Doctors’ reluctance to discuss the possible harms of anal sex is letting down a generation of young women, researchers have warned.
Many doctors are concerned that they may come across as judgemental or homophobic, but by avoiding the topic they may be failing patients who are unaware of the risks, according to a study.
Surgeons Tabitha Gana and Lesley Hunt argue that not discussing it “exposes women to missed diagnoses, futile treatments, and further harm arising from a lack of medical advice”.
Writing in the British Medical Journal, they say 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 that all women have the information they need to make informed choices about sex.”
Data from the National Survey of Sexual Attitudes and Lifestyle shows that participation in heterosexual anal intercourse among 16 to 24 year-olds in Britain rose from 12.5% to 28.5% over the last few decades.
Up to 25% of women with experience of anal sex report they have been pressured into it at least once.
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It is also associated with specific health concerns, the surgeons explain.
For example, increased rates of faecal incontinence and anal sphincter injury have been reported in women who have anal intercourse.
Women are also at a higher risk of incontinence than men, due to their different anatomy.
“The pain and bleeding women report after anal sex is indicative of trauma, and risks may be increased if anal sex is coerced,” the authors said.
Effective management of anorectal disorders requires understanding of the underlying risk factors, and good history taking is key, they say.
Yet clinicians may shy away from these discussions, influenced by society’s taboos.
What’s more, NHS patient information on anal sex considers only 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,” the authors said.
“There is genuine concern that the message may be seen as judgemental or even misconstrued as homophobic.
“However, by avoiding these discussions, we may be failing a generation of young women, who are unaware of the risks.”
They added: “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.”
