factor for anodyspareunia and fecal incontinence in both men and women. This risk of anal intercourse may increase with emotional discomfort, an overactive pelvic floor, lack of lubrication, frequency of anal penetrative intercourse, and hard practice (BDSM: bondage and discipline, dominance and submission, sadism, and masochism). It seems that pelvic floor physical therapists play an essential role in preventing and treating pelvic floor dysfunctions due to anal intercourse, which can lead to anodyspareunia and fecal incontinence; the treatment includes education, pelvic floor training with and without biofeedback, electric stimulation, manual therapy, and dilatators. Further studies are warranted to enhance our understanding of the causes and treatment efficacy of pelvic floor dysfunctions due to anal penetrative intercourse.

HIV burden and correlates of infection among transfeminine people and cisgender men who have sex with men in Nairobi, Kenya: an observational study

Transgender people are disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide, and culturally competent prevention and treatment services are often unavailable or inaccessible. Despite recent improvements in national HIV responses for many key populations in east Africa, evidence of effective responses informed by transgender sexual health needs is sparse. We aimed to assess gender identity among men and transgender people who have sex with men in Kenya, and to explore its associations with sexual health-related outcomes, risk behaviours, and uptake of HIV prevention and care interventions. We did a cross-sectional study in Nairobi, Kenya, and recruited adult cisgender men and transfeminine people who reported having sex with men, through respondent-driven sampling. Inclusion criteria were possession of a valid study coupon, being aged 18 years or older, having male sex assignment at birth or male gender identification currently, living within 50 km of Nairobi, and having had consensual anal or oral sexual activity with a man in the previous 12 months. Seed participants were identified by three community organisations that provide targeted health-care services to gay, bisexual, or other men who have sex with men (MSM) communities in Nairobi. We assessed gender identity, sociodemographics, sexual behaviour, and HIV prevention and care uptake, by self-completed survey. Participants were tested for HIV, syphilis, and rectal and urethral gonorrhoea and chlamydia. We compared prevalence of sexual health outcomes, risk behaviour, and HIV prevention and care service uptake among transfeminine and cisgender participants, using multivariable robust Poisson regression models, with gender identity as the independent variable. Between May 4 and Dec 8, 2017, we enrolled 618 participants. Six participants did not answer the questions on sex assigned at birth and gender identity and so were excluded from the analyses. 522 (sample-weighted percentage 86%) of 612 participants were classified as cisgender men, 70 (11%) as transfeminine, and three (<1%) as transmasculine. 17 participants (2%) did not identify as male, female, or transgender. Compared with cisgender men, transfeminine people were more likely to be HIV-positive (28 [41%] of 70 transfeminine vs 151 [25%] of 521 cisgender men; p=0·0009) and to report current symptoms consistent with a rectal STI (eight [16%] of 67 vs 38 [7%] of 518; p=0·014). Transfeminine people reported higher numbers of recent male sexual partners (22 [27%] of 70 transfeminine people reported four or more male sexual partners in the past 3 months vs 112 [13%] of 522 cisgender men; p=0·042) and were more likely to report condomless anal intercourse with men (43 [62%] of 70 vs 208 [39%] of 522; p=0·0009) and receptive anal intercourse (54 [76%] of 70 vs 252 [46%] of 522; p<0·0001) in the past 3 months, and transactional sex with men (42 [57%] of 69 vs 240 [42%] of 518; p=0·023) and experience of sexual assault (16 [23%] of 69 vs 65 [11%] of 520; p=0·019) in the past 12 months. Use of pre-exposure prophylaxis and post-exposure prophylaxis was low in both groups. Transfeminine people who have sex with men have a higher burden of HIV and associated risk behaviours compared with cisgender MSM in the same context, yet their uptake of prevention and care services is poor. Policies should acknowledge the specific needs of transfeminine people as distinct from cisgender MSM, and support health-care providers to address these needs. Evidence for HIV Prevention in Southern Africa (EHPSA), UK Aid.

