Anal sex

1892 lithograph by Paul Avril

Anal sex most often refers to the sex act involving insertion of the penis into the anus of a sex partner.[1] The term anal sex can also sometimes include other sexual acts involving the anus, including pegging, anal–oral sex, fingering, and object insertion. A 2009 study of American college undergraduates, the large majority heterosexual, found that one in four reported having had anal sex,[2] while the figures for the general population range between thirty and forty percent.

Though anal sex is pleasurable for many people, and some may reach orgasm (through stimulation of the prostate in men, and clitoral and G-Spot leg stimulation in women),[3] others find it painful, in some cases extremely so.[4][5] Some women rate the practice among their least favorite sexual activities because of the pain or discomfort involved. Of the men who receive anal sex, between a tenth and a quarter always find it painful, and almost two thirds rate pain on being penetrated as their most frequent sexual problem. Psychological factors, as well as technique, were found to play a role in the experience of pain during anal sex.[6] As the rectal mucous membrane provides little natural lubrication, a lubricant is generally used when penetrating the anus.[7]

Anal sex is considered a high-risk sexual practice, and unprotected anal sex is the riskiest of all forms of sexual intercourse.[8] The hazards are due to the vulnerability of the tissues, as the penetration of the anus may cause tearing and bleeding of the soft tissues,[9] and can damage the sphincter muscles, causing incontinence and anal prolapse. It is also due to the high concentration of disease causing organisms in the anus and the introduction of pathogens during the sex act itself, exposing the participants to a spectrum of contagious diseases. Some authorities judge that all anal sex is unsafe, due to the high rates of condom failure, including those brands that claim to be specially strengthened.[10][11]

Contents

Anatomy and stimulation

Prostate, clitoral and G-Spot stimulation

Male genital anatomy, showing the location of the prostate with respect to the rectum.

The abundance of nerve endings in the anal region and rectum makes anal sex pleasurable for many men and women.[12] "The opening and closing of the anus is controlled by the internal and external sphincter muscles (the most important muscles when engaging in anal sex). The sphincter muscle is a sensitive membrane with many nerve endings and thus the source of pleasure or pain."[13] In a male receiving partner, being penetrated can produce a pleasurable sensation due to the inserted penis rubbing or brushing against the prostate (also known as the "male G-Spot", "P-Spot" or "A-Spot") through the anal wall.[14][15] This can result in pleasurable sensations and can lead to an orgasm in some cases.[15] The prostate is located next to the rectum and is the larger, more developed[16] male homologue to the Skene's glands, which are believed to be connected to the female "G-Spot".[17] The Skene's glands are sometimes referred to as the "female prostate";[18] they are located around the urethra and can be felt through the wall of the vagina.

Most women can only achieve orgasm through clitoral stimulation,[19][20][21][22] but the clitoris has "legs" that extend along the vaginal lips back to the anus,[23] which can increase pleasure through anal stimulation in women and may allow some to achieve orgasm. The clitoris surrounds the vagina somewhat like a horseshoe."[21] The Gräfenberg spot, or G-Spot, is a small area behind the female pubic bone surrounding the urethra and accessible through the anterior wall of the vagina. Such an orgasm is referred to as "vaginal", because it results from stimulation inside the vagina. The G-Spot is also thought to have legs which are accessible through anal penetration, but recent discoveries about the size of the clitoris show that clitoral tissue extends some considerable distance inside the body, around the vagina. This discovery may possibly invalidate any attempt to claim that clitoral orgasm and vaginal orgasm are two different things.[19]

"Anal sex is portrayed as quite normal in porn imagery," but according to Go Ask Alice!, "in reality, it occurs much less frequently than other sexual behaviors."[24] "Some people like [anal] because it seems taboo or naughty," said Jack Morin, sex therapist and author of Anal Pleasure and Health. "Some people like the flavor of dominance and submission... some don’t."[25] For men, anal sex can yield more tactile pleasure for the penis, the anus being tighter than the vagina.[26] People are advised to familiarize themselves with their body's likes and dislikes, in order to make anal sex more enjoyable. Because each person's sphincter muscles react to penetration differently, one needs to learn how their body works. Exploring the sensitivity of the sphincter and how it reacts when relaxed or tense, practicing relaxation techniques such as deep breathing, using small sex toys, then gradually increasing the size, are just a few suggestions for enjoying anal sex.[13] Open communication with the sex partner is also advised.[13]

