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Try out PMC Labs and tell us what you think. Learn More. Anal intercourse is a highly efficient mode of HIV transmission. Nevertheless, there is evidence to suggest that anal intercourse is also widely practiced by women in the US 1 — 4. Given that anal intercourse is associated with higher rates of heterosexual HIV transmission than vaginal intercourse 10 — 13women who engage in unprotected anal intercourse with sexual partners of unknown or seropositive status may be at greater risk for acquiring HIV than women who do not practice anal intercourse or who use protection while doing so.
Additionally, Halperin 1 found that women who engaged in anal intercourse were less likely to use condoms during anal intercourse than during vaginal intercourse. Most studies of heterosexual HIV transmission fail to distinguish between vaginal and anal intercourse in their assessments of coital acts, thus continuing to overlook anal intercourse as a potential source of HIV transmission.
This oversight may be due to cultural taboos surrounding anal intercourse, including its association with homosexuality and its perceived lack of hygiene 1. A of researchers have already pointed to the need for increased attention to anal intercourse Married and Lonely Dating female anal lover needed an understudied source of HIV transmission from seropositive men to their seronegative female partners 136 A topic that has received even scarcer attention is the circumstances under which women engage in anal intercourse.
Our qualitative study was part of a larger study on rectal microbicide acceptability among men who have sex with men MSM and women who practice anal intercourse. The present analysis comes from 28 in-depth, semi-structured interviews with women with a recent history of unprotected anal intercourse with an HIV-positive or status unknown partner.
Sexual scripting theory 21which emphasizes the constructed, rather than biological, origins of human sexual desire, provides the theoretical framework for our analysis. According to Simon and Gagnon 21in choosing to practice certain sexual behaviors over others, individuals are guided by cultural scenarios that proscribe specific courses of action. These social scripts are so culturally pervasive that even deviations from the script--as heterosexual anal intercourse is often perceived to be--are still largely confined to and defined by the prevailing cultural scenarios p. In contemporary American sexual culture, the predominant sexual script is one of male pursuit and female acquiescence The data for our analysis were collected at a community clinic in the Eastern US [clinic name and location to be specified in the final manuscript] as part of a study of rectal microbicide acceptability in The study de and procedures were approved by the appropriate institutional review boards.
Women were recruited through flyers; palm cards; outreach at community based organizations, colleges, and at community events; Internet and print media advertising; referrals through other studies or staff at the community clinic; and word of mouth.
Women were initially screened for eligibility over the phone and were invited to participate in the study if they were female; 18 years of age or older; HIV-negative; reported having unprotected receptive anal intercourse in the prior year with a man of unknown or seropositive status; had not participated in another research protocol within the past year; and were comfortable with spoken English. Eligible and interested participants reported to the clinic for a one-time, face-to-face meeting with a female interviewer. Participants were ased unique identifier codes, given a brief overview of the procedures, re-screened to ensure eligibility, and asked to review and an informed consent form.
The interview guide consisted of open-ended questions and follow-up probes developed by the co-investigators to assess the psychological, social, and cultural factors associated with anal sex, as per the study objectives. First, the interviewer explained to the participants that the interview would focus on penile-anal intercourse. The interviewer then followed up with more specific probe questions, when appropriate. The qualitative interviews were tape recorded and transcribed. Based on content areas assessed and initial transcript review, investigators identified and themes and developed a codebook.
Using the software NVivo, all transcripts were coded independently by staff members who then compared the codes, compared discrepancies, and discussed them until consensus was reached. Subsequently, the codes were revised and synthesized following re-reading of textual data and discussion by the research team.
A grounded theory approach guided the qualitative data analyses 29 Because participants were not required to answer every question, and because the degree to which each Married and Lonely Dating female anal lover needed responded to a given question varied, it was not appropriate to perform statistical analyses on responses to interview questions.
Instead, when talking about the frequency of certain behaviors, we refer to the percentage of participants who responded affirmatively.
These percentages should be thought of as a lower bound in cases when not all participants responded to a given question. Twenty-eight women participated in the study. In addition to or instead of these racialseven participants also reported Hispanic ethnicity.
The mean age of the participants was Women had unprotected anal intercourse with a wide variety of partners, ranging from friends to casual partners, short-term and long-term boyfriends, husbands, strangers met on the Internet, and fathers of their children. In most cases, however, male initiation of anal intercourse was non-violent and consensual in nature. Although male partners initiated anal sex more often, the women in our sample did not necessarily lack control over the practice; in fact, because they were the ones who had to consent to a specific behavior in order for it to take place, at times women felt that they, not their partners, were the ones who determined the course of a sexual encounter.
The following participant, when asked if she had been pressured to have anal sex by her non-exclusive partner, distinguished between male initiative and male pressure:. In other cases, women recognized that permitting or withholding anal intercourse from their male partners allowed them greater power in other areas of their relationships.