Increasing HIV prevalence and injection drug use among men who have sex with men in Ho Chi Minh City, Vietnam.

Vietnam has been conducting HIV/sexually transmitted infection (STI) integrated bio-behavioral surveillance surveys on men who have sex with men (MSM) as well as other key populations since 2005. Although HIV prevalence in the Vietnamese general population remains below 1%, it is expected to be much higher among MSM.Data on HIV prevalence and sexual and drug use behaviors were collected from MSM in Ho Chi Minh City (HCMC) in 2006 (n = 397), 2009 (n = 399) and 2013 (n = 350) using respondent-driven sampling. Eligible participants were males, aged ≥15 years who reported having manual, oral, or anal sexual activity with males in the past year and lived, worked or socialized in HCMC.HIV seroprevalence among MSM was 5.8% in 2006, 16.1% in 2009 and 12.1% in 2013 and prevalence of at least one STI (syphilis, gonorrhea and/or chlamydia infection) was 11.4% in 2006 and 15.6% in 2009 (no data for 2013). Significant, but small, increasing trends were found for MSM who reported ever testing and receiving results for HIV and for HIV prevalence. No significant changes for condom use, injecting and non-injecting drug use, or and receipt of free condoms were observed.Although a small percentage of MSM reported injecting drugs, HIV was positively associated with ever injecting drugs. Programs targeting MSM should include screening and treatment for injection drug use to most effectively control the HIV/AIDS epidemic among MSM in HCMC.

Dispelling the myth: Exploring associations between the HPV vaccine and inconsistent condom use among college students

Human papillomavirus (HPV) vaccination is safe and effective in preventing anogenital cancers and warts. However, myths have surrounded the HPV vaccine since its approval, including the possibility that HPV vaccinated young people are more likely to engage in risky sexual behaviors. The purpose of this study was to assess the association between HPV vaccination and engaging in inconsistent condom use in a sample of U.S. college students. A secondary data analysis of the National College Health Assessment-II (Fall 2013) was conducted in 2015. Risky sexual activity was operationalized as inconsistent condom use for oral, vaginal or anal sexual activity. Logistic regression models were stratified by sexual activity and gender, and controlled for socio-demographics and history of STIs. Inconsistent condom use was reported among females for vaginal (47%), oral (94%), and anal sex (75%); while males reported levels of inconsistency for vaginal (38%), oral (94%), and anal sex (58%). Sixty-nine percent of females reported receiving the HPV vaccine compared to 43% of males. Among females, there was no significant association between HPV vaccination and inconsistent condom use in any of the sexual activities. Among males, there was no significant association between HPV vaccination and inconsistent condom use in oral or vaginal sex. HPV-vaccinated males were less likely to report inconsistent condom use during anal sexual activity. This study contributes to the increasing evidence that HPV vaccination is not associated with risky sexual behavior. Dispelling this myth is important to facilitate uptake and completion of the HPV vaccine in the U.S.

Anal HPV detection in men who have sex with men living with HIV who report no recent anal sexual behaviours: baseline analysis of the Anal Cancer Examination (ACE) study

ObjectivesMen who have sex with men (MSM) living with HIV are at high risk of infection with high-risk human papillomavirus (HPV), the cause of anal cancer. We assess whether anal...

P16.30 Epidemiology of anal infection in hiv infected patients attending a sexually transmitted infection clinic in brazil

