Sexual Pleasure is Key for Successful Microbicides

via WeNews, by Amy Littlefield

Participants in Kate Morrow's [IRMA Steering Committee Member] recent study may not have felt like they were fighting the global HIV epidemic.

In fact, what they were literally feeling were gels of various consistencies inside their vaginas.

The women in Morrow's Project LINK answered questions after handling the gels, inserting them vaginally, walking around and simulating intercourse with a fake phallus. Did the gel leak out? Did it inhibit the experience . . . or did they actually enjoy it?

Morrow has developed a set of scales to show the range of sensations and experiences women reported. Her goal now is to connect those sensations to data about which gels women would use to prevent HIV. Do they prefer gels that are smooth, thin or thick like hair gel? The answers to those questions could help lead to a microbicide that women will tolerate--and perhaps even enjoy.

For decades, women's health advocates have known that women need a way to protect themselves from HIV that is not dependent on a male partner. Vaginal microbicide gels are among an array of options--including pills, rectal microbicides and vaginal rings--that may one day help. Advocates hope microbicides could even be combined with birth control and help prevent other sexually-transmitted illnesses.

Read the rest.

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Anti-AIDS Gel Also Boosts Sexual Pleasure

Via Times of India.

 South African scientists, who launched a 24-month trial to confirm the efficacy of a microbicide gel that would reduce the risk of women getting HIV, have found an unexpected spin-off – it also boosts sexual pleasure.

Wits professor Helen Rees, of the university's reproductive health and HIV institute, said the R300m trial would involve about 2,200 sexually active women at seven locations countrywide.

The Tenofovir gel study - known as Follow-on African Consortium for Tenofovir Studies (Facts) study - would be a follow-up to the Caprisa 004 study, which showed that a highly consistent use of the microbicide by women resulted in a 59 per cent reduction in the risk of HIV infection.

Rees said during a previous study involving another gel - that proved unsuccessful in the fight against HIV - participants had noted the gel improved their sexual pleasure.

"One of the big messages we got, was many women said 'We liked this', News24.com quoted her as saying. 

 

Read the rest here. 

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Sphincter Riddles - why do women like anal sex?

The Riddle of the Sphincter
Why do women who have anal sex get more orgasms?
via Slate, by William Saletan


Last week, I tried to figure out why more women are having anal sex and why it correlates so highly with orgasms. Since 1992, the percentage of women aged 20-24 who say they've tried anal sex has doubled to 40 percent. The percentage of women aged 20-39 who say they've done it in the past year has doubled to more than 20 percent. And 94 percent of women who received anal sex in their last encounter said they reached orgasm—a higher rate of orgasm than was reported by women who had vaginal intercourse or received oral sex.

Why? For obvious reasons—anatomical, evolutionary, and aesthetic—anal sex should, on average, be less attractive and satisfying than vaginal or oral sex. In last week's column, based on new survey data, I inferred that female orgasms caused anal sex rather than the other way around. The other acts reported by women who engaged in anal sex—vaginal intercourse, cunnilingus, partnered masturbation—delivered the orgasms. In turn, these women indulged their male partners' requests for anal sex.

Well, shame on me. Not for talking about sodomy—that taboo seems to be fading fast—but for doubting that women love it. These women are now coming forward to affirm that they're into it for their own pleasure, thank you very much. And they aren't alone. Bloggers, blog readers, and Slate commenters are offering lots of other theories to explain the orgasm data.

Read the rest.

The asspects of anal sex

via UWM Post, by Jon Tingley



Anal penetration used to be a taboo topic. In fact, for some of you, it might still be. What used to be relegated to men playing in bathhouses and Bally’s locker rooms is now a widespread form of sexual intercourse enjoyed by all different sexual orientations and genders.

Many people decide not to participate in anal penetration with their sexual partner or even on their own because of the pain associated. This kind of sexual pleasure actually doesn’t have to be a pillow-biting experience when done correctly. I’m often surprised by my sexually active gay male friends who are still experiencing extreme pain during sexual intercourse even though they have experience. It just goes to show you that even those with apparent sexual know-how can have it wrong sometimes

There are a few things to remember when considering taking it up the butt:

Read the rest.

