Women's Experiences with Anal Sex: Motivations and Implications for STD Prevention


  • Emily Maynard,

    Corresponding author
    1. Emily Maynard is a doctoral student, Program in Clinical Psychology, Fordham University, New York
    Search for more papers by this author
  • Alex Carballo-Diéguez,

    1. Alex Carballo-Diéguez is research scientist, professor of clinical psychology and associate director
    Search for more papers by this author
  • Ana Ventuneac,

    1. Ana Ventuneac is project manager
    Search for more papers by this author
  • Theresa Exner,

    1. Theresa Exner is research scientist and assistant professor of medical psychology—all at the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York
    Search for more papers by this author
  • Kenneth Mayer

    1. Kenneth Mayer is medical research director, Fenway Institute, Fenway Community Health, Boston, and professor of medicine and community health at the Warren Alpert School of Medicine, Brown University, Providence
    Search for more papers by this author



CONTEXT: Heterosexual anal intercourse is a highly efficient mode of HIV transmission, yet little is known about the contexts in which women engage in it, or when and with whom they use condoms. Similarly, sexuality and reproductive health research has paid little attention to female desire and pleasure-seeking.

METHODS: In-depth interviews were conducted in Boston in 2006 with 28 women who reported having had unprotected anal intercourse in the last year with a man who was HIV-positive or whose serostatus was unknown. Sexual scripting theory guided analyses of their experiences with and motivations to practice anal intercourse.

RESULTS: Participants engaged in anal intercourse for a wide variety of reasons: to experience physical pleasure, enhance emotional intimacy, please their male partners or avoid violence. Male partners usually initiated anal sex. Anal intercourse often occurred in the context of vaginal and oral sex. Among reasons women cited for not using condoms were familiarity with their partner and feeling that condoms made anal sex less pleasurable. Knowledge of HIV and STD risks did not appear to encourage condom use.

CONCLUSIONS: Women who perceive condom use during anal sex as limiting their pleasure or intimacy may be at increased risk for acquiring HIV. Consequently, interventions to promote safer anal intercourse must find a way to increase the use of barrier methods without decreasing pleasure or perceived intimacy between sexual partners.