This is Part 1 of a two-part series on anal sex. For Part 2, click here.
As patient educators, we see female patients in our Program in Integrative Sexual Medicine clinic who want to know more about anal sex. Some have anal sex but have questions or worries about it, like “is it safe,” or “it feels good, but I’m worried about getting an infection.” Other women are considering anal sex for the first time. Because most of the women we see have cancer, we get questions about anal sex as an alternative to vaginal intercourse or oral sex. Side effects of some cancer treatments and other health conditions can make it difficult for some women to have vaginal intercourse or oral sex. When it comes to anal sex, we find very few high quality resources to help us educate our patients.
To our knowledge, there is not a widely available resource for adults that addresses both how to engage in anal intercourse and how to do so safely, despite the fact that as many as 30-40% of heterosexual Americans have had anal sex. By the way, researchers think this number is underreported. Think about it, even just saying “anal sex” can ruffle some feathers. To date, the best resource we’ve found on anal sex is an article published in Teen Vogue. Now, we like the article–it’s anatomically accurate and appropriately descriptive. However, written for teens, the article understandably leaves out some critical information for middle-age and older adults who would also like to learn about safe strategies for anal sex.
So, we decided to get started ourselves on writing a guide to anal sex for adults. We want to be thorough: this first post will focus on the what and the why of anal sex. Part 2 will delve into the details about how to try it in a safe way. We’re sure we’ll get some feedback and we’ll use that information to make the guide even better.
Defining sex is not easy. A survey conducted in 1991 surveyed college students to find out how they defined sex. In 1999, some of the findings were published in the prestigious Journal of the American Medical Association (JAMA), and the study has become a widely-referenced illustration of how differently Americans define sex. At the time the article was written, in the wake of the Clinton/Lewinsky scandal, the nation was asking: what counts as “having sex?” The survey, led by scientists at the Kinsey Institute, revealed widely ranging answers, with some participants (2%) saying that “deep kissing” counted as sex, 40% saying oral-genital contact counted as sex, and 99.5% agreeing that penile-vaginal intercourse counted as sex. Notably, 19% indicated that they would not count penile-anal intercourse as “sex.” This article did not even mention the multiple types of anal sex, described by experts as including oral-anal sex and penetration with fingers or other objects (McBride & Fortenberry 2010; Joannides 2006). For this guide, we will use “anal sex” to mostly refer to anal intercourse, in other words, sexual activity that involves inserting a penis or object (such as a dildo) into the anus, but special considerations for other types of anal sex are also discussed (you’re welcome).
Why do people engage in anal sex?
Before diving into how you might engage in anal sex, you might be wondering why you might want to in the first place. Of course, every person is different: what’s fun and pleasurable to one person might be unimaginable to another. That being said, there is evidence that some women find satisfaction in anal sex. In a 2011 review on anal sex among straight or heterosexual people, a few consistent themes were found for why couples engaged in anal sex. Using quotes and conversations from popular media like magazines and chat rooms, the analysis found that adults enjoyed, among other things, the additional trust and intimacy required for participating in anal sex, the novelty it offered to their sex lives, the excitement of its taboo nature, and the sensation (McBride & Fortenberry, 2010).
“Okay, okay,” you might be wondering, “But how does it feel?” The truth is, according to our search of the literature, very little research has been done on anal sexual pleasure in women. In men, the prostate gland can be stimulated during anal sex through the rectum. Some men find this sensation very pleasurable and attribute orgasm to prostate stimulation via anal intercourse. For women, the typical orgasm hotspots, for example the clitoris, are not directly reached through the rectum. However, some women do still report orgasm during anal sex. The best explanation we’ve come across for the pleasure that some women experience with anal sex (there’s really not a whole lot out there) is in “The Guide to Getting It On,” by psychoanalyst and sex researcher Paul Joannides:
“Aside from the obvious reason [that women might enjoy anal sex], which is that the anus is filled with lots of nerve receptors, it seems that the wall between the vagina and the rectum may swell when the woman is sexually aroused. This wall might tug on the same nerve that transmits vaginal orgasms to the brain. As a result, some women experience extra-pleasant sensations on the wall between the rectum and vagina during anal intercourse that they don’t get otherwise.”
Admittedly, this explanation is pretty vague (we’re not even sure what a “vaginal orgasm” is), but this expert description does give some credence to why anal sex might physically feel good to some women. Of course, a woman could also have her clitoris, breasts or other erogenous zone stimulated during anal sex and these activities, combined with anal sex, may very well lead to orgasm.
Joannides goes on to explain that stimulating the clitoris during anal intercourse might provide an “extra-intense orgasm.” We know that many women need clitoral stimulation, in general, to come to orgasm. In fact, in a recent study of 1,055 women aged 18 to 94 years, 36.6% of women reported needing clitoral stimulation for orgasm (a low estimate, based on our experience) (Herbenick et al. 2018). The same study found that just 18.4% of women reported that they were able to achieve orgasm through vaginal penetration alone (#youarenotalone). The moral of the story? Just like with vaginal intercourse, some women may find that anal sex is enough to have an orgasm, while others might find that it’s pleasurable but they still need the extra “oomph” of stimulating the clitoris to reach climax.
Our clinical experience has shown us that there are sometimes medical reasons that a person or couple might venture into anal intercourse for the first time. Scarring or stiffening of the vagina from radiation to treat vaginal, uterine or cervical cancer, for example, may make vaginal intercourse difficult or impossible and can also affect the anus and rectum. Surgical removal of all or some of the vulva (the external female genital organs) can also limit vaginal intercourse.
If you’ve had radiation to the rectum, vagina or pelvis—or have any other health condition that may interfere with sexual activity–talk to your doctor or other health care professional before attempting anal sex. Yes, it may feel awkward, but research shows that though doctors are receptive to having these conversations with patients, they rarely bring it up. Not sure how to begin? Try bringing a copy of this post along with you to your doctor to help spark a conversation!
Intrigued? Considering giving anal sex a try for the first time? Or just plain curious about what professionals and science say is the safest way to engage in anal sex? Click on through to Part 2!
- Herbenick D, Fu TJ, Arter J, Sanders SA, Dodge B. Women’s Experiences With Genital Touching, Sexual Pleasure, and Orgasm: Results From a U.S. Probability Sample of Women Ages 18 to 94. Journal of Sex and Marital Therapy. 2018 Feb 17;44(2):201-212.
- Joannides P, Gross D. Guide to getting it on! Waldport, OR: Goofy Foot Press; 2006.
- McBride KR, Fortenberry JD. Heterosexual Anal Sexuality and Anal Sex Behaviors: A Review. Journal of Sex Research. 2010 Mar 24;47(2–3):123–136.
- Park, E. Norris, R. Bober, S. Sexual health communication during cancer care: barriers and recommendations Cancer J, 15 (1) (2009), pp. 74-77