Top Scientists Get to the Bottom of Gay Male Sex Role Preferences

via Scientific American, by Jesse Bering

It’s my impression that many straight people believe that there are two types of gay men in this world: those who like to give, and those who like to receive. No, I’m not referring to the relative generosity or gift-giving habits of homosexuals. Not exactly, anyway. Rather, the distinction concerns gay men’s sexual role preferences when it comes to the act of anal intercourse. But like most aspects of human sexuality , it’s not quite that simple.

I’m very much aware that some readers may think that this type of article does not belong on this website. But the great thing about good science is that it’s amoral, objective and doesn’t cater to the court of public opinion. Data don’t cringe; people do. Whether we’re talking about a penis in a vagina or one in an anus, it’s human behavior all the same. The ubiquity of homosexual behavior alone makes it fascinating. What’s more, the study of self-labels in gay men has considerable applied value, such as its possible predictive capacity in tracking risky sexual behaviors and safe sex practices.

People who derive more pleasure (or perhaps suffer less anxiety or discomfort) from acting as the insertive partner are referred to colloquially as “tops,” whereas those who have a clear preference for serving as the receptive partner are commonly known as “bottoms.” There are plenty of other descriptive slang terms for this gay male dichotomy as well, some repeatable (“pitchers vs. catchers,” “active vs. passive,” “dominant vs. submissive”) and others not—well, not for Scientific American , anyway.

In fact, survey studies have found that many gay men actually self-identify as “versatile,” which means that they have no strong preference for either the insertive or the receptive role. For a small minority, the distinction doesn’t even apply, since some gay men lack any interest in anal sex and instead prefer different sexual activities. Still other men refuse to self-label as tops, bottoms, versatiles or even “gay” at all, despite their having frequent anal sex with gay men. These are the so-called “Men Who Have Sex With Men” (or MSM) who are often in heterosexual relations as well.

Several years ago, a team of scientists led by Trevor Hart at the Centers for Disease Control and Prevention in Atlanta studied a group of of 205 gay male participants. Among the group’s major findings—reported in a 2003 issue of The Journal of Sex Research —were these:

Read the rest.

A condom specifically for anal intercourse?

IRMA chats up Dan Resnic of Strata Various Product Design about the ORIGAMI Condom - a new product in development designed specifically for anal intercourse.



IRMA - Tell us about this ORIGAMI condom you are working on. What is it? How is it different from other condoms?

DAN RESNIC - This is a radical new design concept, made of non-latex material and the first AI (anal intercourse) condom data ever presented to the FDA for review. The data will be used to help establish the first safety standards for a condom used exclusively for AI. ORIGAMI Condoms are designed foremost for the pleasure of both partners and simultaneously to improve safety. Its improved capacity for better sensation during AI is intended to increase consumer acceptability and to promote its consistent use among men and women currently at risk.

The non-latex material we developed is unique. It's been lab tested as a male condom against a leading brand of a male latex condoms. The ORIGAMI material had zero viral permability compared with the latex condom, which had 5% viral permeability. Viral permeability is tested by introducing virus smaller than HIV into sterile water inside the condom, suspended in sterile water for 72 hrs. The water outside the condom is then tested to detect virus that may permeate through the condom. The test is repeated in reverse, starting with virus outside the condom then testing for viral premeability in the opposite direction. The tests are repeated again with pinholes punctured into the condoms. Again, the ORIGAMI tested at zero viral permeability even with puncture holes while the latex condom failed. In addition, the new material will not degrade in sunlight as does a latex condom and, after accelerated aging tests, it is expected to offer an extended shelf life of 10-12 yrs.

Future condom studies currently under funding review include a new, reusable ORIGAMI elastomer material we developed that can be washed and dried in a washer/dryer at high temperatures and can even be sterilized in a microwave or boiling in water and air dried in sunlight without compromising its structural integrity. The latter could be especially significant in regions like Africa and India where cost and distribution can be issues that prevent consistent condom use.

