Anal sex

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An illustration of heterosexual anal sex

Anal sex or anal intercourse is generally the insertion and

erotic torture such as figging. Although anal sex most commonly means penile–anal penetration,[3][4][6] sources sometimes use anal intercourse to exclusively denote penile–anal penetration, and anal sex to denote any form of anal sexual activity, especially between pairings as opposed to anal masturbation.[6][7]

Most

lesbian sexual practices.[11] People may experience pleasure from anal sex by stimulation of the anal nerve endings, and orgasm may be achieved through anal penetration – by indirect stimulation of the prostate in men, indirect stimulation of the clitoris or an area of the vagina (sometimes called the G-spot) in women, and other sensory nerves (especially the pudendal nerve).[2][4][12] However, people may also find anal sex painful, sometimes extremely so,[13][14] which may be due to psychological factors in some cases.[14]

As with most forms of sexual activity, anal sex participants risk contracting

sexually transmitted infections (STIs). Anal sex is considered a high-risk sexual practice because of the vulnerability of the anus and rectum. The anal and rectal tissue are delicate and do not provide lubrication like the vagina does, so they can easily tear and permit disease transmission, especially if a personal lubricant is not used.[3][2][15] Anal sex without protection of a condom is considered the riskiest form of sexual activity,[15][16][17] and therefore health authorities such as the World Health Organization (WHO) recommend safe sex practices for anal sex.[18]

Strong views are often expressed about anal sex. It is controversial in various cultures, often because of

religious prohibitions against anal sex among males or teachings about the procreative purpose of sexual activity.[5][7] It may be considered taboo or unnatural, and is a criminal offense in some countries, punishable by corporal or capital punishment.[5][7] By contrast, anal sex may also be considered a natural and valid form of sexual activity as fulfilling as other desired sexual expressions, and can be an enhancing or primary element of a person's sex life.[5][7]

Anatomy and stimulation

See also: Prostate massage
Male genital anatomy, showing the location of the prostate with respect to the rectum

The abundance of

external sphincter muscles control the opening and closing of the anus; these muscles, which are sensitive membranes made up of many nerve endings, facilitate pleasure or pain during anal sex.[2][5] Human Sexuality: An Encyclopedia states that "the inner third of the anal canal is less sensitive to touch than the outer two-thirds, but is more sensitive to pressure" and that "the rectum is a curved tube about eight or nine inches long and has the capacity, like the anus, to expand".[5]

Research indicates that anal sex occurs significantly less frequently than other sexual behaviors,

sex toys such as a dildo, a butt plug or anal beads, engage in anal fingering, anilingus, pegging, anal masturbation, figging or fisting for anal sexual activity, and different sex positions may also be included.[5][21] Fisting is the least practiced of the activities,[22] partly because it is uncommon that people can relax enough to accommodate an object as big as a fist being inserted into the anus.[5]

In a male

Skene's glands.[23] It is also typical for a man to not reach orgasm as a receptive partner solely from anal sex.[24][25]

General statistics indicate that 70–80% of women require direct

dorsal nerve of the clitoris.[4] Although the anus has many nerve endings, their purpose is not specifically for inducing orgasm, and so a woman achieving orgasm solely by anal stimulation is rare.[35][36]
Stimulation from anal sex can additionally be affected by popular perception or portrayals of the activity, such as
bowel is empty, for both aesthetics and practicality, may be desired by participants.[22]

Male to female

Behaviors and views

1892 lithograph by Paul Avril depicting male-to-female anal sex.

The anal sphincters are usually tighter than the pelvic muscles of the vagina, which can enhance the sexual pleasure for the inserting male during male-to-female anal intercourse because of the pressure applied to the penis.[3][41][19] Men may also enjoy the penetrative role during anal sex because of its association with dominance, because it is made more alluring by a female partner or society in general insisting that it is forbidden, or because it presents an additional option for penetration.[5][19]

While some women find being a receptive partner during anal intercourse painful or uncomfortable, or only engage in the act to please a male sexual partner, other women find the activity pleasurable or prefer it to vaginal intercourse.[6][41][42][43]

In a 2010 clinical review article of heterosexual anal sex, anal intercourse is used to specifically denote penile-anal penetration, and anal sex is used to denote any form of anal sexual activity. The review suggests that anal sex is exotic among the sexual practices of some heterosexuals and that "for a certain number of heterosexuals, anal intercourse is pleasurable, exciting, and perhaps considered more intimate than vaginal sex".[6]