Heterosexual

Men may enjoy anal sex due to the anus being tighter than the vagina.[26] The attitude of women towards anal sex is rather diverse: while some consider it painful or uncomfortable, other women find it very pleasing and even prefer it to vaginal intercourse.[27][28] In heterosexual encounters, the risk to the woman is greater than the risk for the man.[29] At the same time, anal sex is held to carry a very low risk of unwanted pregnancy when not accompanied with vaginal intercourse, and in some populations is frequently used as a means of contraception, often in the absence of a condom.[30] A man may also be anally penetrated by a woman. A woman using a strap-on dildo to anally penetrate a man is referred to as pegging.[31]

Anal sex is claimed to be taking place in a climate of reduced sex education and fewer educational media outlets, leading to a lowered awareness of the health risks involved. For example, the risk of injury during anal intercourse is many times higher than that during vaginal sex.[32] Also, the risk for transmission of the HIV virus is higher for anal sex than for vaginal sex.[33] Precautions should be taken to prevent damage to the rectal area, such as lubrication and also the use of protection, such as condoms to stop the transmission of STDs.[34]

Female virginity

Anal sex is sometimes seen as preserving female virginity because it leaves the hymen intact. Though more often applied to first penetration,[35][36][37] the concept of "technical virginity", which includes oral sex and mutual masturbation, is sometimes conceived as resting solely on vaginal penetration.[38] This is considered "technical" virginity, as vaginal intercourse has not occurred but the participants are sexually active.[39][40][41][42] In recent years, "technical" virginity has become popular among teenagers.[41][42]

Prevalence

A 2005 survey of the U.S. Centers for Disease Control and Prevention found a rising incidence of anal relations in the American heterosexual population. The survey showed that 40% of men and 35% of women between 25 and 44 had engaged in heterosexual anal sex; in 1992 a similar survey found that only 26% of men 18 to 59 and 20% of women 18 to 59 had.[43] By way of comparison, seven times as many women as gay men engage in anal intercourse, a figure reflecting the greater overall heterosexual population.[44] Another survey in 2008 focused on a much younger demographic of teens and young adults aged 15–21. It found that 16% of 1350 surveyed had had anal sex in the previous 3 months, with condoms being used 29% of the time.[45] However, given the subject matter, the survey hypothesized the prevalence was probably underestimated.

Figures for prevalence can vary amongst different demographics, regions, and nationalities. A 2001 French survey of five hundred female respondents concluded that a total of 29% had practiced anal sex, though only one third of these claimed to have enjoyed the experience.[46] In contrast, in a 1999 South Korean survey of 586 women, only 3.5% of respondents reported having had anal sex.[47]

Figures for the prevalence of sexual behavior can also fluctuate over time. Edward O. Laumann's 1992 survey, reported in The Social Organization of Sexuality: Sexual Practices in the United States found that about 20% of heterosexuals have engaged in anal sex. Sex researcher Alfred Kinsey, working in the 1940s, had found that number to be closer to 40% at the time. More recently, a researcher from the University of British Columbia in 2005 put the number of heterosexuals who have practiced anal sex at between 30% and 50%.[48] According to Columbia University's health website, Go Ask Alice!: "Studies indicate that about 25 percent of heterosexual couples have had anal sex at least once, and 10 percent regularly have anal penetration."[49]

Homosexual

19th-century erotic interpretation of Hadrian and Antinous, by Paul Avril

Historically, anal sex has been popularly associated with male homosexuality and men who have sex with men (MSM). However, many do not engage in anal sex, and some groups such as frot advocacy groups actively denounce anal sex as degrading toward the receptive partner, mimicking heterosexual vaginal sex, and as an unnecessary health risk.[50][51][52] Part of the rejection is due to the perceived "overly and unhealthily feminized self-image of gay men".[51] Two of the charges often leveled against male/male anal sex by frot advocates are that even with a condom, the objective medical risks of being anally penetrated outweigh the subjective pleasure; and furthermore, that in comparison to the "symmetry" of frot, anal sex tends to introduce an asymmetric and therefore "non-egalitarian" dimension to sex (i.e., one man is the "top" and the other is the "bottom").[52] Among MSM who do have anal sex, the insertive partner is referred to as the top or active partner. The man being penetrated is referred to as the bottom or passive partner. Preference for either is referred to as versatile.[53][54]

