What the science says about anal sex

What the studies say overall

It is a common practice, although not the majority one in every group. In a population survey in Switzerland, slightly more than half of young women and men had never tried it (Meuwly et al., 2021), whereas in a survey of young women, more than six in ten had practised it (Stulhofer et al., 2011).

Pain is the finding that comes up most. In a representative US survey, around seven in ten women and one in seven men reported pain during anal intercourse, and many did not tell their partner (Herbenick et al., 2015).

In a large survey of heterosexual women, almost eight in ten said the first time was painful, although the pain eased over time for most (Stulhofer et al., 2013), and among young women almost half had to stop the first time (Stulhofer et al., 2011).

Among people with a prostate, those with more experience reported more pleasure and less severe pain, although the study did not follow the same people over time (Gaither et al., 2023). Among men treated for prostate cancer, almost one in four of those who tried it had severe pain (Wheldon et al., 2022).

Condoms are little used in this practice. Among women in the United States with and without HIV, anal sex was often without a condom (Owen et al., 2022), and among young people in Switzerland and the United States, condom use was lower or rare (Meuwly et al., 2021; Carter et al., 2010).

Among young people in South Africa, men who reported anal sex were almost twice as likely to have HIV (Lane et al., 2006). A female condom used in anal sex slipped more and caused more discomfort than the male latex condom (Renzi et al., 2003).

In a US national survey, fecal incontinence was more common among those who had had anal sex, especially in men (Markland et al., 2016). By contrast, a meta-analysis found no link between reporting anal sex and having rectal chlamydia in women (Chandra et al., 2018).

Where they disagree

Pain figures vary widely depending on who answers and when: the first time is not the same as regular practice, nor are women the same as men or people with a prostate (Stulhofer et al., 2013; Herbenick et al., 2015; Gaither et al., 2023).

Infections show something similar: anal sex was associated with HIV in young people in South Africa, but not with rectal chlamydia in women in high-income countries (Lane et al., 2006; Chandra et al., 2018).

Limits of the evidence

Almost everything comes from surveys, often of a specific group, and some are old (Carter et al., 2010; Lane et al., 2006). The studies on pain and experience compare groups at one point in time, so they do not show whether pain decreases with practice in the same person (Gaither et al., 2023).

The link with incontinence is an association and does not prove cause (Markland et al., 2016).

The studies, one by one

We have gathered 12 verified studies. Each summary is our own; the quotation in inverted commas is taken word for word from the original abstract, in English.

Other topics in the library

• Lubricants in anal sex13 studies
• The safety of anal toys6 studies