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McBride's “Heterosexual Women's Anal Sex Attitudes and Motivations: A Focus Group Study” (2017)
“Heterosexual Women's Anal Sex Attitudes and Motivations: A Focus Group Study”
In the United States, the prevalence of receptive penile–anal intercourse (PAI) among heterosexual women is well documented, with studies reporting lifetime rates of up to 42% ... and past month rates of up to 8%
Much of the research literature to date has conceptualized heterosexual receptive PAI as a risky substitution for vaginal intercourse, with inquiry being focused on the documentation of negative sexual health outcomes (McBride & Fortenberry, 2010).
There is an absence of research examining nonintercourse anal sex behaviors, such as manual–anal stimulation/penetration and oral–anal contact. The results of research conducted by McBride and Sanders (2010), which examined lifetime prevalence of anal sex behaviors among a sample of adults who reported anal sex experience, found that 83% of women reported lifetime receptive manual–anal stimulation and 50.8% reported receptive oral–anal contact. The most common behavioral pattern was experience with PAI, manual–anal stimulation, and oral–anal contact. However, roughly one-quarter of participants with nonintercourse anal sex experience had never engaged in PAI.
Results revealed a complex and varied range of attitudinal and motivational themes. In general, participants viewed anal sex as an emerging norm. Largely, PAI was constructed as a prevalent but highly stigmatized, painful act motivated by relational factors. However, themes related to a woman’s own sexual pleasure, desire, and curiosity also emerged across groups. Nonintercourse behaviors were more commonly described in favorable terms, although attitudes and motivations varied by behavior. In general, attitudes toward manual–anal behaviors and the use of sex toys were positive, and motivational themes centered on curiosity and pleasure. Attitudes toward oral–anal contact were primarily negative.
All groups identified relational factors as primary behavioral motivators, and acquiescence emerged as a salient theme. The most commonly cited reason for acquiescence was the desire to please a sexual partner ... Participants also described instances where the desire to please a sexual partner took precedence over their own physical pain.
Three groups described occasional acquiescence as being a reward or special “treat” for partners.
Sexual coercion was a commonly cited motivational factor, but none of the participants labeled their own experiences, or the experiences of women that they knew, as “rape.” However, participants consistently reported believing that “pressure” from a male partner was a primary reason that women participate in anal sex.
[W]ith two groups, participants described instances when women coerced male partners.
Communication and consent also emerged as salient relational themes. The majority of participants viewed explicit consent as necessary, and many believed that women needed time to “mentally prepare” for anal sex.
Two groups conceptualized consent as an ongoing process wherein women should have the right to change their mind at any time.
Within and between groups, participants provided examples of instances when men attempted to obtain anal sex by using deceptive tactics such as claiming that their penis “slipped.” The use of deception was attributed to the belief that many men perceive women to be completely disinterested in anal sex and assume they would refuse requests if directly asked.
Across groups, women perceived nonconsensual anal sex to be “confusing” and “humiliating.”
Participants within and between groups described closeness, comfort, intimacy, and trust as factors that would influence their willingness to engage in anal sex.
In two groups, participants believed that trust was independent of past experience, meaning that they would need to trust their current partner to engage in anal sex with him regardless of whether they had done so with past partners.
For many participants, trust included knowing that a partner would be discreet and not “brag” to others.
A number of behaviorally experienced women also noted that trusting and feeling comfortable with a partner facilitated physical relaxation, which was deemed a necessary component of anal sex.
Curiosity emerged as a salient motivational theme across groups ... For many participants, curiosity centered on how anal sex felt and whether it was pleasurable. Several participants cited female friends as important sources of information who influenced behavioral decision making.
[A] handful of participants across groups cited inherent interest and curiosity, independent of friends’ perspectives and experiences, as motivation for experimentation.
All groups associated pain with PAI but not other anal sex behaviors.
[S]everal participants did acknowledge the possibly that pain was not a universal experience and that individual differences exist.
While all 11 participants who disclosed PAI experience indicated that they felt pain during the act, the impact on their attitudes and future behavioral intentions varied. Four women explicitly stated their intentions to continue practicing receptive PAI despite pain
None of the groups categorized nonintercourse behaviors as painful, and “size” emerged as a salient factor. Within all groups, participants noted that fingers, tongues, and sex toys are, or can be, smaller than an average erect penis.
