General Articles

Women’s Experiences of Pain During Anal Intercourse: A Survey of 2,002 Respondents

Aleksandar Stulhofer and Dea Ajdukovic, "Should We Take Anodyspareunia Seriously? A Descriptive Analysis of Pain during Receptive Anal Intercourse in Young Heterosexual Women" Journal of Sex and Marital Therapy (September 2011).

Although frequency of anal intercourse has been increasing among heterosexual men and women over the past decade#, few empirical studies have focused on pain related to receptive anal intercourse, particularly among young women. This study investigated consistent and recurring severe pain due to anal penetration, referred to as anodyspareunia, among women ages 18-30. An online survey was administered to 2,002 women, through which women reported on the frequency of anal intercourse in the past year. If participants reported 2 or more episodes, they were prompted to report the level and frequency of pain at penetration. Researchers classified pain as anodyspareunic if the participant reported unbearable or strong pain at each episode of anal sex.

Key Points:

  • Two-thirds (63.2%) of surveyed women reported experiencing anal intercourse.
  • Approximately half (49%) of women reported their first anal sex experience too painful to continue, and only 52% of women used lubricant during the first anal penetration.
  • Among women who reported 2 or more episodes of anal intercourse in the past year, only 8.7% were classified as anodyspareunic.
  • Among women classified as anodyspareunic, the pain level did not change from their first anal sex experience.

Should anodysparenuria be added to the list of sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders? This question has divided sexual health researchers such as Simon Rosser# and Karl Hollows# who disagree on the meaning of pain as experienced during receptive anal intercourse. While some sexual health experts view pain as a clinical problem in need of medical or therapeutic treatment, others consider it a largely preventable condition, best addressed with education and better communication between partners. The current study attempts to contribute to the debate by exploring the frequency and causes of such pain as reported by a large convenience sample of young adult women.

According the National Health and Sexual Lifestyle Survey conducted in the early 1990s, 31% of men and 23% of women 25-44 years of age had experience of anal intercourse.# A decade later, in 2002, a large-scale national study in the U.S. found prevalence rates for the same-age cohort of 40% and 35% respectively;# nearly a decade beyond that, a 2010 national study found that 40% of women 20-24 years of age had experienced receptive anal intercourse. Various studies have explored the prevalence of anal intercourse, yet few have focused on pain as a dimension of these experiences.

In the current study, a majority of women reported pain during their first experience with anal intercourse, and among those who continued with the practice, most continued to report some pain and discomfort at the beginning of the sexual act. Most women cited their inability to relax, lack of lubrication, or inadequate anal preparation as possible explanations for pain or other discomfort. Ultimately, of all women who reported two or more episodes of receptive anal intercourse over the prior 12 months, fewer than 9% were anodyspareneuric (meaning that they experienced pain during every episode of anal intercourse).

With the increased popularity of male-female anal intercourse, and reports of routine pain among nearly 1 in 10 women who engage in this behavior, there may be a need for increased education surrounding anal health and pleasure. Some of the pain and other discomfort reported by women in this study might be preventable with better education on this topic. While the study suggests that anodyspareunia is relatively rare, the increase in male-female partnered anal intercourse over the past two decades suggests that couples could benefit from education to enhance their health, communication, and pleasure.

Stulhofer A, Ajdukovic D (2011). Should we take anodyspareunia seriously? A descriptive analysis of pain during receptive anal intercourse in young heterosexual women," Journal of Sex and Marital Therapy 37(5): 346-58, <>

Faculty profile web page, University of Minnesota School of Public Health, "B.R. Simon Rosser, Ph.D., M.P.H., L.P." accessed 25 October 2012, <>.

Hollows K (2007). Anodyspareunia: a novel sexual dysfunction? An exploration into anal sexuality. Sexual and Relationship Therapy 22(4): 429-443, <>.

Laumann E, et al, (1994). The Social Organization of Sexuality: Sexual Practices in the United States, 1st Ed. (Chicago IL: University of Chicago Press), <>

Herbenick D, Reece M, Schick V, Sanders SA, Dodge B, Fortenbery DJ (2010). Sexual behavior in the United States: Results from a national probability sample of men and women ages 14-94. Journal of Sexual Medicine. Suppl. 5:255-65, <>