People are inundated with “safe sex” messages and condom advertisements, but heterosexual penetrative penile-anal sex is rarely, if ever mentioned in these, leaving a gaping hole in people’s knowledge and awareness.

by Zoe Duby University of Cape Town

Research on sexual transmission of HIV consistently finds unprotected anal intercourse to be a highly predictive risk factor for sero-conversion. Despite this, most AIDS prevention messages targeted at heterosexuals continue to solely emphasise vaginal (and increasingly but still only occasionally oral) sexual transmission without mention of anal sex. This omission is influenced by the deeply entrenched taboos surrounding this sexual practice, as well as a lack of acknowledgment of its prevalence and significance as a heterosexual behaviour.

Partly as a consequence of this omission, the potential health risks of unprotected anal sex continue to be severely underestimated in the heterosexual community. Although knowledge seems to be high amongst the gay community, this appears not to be the case amongst heterosexuals. Evidence of this lies in the reportedly universal lower use of condoms for anal sex than for vaginal sex by heterosexuals. Data suggests that some people choose to practice anal sex due to misconceptions about the risks it poses. Anal sex is sometimes not considered to be “real sex” and evidence suggests that young girls choose anal sex as a means of preserving their virginity and as a form of contraception.

Evidently there are significant gaps in knowledge and awareness of the risks of unprotected anal sex amongst heterosexuals; many people choose to have anal sex as a “safe” alternative, thinking that it is not possible to transmit HIV through anal intercourse. This is largely due to the lack of information available that explicitly depicts and differentiates all potential sexual transmission vectors – vaginal, anal and oral. People are inundated with “safe sex” messages and condom advertisements, but heterosexual penetrative penile-anal sex is rarely, if ever mentioned in these, leaving a gaping hole in people’s knowledge and awareness.

The censure and stigmatisation of a commonly practiced sexual behaviour not only puts people at greater risk but also creates an atmosphere of shame and disgust around what for many people may be a desirable, pleasurable and consensual part of sexual relationships and intimate interaction.

Why do heterosexuals have anal sex?

i. Virginity
Virginity maintenance is one of an array of reasons given for young people electing to have oral and anal sex over penile-vaginal penetrative sex; the substitution of non-vaginal sexual activities for vaginal intercourse is a means of maintaining “technical virginity.”

Religion and culture play a key role in condoning or prohibiting certain sexual practices. Ample data supports the assertion that young girls in Christian, Islamic and traditional societies throughout Africa practice anal sex in order to protect their vaginal virginity. In many cultures, a high value is placed by the family and society on safeguarding girls’ virginity until marriage. In addition, evidence shows that young people in the United States who pledge to remain virgins are more likely to have engaged in ‘alternative sexual behaviour’, in order to preserve their virginity. Research shows that among those who have not had vaginal intercourse, pledgers have shown to be more likely than their non-pledging peers to have engaged in both oral and anal sex. In communities with a higher proportion of virginity pledgers, overall STI rates are actually higher than in other settings. Reasons for this may lie in the lack of sex education that young people in conservative religious communities receive.

…a lot of my religious friends… who are trying to hold on to some sort of sanctity of waiting until they’re married to have sex – feel that oral sex and anal sex are sex that they can have that’s still not full sex in their eyes… I think that the youth… today… are searching for these things that don’t make them lose their virginity – but allow them to still sort of engage in sexual activity… like they think all their peers are.. It’s like a loophole – it’s like they’re desperate to hold onto their virginity – but they’re not scared to engage in other acts so that they look cool… [Respondent 1, Duby, 2008]

In some communities virginity until marriage is less an established religious issue than a traditional cultural preference. In some communities “virginity testing” is practiced. Young girls are examined before marriage to ensure that their hymen is intact. Discovery of a ruptured hymen brings shame to a girl and her family, and can jeopardise her eligibility for marriage. As a result of the high value placed on virginity and hymen maintenance (a falsity as the hymen can be ruptured in non-sexual activity such as tampon use or physical exercise) it appears that young people choose to have oral and anal sex instead.

