Clinicians' reluctance to discuss the possible harms of anal sex with their patients is letting down a generation of young women who are unaware of the risks, researchers have warned.
In an editorial for the medical journal The BMJ last week, surgeons Tabitha Gana and Lesley Hunt argued that with anal intercourse becoming more common among heterosexual couples, failure by doctors to candidly discuss the risks can expose women to "missed diagnoses, futile treatments, and further harm arising from a lack of medical advice".
Gana and Hunt, a colorectal surgeon and consultant surgeon respectively at the Northern General Hospital in Sheffield, UK, have warned that healthcare professionals - particularly those in general practice, gastroenterology and colorectal surgery - "have a duty to acknowledge changes in society around anal sex in young women".
"And to meet these changes with open neutral and non-judgemental conversations to ensure all women have the information they need to make informed choices about sex," they added.
In Britain, the National Survey of Sexual Attitudes and Lifestyle found that participation in heterosexual anal intercourse among 16 to 24-year-olds rose from 12.5 percent to 28.5 percent over the last few decades. Similar trends have also been observed in the US, where 30 to 44 percent of men and women have reported having anal sex - indicating as many as one in three people have tried the activity.
Young women have cited pleasure and curiosity as factors, but also concerningly acknowledged that pleasing their male partners and coercion could both play a role in participation. Up to 25 percent of women with experience of anal sex have reported being pressured into it at least once, the authors noted.
Anal intercourse is considered a risky sexual act due to its association with alcohol, drug use and multiple sex partners, as well as being associated with specific health concerns, Gana and Hunt explained, including incontinence and injuries caused by trauma.
For example, increased rates of faecal incontinence and sphincter injury have been reported in women who have anal intercourse and due to their different anatomy, women are also at a higher risk of incontinence than men.
"The pain and bleeding women report after anal sex is indicative of trauma, and risks may be increased if anal sex is coerced," they wrote.
Effective management of anorectal disorders requires a good understanding of the underlying risk factors as well as their patient's sexual history, they said. However, clinicians may shy away from these discussions due to the continued prevalence of sexual taboos in society.
Additionally, the authors noted that the NHS' patient information on anal sex only considers sexually transmitted diseases, making no mention of anal trauma, incontinence, or the psychological aftermath of the coercion young women report in relation to this activity.
"It may not be just avoidance or stigma that prevents health professionals talking to young women about the risks of anal sex. There is genuine concern that the message may be seen as judgmental or even misconstrued as homophobic," Gana and Hunt said.
"However, by avoiding these discussions, we may be failing a generation of young women, who are unaware of the risks.
"With better information, women who want anal sex would be able to protect themselves more effectively from possible harm, and those who agree to anal sex reluctantly to meet society's expectations or please partners, may feel better empowered to say no."