Three groups discussed women using sex toys and manual– anal penetration as strategies to prepare for PAI. Within this theme, a trajectory of anal sex was described and nonintercourse behaviors were viewed as a starting point. Participants reported that these behaviors allowed women to become comfortable with the sensations of anal penetration while minimizing the likelihood of pain.
[N]onintercourse behaviors were described by some participants as a way to “test” enjoyment prior to PAI.
Sexual pleasure emerged as a salient motivational theme across groups. Within each group, participants described instances when they or someone they knew derived physical pleasure from PAI and/or nonintercourse anal sex.
Two groups suggested that a partner’s approach was an important determinant of pleasure and that attempts needed to be gentle and allow time for relaxation.
Participants across groups described women deriving pleasure from psychological components of anal sex. For example, a 20-year-old White participant discussed a friend who preferred PAI to vaginal intercourse, but noted that her pleasure derived from the novelty and violation of social norms
The same participant described a different friend who enjoyed oral–anal stimulation because “she felt like a goddess, like she was being was being worshipped,” and noted that her friend interpreted her partner’s willingness to violate a social taboo as a sign of love and devotion
All groups described PAI as a highly stigmatized, socially proscribed behavior that people feel uncomfortable discussing.
All groups described PAI as a highly stigmatized, socially proscribed behavior that people feel uncomfortable discussing ... Several participants suggested that disclosing behavioral experience would lead to negative social judgment and labeling.
Two groups described a sexual double standard and believed that women who participate in anal sex are judged more harshly than men.
In some cases, fear of judgment and labeling were so profound that participants described women making active efforts to conceal behavior from others.
Three groups believed that stigma restricted women’s ability to admit desire and/or enjoyment, as discussed by a 22-year-old White participant: “There are different stigmas that come with hearing an individual say, ‘I do anal sex” … So I think it is totally understandable why someone would feel shameful about it, because some people might think, ‘That’s not something I’m supposed to be enjoying.’” A 19-year-old White participant who agreed provided the following example: “I think a lot of people claim that they don’t do it [referring to PAI] or don’t like it, but they really do, because it’s still like a taboo.”
Participants did not consistently associate stigma with manual-anal behaviors or the use of sex toys; however, oral-anal contact was viewed as socially proscribed despite its presence on social media and in popular culture ... Largely, negative attitudes associated with oral–anal sex were attributed to concerns about the health implications of oral–fecal contact ... Whereas, manual–anal sex and the use of sex toys were not associated with the same concerns.
Within and between groups, stigma surrounding PAI and oral–anal contact was often attributed to sociocultural representations of the anus as a “dirty” organ that’s sole function is defecation, the vagina as the “natural” or “normal” place for sex, and PAI as a strictly “homosexual” behavior.
Despite the salience of stigma, participants in all groups reported a recent shift in social norms that was attributed to frequent representations of anal sex in social media and popular culture.
While attitudes toward men as receptive heterosexual anal sex partners were not directly assessed, the topic was introduced in three of the six groups, and the unexpected finding deserves attention. Six women reported that they knew heterosexual men who enjoyed manual–anal and/or oral–anal stimulation, and several others mentioned that they had heard the same from friends or media.
The majority of participants in these groups did not appear to interpret a man enjoying receptive anal sex as him being gay or bisexual; however, two did say that a male partner requesting anal stimulation would cause them to question his masculinity or create feelings of discomfort.
A few points of divergence in results from the current study and those reported previously should be noted. First, study participants did not identify substance use as a motivating factor, and it is possible that that these differences can be explained by the fact that the current sample was recruited from the general population. Second, technical virginity was not a salient motivational theme, although some participants did believe that it might have relevance among adolescents. This finding suggests that age-related developmental factors may influence behavioral motivations and could help explain the differences between current results and those reported in existing research. Finally, pornography did not emerge as a primary theme. None of the participants said that pornography motivated their own behavior, but the majority did acknowledge PAI as a normative component of contemporary pornography. Further, many believed that pornography was a primary driver of most men’s and, to a lesser extent, some women’s interests in anal intercourse.
