Heterosexual Anal Sexuality and Anal Sex Behaviors: A Review

Article excerpt

Heterosexual anal intercourse is associated with increased risk for HIV and other genital and anal sexually transmitted infections (STIs; Buchacz, van der Straten, Saul, Shiboski et al., 2001; Halperin, 1999). Increasing rates of anal cancer may be attributable to more prevalent practice of anal intercourse and to the high prevalence of human papillomavirus (HPV) infection (Eng, 2006; Scott, Khoury, Moore, & Weissman, 2008). However, most research on anal intercourse addresses men who have sex with men (MSM), with relatively little attention given to anal intercourse and other anal sexual behaviors between heterosexual partners (Halperin, 1999). Heterosexual penile-anal intercourse has been treated as analogous to coitus in most published research. Research is quite rare that specifically differentiates the anus as a sexual organ or addresses anal sexual function or dysfunction as legitimate topics. As a result, we do not know the extent to which anal intercourse differs qualitatively from coitus. The purpose of this article is to review literature in four primary areas of heterosexual anal sex research--history and culture, prevalence and frequency, public health and sexual health issues, and behavioral antecedents and correlates--and to provide recommendations for future research.

Terminology

The terms anal sex and anal intercourse are typically used synonymously to refer to a dyadic sex act involving insertion and thrusting of one partner's penis in the anus of the other (Merriam-Webster Dictionary Online, 2009). The term sodomy sometimes indicates anal intercourse in historical, journalistic, and legal settings, but will not be used here. The Internet site Sex-Lexis.com (2009) lists more than 200 slang terms for anal intercourse, although many refer to same-sex rather than opposite-sex behavior. In this article, anal sex is used to encompass anal intercourse, as well as other anal sexual behaviors, such as oral-anal contact (analingus) and penetration by fingers or other objects. The term anal intercourse refers specifically to penile-anal intercourse.

Historical Overview and Shifting Cultural Norms

Historical Overview

Depictions of heterosexual anal sex can be found in art and artifacts dating to antiquity (Reinisch, Ziemba-Davis, & Sanders, 1990). Peruvian Moche stirrup-spout pots, erotic ceramic vases, from 300 AD may be some of the earliest and most prolific examples of such representations (see Figure 1). A survey of Moche pots found that 31% depicted heterosexual anal intercourse, significantly more than any other sexual act (Tannahill, 1992).

Chinese and Japanese shunga, woodblock prints and painted handscrolls, produced between the 16th and 19th centuries, depict a vast array of sexual practices, including heterosexual anal sex. Erotic French lithography and photography from the late 19th and early 20th centuries include both images of penile-anal intercourse, as well as digital-anal penetration. Erotica from the same period has described heterosexual anal sex acts. Today, images of heterosexual anal sex are so highly prevalent in pornographic films and Web sites that the sites advertise material based on whether it includes anal sex (e.g., "100% vaginal," "no anal," "100% anal," and "double penetration").

[FIGURE 1 OMITTED]

The term sodomy is broadly defined as anal penetration or oral copulation with a member of the opposite or same sex, or with an animal (Merriam-Webster Dictionary Online, 2009). The sexual use of the term sodomy as a synonym for anal intercourse among homosexual men is attributed to the Byzantine emperor Justinian I (538 AD). During the Medieval Inquisition (1184), hereticism was increasingly associated with fornication and sodomy, thus linking the behaviors to witchcraft and satanism. Since these times, sodomy and its biblical proscription have influenced the meaning and acceptability of anal intercourse behavior in Western culture. …