In an era of abstinence and HIV prevention programmes advocating delayed sexual initiation, it can be argued that the social pressure to remain a virgin actually contributes to young women’s risk of infection, acts as a barrier to their adoption of preventive behaviours and encourages the subsitution of alternative non-vaginal sexual practices. Some young adults have unprotected anal sex unaware of the high risk of HIV and STI transmission it poses.

Research on adolescent sexual behaviour in the past has been largely limited to vaginal intercourse, thus accurate prevalence statistics for non-vaginal genital activity amongst adolescents are unavailable. Research and sexual health programmes have traditionally used the classification of an individual as ‘sexually active’ based on vaginal intercourse. This means that ‘technical virgins’ who are engaging in non-vaginal sexual activities are omitted from discussions on sexual risk, potentially excluding many sexually active young people and consequently placing them at greater risk.

ii. Contraception
In a similar vein to virginity maintenance, evidence suggests that heterosexual anal sex is also practiced as a means of contraception. Young women wishing to avoid pregnancy but still desirous of sexual activity choose anal sex as an alternative means of attaining sexual pleasure without fear of conception.

…the main reason for having anal sex, other than it just being nice for the guy – is ejaculation. He can come inside you and there’s no risk. [Female respondent, Duby, 2008]

Sexual partners wanting to have non-reproductive “flesh to flesh” sex without the presence of any form of contraception and without the physical barrier of a condom, may choose to have anal sex so that there will be no chance of conception if the male ejaculates inside the female.

…it’s a nice way because then there’s no stress if he comes inside you… [Female respondent, Duby, 2008]

iii. Misconceptions: Misinformed and Unaware
Sadly, available evidence suggests that anal sex is sometimes practiced as a form of “safe sex”, ironically as a means of avoiding HIV transmission. Due to the silence around the topic of heterosexual anal sex and its omission from discussion on safe sex, the assumption is made that it must be safe. Health care providers themselves are also often unaware of the risks of anal sex. The false impression created that anal sex is safer than vaginal sex may be due to its lack of address in health education. Safe sex promotion and HIV prevention strategies unwittingly encourage misperceptions that anal sex is a ‘safer’ form of sex. Evidence from anecdotal reports suggest that some people practice anal sex (either with a female or a male) because they believe it will protect them from STIs/HIV. The reason for this is because they have heard no discussion about the risks of infection through anal sex.

Condom Use and Anal Sex
Despite anal sex having been identified as the most predictive risk factor for sero conversion in heterosexual HIV transmission, its risks are still underestimated by the vast majority of sexually active heterosexuals. This is illustrated by data showing that reported rates of condom use are universally lower for heterosexual anal intercourse than vaginal, and that far more women engage in unprotected anal sex than gay men. The male homosexual population are more sensitised to condom use for anal sex than heterosexuals. This can be attributed to the fact that HIV and STI programs targeted at the general population do not specifically address anal sex, whereas prevention programmes aimed at the gay population do. Another reason may be that condoms are primarily used by women for contraceptive purposes rather than protecting against STIs. Due to the failure of prevention programmes to sensitise heterosexuals to the high risk of infection of HIV and other STIs through unprotected anal intercourse, the widespread assumption that HIV transmission between heterosexuals is synonymous with penile-vaginal penetrative sex is inadvertently reinforced. Most literature on HIV and AIDS does not pay heed to heterosexual anal sex, although contrary to the popular association of anal sex with homosexual men, numerically more heterosexuals engage in anal sex than homosexuals. But due to the highly stigmatised and hidden nature of heterosexual anal sex as a topic, both male and female heterosexuals are less likely to discuss and negotiate safe sex approaches to anal intercourse than homosexual men.