Anal intercourse is sometimes used as a substitute for vaginal intercourse during menstruation.[5] The likelihood of pregnancy occurring during anal sex is greatly reduced, as anal sex alone cannot lead to pregnancy unless sperm is somehow transported to the vaginal opening. Because of this, some couples practice anal intercourse as a form of contraception, often in the absence of a condom.[5][37][44]

Male-to-female anal sex is commonly viewed as a way of preserving female

technical virginity.[45][46][47][48] Heterosexuals may view anal sex as "fooling around" or as foreplay; scholar Laura M. Carpenter stated that this view "dates to the late 1600s, with explicit 'rules' appearing around the turn of the twentieth century, as in marriage manuals defining petting as 'literally every caress known to married couples but does not include complete sexual intercourse.'"[45]

Prevalence

Because most research on anal intercourse addresses

norms may affect the frequency of heterosexual anal sex. McBride and her colleagues investigated the prevalence of non-intercourse anal sex behaviors among a sample of men (n=1,299) and women (n=1,919) compared to anal intercourse experience and found that 51% of men and 43% of women had participated in at least one act of oral–anal sex, manual–anal sex, or anal sex toy use.[6] The report states the majority of men (n=631) and women (n=856) who reported heterosexual anal intercourse in the past 12 months were in exclusive, monogamous relationships: 69% and 73%, respectively.[6] The review added that because "relatively little attention [is] given to anal intercourse and other anal sexual behaviors between heterosexual partners", this means that it is "quite rare" to have research "that specifically differentiates the anus as a sexual organ or addresses anal sexual function or dysfunction as legitimate topics. As a result, we do not know the extent to which anal intercourse differs qualitatively from coitus."[6]

According to a 2010 study from the National Survey of Sexual Health and Behavior (NSSHB) that was authored by Debby Herbenick et al., although anal intercourse is reported by fewer women than other partnered sex behaviors, partnered women in the age groups between 18 and 49 are significantly more likely to report having anal sex in the past 90 days. Women engaged in anal intercourse less commonly than men. Vaginal intercourse was practiced more than insertive anal intercourse among men, but 13% to 15% of men aged 25 to 49 practiced insertive anal intercourse.[50][51]

With regard to adolescents, limited data also exists.[49] This may be because of the taboo nature of anal sex and that teenagers and caregivers subsequently avoid talking to one another about the topic. It is also common for subject review panels and schools to avoid the subject.[49] A 2000 study found that 22.9% of college students who self-identified as non-virgins had anal sex. They used condoms during anal sex 20.9% of the time as compared with 42.9% of the time with vaginal intercourse.[49]

Anal sex being more common among heterosexuals today than it was previously has been linked to the increase in consumption of anal pornography among men, especially among those who view it on a regular basis.[38][39][10] Seidman et al. argued that "cheap, accessible and, especially, interactive media have enabled many more people to produce as well as consume pornography", and that this modern way of producing pornography, in addition to the buttocks and anus having become more eroticized, has led to a significant interest in or obsession with anal sex among men.[10]

Male to male

Behaviors and views

19th-century erotic interpretation of Hadrian and Antinous (detail), by Paul Avril.

Most homosexual men are reported to engage in anal sex.

versatile.[52]

Some men who have sex with men, however, believe that being a receptive partner during anal sex questions their masculinity.[53][54]

Prevalence

Reports regarding the prevalence of anal sex among gay men and other men who have sex with men vary. A survey in

The Advocate in 1994 indicated that 46% of gay men preferred to penetrate their partners, while 43% preferred to be the receptive partner.[52] Other sources suggest that roughly three-fourths of gay men have had anal sex at one time or another, with an equal percentage participating as tops and bottoms.[52] A 2012 NSSHB sex survey in the U.S. suggests high lifetime participation in anal sex among gay men: 83.3% report ever taking part in anal sex in the insertive position and 90% in the receptive position, even if only between a third and a quarter self-report very recent engagement in the practice, defined as 30 days or less.[55]

Oral sex and mutual masturbation are more common than anal stimulation among men in sexual relationships with other men.[1][56][57] According to Weiten et al., anal intercourse is generally more popular among gay male couples than among heterosexual couples, but "it ranks behind oral sex and mutual masturbation" among both sexual orientations in prevalence.[1] Wellings et al. reported that "the equation of 'homosexual' with 'anal' sex among men is common among lay and health professionals alike" and that "yet an Internet survey of 180,000 MSM across Europe (EMIS, 2011) showed that oral sex was most commonly practised, followed by mutual masturbation, with anal intercourse in third place".[9]

Female to male

A woman wearing a strap-on dildo about to engage in anal sex with a man (pegging).

