Shaping Sexual Behaviors & Sexual Scripts
Perceptions and experiences of receptive anal intercourse among women: a systematic review and thematic analysis.
Open Access: Yes.
Abstract
Introduction
Receptive anal intercourse (RAI) is an increasingly reported sexual practice across diverse populations and carries a higher risk of certain health consequences, including HIV and other sexually transmitted infections, anal trauma and anorectal disorders, compared with vaginal intercourse. Despite these risks, research exploring women’s experiences, motivations and perceptions of RAI remains limited. Much of the existing literature has focused on gay and bisexual men, leaving women’s perspectives comparatively underexamined and their ability to make fully informed sexual-health decisions constrained by this evidence gap.
Objectives
This qualitative systematic review and thematic synthesis aimed to explore women’s perceptions, motivations and experiences of RAI, including how societal attitudes and gender dynamics shape these experiences.
Methods
A qualitative systematic review and thematic analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of PubMed, PsycINFO, CINAHL and Embase identified peer-reviewed qualitative studies published between January 2010 and June 2025 that examined women’s views and experiences of RAI. The Sample, Phenomenon of Interest, Design, Evaluation, Research type framework guided study selection, and data extraction captured study characteristics and verbatim qualitative findings for synthesis.
Results
22 studies encompassing 593 women across 12 countries were included. Participants represented diverse ages (14–84 years) and socioeconomic backgrounds. Three overarching themes emerged: (1) motivations for engaging in RAI, often linked to partner expectations, intimacy or curiosity; (2) experiences, spanning pain, discomfort and coercion, but also instances of pleasure and agency and (3) societal views, which reflected both normalisation and enduring stigma. Women’s accounts revealed that RAI is negotiated within relational and cultural constraints, where agency and coercion, pleasure and pain, frequently coexist rather than oppose one another.
Conclusions
Women’s experiences of RAI reveal a complex interplay between sexual agency, bodily autonomy and social meaning. Recognising that pleasure and discomfort can coexist and that decisions are often shaped by relational and cultural dynamics highlights the need for open, non-judgemental discussion of RAI within sexual-health education and clinical practice. Addressing stigma and providing evidence-based guidance can support informed, consensual and safe sexual decision-making for women.
Relevance
“Receptive anal intercourse [RAI] has been reported to carry a higher risk of sexually transmitted infections (STIs), anal malignancy and anorectal disorders.” RAI also has an “elevated anal cancer risk” (if exposed to the human papillomavirus or HPV during RAI), greater potential for traumatic abrasions, lower condom use, and “is linked to a spectrum of anorectal disorders, including anal fissures, bleeding, incontinence and anal sphincter injury.” Furthermore, “Women are particularly vulnerable to these conditions owing to anatomical differences, specifically, a shorter and less robust anal sphincter compared with men’s. These differences may be further compounded by hormonal changes, pregnancy and ageing, all of which can weaken sphincter function and increase the likelihood of anorectal complications.”
Despite these demonstrated harms, the sexual practice is increasing. An important source of “external pressure” to engage in RAI as a “routine element of heterosexual sex” and a “socially reinforced expectation” was pornography. “Exposure to pornography was repeatedly cited as a major force behind RAI’s normalisation, shaping both men’s expectations and women’s sense of sexual adequacy.”
“Many women engaged in anal intercourse primarily to satisfy their male partners.” Women described anal intercourse as a “sacrifice,” “a way to demonstrate devotion,” “reward for their partners,” a way to “avoid losing their partner” during menstruation, “a duty,” to preserve vaginal virginity in patriarchal societies, and because “some men felt entitled to it, and women, despite previous negative experiences, offered it as a gesture of intimacy.” Prostituted women in dire economic circumstances also participate in RAI because they feel that they have no other financial choice. For the “vast majority” of the women, they did not engage in RAI because they desired or liked it. It was painful and unpleasant, and some cried during the act. “Pain was the most consistent experience reported across studies, in both consensual and coercive contexts. Many women described tearing, bleeding and prolonged discomfort.”
Many women reported coercion. “The tactics employed by men ranged from persistent verbal pressure to physical force and exploitation of intoxicated states.” Many of the women in the study “portrayed RAI as the outcome of relentless requests, ‘nagging’ or manipulation.” Some of the women “reflected on how partners interpreted their passivity as consent.” “Fear of violence, rejection or accusations of infidelity frequently motivated participation.” “Women’s narratives reveal a continuum—from reluctant acquiescence after badgering, through fearful submission, to acts under intoxication or force. Even when labelled ‘consensual’, many accounts involved pressure, obligation or impaired capacity to refuse.”
Citation
