Editing Anal sex (section)

==Health risks==

===General risks===
[[File:Gray1082.png|thumb|Mucous membranes of the [[rectum]]]]
Anal sex can expose its participants to two principal dangers which are infections due to the high number of infectious [[microorganism]]s not found elsewhere on the body, and physical damage to the anus and rectum due to their fragility.<ref name="Krasner"/><ref name="Werner"/> Unprotected penile-anal penetration, colloquially known as ''[[Bareback (sex)|barebacking]]'',<ref>{{Cite book |last1=Partridge |first1=Eric |year=2006 |title=The New Partridge Dictionary of Slang and Unconventional English: A-I |first2=Tom |last2=Dalzell |first3=Terry |last3=Victor |edition=reprint |publisher=Taylor & Francis |isbn=978-0-415-25937-8 |url=https://books.google.com/books?id=4YfsEgHLjboC |quote=Bareback&nbsp;– to engage in sex without a condom. |page=92 |access-date=June 3, 2020 |archive-date=May 17, 2016 |archive-url=https://web.archive.org/web/20160517031540/https://books.google.com/books?id=4YfsEgHLjboC |url-status=live}}</ref> carries a higher risk of passing on [[sexually transmitted infections]] (STIs) because the anal sphincter is a delicate, easily torn tissue that can provide an entry for pathogens.<ref name="Krasner"/><ref name="Werner"/> Use of [[condom]]s, ample lubrication to reduce the risk of tearing,<ref name="Carroll"/><ref name=lubrication/> and [[safer sex]] practices in general, reduce the risk of STIs.<ref name="Werner"/><ref name="Ignatavicius and Workman">{{cite book| author = Donna D. Ignatavicius| author2 = M. Linda Workman| title = Medical-Surgical Nursing: Patient-Centered Collaborative Care| publisher = [[Elsevier Health Sciences]]| year = 2013| page = 1655| access-date = April 30, 2015| isbn = 978-0323293440| url = https://books.google.com/books?id=-rjwAwAAQBAJ&pg=PA1655| archive-date = March 10, 2021| archive-url = https://web.archive.org/web/20210310000430/https://books.google.com/books?id=-rjwAwAAQBAJ&pg=PA1655| url-status = live}}</ref> However, a condom can break or otherwise come off during anal sex, and this is more likely to happen with anal sex than with other sex acts because of the tightness of the anal sphincters during friction.<ref name="Werner"/>

Unprotected receptive anal sex (with an HIV positive partner) is the sex act most likely to result in [[HIV]] transmission.<ref name="Krasner"/><ref name="Werner"/>

As with other sexual practices, people without sound knowledge about the sexual risks involved are susceptible to STIs. Because of [[#Behaviors and views|the view]] that anal sex is not "real sex" and therefore does not result in virginity loss, or pregnancy, teenagers and other young people who are unaware of the risks of the anal sex may consider vaginal intercourse riskier than anal intercourse and also they may believe that an STI can only result from vaginal intercourse.<ref name="Kumar">{{cite book |first1=Bhushan |last1=Kumar |first2=Somesh |last2=Gupta |title=Sexually Transmitted Infections |publisher=[[Elsevier Health Sciences]] |year=2014 |page=123 |access-date=December 15, 2016 |isbn=978-8131229781|url =https://books.google.com/books?id=kQ9tAwAAQBAJ&pg=PA123}}</ref><ref name="White">{{cite book |author=Katharine O'Connell White |title=Talking Sex With Your Kids: Keeping Them Safe and You Sane - By Knowing What They're Really Thinking |publisher=[[Adams Media]] |year=2010 |pages=85–86 |access-date=May 1, 2015 |isbn=978-1440506840 |url=https://books.google.com/books?id=SGSJfC8ku_4C&pg=PA85 |archive-date=April 7, 2016 |archive-url=https://web.archive.org/web/20160407194052/https://books.google.com/books?id=SGSJfC8ku_4C&pg=PA85 |url-status=live}}</ref><ref name="Pearson">{{cite book |author=Twila Pearson |title=The Challenging Years: Shedding Light on Teen Sexuality |publisher=[[WestBow Press]] |year=2012 |page=63 |access-date=December 15, 2016 |isbn=978-1449773281 |url=https://books.google.com/books?id=AiedzzsCoz0C&pg=PT63}}</ref> It may be because of these views that condom use with anal sex is often reported to be low and inconsistent across all groups in various countries.<ref name="Kumar" />