For example, engaging in an unusual practice with her casual sexual partner made one participant feel more desirable:. Isabella: I love the attention [from anal intercourse]. Far from being uncomfortable with anal intercourse, as we might expect of an activity that is so often stigmatized 1 Married and Lonely Dating female anal lover needed, this participant took satisfaction in being the object of male desire and, in doing so, reaffirmed her sense of being a beautiful, desirable woman.
In acting out this part, she did not so much relinquish her power as assume her scripted role as the pursued. Non-consensual anal intercourse occurred with a range of partners both familiar and unfamiliar, from former husbands and boyfriends to strangers and men met on the Internet. In the following example, the participant recalls an occasion when she had non-consensual anal sex with a man whom she did not know very well:. Among the seven women who experienced non-consensual anal intercourse, two of them also reported having had anal intercourse during transactional sex on at least one occasion, suggesting, for these women, a history of limited sexual agency.
Among those women who had experienced non-consensual anal intercourse in the past, more than one participant also reported engaging in anal intercourse of her own accord, for non-transactional purposes, on other occasions. Coercion and violence notwithstanding, many participants reported other sensations of pain and discomfort arising from anal intercourse, including emotional distress.
Mild intestinal discomfort was also experienced as an aftereffect of anal intercourse, such as in disrupted bowel movements. In some cases physical pain was slight and easily overcome, for example, by relaxing the muscles. Given the frequent mentions of pain during consensual anal intercourse, we were interested in understanding why and how women engaged in anal sex in spite of these unpleasant sensations. In cases where women expected anal sex to be painful, they listed various reasons for engaging in the practice anyway: to try something new, to please their partners, or to experience sexual pleasure.
Indeed, some participants experienced pain during anal Married and Lonely Dating female anal lover needed as enhancing their sexual pleasure. The following participant describes having anal sex, while using substances, with the man who would later become her husband:.
Valeria: I let him do it. And we did it in the big recliner chair. It hurt and it felt good at the same time. That some participants experienced anal intercourse as simultaneously pleasurable and painful supports our view that anal intercourse usually occurred as a complex emotional and physiological event for our participants, and cannot be easily categorized as entirely pleasurable or entirely painful, even for the same individual.
For all but one participant, the last occasions of anal intercourse occurred alongside other Married and Lonely Dating female anal lover needed of sexual activity, such as oral sex and vaginal intercourse. Viewed as a complementary form of sexual expression, anal intercourse took on meaning not only as a site of negotiation and pressure, but as a source of sexual pleasure and eroticism for the women in our study. In considering the motivations for women to engage in high-risk sexual behaviors such as unprotected anal intercourse, it is important not to overlook female desire 2431 Among our participants, pleasure-seeking behavior, encompassing both physical arousal and emotional desire, emerged as a factor associated with a greater willingness to both engage in and request anal intercourse from male partners.
Regardless of who initiated it, many women in our study reported enjoying anal intercourse and the physical sensations related to the practice, such as this participant:. Jada: Wanting it. I like it. If I have anal sex, I have orgasms. My body likes it. It feels like vaginal but almost a little better, it seems like. And it feels good. However, just as the sensation of physical pleasure during anal intercourse varied among participants, so did the importance that participants placed on physical pleasure alone as a motivating factor for engaging in anal intercourse.
Participants often cited the desire for intimacy or closeness to their partners as either the motivation for anal intercourse, or as the necessary preconditions for anal intercourse to occur. Just [for] something different. And I just found a new part of my body I can enjoy. In the following example, the participant talks about the first time she had anal sex, with a man that she met on the Internet for the purpose of having sex:.
In this sense, anal intercourse was sought not only for the physical pleasure that it afforded women, but also valued as a marker for exceptional sex. By equating exceptional sex with exceptional relationships, women sought to express their love, commitment, and openness towards theirpartners through their willingness to have anal intercourse, as this woman did with her husband:.
Sarah: Anal sex? This notion of sexuality does not so much uphold the masculine model of the autonomous sexual actor seeking his own satisfaction, but instead identifies women--and by extension, their male partners--as sexual beings by virtue of their relational stance towards others. Infrequent condom use during anal activity was to be expected among participants, given the eligibility requirements. Eighty-two percent of the sample indicated that they had not used condoms during the first occasion of anal intercourse and the same proportion though not necessarily the same participants reported no condom use during the last occasion of anal intercourse.
In the following example, the participant was asked if she had used condoms with her boyfriend the last time they had had anal intercourse:. Emma: No, [we did not use condoms]. The reason is that Married and Lonely Dating female anal lover needed mostly used the condoms in order not to get pregnant.