Women may sexually stimulate a man's anus by fingering the exterior or interior areas of the anus; they may also stimulate the perineum (which, for males, is between the base of the scrotum and the anus), massage the prostate or engage in anilingus.[5][22][58] Sex toys, such as a dildo, may also be used.[5][22] The practice of a woman penetrating a man's anus with a strap-on dildo for sexual activity is called pegging.[21][59]

Reece et al. reported in 2010 that receptive anal intercourse is infrequent among men overall, stating that "an estimated 7% of men 14 to 94 years old reported being a receptive partner during anal intercourse".[60]

The BMJ stated in 1999:

There are little published data on how many heterosexual men would like their anus to be sexually stimulated in a heterosexual relationship. Anecdotally, it is a substantial number. What data we do have almost all relate to penetrative sexual acts, and the superficial contact of the anal ring with fingers or the tongue is even less well documented but may be assumed to be a common sexual activity for men of all sexual orientations.[61]

Female to female

A woman performing anilingus on another woman

With regard to

lesbian sexual practices, anal sex includes anal fingering, use of a dildo or other sex toys, or anilingus.[11][62]

There is less research on anal sexual activity among women who have sex with women compared to couples of other sexual orientations. In 1987, a non-scientific study (Munson) was conducted of more than 100 members of a lesbian social organization in Colorado. When asked what techniques they used in their last ten sexual encounters, lesbians in their 30s were twice as likely as other age groups to engage in anal stimulation (with a finger or dildo).[2] A 2014 study of partnered lesbian women in Canada and the U.S. found that 7% engaged in anal stimulation or penetration at least once a week; about 10% did so monthly and 70% did not at all.[63] Anilingus is also less often practiced among female same-sex couples.[64][65]

Health risks

General risks

Mucous membranes of the rectum

Anal sex can expose its participants to two principal dangers: infections due to the high number of infectious

safer sex practices in general, reduce the risk of STIs.[17][67] However, a condom can break or otherwise come off during anal sex, and this is more likely to happen with anal sex than with other sex acts because of the tightness of the anal sphincters during friction.[17]

Unprotected receptive anal sex (with an HIV positive partner) is the sex act most likely to result in HIV transmission.[15][17]

As with other sexual practices, people without sound knowledge about the sexual risks involved are susceptible to STIs. Because of the view that anal sex is not "real sex" and therefore does not result in virginity loss, or pregnancy, teenagers and other young people may consider vaginal intercourse riskier than anal intercourse and believe that an STI can only result from vaginal intercourse.[68][69][70] It may be because of these views that condom use with anal sex is often reported to be low and inconsistent across all groups in various countries.[68]

Although anal sex alone does not lead to pregnancy, pregnancy can still occur with anal sex or other forms of sexual activity if the penis is near the vagina (such as during intercrural sex or other genital-genital rubbing) and its sperm is deposited near the vagina's entrance and travels along the vagina's lubricating fluids; the risk of pregnancy can also occur without the penis being near the vagina because sperm may be transported to the vaginal opening by the vagina coming in contact with fingers or other non-genital body parts that have come in contact with semen.[71][72]

There are a variety of factors that make male-to-female anal intercourse riskier than vaginal intercourse for women, including the risk of HIV transmission being higher for anal intercourse than for vaginal intercourse.

urinary tract) due to bacteria present within the anus; these infections can also result from switching between vaginal sex and anal sex by the use of fingers or sex toys.[2][3][77]

Pain during receptive anal sex among gay men (or men who have sex with men) is formally known as anodyspareunia.[14] In one study, 61% of gay or bisexual men said they experienced painful receptive anal sex and that it was the most frequent sexual difficulty they had experienced. By contrast, 24% of gay or bisexual men stated that they always experienced some degree of pain during anal sex,[14] and about 12% of gay men find it too painful to pursue receptive anal sex; it was concluded that the perception of anal sex as painful is as likely to be psychologically or emotionally based as it is to be physically based.[14][78] Factors predictive of pain during anal sex include inadequate lubrication, feeling tense or anxious, lack of stimulation, as well as lack of social ease with being gay and being closeted. Research has found that psychological factors can in fact be the primary contributors to the experience of pain during anal intercourse and that adequate communication between sexual partners can prevent it, countering the notion that pain is always inevitable during anal sex.[14][78]