Though some gay men view anal sex as "[their] version of intercourse",[25] it is common for gay men to experience pain when being penetrated, and around one in ten find it too painful to continue.[55] Various studies indicate that between one tenth and one quarter of all males always experience pain during receptive anal sex, while another study of gay and bisexual men found that 61% considered pain during receptive anal sex as their most frequent lifetime sexual difficulty.[56] The experience of pain among insertive partners was rarer, with only three percent reporting it.[57]

Prevalence

According to Dr. John Dean and Dr. David Delvin, "in absolute numbers, it is hypothesized that more heterosexual couples have anal sex than homosexual couples".[58] The prevalence of anal sex among homosexual couples in the West has varied over time. Magnus Hirschfeld, in his 1914 magnum opus, The Homosexuality of Men and Women reports the rate of anal sex among homosexual men surveyed to be 8%, the least favored of all the practices documented.[59] Oral sex and mutual masturbation are more common than anal stimulation among gay men in long-term relationships.[24]

By the 1950s in the United Kingdom, it was thought that about fifteen percent of male homosexuals practiced the method.[60] The Gay Urban Men's Study (P.I. Stall, UCSF) and the Young Men's Study (YMS, PI Osmond/Catania, UCSF), indicate that 50% of men surveyed engage in anal sex. The Laumann study claims that 80% of gay men practice it, while the remaining 20% never engage in it at all.

A survey conducted from 1994 to 1997 in San Francisco by the Stop AIDS Project indicated that over the course of the study, among men who have sex with men, the proportion engaging in anal sex increased from 57.6% to 61.2%.[61]

Health risks

Anal sex exposes participants to two principal dangers: infections, due to the high number of infectious microorganisms not found elsewhere on the body, and physical damage to the anus and the rectum due to their vulnerability. It is generally understood that penetration can be painful.[62] Frequent anal sex is associated with hemorrhoids, anal prolapse, leakage, ano-rectal pain and ulcers and fissures.[63]

Recent reports have documented that risky behavior is on the rise among men who have sex with men.[61] Likewise, among men who have sex with women, a 1992 study of socially and sexually active Puerto Rican men indicated that of the more than 40% who reported having anal sex with women, very few had used condoms.[64] Anal sex without the use of a condom is often referred to as barebacking.[65]

HIV/AIDS and other infectious diseases

Mucous membranes of the rectum.

Among the diseases with which anal sex is associated are HIV,[66] human papilloma virus (HPV) (which can increase risk for anal cancer)[67] typhoid fever[68] and various diseases associated with the infectious nature of fecal matter or sexual intercourse in general. Among these are: amoebiasis; chlamydia; cryptosporidiosis; E. coli infections; giardiasis; gonorrhea; hepatitis A; hepatitis B; hepatitis C; herpes simplex; human papillomavirus; Kaposi's sarcoma-associated herpesvirus (HHV-8);[69] lymphogranuloma venereum; Mycoplasma hominis; Mycoplasma genitalium; pubic lice; salmonellosis; shigella; syphilis; tuberculosis; and Ureaplasma urealyticum.[12][70][71][72]

The high concentration of white blood cells around the rectum, together with the risk of cuts to the rectum and that one of the functions of the rectum is to absorb fluid, increases the risk of HIV transmission because the HIV retrovirus reproduces within the immune system's T-cells/CD4 cells. Use of condoms and other precautions are a medically recommended way to lessen risk of infections. Unprotected receptive anal sex is the most risky sexual behavior in terms of HIV transmission.[73][74][75]