To some extent, stigma may also reflect sexual scripts that restrict women’s abilities to express sexual interest and desire for any type of sex. While Roye et al. (2013) suggested that there is no cultural script for heterosexual anal sex, existing research that has examined vaginal sex indicates that ambivalence can emerge from simultaneous curiosity and desire tempered by fears of developing a “reputation” (Graham et al., 2004; Tolman, 2005).
Stigma is a known threat to sexual health, and Kettrey (2016) found that feeling judged predicts power disadvantages that might further increase risk for negative sexual health outcomes.
Regardless of their own attitudes and experiences, none of the participants openly dismissed the idea that some women might find PAI pleasurable. However, the fact that PAI was more commonly associated with pain than pleasure was unsurprising given findings from existing qualitative and quantitative research (Fahs & Gonzalez, 2014; Herbenick et al., 2015; Reynolds, Fisher, & Rogala, 2015; Stulhofer & Ajduković, 2011, 2013). Herbenick et al. (2015) noted that roughly 72% of their sample reported experiencing pain during receptive PAI, with women most often rating the intensity as either moderate or severe. Stulhofer and Ajduković (2011) found that approximately 49% of women in their sample had to stop receptive PAI on their first attempt because the pain was too intense to continue, which was consistent with experiences described by some of the participants in the current study. However, Herbenick et al. (2015) also noted that 63% of subjects reported pain lasting five or fewer minutes, and Stulhofer and Ajduković (2013) found that continued receptive PAI practice was associated with reduced intensity and duration of pain over time. Further, Stulhofer and Ajduković (2013) found that pain was not a good indicator of subsequent behavior, and Fahs and Gonzalez (2014) reported that the importance of relational and emotional aspects of anal sex often took precedence over pain in their sample of women. The results of these studies may help explain the group of women in the current sample who described pain as “not that bad,” “fine,” or something “you get used to,” as well as intentions to continue practicing PAI despite pain.
Underlying sexual scripts, broader relational schemas, and beliefs about sexual agency, gender roles, power, and control have been linked to sexual acquiescence. A study examining gender, power, and contraceptive use found that anal sex occurred more frequently in relationships where men were the sexual and contraceptive decision makers (Wiebe, 2012). Conroy, Krishnakumar, and Leone (2015) examined heterosexual women’s experiences of sexual acquiescence and noted that 64% of the women who reported PAI experience admitted to acquiescence on at least one occasion, and roughly one-third of those did so one-quarter of the time. Participants most often cited partner pleasure or enhanced intimacy as reasons for acquiescence to PAI, which was not distinct from their reasons for engaging in unwanted vaginal intercourse, oral sex, and manual stimulation.
This point is critical given that much of the existing literature has attempted to distinguish motivations for anal sex from those influencing vaginal sex behaviors rather than considering the similarities. It may be necessary for scientists and clinicians to reconceptualize anal sex as an extension of the broader sexual repertoire rather than assume that it is an entirely unique set of sexual behaviors.
[P]articipants emphasized the importance of mental readiness for anal sex of any kind and cited communication and consent as necessary components. In fact, some participants expressed that they would be willing to engage in anal sex with the “right” partner, who was described as someone that was gentle, trustworthy, and close. Within that context, it was suggested that anal sex could conceivably be pleasurable, comfortable, and a facilitator of intimacy and trust. These findings suggest that contextual and relational factors play an important role in women’s framing of anal sex experiences. Further, the results indicate that, for some women, anal sex behaviors cannot be considered pleasurable if they are spontaneous acts initiated in the moment without prior communication and consent, but can be if they are planned, thoughtful acts that are negotiated in advance.
The study findings have several limitations. First, the qualitative nature of the data and the small sample size do not allow for causal inferences. Second, data were collected in two cities in the Midwestern United States, and participation was limited to women between the ages of 18 and 30 years; thus attitudes and motivations may not be representative of women in other geographic locations or age groups. It is possible that volunteers were, generally, more comfortable discussing sexuality and that some proportion of dropouts were due to the nature of the research rather than scheduling conflicts. Further, some participants’ responses may have been influenced by social desirability, their own embarrassment, and/or other psychosocial factors, which is a limitation inherent to focus group research methods.
When compared to other heterosexual sexual behaviors, scientific understanding of anal sex is still in its infancy. However, the documented prevalence indicates that it is part of the heterosexual repertoire.
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