Doctors are putting young women at risk by failing to warn them about the harms of anal sex, researchers say.
Writing in the British Medical Journal, two female NHS surgeons claimed anal intercourse is becoming more common among straight couples because it is portrayed as ‘racy and daring’ in popular TV shows.
They said GPs and other doctors ‘have a duty to acknowledge changes in society’ and ‘to meet these changes with open neutral and non-judgmental conversations’.
But medics are ‘shying away’ from flagging the risks due to ‘societal taboos’, which risks ‘failing a generation of young women, who are unaware of the risks’.
Official estimates suggest more than a quarter of British and American women have tried anal sex with their male partners, either because they were curious, enjoy it or they felt pressured to.
But current NHS guidance on anal sex only considers only sexually transmitted diseases, omitting physical injury risks or the psychological trauma.
Writing in the BMJ, Dr Tabitha Gana and Dr Lesley Hunt said the style of intercourse can cause pain, bleeding, incontinence and long-term injuries.
More than a quarter of women in the UK and US now report having anal sex with their partners, with curiosity, enjoyment or pressure from partners driving the trend
Dr Gana and Dr Hunt – who are colorectal surgeons at Sheffield Teaching Hospitals – said anal sex has ‘moved from the world of pornography to mainstream media’.
It has become more common among heterosexual couples, with 28.5 per cent of British women aged 16 to 24 saying they have done it.
WHAT DOES THE NHS SAY ON ANAL SEX?
The health service warns that anal sex carries a higher risk of transmitting sexually transmitted infections than other sexual activities.
This is because the lining of the anus is thin and can be easily damaged, which makes it more vulnerable to infection.
Inserting a penis, fingers or sex toy in the anus all count as anal sex.
It urged people to use condoms when having anal sex and use a new condom if having vaginal sex straight after.
But colorectal surgeons warn that the risk of anal sex goes further than STIs.
They say women who do it are at risk of faecal incontinence, injuries to their anal sphincter and bleeding.
They called for doctors to warn women about the risks.
They also urged the NHS to address their ‘lacking’ public health messaging.
The rate jumps to 30 to 44 per cent among American men and women.
TV shows such as Sex and the City and Fleabag ‘may unwittingly add to the pressure’ by making it appear ‘racy and daring’ in heterosexuals relationships, the pair wrote.
Dr Gana and Dr Hunt said: ‘It is no longer considered an extreme behaviour but increasingly portrayed as a prized and pleasurable experience.’
They warned it is ‘risky’ because it is linked with alcohol, drugs, multiple sexual partners, less use of condoms and a higher risk of sexually transmitted disease.
Women who engage in anal sex more likely to suffer incontinence than men, as women have ‘less robust’ anal sphincters and lower anal canal strength, so damage is ‘more consequential’, they wrote.
Traumatic abrasions, bleeding and tear to the anus are also risks, the surgeons said.
Additionally, a quarter of women with experience of anal sex say they were pressured into it at least once.
The surgeons called for doctors to quiz patients with these symptoms about whether they have anal sex.
They said medics were put off doing so by concerns about ‘taboos’ or being branded ‘judgmental’ or ‘homophobic’.
Otherwise they risk ‘missed diagnoses, futile treatments and further harm arising from a lack of medical advice’, they warned.
And GPs and specialist digestive and colorectal medics should ensure women ‘have all the information they need to make informed choices about sex’.
They also urged the NHS to address their ‘lacking’ public health messaging on anal sex, which only details the higher rate of of STIs without setting out other physical risks as well as the ‘psychological aftermath’ of being coerced into it.
This has led to a ‘plethora of non-medical or pseudomedical websites fill the health information void’.
These sites ‘may increase societal pressure to try anal sex’ rather than helping women ‘make informed decisions’, they said.
Dr Gana and Dr Hunt wrote: ‘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.’
The pair said that health workers are duty-bound to ‘acknowledge changes in society around anal sex in young women’.
These should be met ‘with open neutral and non-judgmental conversations’ so all women have information to make informed choices about sex, they added.