Increased risk of anal cancer

Anal cancer is relatively rare, accounting for about 1 percent of gastrointestinal malignancies, but as many as 4,000 new cases can be diagnosed within a year in the United States, according to the American Cancer Society.[76][77] Most cases of anal cancer are related to infection with the human papilloma virus.[76][77] The incidence of the disease has jumped 160% in men and 78% in women in the last thirty years, according to a 2004 American study. The increase is attributed to changing trends in sexual behavior (such as a history of multiple sex partners, fifteen or more, or receptive anal sex) and smoking. If a current smoker, there is a fourfold increase in risk, though independent of other behavioral risk factors, such as sexual activity. Receptive anal sex increases the incidence sevenfold.[77] "The sharpest increase was among African American men, whose incidence of anal cancer has more than doubled in the past three decades. Black men also had a lower survival rate from the disease." The study reported that the five-year survival rate for black men with early stage disease was 62 percent as compared to 79 percent for white men with localized cancer. However, the survey also reported that black men were more likely than white men to report having had intercourse with another male in the last year. Regarding all the increases, whether or not sexual practices have changed, epidemiologist Janet Daling, Ph.D., a member of Fred Hutchinson's Public Health Sciences Division, concluded, "[I]t also could be that people are just more likely to discuss their sexual behavior these days."[77]

Physical damage

Physical damage to the rectum and anus can manifest as generalized ano-rectal trauma, anal fissures,[12] rectal prolapse, and exacerbating (but not causing) hemorrhoids.[78] An insufficient amount of lubricant can make it especially painful or injurious.[79] Damage is more likely to occur if intercourse is forcible or aggressive or if alcohol or other drugs have dulled sensitivity.

Loss of control over the bowels, though rare according to some, is thought to be a valid concern[80] and is reported to be caused by repeated injury, or by the insertion of large objects,[81] or simply by regular anal sex, which "leads to internal sphincter dilation and soiling."[82]

A 1993 study published in the Journal of the Royal Society of Medicine found that fourteen out of a sample of forty men receiving anal intercourse experienced episodes of frequent anal incontinence.[83] However, a 1997 study published in the American Journal of Gastroenterology found no difference in levels of incontinence between homosexual men who engaged in anal sex and heterosexual men who did not, and criticized the earlier study for its inclusion of flatulence in its definition of incontinence.[84]

Dr. Jack Morin recommended kegel exercises to prevent loss of muscle tone from anal fisting or insertion of large objects in a presentation of clinical aspects of anal sexuality, delivered at the 1998 joint conference of the Society for the Scientific Study of Sexuality and the American Association of Sex Educators. He added, however, that he had never personally observed "loosening" in any of his patients.[85]

Cultural issues

A shunga print depicting a man and a youth

Historically, a number of cultures have recorded the practice of anal intercourse between men. The males who participated in such relationships often did not do so exclusively, as participation in these relationships between men did not preclude sex with women. Such relations have also been documented as taking place in houses of prostitution that provided youths or young men.

Ancient and non-Western cultures

The term "Greek love" has long been used to refer to the practice, and in modern times, "doing it the Greek way" is sometimes used as slang for anal sex. However, homosexual anal sex was far from a universally accepted practice in Ancient Greece. It was the target of jokes in surviving comedies; Aristophanes mockingly alludes to the practice, claiming that "Most citizens are europroktoi (wide-arsed) now."[86] While pedagogic pederasty was an essential element in the education of male youths, these relationships, at least in Athens and Sparta, were expected to steer clear of penetrative sex of any kind. There are very few works of pottery or other art that display anal sex between older men and boys, let alone with adult men. Most such works depict fondling or intercrural sex, which was not condemned for violating and feminizing the boys. Other sources make it clear that the practice was criticized as shameful,[87] and seen as a form of hubris.[88]

Two Roman males in a lupanar; Warren Cup, British Museum

In later Roman age Greek poetry, anal sex became a common topos, represented as taking place with "eligible" youths: those who had attained the proper age but had not yet become adults. Seducing children into the practice was considered very shameful for the adult, and having such relations with a male who was no longer adolescent was considered more shameful for the young male than for the one mounting him. Greek courtesans, or hetaerae, are said to have frequently practiced heterosexual anal intercourse as a means of preventing pregnancy.[89] The acceptability of anal sex thus varied with the time-period and the location, as Ancient Greece spanned a long time and stretched over three continents and two major seas.

