The topic of heterosexual anal intercourse has gained significant attention in recent years. General population surveys in the United States suggest that the prevalence of anal intercourse among heterosexual couples has increased over time (Leichliter, 2008). However, it is unclear whether this is due to an actual increase in the practice or simply a greater willingness of people to admit to it along with other sexual activities like oral and vaginal sex (Leichliter, 2008; McBride & Fortenberry, 2010).
Unlike in the past, there is now less stigma associated with anal intercourse, which may explain why more people are open to discussing it during surveys (Mosher, Chandra, & Jones, 2005). It is worth noting that in the United States, no state currently has laws criminalizing anal intercourse (Kelvin, Smith, Mantell, & Stein, 2009). The rise in reported anal intercourse among heterosexual couples has implications for public health efforts to educate individuals about the risks of sexually transmitted infections, including those that can be transmitted through anal contact (Fleming & Wasserheit, 1999; Gorbach et al., 2009; Gross et al., 2000; Halperin, 1999; Javanbakht et al., 2010; Tian et al., 2008).
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Interest in anal intercourse has also stemmed from research on HIV transmission. Several studies have shown that the risk of HIV transmission through anal intercourse is higher compared to vaginal intercourse (Boily et al., 2009; Leynaert, Downs, & de Vincenzi, 1998; Powers, Poole, Pettifor, & Cohen, 2008). While the increased risk of HIV transmission through anal intercourse has been extensively studied in homosexual and bisexual men, there has been a recent focus on documenting comparable risks among heterosexual individuals. This is especially relevant in parts of the world, like South Africa, where there are high rates of anal intercourse among heterosexuals, high HIV prevalence in the general population, and a high number of concurrent partners (Kalichman et al., 2011; Thomas, 2009).
In the United States, the prevalence of HIV is predominantly high among ethnic minority groups, particularly African American and Latina women who have sex with men (McLellan-Lemal et al., 2012; Neblett & Davey-Rothwell, 2011; Reynolds, Fisher, & Napper, 2010). According to the U.S. Centers for Disease Control and Prevention (CDC, 2013), 86% of HIV cases among women are attributable to heterosexual contact. Furthermore, 65% of HIV infections in African American women and 17% of HIV infections in Latina women are a result of heterosexual contact. Research on women with male partners recently released from jail or prison has also shown high rates of anal intercourse (Bland et al., 2012; Swartzendruber, Brown, Sales, Murray, & DiClemente, 2011). Harawa and Adimora (2008) have linked high incarceration rates in the African American community to HIV transmission, as this reduces the number of male sexual partners available to African American women.
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Studies have also explored the relationship between anal intercourse and drug use, both injection and non-injection (Bogart et al., 2005; Lorvick, Martinez, Gee, & Kral, 2006; Powis, Griffiths, Gossup, & Strang, 1995; Risser, Padget, Wolverton, & Risser, 2009; Strang, Powis, Griffiths, & Gossup, 1994; Zule, Costenbader, Meyer, & Wechsberg, 2007). Additionally, the use of prescription drugs and PD5 inhibitors like Viagra has been associated with anal intercourse (Fisher et al., 2006). Mackesy-Amiti et al. (2010) found that among drug-using women, anal sex was more likely to occur during transactional sex, such as sex in exchange for drugs or money, and was not associated with emotional closeness.
While there is evidence suggesting that anal intercourse among heterosexual women may be more prevalent than previously assumed, particularly among drug-abusing women, there is still limited information on why these women engage in anal intercourse. Some believe that media images of sexual behavior may influence both men and women’s choices (Peterson & Hyde, 2010), but the extent to which these images impact women’s decisions to engage in anal intercourse, or men’s requests for it, remains unclear. Similarly, while there is a belief that women’s decisions to engage in anal intercourse may be influenced by traditional gender roles that prioritize male pleasure and female subjugation (Hekma, 2008; Peterson & Hyde, 2010), the extent to which women reference these roles and sexual scripts when deciding to engage in anal intercourse is still uncertain (Dworkin, Beckford, & Ehrhardt, 2007; Simon & Gagnon, 1986).
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