Photos and further details will be made available following FDA pre-market approval.


I – Where is the research at the moment?

DR - Phase 1 research will begin next month, in July 2009, with the Behavioral Epidemiology Research Group at the UCLA Dept of Epidemiology, with co-Investigator Dr. Pamina Gorbach. R&D will be supported with the assistance of male and female consultants from design, medical and commercial sectors. The optimal design will undergo pre-clinical testing, with modified structural testing crietria appropriate for the higher stress in AI use. Clinical research will follow with study groups and data will be analized for final reports.


I – How are you collaborating with the NIH and UCLA? What is the timeline?

DR - As the PI for the project, I've awarded a sub-contract to UCLA, which will conduct the clinical research with volunteer couples who will test the condom in a unique study design developed by Dr. Gorbach, who heads the Behavioral Epidemiology Research Group at UCLA. The project has been funded by a substantial grant from the NIH. The study will run for 18-24 mos. starting July 1st. Subsequent Phase II research will take the project through to the end
of 2014, when the data can be reviewed by the FDA. Since there is no existing precedent the data cannot be reviewed under FDA's 510K application. Consequently, the process is much longer and much more expensive. The same is true of the ORIGAMI Female Condom we've developed. The FDA requires 3-4 similar products approved on the market before a similar device can be reviewed under a 510K application, which is typically a 90 day review process.


I – Why is it so important to have a condom specifically designed for anal intercourse?

DR- This is an excellent question. It would appear to many to be a frivolous and unnecessary product, however, the typical rolled condom design we are all familiar with, has not been tested for anal intercourse (AI), yet its the only means of protection available to men and women who engage in AI. The FDA states that condoms are the ". . . best available protection for anal sex..." although, to date, no data has been submitted to the FDA for review to support its use for AI.


I – Since unprotected anal intercourse is the most efficient means of sexual transmission of HIV, and since many people don’t use traditional condoms during anal intercourse each and every time, it seems odd that a condom like ORIGAMI hasn’t been thought of before. Why do you think that is?

DR- Inventive ideas for new condoms that address specific needs such as AI have been consistently inhibited by the high cost of R&D as well as the socio/political barriers that existed until 2008. It wasn't until the concept of a female condom emerged that it was even possible to consider an inseted anal condom. For many years people had tried using the female condom for AI but it's not strong enough and it's lacking the unique design features compatible with AI.

Essentially, condoms are tested and FDA approved for vaginal use only. The FDA is typically provided with testing documentation from condom manufacturers based exclusively on vaginal use, and consequently there are no established guidance documents available from the FDA for condoms used for AI. For many years, in the US and elsewhere, it was considered taboo to discuss AI. In recent years, the subject was discussed at a special summit conference conducted by the FDA, specifically intended to encourage manufacturers to produce condoms for AI, however, none of the manufacturers who attended the meeting followed through. No existing condom manufacturer would risk producing such testing data as the failure rate for breakage, leakage and viral permeability would be significantly higher than testing results for vaginal use.

The FDA relies on manufacturers to present data for their review. Unless a manufacturer submits data (of any medical device) for review, the FDA does not conduct independent testing. As a regulatory agency, they are authorized only to review data from manufacturers but the agency cannot conduct its own independent research to set guidelines. It would be cost prohibitive to cover all medical devices. FDA Guidance Documents are established over time based on existing products and related testing data provided by manufacturers. Regarding latex condoms, the most current guidance document for manufacturers was last updated with minor changes on November 14, 2005.


I – Next steps?

DR - We anticipate successful Phase I study data by June 2011, which we intend to follow with a larger, Phase II study. We will work closely with the FDA to help determine further testing criteria appropriate for condoms used for AI. For example, the breakage standards, not yet established for AI, will be significantly different from existing condoms designed and sold for vaginal intercourse. AI condoms must meet a higher safety standards than typical existing condoms that were originally designed in 1918 for vaginal sex.


Thank you Dan! We look forward to learning more about this important work.