iv. Peer group pressure: “because everyone else is doing it”
In contrast to the pressure to maintain virginity exerted by religious and traditional communities, the power of the peer group should not be underestimated. Young people are subject to the powerful force of wanting to conform, of needing to be accepted into social groups. In ‘school yard’ discussions about sex prestige may be gained through sexual prowess and sexual experience. Some youths, in an effort to win respect and admiration from peers may exaggerate and boast about sexual experiences, in order to appear ‘mature’. Banter about adventurous and exciting new sexual positions, that may only be entirely theoretical, may exert pressure on more inexperienced teenagers to try out ‘what everyone else is doing’. Sexual prowess, expressed in terms of numerous sexual partners or claimed wide sexual experience, is linked to both peer and general social recognition, especially of a masculine profile.

v. Menstruation
Anal sex is sometimes used as an alternative form of penetrative sex when a woman is menstruating. Anal sex can constitute a more ‘convenient’ form of penetrative intercourse when a woman is menstruating, avoiding embarrassment, discomfort and the ‘messiness’ of blood on the bed sheets and bodies of both sexual partners.

…when she (my friend) had her period, they (her and her boyfriend) used to always just have anal sex instead, because then she could wear a tampon, and so that there didn’t have to be any blood. [Female respondent, Duby, 2008]

Interviewer: You mentioned before that anal sex was something you did in your first relationship when you were menstruating – why?
Female respondent: Um – just because… firstly you didn’t want to get blood everywhere, all over the sheets and stuff, and secondly I didn’t feel very comfortable with getting blood on him… I felt like… I dunno – I just didn’t like the thought of that. And I never really asked him about what he thought about that – and then sometimes it can be a bit painful to have (vaginal) sex when you’re menstruating. [Duby, 2008]

Additionally, in some societies menstrual blood is seen as a dirty polluting substance, potentially dangerous for men to come into contact with.

vi. For money
In the world of commercial sex work, evidence suggests that men will pay more for anal sex, with added value if it is without a condom. Motivation for commercial sex workers to engage in anal intercourse with their clients lies in the offer of higher financial benefits for anal sex than for vaginal sex. Evidence also suggests that more economically or socially vulnerable sex workers, as well as drug-abusing women, are more likely to offer unprotected anal intercourse for clients, being more driven by financial incentives than their less vulnerable and more financially secure co-workers.

vii. For him
Some feminist writers have argued that women have only come to understand their sexual pleasure and desire in terms of a patriarchally defined female sexuality which serves the male. In the process women are denied their own sexual subjectivity and pleasure. However it may be informative to examine the personally perceived moral obligations that a woman has to fulfill and satisfy her sexual partner’s desires, needs and fantasies. Popular contemporary media often compounds the perception that good sex in a relationship is the woman’s responsibility (however it would not be fair to say that men do not also come under pressure to provide sexual pleasure to women).

…my partner is always eager to do that (have anal sex)… and then I’m always kind of like “I don’t know” – so I think that mutual enjoyment out of it would be nice… which is probably why I really want to explore it a little more… I think it’s… it’s selfish in a way – you know you don’t want to be too giving in a sexual relationship – you want to get just as much enjoyment out of it as him at the same time… so I suppose it’s about getting to that point where we’re both enjoying it as much as the other. [Female respondent, Duby, 2008]

Many heterosexual women feel compelled to provide anal sex to their male partner, believing it to be more pleasurable for him. Women accommodate the perceived needs and desires of men, incorporating male needs into their own perceptions of what they want themselves. Many heterosexual women express the concern that if they fail to provide the sex that their male partner desires, they will be rejected; the provision and accomodation of a male partner’s needs enhances security within a relationship. This is especially the case in cultures where women’s sexual pleasure is not recognised or valued.