For a male citizen to take the passive (or receptive) role in anal intercourse was condemned in Rome as an act of impudicitia (immodesty or unchastity). Free men, however, frequently took the active role with a young slave, known as a catamite or puer delicatus. In fact the Romans thought of anal sex as something specifically "Greek," although Roman men often availed themselves of their own slaves or others in this way.[90]

In Japan, records (including detailed shunga) show that at least some men in relationships with other men did engage in penetrative anal intercourse.

Man and woman having anal sex. Ceramic, Moche Culture. 300 C.E. Larco Museum Collection

Evidence suggestive of widespread heterosexual anal intercourse in a pre-modern culture can be found in the erotic vases, or stirrup-spout pots, made by the Moche people of Peru; in a survey[91] of a collection of these pots, it was found that 31 percent of them depicted heterosexual anal intercourse, more by far than any other sex act. Moche pottery of this type belonged to the world of the dead, which was believed to be a reversal of life. Thus the reverse of common practices was often portrayed. The Larco Museum houses an Erotic Gallery in which this pottery is showcased.

The 19th century anthropologist Richard Francis Burton has theorized that there is a geographical Sotadic zone wherein penetrative intercourse between men is particularly prevalent and accepted; moreover he was one of the first writers to advance the premise that such an orientation is biologically determined.[92]

Western cultures

In many Western countries, anal sex has generally been taboo since the Middle Ages when heretical movements were sometimes attacked by accusations that their members practised anal sex among themselves. At that time the mainstream Christian clergy was not celibate, but the highest orders of some heretical sects were, leading to rumours that their celibacy was a sign of their attraction to members of the same sex. The term buggery originated in medieval Europe as an insult used to describe the rumoured same-sex sexual practices of the heretics from a sect originating in Bulgaria, where its followers were called bogomils; when they spread out of the country they were called buggres (from the ethnonym Bulgars). Another term for the practice, more archaic, is "pedicate" from the Latin pedicare, with the same meaning.[93]

The Renaissance poet Pietro Aretino advocated the practice in his Sonetti Lussuriosi (Lust Sonnets).[94]

While men who engaged in homosexual relationships were generally suspected of engaging in anal sex, many such individuals did not. Among these, in recent times, have been André Gide, who found it repulsive;[95] and Noel Coward, who had a horror of disease, and asserted when young that "I'd never do anything – well the disgusting thing they do – because I know I could get something wrong with me."[96]

In religion

François-Rolland Elluin, Sodomites provoking divine wrath, from Le pot-pourri (1781)

This prohibition of the Abrahamic religions against anal sex has been promulgated under the rubric of "sodomy", which includes various other transgressions of a sexual nature, whether with men, women or animals. This idea is vividly brought to life in the popular interpretation of the story of Sodom and Gomorrah, where the people were prone to sexual immorality, and as a result were destroyed. There are conflicting views as to why Sodom was destroyed.

Judaism

Orthodox Judaism teaches that anal sex is a sin and an abomination. The Conservative, Reform and Reconstructionist branches of Judaism are accepting of homosexuality, but less so of sodomy,[97] and anal sex is considered to be a type of sodomy.

Christianity

Further information: Sodomy

In Christian countries it has often been referred to euphemistically as the peccatum contra naturam (the sin against nature, after Thomas Aquinas) or Sodomitica luxuria (sodomitical lusts, in one of Charlemagne's ordinances), or peccatum illud horribile, inter christianos non nominandum (that horrible sin that among Christians is not to be named).

Although some Christian denominations disapprove of anal sex, some believe it to be an acceptable part of human sexuality. A number of Christian denominations confirm the importance of accepting and welcoming homosexuals into their communities, and protecting their civil rights.