Let's all start sucking around!

by Jan Wijngaarden

Fridae’s Men’s Sexual Health columnist Jan Wijngaarden wonders why oral sex has not been as widely recommended as a 'safer option' given that it has been found to be of much lower risk compared to anal sex.

A while ago, a friend of mine, who is around 55 years old and from Europe, sadly looked back on his life during a birthday dinner. He said that none of his (gay) friends from when he was in his twenties and thirties was alive to celebrate his birthday with him. They had all died - most of them, by far, died of AIDS.

I was intrigued. Why did he survive? Was he immune, or what? Or was he the only one who used condoms? When we were alone, after the dinner was finished, I decided to ask him.

He said: "Condoms? Nobody used them at that time. It was true; I had syphilis, gonorrhea and chlamydia several times, but those could be treated easily. That was not it, for sure."

So, what then? He answered: "It is the fact that I HATE anal sex which must have saved my life!"

It is an interesting conclusion, with a lot of truth in it. Anal intercourse is the sexual behaviour which is - by far - most likely to transmit HIV among gay men (and - much less well known - maybe among some heterosexuals, too).

Read the rest.

Anal 101 with Tristan Taormino

Tristan Taormino recently sat down with Keith Orr from AIDS Action's MALE Center before she held a workshop dealing with issues around anal sex.




Check out her Pucker Up posts on anal sex.

"Bareback Sex" motivations in HIV risk contexts

Assessing motivations to engage in intentional condomless anal intercourse in HIV risk contexts ("Bareback Sex") among men who have sex with men.
JA Bauermeister, A Carballo-Dieguez, A Ventuneac, and C Dolezal
AIDS Educ Prev, April 1, 2009; 21(2): 156-68.

Although condom use is an effective barrier against HIV transmission, some men who have sex with men (MSM) engage in bareback sex (unprotected anal sex in risky contexts) and increase their risk for HIV (re)infection. Understanding MSM's decision to bareback (vis-à-vis condom use) is essential to develop effective HIV/AIDS prevention programs for this population.

An ethnically diverse sample of men who bareback (n = 120) was recruited exclusively on the Internet and stratified to include two thirds who reported both unprotected receptive anal intercourse (URAI) and being HIV uninfected.

We used exploratory factor analysis to explore the domains within the Decisional Balance to Bareback (DBB) scale, and test the association between DBB and risky sexual behaviors. HIV-positive MSM (n = 31) reported higher costs/losses associated with condom use than HIV-negative men (n = 89).

We found two underlying factors in the DBB scale: a Coping with Social Vulnerabilities subscale (eight items; alpha = .89) and a Pleasure and Emotional Connection subscale (five items; alpha = .92). We found a positive association between DBB (i.e. greater gains associated with bareback sex) and URAI occasions, number of partners, and having one or more sero-discordant partners in the past 3 months.

We conclude that because MSM may avoid using condoms in order to cope with psychosocial vulnerabilities and create intimacy with other MSM, this population could benefit from alternatives to condoms such as pre/post exposure prophylaxis and rectal microbicides.

Journal article: "Is ‘bareback’ a useful construct in primary HIV-prevention? Definitions, identity and research"

by A. Carballo-Diéguez, A. Ventuneac, J. Bauermeister, G. W. Dowsett, C. Dolezal, R. H. Remien I. and Balan M. Rowe, January 2009,Culture, Health & Sexuality.

The terms bareback and bareback identity are increasingly being used in academic discourse on HIV/AIDS without clear operationalisation. Using in depth,face-to-face interviews with an ethnically diverse sample of 120 HIVinfected and -uninfected men, mainly gay-identifying and recruited online in New York City, this study explored respondents’ definitions of bareback sex, the role that intentionality and risk played in those definitions, and whether respondents identified as ‘barebackers’. Results showed overall agreement with a basic definition of bareback sex as condomless anal intercourse, but considerable variation on other elements. Any identification as barebacker appeared too loose to be of use from a public health prevention perspective. To help focus HIV prevention efforts, we propose a re-conceptualisation that contextualises risky condomless anal intercourse and distinguishes between behaviours that are intentional and may result in HIV-primary transmission from those that are not.

