Anal intercourse among females in the UK

Oty, Tabitha and Mateus, Ceu and Limmer, Mark (2026) Anal intercourse among females in the UK. PhD thesis, Lancaster University.

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Abstract

The prevalence of receptive anal intercourse among women is increasing; however, public health discourse and education have not evolved proportionally to address this trend. While anal intercourse is well-documented as a risk factor for sexually transmitted infections (STIs) and anal malignancies, its association with anorectal disorders remains underexplored. Women may be particularly susceptible to these disorders due to anatomical differences compared to men. This thesis investigates the perspectives, attitudes, and clinical practices of healthcare professionals who treat female patients with anorectal disorders, aiming to establish an evidence-based understanding of the relationship between anal intercourse and anorectal health, and develop guidance on appropriate sexual history taking in the clinical setting. The research begins with a systematic synthesis of existing literature on the motivations and experiences of women who engage in anal intercourse, providing crucial context for understanding the female perspective on this sexual practice. Following PRISMA guidelines, databases including PubMed, EMBASE, PsycINFO, and CINAHL were searched for peer-reviewed studies published in English from 2010 to 2023. Thematic synthesis, guided by the approach developed by Thomas & Harden, highlighted the normalization of anal intercourse among many women, despite persistent societal stigma that hinders open discussions—particularly within clinical settings when health issues arise. The empirical component employs a mixed-methods design, integrating survey data with semi-structured interviews, to examine healthcare professionals’ attitudes toward women with anorectal disorders. A structured online survey was distributed to healthcare professionals in general surgery to assess their attitudes, knowledge, and practices concerning sexual history-taking. Quantitative data were analysed using descriptive and inferential statistics, including chi-square tests to examine associations between demographics and clinical behaviours. Complementing this, semi-structured interviews were conducted with a purposive sample of practitioners to explore institutional, interpersonal, and cultural influences on discussions of anal intercourse. Thematic analysis of interview data—facilitated by NVivo—identified key barriers, including provider discomfort, perceived patient resistance, and systemic limitations such as time constraints and lack of training. The study underscores the urgent need for enhanced clinician training, structured protocols for sexual history-taking, and targeted public health initiatives. Policy recommendations are proposed for the NHS and relevant stakeholders. These include standardised sexual history protocols, the use of chaperones and structured questionnaires, extended consultation times in specialist clinics, and training on managing sensitive sexual health issues, including safeguarding. Public health recommendations involve updating NHS resources to include information on anorectal disorders and expanding sex education curricula to incorporate anal intercourse. Finally, the thesis contributes to health policy and health economics by highlighting gaps in clinical efficiency and patient outcomes, and it outlines areas for future research, including the economic impact of delayed diagnosis and treatment of anorectal conditions related to anal intercourse.