Islam

Liwat, or the sin of Lot's people, is officially prohibited by most Islamic sects. There are parts of the Qur'an which talk about smiting on Sodom and Gomorrah, and this is thought to be a reference to unnatural sex, and so there are hadith and Islamic laws which prohibit it. Practitioners of anal relations are called luti and are seen as criminals in the same way that a thief is a criminal, meaning that they are giving in to a universal temptation. Liwat with a woman is known as lesser liwat and with a man as greater liwat. "Some scholars refer back to the Sharia rules ... argue that anal sex between men, as considered equivalent to heterosexual intercourse, is punishable by one hundred whiplashes for an unmarried man and death by stoning for a married man. Other traditional scholars have ruled that “sodomy” between men is always punishable by death for both partners, whether married or not, based on a hadith. The punishment of toppling a wall on two men who practiced “sodomy,” which is sometimes reported, particularly in Afghanistan, is based on another hadith."[98]

As the fact that liwat is regarded as a temptation indicates, anal intercourse is not seen as repulsively unnatural so much as dangerously attractive: "one has to avoid getting buggered precisely in order not to acquire a taste for it and thus become addicted."[99] In practise, the segregation of women and the strong emphasis on virility leads to adolescents and unmarried young men seeking sexual outlets with males younger than themselves – in one study in Morocco, with boys in the age-range 7 to 13.[100] But deep shame attaches to the passive partner: "for this reason men stop getting fucked at the age of 15 or 16 and "forget" that they ever allowed/suffered/enjoyed it earlier."[99] Similar sexual sociologies are reported for other Muslim societies from North Africa to Pakistan and the Far East.[101]

Buddhism

The most common formulation of Buddhist ethics is the Five Precepts. These precepts take the form of voluntary, personal undertakings, not divine mandate or instruction. The third of the Precepts is "To refrain from committing sexual misconduct."[102] However, "sexual misconduct" (Sanskrit: Kāmesu micchācāra literally "sense gratifications arising from the 5 senses"") is subjected to interpretation relative to the social norms of the followers.[103] In fact, Buddhism in its fundamental form, does not define what is right and what is wrong in absolute terms for lay followers. Therefore the interpretation of what kinds of sexual activity is acceptable for a layperson, is not a religious matter as far as Buddhism is concerned.[104]

Unlike most other world religions, most variations of Buddhism do not go into details about what is right and what is wrong in what it considers mundane activities of life. Details of accepted or unaccepted human sexual conduct are not specifically mentioned in any of the religious scriptures in the Pali language.

Buddhism teaches that sensual enjoyment and desire in general, and sexual pleasure in particular, are hindrances to enlightenment.[105] Buddhist monks and nuns of most traditions are expected to refrain from all sexual activity and take vows of celibacy; lay people, however, are not expected to refrain from any specific form of sexual activity, and there is no concept of sinfulness attaching to sex.

The 14th Dalai Lama of Tibet has said that he interprets sexual misconduct to include any sex other than penis-vagina intercourse, including oral sex, anal sex, and masturbation.[106] In an 1997 interview he said "even with your own wife, using one's mouth or the other hole is sexual misconduct."[107][108]

See also

  • Anal beads
  • Anal fingering
  • Anal fisting
  • Anal masturbation
  • Anal-oral contact
  • Anal orgasm
  • Ass to mouth, (ATM or A2M)
  • Butt plug
  • Coprophilia
  • Creampie (sexual act)
  • Erogenous zone
  • Felching
  • Fifth base
  • Klismaphilia
  • List of anal sex positions
  • LGBT topics and Buddhism
  • Pegging
  • Sodomy
  • Sodomy law