Introduction Anal squamous cell carcinoma is rare in the general population but certain populations, such as persons with HIV, are at increased risk. High-risk populations can be screened for anal cancer using strategies similar to those used for cervical cancer. The objective of this study was determinating the prevalence, genotype distribution and risk factors associated with anal HPV infection among persons of both sexes with HIV attending a STI clinic in Espirito Santo, Brazil. Methods Cross sectional study assessing HIV-infected persons. A comprehensive survey was administered that included a demographic and behavioural assessment. Anal specimens were collected for cytology and HPV screening using Polymerase Chain Reaction. Results A total of 169 patients completed the study, 122 female and 47 male, mean age was 40.3 years, 81.4% lived in Vitoria, the average education was 8.6 years, 48.8% were married, 42.1% had between 5 and 20 sexual partners, 25.4% initiated sexual activity before age 15. 72% reported anal sexual activity, 58.3% had a history of STI, the most frequent being condyloma acuminata (25.4%) followed by syphilis (9%). 31.6% knew to be HIV positive for more than 10 years, 65.1% had an undetectable viral load, only 3.5% had CD4 below 200 cells and 82.9% were taking HAART. Anal cytology in both sexes had a 13.2% prevalence changes. The prevalence of HPV infection of any type was 71%, and high-risk HPV types were 52.4%. The HPV types most frequent high-risk types were: 16, 51 and 53. 37.3% had multiple HPV types. Conclusions Anal HPV is common among HIV-infected persons attending this STI clinic, repeated annual cytology screening for HIV-infected, particularly for those with increased immunosuppression, anal HPV, history of the other STIs, or abnormal cervical cytology will increase the likelihood of detecting AIN 2–3. Disclosure of interest statement There is no conflict of interest.

Sexual behaviours, sex toy and sexual safety methods reported by women who have sex with women and men

Background Relative to women who engage in sex with exclusively men or women, women who have sex with women and men (WSWM) are more likely to report a history of sexually transmissible infections. Knowledge of the diversity and specificity of the sexual behaviours in which they engage may provide insight into the behavioural modes of infection. The present study sought to document a range of behaviours including concurrent multi-person sexual activity (e.g. orgy, threesome), anal sexual activity and sex toy use. Barrier use methods during specific behaviours were also assessed. Eighty women who reported recent genital contact with at least one man and one woman were recruited via targeted Internet, venue-based and snowball sampling methods. Consenting participants were directed to an online survey. During an in-person timeline follow-back interview (the SEQUENCE(©) calendar method), a subset of participants (n=53) provided detailed sexual behaviour data for each sexual partner over the previous 12 months. Almost three-quarters of the sample reported at least one concurrent multi-person sexual activity. Nearly two-thirds of participants reported engaging in sexual behaviour that involved their own (66.7%) or their partner's (49.4%) anus in the past year. Barrier use for sexual behaviours other than penile-vaginal intercourse was uncommon. Behaviours and safety strategies were similar with men and women regardless of partner gender. The sexual repertoires reported by participants in this study were diverse. Understanding the range of diverse sexual behaviours of the participants may enable the construction of tailored recommendations for sexual health maintenance among WSWM.

Correlates of adolescent and young adult sexual initiation patterns.

Identifying adolescent characteristics associated with different patterns of sexual initiation is critical to promoting healthy sexual development. Patterns of sexual initiation were examined among 12,378 respondents to Waves 1 (1994-1995) and 4 (2008) of the National Longitudinal Study of Adolescent Health. Multinomial logistic regression explored associations between adolescent characteristics and membership in five latent classes capturing the timing, sequence, pace and variety of sexual initiation patterns. Age and indicators of greater psychosocial conventionality were associated with membership in the atypical "postponers" class (characterized by postponement of oral, vaginal and anal sexual activity until early adulthood), although patterns of associations varied by gender. For example, compared with males who attended religious services at least once a week, males who never attended religious services were more likely to appear in the vaginal initiators/multiple behaviors class (characterized by initiation of vaginal sex first and then initiation of another behavior after at least one year), rather than in the postponers class (relative risk ratio, 2.5). Compared with women who prayed at least once a day, those who never prayed were more likely to be in the vaginal initiators/single behavior class (whose members typically engaged in only one type of behavior), rather than in the postponers class (2.0). Individuals who are more adherent, and presumably more committed, to the attitudes, values and expectations of conventional society are more likely than others to delay multiple types of sexual activity until well beyond the norm for their peers.