Although anal sex alone does not lead to pregnancy, pregnancy can still occur with anal sex or other forms of sexual activity if the penis is near the vagina (such as during [[intercrural sex]] or other [[Sex position#Genital-genital rubbing|genital-genital rubbing]]) and its sperm is deposited near the vagina's entrance and travels along the vagina's lubricating fluids; the risk of pregnancy can also occur without the penis being near the vagina because sperm may be transported to the vaginal opening by the vagina coming in contact with fingers or other non-genital body parts that have come in contact with semen.<ref>{{cite book|last=Thomas|first=R. Murray|title=Sex and the American Teenager: Seeing through the Myths and Confronting the Issues|publisher=[[Rowman & Littlefield|Rowman & Littlefield Education]]|location=Lanham, Md.|isbn=9781607090182|page=81|year=2009|access-date=May 21, 2014|url=https://books.google.com/books?id=gM9EFgsJHyoC&pg=PA81|archive-date=November 16, 2016|archive-url=https://web.archive.org/web/20161116155105/https://books.google.com/books?id=gM9EFgsJHyoC&pg=PA81|url-status=live}}</ref><ref>{{cite book|last=Edlin|first=Gordon|title=Health & Wellness.|publisher=[[Jones & Bartlett Learning]]|isbn=9781449636470|page=213|year=2012|access-date=May 21, 2014|url=https://books.google.com/books?id=csGk6j5rlN0C&pg=PA213|archive-date=November 16, 2016|archive-url=https://web.archive.org/web/20161116175037/https://books.google.com/books?id=csGk6j5rlN0C&pg=PA213|url-status=live}}</ref>

There are a variety of factors that make male-to-female anal intercourse riskier than vaginal intercourse for women, including the risk of HIV transmission being higher for anal intercourse than for vaginal intercourse.<ref name="WebMD"/><ref name="Hales 2">{{cite book|author = Dianne Hales|title = An Invitation to Health|publisher = [[Cengage Learning]]|year = 2014|page = 363|access-date = May 1, 2015|isbn = 978-1305142961|url = https://books.google.com/books?id=2OTKAgAAQBAJ&pg=PT382|archive-date = March 10, 2021|archive-url = https://web.archive.org/web/20210310000600/https://books.google.com/books?id=2OTKAgAAQBAJ&pg=PT382|url-status = live}}</ref><ref>{{cite journal | last1 = Leichliter | first1 =Jami S| year = 2008 | title = Heterosexual Anal Sex: Part of an Expanding Sexual Repertoire?| journal = Sexually Transmitted Diseases | volume = 35 | issue = 11 | pages = 910–911| doi = 10.1097/olq.0b013e31818af12f| pmid =18813143| s2cid =27348658| doi-access = free}}</ref> The risk of injury to the woman during anal intercourse is also significantly higher than the risk of injury to her during vaginal intercourse because of the durability of the vaginal tissues compared to the anal tissues.<ref name="WebMD"/><ref name="Rosenthal2">{{cite book |author=M. Sara Rosenthal| title = The Gynecological Sourcebook| publisher =[[McGraw-Hill Education|McGraw Hill Professional]]|year = 2003|page=[https://archive.org/details/gynecologicalsou00msar/page/153 153]|access-date = August 28, 2013| isbn = 0071402799 |url = https://archive.org/details/gynecologicalsou00msar|url-access=registration}}</ref><ref name="Dortzbach">{{cite book |author=Deborah Dortzbach |author2=W. Meredith Long| title = The AIDS Crisis: What We Can Do| publisher =[[InterVarsity Press]]|year = 2006|page=[https://archive.org/details/aidscrisiswhatwe0000dort/page/97 97]|access-date = August 28, 2013| isbn = 0830833722 |url = https://archive.org/details/aidscrisiswhatwe0000dort|url-access=registration }}</ref> Additionally, if a man abruptly changes from anal intercourse to vaginal intercourse without a condom or without changing it, infections can arise in the vagina (or [[urinary tract]]) due to bacteria present within the anus; these infections can also result from switching between vaginal sex and anal sex by the use of fingers or sex toys.<ref name="Carroll"/><ref name="WebMD"/><ref name="Hasler">{{cite book|author = Nikol Hasler|title = An Uncensored Introduction|publisher = [[Houghton Mifflin Harcourt]]|year = 2015|page = 91|access-date = May 1, 2015|isbn = 978-1936976843|url = https://books.google.com/books?id=_Mp5CAAAQBAJ&pg=PA91|archive-date = April 10, 2021|archive-url = https://web.archive.org/web/20210410055459/https://books.google.com/books?id=_Mp5CAAAQBAJ&pg=PA91|url-status = live}}</ref>