Damage

Anal sex can exacerbate hemorrhoids and therefore result in bleeding; in other cases, the formation of a hemorrhoid is attributed to anal sex.[3][79] If bleeding occurs as a result of anal sex, it may also be because of a tear in the anal or rectal tissues (an anal fissure) or perforation (a hole) in the colon, the latter of which being a serious medical issue that should be remedied by immediate medical attention.[3][79] Because of the rectum's lack of elasticity, the anal mucous membrane being thin, and small blood vessels being present directly beneath the mucous membrane, tiny tears and bleeding in the rectum usually result from penetrative anal sex, though the bleeding is usually minor and therefore usually not visible.[17]

By contrast to other anal sexual behaviors, anal fisting poses a more serious danger of damage due to the deliberate stretching of the anal and rectal tissues; anal fisting injuries include anal sphincter lacerations and rectal and sigmoid colon (rectosigmoid) perforation, which might result in death.[5][80]

Repetitive penetrative anal sex may result in the anal sphincters becoming weakened, which may cause rectal prolapse or affect the ability to hold in feces (a condition known as fecal incontinence).[3][79] Rectal prolapse is relatively uncommon, however, especially in men, and its causes are not well understood.[81][82] Kegel exercises have been used to strengthen the anal sphincters and overall pelvic floor, and may help prevent or remedy fecal incontinence.[3][83]

Cancer

Most cases of anal cancer are related to infection with the

human papilloma virus (HPV). Anal sex alone does not cause anal cancer; the risk of anal cancer through anal sex is attributed to HPV infection, which is often contracted through unprotected anal sex.[84] Anal cancer is relatively rare, and significantly less common than cancer of the colon or rectum (colorectal cancer); the American Cancer Society estimates that in 2023 there were approximately 9,760 new cases (6,580 in women and 3,180 in men) and approximately 1,870 deaths (860 women and 1,010 men) in the United States, and that, though anal cancer has been on the rise for many years, it is mainly diagnosed in adults, "with an average age being in the early 60s" and it "affects women somewhat more often than men."[84]

Cultural views

General

kylix
shunga
print depicting an older and a younger man

Different cultures have had different views on anal sex throughout human history, with some cultures more positive about the activity than others.[5][10][85] Historically, anal sex has been restricted or condemned, especially with regard to religious beliefs; it has also commonly been used as a form of domination, usually with the active partner (the one who is penetrating) representing masculinity and the passive partner (the one who is being penetrated) representing femininity.[5][7][10] A number of cultures have especially recorded the practice of anal sex between males, and anal sex between males has been especially stigmatized or punished.[7][86][87] In some societies, if discovered to have engaged in the practice, the individuals involved were put to death, such as by decapitation, burning, or even mutilation.[5]

Anal sex has been more accepted in modern times; it is often considered a natural, pleasurable form of sexual expression.[5][7][85] The buttocks and anus have become more eroticized in modern culture, including via pornography.[10] Engaging in anal sex is still, however, punished in some societies.[7][88] For example, regarding LGBT rights in Iran, Iran's Penal Code states in Article 109 that "both men involved in same-sex penetrative (anal) or non-penetrative sex will be punished" and "Article 110 states that those convicted of engaging in anal sex will be executed and that the manner of execution is at the discretion of the judge".[88]

Ancient and non-Western cultures

See also: Homosexuality in ancient Greece, Homosexuality in ancient Rome, and Sexuality in ancient Rome § Anal sex

From the earliest records, the ancient

ligature of the signs for 'penis' and 'anus'.[92] One Sumerian proverb reads: "When the gala wiped off his ass [he said], 'I must not arouse that which belongs to my mistress [i.e., Inanna].'"[92]

The term Greek love has long been used to refer to anal intercourse, and in modern times, "doing it the Greek way" is sometimes used as slang for anal sex.[93] Male-male anal sex was not a universally accepted practice in Ancient Greece; it was the target of jokes in some Athenian comedies.[94] Aristophanes, for instance, mockingly alludes to the practice, claiming, "Most citizens are europroktoi ('wide-arsed') now."[95] The terms kinaidos, europroktoi, and katapygon were used by Greek residents to categorize men who chronically[96] practiced passive anal intercourse.[97] Pederastic practices in ancient Greece (sexual activity between men and adolescent boys), at least in Athens and Sparta, were expected to avoid penetrative sex of any kind. Greek artwork of sexual interaction between men and boys usually depicted fondling or intercrural sex, which was not condemned for violating or feminizing boys,[98] while male-male anal intercourse was usually depicted between males of the same age-group.[99] Intercrural sex was not considered penetrative and two males engaging in it was considered a "clean" act.[94] Some sources explicitly state that anal sex between men and boys was criticized as shameful and seen as a form of hubris.[98][100] Evidence suggests, however, that the younger partner in pederastic relationships (i.e., the eromenos) did engage in receptive anal intercourse so long as no one accused him of being 'feminine'.[101]