…he didn’t make me do it (have anal sex) if I really didn’t want to, but I did it because it was interesting for him to… explore this activity… this feeling… [Female respondent, Duby, 2008]

Interviewer: So why do you think men enjoy anal sex?
Female respondent: I think… in an animalistic sense, it’s more the power… the control, without it really even being rape – you know it’s not violent, it’s not… the person is allowing you to do it… and it probably makes them feel powerful – and you know it’s supposed to be tighter as well…

Interviewer: And do you feel, when you’re in that situation, do you feel it makes you more submissive?
Female respondent: Definitely. Because I’m not submissive by nature – and I suppose that’s why it feels a bit weird emotionally because you know I am literally not in control… I mean even from my experience of a partner’s reaction during anal sex, he kind of gets very… like an animal in a way… and he kind of loses a bit of himself and it becomes kind of… It’s difficult to explain… it has happened where it got to the point where I was like “ok, enough”… and they haven’t heard me… by choice – to put it bluntly… and that’s not… that’s not nice… that’s not cool, and that’s very sort of demoralising – and afterwards you really do feel violated… [Duby, 2008]

viii. Domination/submission
…some women enjoy it (anal sex) mostly because it pleases their partner and some women enjoy it because they do like the sensation – or they like being maybe more submissive or something like that… [Female respondent, Duby, 2008]

Penile-anal sex is sometimes viewed as more aggressive and transgressive than penile-vaginal sex, involving the domination of one partner over the subordinate other.

I think it’s definitely… the most vulnerable position a woman can be in… it obviously depends on the partner as well … what space he’s in when he initiated it… If it’s more because he’s not thinking about you in the process… there have been times when it’s been great, but sometimes it just makes you feel violated… even though you love the person that you’re with – and you care for them, you still feel a little bit violated after that… It also depends on how it’s received – how it’s valued… by the partner – because if it’s kind of like as they say “wham bam thank you maam”, then it’s sort of not appealing after that – but if it’s – if something does happen emotionally – and you do feel closer to that person and you can see that it’s reciprocated, then it becomes more intriguing, and then you think “maybe it won’t be so bad”… [Female respondent, Duby, 2008]

I think it’s quite a submissive thing to do… to be on the receiving end of it – I think there’s much more of a power dynamic than I think there is with ‘normal sex’…. That was all part of it – that was just part of the fantasy and the – you know what makes it fun…. and for him – I think that’s why he liked it as well – I think partly because you know you’re not facing each other – so it’s more about just the sex than about the love or anything…. [Female respondent, Duby, 2008]

ix. Love and intimacy
Some people feel that anal sex requires greater intimacy between sexual partners; couples may practice it out of the desire to expand their physical and intimacy boundaries, to “get closer” to each other and perhaps explore previously uncharted territory together.

…there’s a comfort level that goes above and beyond the comfort level of just having regular sex with somebody. Just to be able to do that and not feel gross and self-conscious about it… [Female respondent, Duby, 2008]

Due to both the physically and morally sensitive nature of anal sex, sometimes it is more symbolically imbibed than vaginal sex, involving a further degree of intimacy and trust between individuals (in the case of consensual anal sex).

x. Sexual adventure and sensation seeking
The historical association of anal sex with deviancy and pathology gives the impression that anal sex is something only practiced by perverse individuals. This of course is not the case; consensual anal sex constitutes a pleasurable part of many healthy sexual relationships. Heterosexual couples may practice anal sex out of a desire to try new things, experience novel sensations, explore physical boundaries and anatomical regions. Curiosity may induce temptation to try new sexual acts and positions.

…it’s like bungee jumping – you know you’re going to get scared – and you know it’s not going to be pleasant for the first few minutes but you know afterwards you’ll think: that wasn’t so bad… [Female respondent, Duby, 2008]

…it was mostly just because it was… just a different sensation or whatever… [Female respondent, Duby, 2008]

The first time I did it, I had to get used to the feeling – you know because it’s something that’s completely different from anything you’ve felt before… [Female respondent, Duby, 2008]

The ‘accomplishment motive’ may be particularly relevant to adolescents practicing anal sex, feeling they are under pressure to do everything that their peers have done. Alfred Kinsey referred to this desire that some people have to ‘keep score’ and have sex in every position available and known about, to attain a sense of achievement.