Pain during receptive anal sex is formally known as ''anodyspareunia.''<ref name=Heidelbaugh/><ref name=Ritter_Terndrup>[https://books.google.com/books?id=0sHWnt9WmRsC Handbook of affirmative psychotherapy with lesbians and gay men] {{Webarchive|url=https://web.archive.org/web/20210310001007/https://books.google.com/books?id=0sHWnt9WmRsC |date=March 10, 2021 }} By Kathleen Ritter, Anthony I. Terndrup; p350</ref><ref name=":0">{{Cite journal |last1=Nercessian |first1=Tiga-Rose |last2=Banbury |first2=Samantha |last3=Chandler |first3=Chris |date=2023-10-03 |title=A Systematic Review Looking at Anodyspareunia Among Cisgender Men and Women |url=https://repository.londonmet.ac.uk/8525/1/anos.pdf |journal=Journal of Sex & Marital Therapy |language=en |volume=49 |issue=7 |pages=829–841 |doi=10.1080/0092623X.2023.2196265 |pmid=37089031 |issn=0092-623X |url-access=}}</ref> Factors predictive of pain during anal sex include inadequate lubrication, feeling tense or anxious, lack of stimulation, as well as lack of social ease with being gay and being [[closeted]]. Research has found that psychological factors can in fact be the primary contributors to the experience of pain during anal intercourse and that adequate communication between sexual partners can prevent it, countering the notion that pain is always inevitable during anal sex.<ref name=Heidelbaugh/><ref name=Ritter_Terndrup/> The prevalence of anodyspareunia is difficult to measure; in two population studies of men receiving anal sex, 18% and 14% reported experiencing anodyspareunia. In a study of 2002 women, 8.7% of those who had engaged in anal sex reported experiencing severe pain.<ref name=":0" />

===Damage===

Anal sex can exacerbate [[hemorrhoid]]s and therefore result in bleeding; in other cases, the formation of a hemorrhoid is attributed to anal sex.<ref name="WebMD"/><ref name="Kelley">{{cite book|author=Janet R. Weber|author2=Jane H. Kelley|title=Health Assessment in Nursing|publisher=[[Lippincott Williams & Wilkins]]|isbn=978-1469832227|page=588|year=2013|access-date=May 1, 2015|url=https://books.google.com/books?id=XuGdAgAAQBAJ&pg=PA588|archive-date=March 24, 2021|archive-url=https://web.archive.org/web/20210324112614/https://books.google.com/books?id=XuGdAgAAQBAJ&pg=PA588|url-status=live}}</ref> If bleeding occurs as a result of anal sex, it may also be because of a tear in the anal or rectal tissues (an [[anal fissure]]) or [[perforation]] (a hole) in the [[Large intestine|colon]], the latter of which being a serious medical issue that should be remedied by immediate medical attention.<ref name="WebMD"/><ref name="Kelley"/> Because of the rectum's lack of elasticity, the anal [[mucous membrane]] being thin, and small [[blood vessel]]s being present directly beneath the mucous membrane, tiny tears and bleeding in the rectum usually result from penetrative anal sex, though the bleeding is usually minor and therefore usually not visible.<ref name="Werner"/>