Two Roman males on the Warren Cup, British Museum

In later

hetaerae, are said to have frequently practiced male-female anal intercourse as a means of preventing pregnancy.[102]

A male citizen taking the passive (or receptive) role in anal intercourse (paedicatio in Latin) [103] was condemned in Rome as an act of impudicitia ('immodesty' or 'unchastity'); free men, however, could take the active role with a young male slave, known as a catamite or puer delicatus. The latter was allowed because anal intercourse was considered equivalent to vaginal intercourse in this way; men were said to "take it like a woman" (muliebria pati 'to undergo womanly things') when they were anally penetrated, but when a man performed anal sex on a woman, she was thought of as playing the boy's role.[104] Likewise, women were believed to only be capable of anal sex or other sex acts with women if they possessed an exceptionally large clitoris or a dildo.[104] The passive partner in any of these cases was always considered a woman or a boy because being the one who penetrates was characterized as the only appropriate way for an adult male citizen to engage in sexual activity, and he was therefore considered unmanly if he was the one who was penetrated; slaves could be considered "non-citizen".[104] Although Roman men often availed themselves of their own slaves or others for anal intercourse, Roman comedies and plays presented Greek settings and characters for explicit acts of anal intercourse, and this may be indicative that the Romans thought of anal sex as something specifically "Greek".[105]

Moche Culture. 300 C.E. Larco Museum
Collection.

In Japan, records (including detailed

Moche people of Peru; in a survey, of a collection of these pots, it was found that 31 percent of them depicted male-female anal intercourse significantly more than any other sex act.[107] Moche pottery of this type belonged to the world of the dead, which was believed to be a reversal of life. Therefore, the reverse of common practices was often portrayed. The Larco Museum houses an erotic gallery in which this pottery is showcased.[108]

Western cultures

In many Western countries, anal sex has generally been taboo since the Middle Ages, when heretical movements were sometimes attacked by accusations that their members practiced anal sex among themselves.[109][110]

The term

medieval Europe as an insult used to describe the rumored same-sex sexual practices of the heretics from a sect originating in Bulgaria, where its followers were called bogomils;[111] when they spread out of the country, they were called buggres (from the ethnonym Bulgars).[111]

The Renaissance poet Pietro Aretino advocated anal sex in his Sonetti Lussuriosi ('Lust Sonnets').[112]

During the 1980s, Margaret Thatcher questioned the inclusion of "risky sex" in the United Kingdom's AIDS related government advertisements.[113] Thatcher questioned the inclusion of the term "anal sex" in line with the Obscene Publications Act 1959. The term "rectal sex" was agreed upon to be used instead.[114]

Religion

François-Rolland Elluin, Sodomites provoking divine wrath, from Le pot-pourri (1781)
Further information: Sodomy
See also:
LGBT topics and Hinduism

Judaism

The Mishneh Torah, a text considered authoritative by Orthodox Jewish sects,[115] states "since a man's wife is permitted to him, he may act with her in any manner whatsoever. He may have intercourse with her whenever he so desires and kiss any organ of her body he wishes, and he may have intercourse with her naturally or unnaturally [traditionally, unnaturally refers to anal and oral sex], provided that he does not expend semen to no purpose. Nevertheless, it is an attribute of piety that a man should not act in this matter with levity and that he should sanctify himself at the time of intercourse."[116]

Christianity

See also: Sodomy § Christianity

Christian texts may sometimes euphemistically refer to anal sex as the peccatum contra naturam ('the sin against nature', after Thomas Aquinas) or Sodomitica luxuria ('sodomitical lusts', in one of Charlemagne's ordinances), or peccatum illud horribile, inter christianos non nominandum ('that horrible sin that among Christians is not to be named').[117][118][119]

Islam

Main article:
Islamic views on anal sex
Ottoman illustration depicting two young men having sex (from Sawaqub al-Manaquib)

Liwat, or the sin of Lot's people, which has come to be interpreted as referring generally to same-sex sexual activity, is commonly officially prohibited by Islamic sects; there are parts of the Quran which talk about smiting on Sodom and Gomorrah, and this is thought to be a reference to "unnatural" sex, and so there are hadith and Islamic laws which prohibit it.[120] Same-sex male practitioners of anal sex are called luti or lutiyin in plural and are seen as criminals in the same way that a thief is a criminal.[121] [122]

Other animals

As a form of non-reproductive sexual behavior in animals, anal sex has been observed in a few other primates, both in captivity and in the wild.[123][124][125]

See also

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