Should we screen heterosexuals for extra-genital chlamydial and gonococcal infections?

Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) are two of the most prevalent bacterial sexually transmitted infections in the UK. Although the high burden of extra-genital infections with GC and CT in men who have sex with men has been well established, a significant number of extra-genital site infections with CT and GC could similarly be present in heterosexual women. For this reason we started to routinely offer extra-genital site testing for GC and CT in all patients attending our sexual health clinic who reported having had receptive anal sex and/or giving oral sex. This followed a review of current evidence by the clinical team and a change in local testing policy. This study not only confirmed a large reservoir of extra-genital infection amongst men who have sex with men, but also demonstrates that a comparable reservoir of extra-genital infection is present amongst heterosexual women. Our study adds to the mounting evidence that extra-genital site testing in heterosexual women should occur when oral or anal sexual activity is reported.

Prevalence of Human Immunodeficiency Virus Testing and Associated Risk Factors in College Students

Objective: This study documents the prevalence of human immunodeficiency virus (HIV) testing in a sample of college students and examines associated demographic and behavioral characteristics. Participants: College students aged 18 or older were randomly selected to participate in a health behavior survey at a southeastern university in September 2011. Methods: Only sexually active students were included (N = 905). Relationships between demographic and sexual behavior characteristics were explored using logistic regression and classification regression tree (p ≤.05). Results: Only 36.2% reported having been tested for HIV. Age was the most significant factor associated with testing. Factors associated with those least likely to be tested were race and anal sexual activity. Unsafe sexual behaviors were also associated with lower rates of HIV testing. Conclusions: Findings support the need for targeted HIV interventions on college campuses. Such interventions need to be tailored for at-risk students and take into consideration factors likely to contribute to HIV testing.

Fecal Incontinence Decreases Sexual Quality of Life, But Does Not Prevent Sexual Activity in Women

The impact of anal incontinence on women's sexual function is poorly understood. The aim of this study was to investigate the relationship between anal incontinence and sexual activity and functioning in women. This is a cross-sectional study. This investigation was conducted in a community-based integrated health care delivery system. Included were 2269 ethnically diverse women aged 40 to 80 years. Self-administered questionnaires assessed accidental leakage of gas (flatal incontinence) and fluid/mucus/stool (fecal incontinence) in the past 3 months. Additional questionnaires assessed sexual activity, desire and satisfaction, as well as specific sexual problems (difficulty with arousal, lubrication, orgasm, or pain). Multivariable logistic regression models compared sexual function in women with 1) isolated flatal incontinence, 2) fecal incontinence (with or without flatal incontinence), and 3) no fecal/flatal incontinence, controlling for potential confounders. Twenty-four percent of women reported fecal incontinence and 43% reported isolated flatal incontinence in the previous 3 months. The majority were sexually active (62% of women without fecal/flatal incontinence, 66% with isolated flatal incontinence, and 60% with fecal incontinence; p = 0.06). In comparison with women without fecal/flatal incontinence, women with fecal incontinence were more likely to report low sexual desire (OR: 1.41 (CI: 1.10-1.82)), low sexual satisfaction (OR: 1.56 (CI: 1.14-2.12)), and limitation of sexual activity by physical health (OR: 1.65 (CI: 1.19-2.28)) after adjustment for confounders. Among sexually active women, women with fecal incontinence were more likely than women without fecal/flatal incontinence to report difficulties with lubrication (OR: 2.66 (CI: 1.76-4.00)), pain (OR: 2.44 (CI: 1.52-3.91)), and orgasm (OR: 1.68 (CI: 1.12-2.51)). Women with isolated flatal incontinence reported sexual functioning similar to women without fecal/flatal incontinence. The cross-sectional design prevented evaluation of causality. Although most women with fecal incontinence are at high risk for several aspects of sexual dysfunction, the presence of fecal incontinence does not prevent women from engaging in sexual activity. This indicates that sexual function is important to women with anal incontinence and should be prioritized during therapeutic management.