Read the full article here (housed on the IRMA website.)

Increase In Anal Intercourse Involving At-Risk Teens And Young Adults

via Medical News Today

Source

A new study by researchers at the Bradley Hasbro Children's Research Center suggests that the incidence of heterosexual anal sex is increasing among teens and young adults - particularly those who have recently had unprotected vaginal sex. These findings mirror recent data that show anal sex rates among adults doubled between the years 1995 and 2004.

The study, published online by the American Journal of Public Health, is among the first to report on the little-known factors associated with heterosexual anal intercourse among adolescents and young adults.

"The topic of anal intercourse is often considered taboo - especially when discussed in the context of youth relationships - even though we know that this behavior is a significant risk factor for HIV and other sexually transmitted infections. It's critical that we recognize that more and more young people are engaging in anal sex so we can open the lines of communications and help them protect their sexual health," says lead author Celia Lescano, PhD, of the Bradley Hasbro Children's Research Center (BHCRC).

Researchers assessed the sexual behavior of 1,348 adolescents and young adults between the ages of 15 and 21 who had unprotected sex in the previous three months. They found that 16 percent had engaged in heterosexual anal intercourse within the timeframe, with condoms being used just 29 percent of the time.

Females who had heterosexual anal sex were more likely to be living with their partners, to have two or more sexual partners and to have previously experienced coerced intercourse. Males who engaged in heterosexual anal intercourse were more likely to identify themselves as being homosexual, bisexual or undecided.

"These findings suggest that the factors associated with anal intercourse among females in the study relate to the context and power balance of sexual relationships," says Lescano, who's also an assistant professor of psychiatry (research) at the Warren Alpert Medical School of Brown University. "We must teach teen girls and young women how to be assertive in sexual relationships, such as refusing unwanted sexual acts and negotiating for safer sex, whether it's anal or vaginal."

However, there were several factors related to anal intercourse that were consistent in both genders. In general, those who felt that using condoms decreased the pleasure of sex and those who used drugs at the time of intercourse engaged in riskier behaviors, suggesting that interventions should emphasize that sex can be both pleasurable and safe.

"An open dialogue between health care providers and their young patients about anal intercourse is becoming increasingly important, and clinicians should ask about anal sex during discussions about vaginal intercourse and protection - regardless of the patient's gender or reported sexual orientation," says Lescano.

Study participants in Atlanta, Miami and Providence completed a self-interview designed to measure sexual risk behaviors, relationships, sexual risk attitudes, substance use and mental health. The majority of the group (92 percent) defined themselves as being heterosexual. Overall, 56 percent were female; approximately half of the participants were African American, 24 percent were Hispanic and 20 percent were white.

Learn more.

Indian Youth Festival Puts Sexy Back in Dialogue About Safe Sex

by Rama Lakshmi for the Washington Post

"Talking about disease and fear haven't worked very well. People believe they are in a safe relationship and that disease does not apply to them," said Arushi Singh, a resource officer for the International Planned Parenthood Federation, which trains health educators in South Asia. "But pleasure," she said, "applies to everybody."

NEW DELHI -- A recent youth festival aimed at raising awareness about health issues and HIV in India did something unique to draw visitors. Amid all the sobering talk of at-risk communities, safe sex and health care, the festival invited bashful attendees to talk about pleasure.

At one booth, visitors were urged to leave tips in a drop box under a sign that asked, "Can safe sex be sexy?" In another booth nearby, the use of the female condom was demonstrated to curious onlookers.

But talking about sex can be an uphill task in India's traditional and patriarchal society. Even though India gave the world the "Kama Sutra," the ancient Sanskrit text about sexual behavior, open conversations about sex remain taboo in the country.

Read the rest.

Mardi Gras and Sexual Behavior

excerpt from Kinsey Confidential

...Several years ago, some of our colleagues in the School of Health, Physical Education and Recreation here at Indiana University actually studied sexual behavior in the context of Mardi Gras. Using a theory that takes notice of the influence of a person's environment (the people around them as well as their surroundings) and perceptions about what's appropriate in a given context (say, on Bourbon Street), they examined people's behavior at Mardi Gras.