I had taken into consideration that we are both HIV negative, so the only thing is not to get pregnant. On the other hand, those participants who had used a condom during anal intercourse listed the following reasons for doing so: a concern regarding hygiene; the erroneous belief that one could get pregnant through anal sex; and the condom that had been used for vaginal sex was kept on during anal sex. When describing discrete occasions of anal intercourse, on eight occasions participants reported that they had used a condom for vaginal sex to prevent pregnancy, but had removed the condom prior to anal sex.
Among those who reported using a condom during anal intercourse, on three occasions participants used the same condom for both vaginal and anal intercourse; on another three occasions participants used separate condoms for vaginal and anal intercourse; and on four occasions participants used condoms for anal intercourse but not vaginal intercourse, citing concern about hygiene or pregnancy as motivations.
Kimberly: Not at all. Alyssa: It was with my ificant other. He never had done it before. Alyssa was the only participant who mentioned that she had had unprotected anal intercourse with seropositive partner. However, another participant Valeria, 41, Hispanic said that she regularly had anal sex with a man whose other partner was HIV-positive. Although nearly all of the participants were aware that unprotected anal intercourse might put them at risk for sexually transmitted infections, this knowledge apparently did not translate into behavioral change, as evidenced by the participant who had unprotected anal intercourse with her HIV-positive partner.
To avoid sounding confrontational, our interviewer did not ask participants why they continued to practice unprotected anal intercourse with partners of unknown or positive HIV status, despite the risks involved. Because our participants tended to follow traditional gender roles when it came to initiating anal intercourse, and because anal intercourse emerged in our interviews Married and Lonely Dating female anal lover needed a sexual behavior that complemented vaginal and oral sex, it may be useful to view heterosexual anal intercourse not so much as a deviant behavior, but as an intensified example of how sexual decisions are negotiated between men and women.
Following this line of reasoning, at first glance the pattern of male initiative over anal intercourse suggests that women might engage in anal intercourse under pressure, coercion, or persuasion from male partners. Taking sexual scripting theory intohowever, a more complex story emerges from the data. In this context, male initiative alone may not necessarily indicate a lack of female agency, but rather serve as a marker for the presence of a strong sexual script that dictates male pursuit and female acquiescence or rejection of male desire.
Although researchers have documented the relationship between pleasure-seeking behavior and sexual risk-taking in men who have sex with men 36 — 38it is not yet clear how pleasure-seeking may be related to sexual risk-taking among women. Nevertheless, as we did not survey a control group of women who engaged in low-risk, protected anal intercourse, it may be difficult to draw conclusions about the relationship between sexual risk-taking and pleasure-seeking behaviors from our sample alone.
Future research is needed to elucidate such relationships. When taken together, unprotected anal intercourse seemed to offer women a way to please their partners, to please themselves, and to avoid pregnancy.
As long as some women view anal sex as a way to bypass pregnancy concerns while maintaining intimacy and sexual pleasure, the failure to educate this population on HIV and STI prevention may lead to increased infection. A similar dynamic may be at work among women who engage in unprotected anal intercourse in order to achieve a greater degree of intimacy with their male partners, as in the case of some of our participants. Interventions to promote safer anal sex must find a way to increase the use of barrier methods without decreasing perceived intimacy between sexual partners. This may be done by emphasizing the intimate nature of anal intercourse, even when accompanied by condom use.
Too often, note Gupta and Weiss 40interventions to address high-risk sexual practices collude with existing hierarchies, rather than challenge the underlying structures that contribute Married and Lonely Dating female anal lover needed economic and sexual marginalization. Therefore, if part of what makes a woman feel like a woman is being desired by her male partner, vaginal and rectal microbicides should be marketed to women as products that will enhance their sexual desirability.
On the other hand, HIV and STI interventions geared towards women who have unprotected anal intercourse must not lose sight of societal factors that disadvantage women. Indeed, even in our small sample, the subgroup of women who had experienced non-consensual anal sex tended to report lower annual incomes than those who had not, though we did not test for statistical ificance.
Future studies should seek to identify the specific factors that put women at risk for non-consensual, unprotected anal intercourse. To be successful, interventions must take into the ways in which violence directed towards women can impact their ability to negotiate safe vaginal and anal sex. Given that the need for female-controlled alternatives to condoms encompasses products that can be used intrarectally as well as vaginally, rectal microbicides should be marketed to women as well as to MSM.
Our findings must be interpreted within the limitations of this study. Although the sample was ethnically and racially diverse, participation was limited to English-speaking women, and more low-income women were interviewed than middle- and upper-income women. Additionally, as the participants included only those women who were willing to be interviewed about a highly-stigmatized practice, we know little about the experiences of women who may feel uncomfortable discussing anal intercourse with a stranger In terms of the generalizability of our discussion on condom use and HIV and STI prevention, we must emphasize that our sample only consisted of women who had recently engaged in unprotected anal intercourse with a partner of unknown or seropositive HIV status.Married and Lonely Dating female anal lover needed
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Women who have anal sex: Pleasure or pressure? Implications for HIV prevention