Midwestern Rural Adolescents’ Anal Intercourse Experience

The purpose of this study was to examine the prevalence of anal intercourse and its associated risk behaviors in a sample of Midwestern, predominantly white rural adolescents. Most of the research on this activity has been local or regional studies, with urban East and West Coast racial and ethnic minority adolescents. A surveillance questionnaire based on the Youth Risk Behavior Survey was distributed in 2009 to 820 rural middle and high school students in grades 6-12, across 2 rural counties in a Midwestern state. The school districts were stratified by grade level and a stratified random sample of schools (n = 17) was used. Data were analyzed using Fisher's exact test and multiple logistic regression. A total of 778 (95%) students completed the survey. The rural adolescents were in grades 6-12, were primarily white (95%), and were evenly distributed by gender. Similar amounts of students had engaged in sexual intercourse (24%) and oral sex (23%). Seven percent reported engaging in anal sex (1.6% middle school, 10.9% high school). Multivariate logistic regression controlling for other risk behaviors found that 2 variables were associated with increased anal sexual activity: ever had sexual intercourse (adjusted odds ratios [AOR]= 14.5) and ever had oral sex (AOR = 6.0). Anal sexual activity is a component of some rural adolescents' sexual experiences. These findings have important implications for sex education programs targeted to rural schools, where the typical high school classroom may have some students engaging in anal sex.

Perceptions of Vulnerability to HIV/AIDS: A Comparison of Two College Cohorts, 1990 and 2005

Theories of preventive health behavior posit that perceived vulnerability to health threats motivates self-protective behavior. Fifteen years after an initial study of college students' perceptions of their vulnerability to HIV, a replication was conducted on the same campus in 2005. Comparisons between cohorts on vulnerability judgements were conducted to examine whether, and to what extent, student perceptions had changed across time. Respondents in the 1990 study had judged themselves as less vulnerable to HIV/AIDS than others about whom they also made risk estimates; this pattern was replicated among 2005 respondents, even though many in both cohorts were involved in objectively risky practices. Comparisons between the cohorts on risk behaviors revealed that fewer of the 2005 students reported being sexually active, and those who were active used condoms more frequently. However, 2005 respondents also reported more recreational drug use, and oral and anal sexual activity than the 1990 students.

HIV transmission risk behavior among men and women living with HIV in 4 cities in the United States.

Determining rates of HIV transmission risk behavior among HIV-positive individuals is a public health priority, especially as infected persons live longer because of improved medical treatments. Few studies have assessed the potential for transmission to the partners of HIV-positive persons who engage in high-risk activities. A total of 3723 HIV-infected persons (1918 men who have sex with men [MSM], 978 women, and 827 heterosexual men) were interviewed in clinics and community-based agencies in Los Angeles, Milwaukee, New York City, and San Francisco from June 2000 to January 2002 regarding sexual and drug use behaviors that confer risk for transmitting HIV. Less than one quarter of women and heterosexual men had 2 or more sexual partners, whereas 59% of MSM reported having multiple partners. Most unprotected vaginal and anal sexual activity took place in the context of relationships with other HIV-positive individuals. Approximately 19% of women, 15.6% of MSM, and 13.1% of heterosexual men engaged in unprotected vaginal or anal intercourse with partners who were HIV-negative or whose serostatus was unknown. The majority of sexually active participants disclosed their serostatus to all partners with whom they engaged in unprotected intercourse. An estimated 30.4 new infections (79.7% as a result of sexual interactions with MSM) would be expected among the sex partners of study participants during the 3-month reporting period. Eighteen percent of 304 participants who injected drugs in the past 3 months reported lending their used injection equipment to others. In addition to the more traditional approaches of HIV test counseling and of focusing on persons not infected, intensive prevention programs for persons with HIV infection are needed to stem the future spread of the virus.