By contrast to other anal sexual behaviors, anal fisting poses a more serious danger of damage due to the deliberate stretching of the anal and rectal tissues; anal fisting injuries include anal sphincter lacerations and rectal and [[sigmoid colon]] (rectosigmoid) perforation, which might result in death.<ref name="LeRoy"/><ref name="Miletich">{{cite book|author=John J. Miletich|author2=Tia Laura Lindstrom|title=An Introduction to the Work of a Medical Examiner: From Death Scene to Autopsy Suite|publisher=[[ABC-CLIO]]|isbn=978-0275995089|page=29|year=2010|access-date=September 15, 2014|url=https://books.google.com/books?id=_l_9peGFRz0C&pg=PA29|archive-date=April 28, 2021|archive-url=https://web.archive.org/web/20210428003636/https://books.google.com/books?id=_l_9peGFRz0C&pg=PA29|url-status=live}}</ref>

Repetitive penetrative anal sex may result in the anal sphincters becoming weakened, which may cause [[rectal prolapse]] or affect the ability to hold in feces (a condition known as [[fecal incontinence]]).<ref name="WebMD"/><ref name="Kelley"/> Rectal prolapse is very uncommon, and its causes are not well understood.<ref name="Altomare">{{cite book|author=Donato F. Altomare|author2=Filippo Pucciani|title=Rectal Prolapse: Diagnosis and Clinical Management|publisher=[[Springer Science & Business Media]]|isbn=978-8847006843|pages=12–14|year=2008|access-date=May 1, 2015|url=https://books.google.com/books?id=uv8PNLiIOmEC&pg=PA12|archive-date=March 10, 2021|archive-url=https://web.archive.org/web/20210310000404/https://books.google.com/books?id=uv8PNLiIOmEC&pg=PA12|url-status=live}}</ref><ref name="Walters">{{cite book|author=Mark D. Walters|author2=Mickey M. Karram|title=Urogynecology and Reconstructive Pelvic Surgery|publisher=[[Elsevier Health Sciences]]|isbn=978-0323262576|page=501|year=2015|access-date=May 1, 2015|url=https://books.google.com/books?id=ZZu9BwAAQBAJ&pg=PA501|archive-date=March 10, 2021|archive-url=https://web.archive.org/web/20210310000402/https://books.google.com/books?id=ZZu9BwAAQBAJ&pg=PA501|url-status=live}}</ref> [[Kegel exercise]]s have been used to strengthen the anal sphincters and overall [[pelvic floor]], and may help prevent or remedy fecal incontinence.<ref name="WebMD"/>

===Cancer===
Most cases of anal cancer are related to infection with the [[human papilloma virus]] (HPV). The risk of anal cancer through anal sex is attributed to HPV infection, which is often contracted through unprotected anal sex.<ref name="Anal cancer">*{{cite web |date=May 2, 2014 |title=Detailed Guide: Anal Cancer What Are the Key Statistics About Anal Cancer? |url=http://www.cancer.org/cancer/analcancer/detailedguide/anal-cancer-what-is-key-statistics |url-status=live |archive-url=https://web.archive.org/web/20161203184456/http://www.cancer.org/cancer/analcancer/detailedguide/anal-cancer-what-is-key-statistics |archive-date=December 3, 2016 |access-date=September 14, 2014 |publisher=[[American Cancer Society]]}}
*{{cite web |date=May 2, 2014 |title=What are the risk factors for anal cancer? |url=http://www.cancer.org/cancer/analcancer/detailedguide/anal-cancer-risk-factors |url-status=live |archive-url=https://web.archive.org/web/20161123132121/http://www.cancer.org/cancer/analcancer/detailedguide/anal-cancer-risk-factors |archive-date=November 23, 2016 |access-date=September 14, 2014 |publisher=[[American Cancer Society]]}}</ref> Anal cancer is significantly less common than cancer of the colon or rectum ([[colorectal cancer]]); the [[American Cancer Society]] estimates that in 2023 there were approximately 9,760 new cases (6,580 in women and 3,180 in men) and approximately 1,870 deaths (860 women and 1,010 men) in the United States, and that, though anal cancer has been on the rise for many years, it is mainly diagnosed in adults, "with an average age being in the early 60s" and it "affects women somewhat more often than men."<ref name="Anal cancer" />