References

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  39. ↑ Frederic C. Wood (1968, Digitized July 23, 2008). Sex and the new morality. Association Press, 1968/Original from the University of Michigan. pp. 157 pages. http://books.google.com/?id=sIpqAAAAMAAJ&q=Technical+virginity&dq=Technical+virginity. 
  40. ↑ Richard D. McAnulty, M. Michele Burnette (2000). Exploring human sexuality: making healthy decisions. Allyn and Bacon. pp. 692 pages. ISBN 0205195199, 9780205195190. 
  41. ↑ 41.0 41.1 Mark Regnerus (2007). "The Technical Virginity Debate: Is Oral Sex Really Sex?". Forbidden fruit: sex & religion in the lives of American teenagers. Oxford University Press US. pp. 290 pages. ISBN 0195320948, 9780195320947. http://books.google.com/books?id=F-Qu-FCNHBYC&pg=PA167&dq=Technical+virginity#v=onepage&q=Technical%20virginity&f=false. 
  42. ↑ 42.0 42.1 Jayson, Sharon (October 19, 2005). "'Technical virginity' becomes part of teens' equation". USA Today. http://www.usatoday.com/news/health/2005-10-19-teens-technical-virginity_x.htm. Retrieved August 7, 2009. 
  43. ↑ [3] 2006 survey of sexual behavior from the CDC.
  44. ↑ Anne-Christine d'Adesky, Expanding Microbicide Research in amfAR Global Link – Treatment Insider; May 2004
  45. ↑ "Bradley Hasbro Children's Research Center". http://www.thedenverchannel.com/news/18245402/detail.html#-. 
  46. ↑ "Les pratiques sexuelles des Françaises" (in French). TNS/Sofres. http://www.tns-sofres.com/etudes/pol/030701_sexualite_r.htm. Retrieved April 30, 2007. Survey carried out by TNS/Sofres in a representative sample of 500 women from 18 to 65 years of age, in April and May, 2002.
  47. ↑ Yi, Ung-hoe; Sin, Jong-seong; Choe, Hyeong-gi (1999). "한국여성의 성형태에 대한 연구 (Sexual Behavior of Korean Women)". Daehan Namseong Gwahak Hoeji 17 (3): 177–185. http://kmbase.medric.or.kr/Main.aspx?d=KMBASE&m=VIEW&i=0356419990170030177. 
  48. ↑ "Healthy sex is all in the talk". The Georgia Straight. May 5, 2005. http://www.straight.com/article/healthy-sex-is-all-in-the-talk. Retrieved June 14, 2007. 
  49. ↑ Not all gay men have anal sex Originally Published: May 10, 1996 ~ Last Updated / Reviewed on: October 14, 2005
  50. ↑ "Frot: The Next sexual revolution". man2manalliance.org. http://man2manalliance.org/crw/frot/not.html. Retrieved April 26, 2010. 
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  52. ↑ 52.0 52.1 Saletan, William (September 20, 2005). slate.com "Ass Backwards: The media's silence about rampant anal sex.". Slate. http://www.slate.com/id/2126643/ slate.com. Retrieved April 26, 2010. 
  53. ↑ [4] Role versatility among men who have sex with men in urban Peru. In: The Journal of Sex Research, August 2007
  54. ↑ "Männer, die sowohl passiven als auch aktiven Analsex praktizieren, nennt man versatile." Georg Pfau, Präventionsmedizin für den Mann, Linz 2009 [5]
  55. ↑ Handbook of affirmative psychotherapy with lesbians and gay men By Kathleen Ritter, Anthony I. Terndrup; p350
  56. ↑ Clinical men's health: evidence in practice By Joel J. Heidelbaugh; p273; Elsevier Health Sciences, 2007
  57. ↑ Sexual dysfunction: a guide for assessment and treatment By John P. Wincze, Michael P. Carey; p59
  58. ↑ "There is a common misconception that anal sex is practiced almost exclusively by gay men. This is certainly not the case. It is thought that an estimated one third of gay couples do not include anal intercourse in their lovemaking. About one third of heterosexual couples try it from time to time. It is thought that about 10 per cent of heterosexual couples have anal intercourse as a regular feature of their lovemaking. In absolute numbers, it is hypothesized that more heterosexual couples have anal sex than homosexual couples.[6]
  59. ↑ William A. Percy and John Lauritsen, Review in The Gay & Lesbian Review, November–December 2002
  60. ↑ H. Montgomery Hyde, The Love That Dared not Speak its Name; pp.6–7
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  62. ↑ Pornography: the production and consumption of inequality By Gail Dines, Robert Jensen, Ann Russo; p80
  63. ↑ Primary Care in Obstetrics and Gynecology: A Handbook for Clinicians By Joseph S. Sanfilippo, Roger P. Smith; p408