They found that about half of men in their study expected to have a new vaginal or oral sex partner while at Mardi Gras and about 20% expected to have anal sex with a new partner. Fewer women had such expectations. What happened is that more women had new partners than planned to - and, as you might guess, some of the men overestimated their chances of hooking up at Mardi Gras. A person's situational conditions (in this case, feeling as though they were in a sexualized environment, drinking and being a part of the Mardi Gras culture of beads and costumes) was also linked to their sexual behavior at Mardi Gras. (Read the full study here.) In other words, context matters...

Read the whole item.

Sex Ed should actually talk about sex - and not just the scary stuff

High school kids are being taught about the birds and the bees with the same fear-mongering tactics many of us remember. But some health educators today are offering teens a more grown-up lesson: Sex isn't necessarily a bad thing.

excerpt from the boston globe

... Halfway through one of Megara Bell's classes, a ponytailed girl in a bright-green shirt asks the most basic of questions.

"Wait," she calls out. "What is sex?"

Bell is a Newton mother of three with short, spiky brown hair and a wry smile that suggests she would be hard to rattle. As director of the nonprofit Partners in Sex Education, she teaches about human sexuality at youth organizations, public and private schools, and juvenile detention centers around Greater Boston, and on this sunny fall afternoon, she's at an all-girls' residential school in Arlington. Six teens have gathered in a small, fluorescent-lit classroom, made name cards in pink and purple ink, and established ground rules like "It is OK to laugh." A game about decision making led to a question about how old a person must be to "have sex," which prompted, "What is sex?"

There's a little snickering, but the ponytailed girl presses ahead, explaining that if they're going to talk about how old you have to be to do certain things, she wants to know exactly which things falls under the rubric of "sex."

"OK, great question." Bell nods at the girl and explains that when "sex" is used to refer to a behavior (as opposed to, say, the male or female sex), it's usually referring to vaginal, anal, or oral intercourse. She defines all three.

"Does foreplay count?" someone shouts. "No!" another girl replies at exactly the same moment a third asks, "What is foreplay?"

The teens start talking over one another: "My friend said . . ." and "I know this dude who . . ." and "What I heard was . . ." Bell steers them back to the main task at hand.

The girl's question epitomizes the murky definitions, and murkier goals, that have plagued US sexuality education since its beginnings in Chicago nearly a century ago. We don't all agree which behaviors constitute "sex," and we agree even less on what sex means. Seen through different eyes, sex can be a pleasurable activity, a sacrament, a means to procreation, an ecstasy, a disappointment, or a source of shame -- the list goes on. These conflicting, deeply personal attitudes toward sex make it difficult to articulate a curricular vision for public schools, where all opinions must be honored...

Read the whole item.

Increase in serodiscordant casual sex among Sydney gay men at a time when HIV diagnoses have not increased

via Aidsmap

Between 2003 and 2006, there was an increase in the numbers of HIV-negative gay men in Sydney who reported having unprotected anal intercourse with casual HIV-positive partners, report researchers in the online edition of AIDS and Behavior. However the researchers do not believe that these men form "a core group of high risk men".

Iryna Zablotska and her colleagues from the University of New South Wales analysed data from two cohort studies among Sydney gay and bisexual men: the Positive Health cohort of 760 HIV-positive men, and the Health in Men cohort of 1427 HIV-negative men. Both studies asked identical questions about sexual behaviour in annual surveys from 2003 to 2006, including questions on sex with partners of a different HIV status (rather than, as in some other studies, sex which could have been with a partner of a different HIV status).

Among the HIV-negative men, whilst the number having sex with casual partners decreased from survey to survey, there were small but statistically significant increases in the numbers having serodiscordant sex. Those having sex with casual partners they believed to be HIV positive rose from 11% to 13%, and the number specifically having unprotected anal intercourse with those men increased from 3% to 4%.

