Background There is increasing evidence that anal intercourse (AI) is a relatively common sexual practice among women. Although AI has a high probability of transmission of STIs/HIV, circumstances surrounding AI and the potential risk context among women are not well understood.
Methods Between May and August 2008, we recruited 30 racially and ethnically diverse women (10 African American, 10 Latina, and 10 White) age 18 years and older through community outreach efforts in Los Angeles, CA. Women underwent an in-depth interview that examined their intravaginal and anal practices. In this analysis we focus on identifying differing contextual meanings associated with AI through emergent themes and explore differences in these themes by race/ethnicity.
Results The majority of women reported experience with anal intercourse with a substantial number reporting recent experience with AI (ie, in the past year). While there were discussions of AI from women describing casual or transactional sexual partnerships, most women reported AI in the context of serious relationships. AI had varied meanings for women such as an expression of deeper intimacy, a representation of partner's pleasure, and a method for increased sexual gratification. In terms of what AI means in relation to other sexual acts, very few women reported having only AI and in fact it was considered going all out" and generally followed oral and vaginal sex. It is unclear if the women associated STI risk with AI practices since consistent condom use with AI was rare and those who reported condom use noted it as a strategy to improve “cleanliness” (unrelated to STIs) and reduce discomfort so that AI was “not so rough.” Lubricant use for AI, including saliva, petroleum jelly, and baby oil was common and at least one woman specifically reported on the use of “spermicide jelly.” Each of the race/ethnic groups provided support for the themes identified suggesting that the groups may not differ much regarding some of the contextual factors surrounding anal intercourse.
Conclusions These findings highlight that AI is common among women, particularly among those in serious relationships suggesting a need to reframe AI as not just risk behaviour but as a sexual health issue. While condom use with AI is not common, the use of anal lubricating products not specifically designed for intercourse is common. The frequency and potential health effects of AI lubricants warrant further study.
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