  64. ↑ Crandon JE. Int Conf AIDS. 1992 Jul 19–24; 8: D527 (abstract no. PoD 5830) Hertford College, Oxford University, UK; "A study concerning HIV related knowledge, attitudes, and behaviours in a sample of Puerto Rican men and its relevance to AIDS education, prevention and outreach in San Juan, Puerto Rico."[8] Accessed September 27, 2007
  65. ↑ Partridge, Eric; Dalzell, Tom; Victor, Terry (2006). The New Partridge Dictionary of Slang and Unconventional English: A-I (reprint ed.). Taylor & Francis. p. 92. ISBN 9780415259378. http://books.google.com/?id=4YfsEgHLjboC&q=bareback#v=snippet&q=barebacking. "Bareback – to engage in sex without a condom." 
  66. ↑ What are the Dangers of Anal Sex?, SexInfo, University of California at Santa Barbara, retrieved April 29, 2007
  67. ↑ Anal Cancer in Gay & Bisexual Men, LGBTHealthChannel, retrieved April 29, 2007
  68. ↑ Sexual Transmission of Typhoid Fever: A Multistate Outbreak among Men Who Have Sex with Men, Reller, Megan E. et al., Clinical Infectious Diseases, volume 37 (2003), pages 141 – 144, retrieved April 29, 2007
  69. ↑ John Pauk, M.D., M.P.H., Meei-Li Huang, Ph.D., et al., "Mucosal Shedding of Human Herpesvirus 8 in Men" New England Journal of Medicine 343 19: 1369–1377
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  73. ↑ High-Risk Sexual Behavior by HIV-Positive Men Who Have Sex with Men --- 16 Sites, United States, 2000—2002, MMWR Weekly, October 1, 2004 / 53(38);891–894, retrieved April 29, 2007
  74. ↑ "Am I at Risk for HIV Infection?" Mark Cichocki, About:HIV/AIDS, retrieved April 29, 2007
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  77. ↑ 77.0 77.1 77.2 77.3 "Fred Hutchinson Cancer Research Center, Changing Trends in Sexual Behavior May Explain Rising Incidence of Anal Cancer Among American Men and Women". Fred Hutchinson Cancer Research Center (fhcrc.org). July 6, 2004. http://www.fhcrc.org/about/ne/news/2004/07/06/analcancer.html. Retrieved April 21, 2010. 
  78. ↑ http://pedclerk.bsd.uchicago.edu/rectalProlapse.html
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  83. ↑ Effect of anoreceptive intercourse on anorectal function AJ Miles, TG Allen-Mersh and C Wastell, Department of Surgery, Westminster Hospital, London; in Journal of the Royal Society of Medicine Vol 86, Issue 3 144–147; 1993, retrieved April 29, 2007
  84. ↑ Chun AB, Rose S, Mitrani C, Silvestre AJ, Wald A: Anal sphincter structure and function in homosexual males engaging in anal receptive intercourse. Amer J of Gastroenterology 92:465–468, 1997
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  88. ↑ David Cohen, "Sexuality, Violence, and the Athenian Law of Hubris" Greece and Rome; V.38.2 pp171-188
  89. ↑ James E. Miller, "The Practices of Romans 1:26: Homosexual or Heterosexual?" Novum Testamentum 37 1 (1995): 9. "Heterosexual anal intercourse is best illustrated in Classical vase paintings of hetaerae with their clients, and some scholars interpret this as a form of contraception."
  90. ↑ Quignard, Pascal (1996) Le Sexe et l'effroi
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  96. ↑ Philip Hoare, Noel Coward: A Biography p.18
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  101. ↑ See Stephen O. Murray, Will Roscoe, Islamic Homosexualities: Culture, History and Literature" (New York University Press, 1997)
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  104. ↑ GLBT in World Religions, Sermon by Rev. Gabriele Parks, along with Phil Manos and Bill Weber.[11]
  105. ↑ See Religion and sexuality#Buddhist views of sex and morality
  106. ↑ "Even with your wife, using one's mouth or the other hole is sexual misconduct. Using one's hand, that is sexual misconduct." (Dalai Lama, at a meeting with lesbian and gay Buddhists, June 11, 1997). Reported widely, including in: Dalai Lama Speaks on Gay Sex – He says it's wrong for Buddhists but not for society. By Don Lattin, Chronicle Religion Writer, Tuesday, June 11, 1997, San Francisco Chronicle. Text online; Dalai Lama urges 'respect, compassion, and full human rights for all,' including gays, by Dennis Conkin, Bay Area Reporter, June 19, 1997. Text online; Dalai Lama says 'oral and anal sex' not acceptable, Jack Nichols, May 13, 1997. Text online
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