Tracing the Roots of Early Sexual Debut Among Adolescents in Psychiatric Care

To identify the most important social and personal characteristics related to early sexual debut among troubled teenagers. One hundred ninety-eight youths aged 12-19 years were recruited from outpatient mental health clinics and completed self-reports and interviews about their age of sexual debut; family, peer, and partner relationships (e.g., parental hostile control, negative peer influence, need for intimacy); and personal characteristics (e.g., achievement motivation, externalizing problems). Broad-band (externalizing, internalizing) and narrow-band (depression/anxiety, delinquency) psychopathology was assessed with the Youth Self-Report and Child Behavior Checklist. Optimal Data Analysis was used to generate a classification tree model to identify variables associated with whether or not youths initiated oral, vaginal, and/or anal sexual activity before or after age 14. Three social context variables (parental hostile control, negative and positive peer influence) and one personal characteristic (externalizing problems) correctly classified 87.4% of teenagers as initiating sexual activity at < or =14 or >14 years of age. Parental behavior and peer influence were the most important variables associated with the timing of sexual debut. Results support a social-personal framework for understanding sexual risk-taking among adolescents in psychiatric care, and the data offer relatively strong evidence that specific factors could be used to identify troubled teens at risk for early sexual debut.

Sexualität in der Schwangerschaft: Risiko- oder Schutzfaktor? - Sexual Activity During Pregnancy: Risk Factor or Protection? -

Prenatal care should include discussions of sexuality and sexual activity during pregnancy. These discussions should be based on evidence in the medical literature rather than on personal opinion, but many obstetric textbooks contain little information on sexuality during pregnancy. Most studies have concluded that sexual intercourse is not a risk factor for a normal pregnancy. Genital, non-genital, oral, manual, anal or other sexual activity can be practiced. There are few data on which to base recommendations for patients with complicated pregnancies. Pregnancy is not a period of reduced sexual risk. Obstetricians should advise patients at risk for sexually transmitted diseases to use condoms. About 16 cases of life-threatening air insufflation due to oral-genital contact have been reported. Sexual activity may help stabilize a relationship during pregnancy and beyond delivery. In a phase of multiple modification, sexual activity facilitates a positive body image and acceptance of the pregnancy and pregnancy-associated changes. Sexual activity may help counteract mutual estrangement. A good sexual relationship does not necessarily mean active sexual activity or a certain frequency of sexual activity. Expectant parents should be encouraged to maintain adequate individual sexuality during pregnancy and beyond.

The relation between nitrite inhalants, unprotected receptive anal intercourse, and the risk of human immunodeficiency virus infection.

The role of nitrite was evaluated between 1985 and 1988 in a study of sexual transmission of the human immunodeficiency virus (HIV) among homosexual male couples in Boston, Massachusetts. Initial enrollment data suggested that a history of unprotected receptive anal intercourse (odds ratio (OR) = 2.3, 95% confidence interval (CI) 1.4-3.6) and a history of nitrite use (OR = 1.7, 95% CI 1.1-2.5) were independent risk factors for HIV infection. In addition, interaction between nitrite use and unprotected receptive anal intercourse was observed (OR = 5.5, 95% CI 2.8-11.1) after controlling for number of unprotected receptive anal sex partners and history of sexually transmitted diseases. Since it was felt that nitrite use might be a marker for unprotected receptive anal sexual activity, a supplemental questionnaire was administered to obtain information on simultaneous nitrite use and unprotected receptive anal intercourse. The supplemental data suggested a strong interaction between nitrite use and unprotected receptive anal intercourse in increasing the risk of HIV infection. In the adjusted analyses, the odds ratio for HIV infection was considerably greater among men who always used nitrites during unprotected receptive anal intercourse (OR = 31.8, 95% CI 12.9-76.7) compared with men who sometimes (OR = 7.1, 95% CI 2.1-23.6) or never (OR = 9.0, 95% CI 2.5-32.1) used them. These findings have preventive public health implications and may add insight into our understanding of the mechanism by which HIV infection spread rapidly among homosexual men in the early 1980s.