The number of HIV-positive men reporting serodiscordant casual partners did rise, but there was no statistically significant rise in unprotected anal intercourse with them.

The study examined a number of behaviours that have been previously found to be associated with sexual risk-taking, and confirmed that serodiscordant unprotected anal intercourse with casual partners was more common among men with higher numbers of sexual partners, men who met partners online or in sex clubs, Viagra users, those who injected drugs, men who used 'party' drugs regularly and those having ‘esoteric’ sexual practices (fisting, sex toys, water sports, bondage etc).

However the researchers note that men who had risky sex did not do so consistently. Over 85% of the men who reported having serodiscordant unprotected anal intercourse only reported it at one of their annual interviews, and they typically reported that behaviour with just one or two partners in the previous six months.

Read the rest on Aidsmap.

Heterosexual Anal Sex in the Age of HIV

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]


Conclusion
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

'It's like the treasure': beliefs associated with semen among young HIV-positive and HIV-negative gay men

Published in: Culture, Health & Sexuality, Volume 10,
Issue 7 October 2008 , pages 667 - 679

Authors:
Arn J. Schilder a; Treena R. Orchard ab; Christopher S. Buchner c; Mary Lou Miller a; Kim A. Fernandes a; Robert S. Hogg ad; Steffanie A. Strathdee ade

Affiliations:
a British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
b Department of Women's Studies, Faculty of Health Sciences, University of Western Ontario, Canada
c Vancouver Coastal Health Authority, Vancouver, Canada
d Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
e Division of International Health and Cross-Cultural Medicine, University of California San Diego School of Medicine, San Diego, USA

Abstract
This paper examines cultural and social meanings associated with semen, along with related issues of unprotected receptive anal intercourse, HIV seroconversion, treatment optimism and viraemia. The findings are derived from qualitative interviews conducted with 12 HIV-positive young gay men and 12 HIV-negative counterparts who participated in a prospective cohort study in Vancouver, Canada. Focussing on the narratives of young gay men, the analysis reveals a diverse range of knowledge, values and functions of semen, especially in relation to its exchange. Beliefs about semen appeared to differ by HIV serostatus and were linked with intimacy, identity and pleasure, particularly among the HIV-positive men. Against dominant representations of semen in relation to issues of loss, anxiety and infertility, this unique study sheds much needed light on its role within the cultural construction of sexuality among gay men. As such, these narratives are of direct importance to primary and secondary HIV prevention, including condom promotion and the development of rectal microbicides.

Sexual Pleasure... and Showering in Raincoats

OUP Blog (Oxford University Press)
has a couple of great posts that are a must read.

Sexual Pleasure - What a Concept!

What is sexual pleasure? Unfortunately, the concept denoted here by “sexual pleasure” is a rather slippery creature, weighted down by considerable pop psychological baggage, and subject to cross-cultural and cross-historical variation. Nevertheless, it is desirable to have some definition of this concept, however inexact, to provide an anchor for subsequent discussions. With this in mind, we offer the following very simple (and regrettably vague) definition: Sexual pleasure consists of those positively valued feelings induced by sexual stimuli. Notice that this conceptualization encompasses a broad range of sexual pleasures, from the soothing sensations of sensual massage, to the explosion of feeling that accompanies orgasm.

Read the whole post.


And following that post, OUP Blog published this gem:

Showers in Raincoats

Probably the most influential reason that many people choose to forgo safe sex is that they believe it to be less pleasurable than the riskier alternatives. This is particularly true of condoms, the use of which has been unflatteringly compared to taking a shower in a raincoat. The primary complaint of men is that condoms decrease penile sensitivity, hence pleasure; some women also complain of a loss of sensation. (As one eighteenth-century rake brags, “I picked up a fresh agreeable girl called Alice Gibbs. We went down a lane to a snug place, and I took out my armor, but she begged that I might not put it on, as the sport was much pleasanter without it.”) Both men and women further dislike condoms for the related reason that they form an artificial barrier against intimate contact. Many people also believe that condoms decrease sexual spontaneity and therefore romance.

Read the whole post.