Interviewer: So what would you say are your key motivations for having anal sex?
Female respondent: I think just curiosity… to finally prove whether I’m going to like it or not… I don’t think I’ve explored it enough… to be honest… Just curiosity – I need to get it out of the way… otherwise I’ll just be wondering… [Duby, 2008]

xi. Sexual choice and variety
Sex is a consumer product in the context of the consumerist society we live in. There is a plethora of sexual choices and lifestyles that the (‘free’ and ‘modern’) individual sifts through and samples as a means through which to express the self. With sex shops, pornographic material, sex toys and sex shows becoming increasingly accessible and popular, we are inundated with imagery of the weird and wonderful world of adventurous and exciting sex. Within this jungle of sexual opportunities we are encouraged to find our sexual selves. In a context free from coercion, exploitation and economic pressure, the modern Western individual reaches sexual self-realisation through conscious choice.

Until now safe sex messages and HIV prevention programmes have retained a limited and narrow view of sex. Only recently have condom and lubricant manufacturers cottoned onto this thirst for sexual adventure and fun in the affluent West, and have increasingly geared certain products towards this and away from boring, outdated and conventional sex.

Interviewer: What would you say your motivations for trying anal sex the first time were?
Male respondent: I suppose curiosity… it feels like a part of my sexuality – maybe aspects of… aspects of it that intrigued me or aroused me – um… yeah all those reasons – and maybe I could even ask myself whether boredom, sexual boredom was initially a reason… [Duby, 2008]

xii. Subversion and deviance
The Christian influenced Western world has been largely conditioned by the pervasive philosophy of sex as a sin. In the dualistic notion of the temptation of the ‘forbidden fruit’, desire is increased by the forbidden nature of a sexual act, and sexual activity itself is enhanced by the very fact of transgression. The risk of ‘defying rules’ creates an aura of excitement and ‘additional thrill’. Arousal may be substantially increased if the sexual act is perceived to be an ‘illegitimate activity’.

…with my last sexual partner, I would often say to her, I feel like something nasty tonight… some days we’d be on the same page and other days we wouldn’t… I don’t know if subversion is the right word but something… you know sometimes you feel a little destructive – and letting your hair down and being a little nasty… is attractive… [Male respondent, Duby, 2008]

Some individuals choose to practice anal sex because of its moral positioning as “deviant”. In an attempt to challenge society and break from mainstream culture, people seek to indulge in behaviour, sexual and otherwise, that they perceive to be in opposition to societal norms and expectations. By making the conscious decision to practice anal sex they may be engaging in a discourse of subversion. The individual choosing to assert their agency in experimenting with sex and breaking away from socially ascribed sex norms and positions may get some satisfaction from the sense of subversion and escape from societal control.

…just because it is so taboo – I think that’s what makes it more appealing. [Female respondent, Duby, 2008]

Evidence for the high incidence of heterosexual anal sex increases, alongside scientific knowledge about the high risks of HIV and STI transmission through penile-anal intercourse. It can no longer be ignored. As long as the cloak of denial and taboo remains over the subject of heterosexual anal sex, not only are people continually being denied access to comprehensive information and health service provision catering to all their sexual health needs, but they are not being given the opportunity to make informed choices about practicing safe sex and thus protecting themselves and their partners from HIV infection.

The censure and stigmatisation of a commonly practiced sexual behaviour not only puts people at greater risk but also creates an atmosphere of shame and disgust around what for many people may be a desirable, pleasurable and consensual part of sexual relationships and intimate interaction.

Pervading moral judgements are hard to change but in creating and allowing space for discussion and expression of sexuality, sexual attitudes and sexual desires, dialogue will inevitably lead to a greater acceptance and acknowledgement of what has for so long been hidden and ignored. Research must begin to address heterosexual anal sexual practices more attentively to enable greater understanding of sexual motives and sexual behaviour, which in turn will inform HIV prevention programmes.

Interview data referenced from:
Duby, Zoe 2008. Heterosexual anal sex in the age of HIV: An exploratory study of a silenced subject Unpublished Master’s dissertation, Department of Sociology, Graduate School of Humanities, University of Cape Town