Anal sex is no longer quite the salacious taboo it once was.
Not only has society steadily become more accepting of sexual relationships between men, but more heterosexual people are trying it and trying it more often than ever before. Recent surveys estimate that 40 percent of women between the ages of 20 to 24 have tried anal sex, and 20 percent of all women have tried it in the last year.
Our greater societal acceptance aside, you may have heard that anal sex can have some dangerous effects on our health, particularly as a leading cause of anal cancer. So let’s take a brief look at some basic facts and myths about anal sex and its connection to cancer.
The myths and facts behind the connection between anal sex and anal cancer.
1. It Can Cause Anal Cancer
The long and short of it is that yes, anal sex is a risk factor for anal cancer.
Anal sex can transmit the human papillomavirus (HPV), and HPV in turn leaves the cells around our rectum more vulnerable to mutating and becoming cancerous. A similar risk exists wherever HPV rears its ugly microscopic head, including the mouth, throat, and cervix. And because anal sex is generally more damaging to the inner lining of the rectrum than the stereotypical notion of heterosexual sex is to the vagina, HPV and other sexually transmitted infections are more easily spread between people who engage in anal sex. Similarly, the greater number of sexual partners, the greater the risk of cancer.
2. But It’s Rare
Close to 90 percent of anal cancer cases can be traced back to HPV. But the cancer itself is relatively rare.
According to The American Society of Colon and Rectal Surgeons, only 8,000 people will be newly diagnosed with anal cancer this year. And though cases have been slowly increasing in recent decades, only one of every 500 people will develop anal cancer in their lifetime, generally between the ages of 55 to 64 — a stark contrast to the one in every 22 people who will develop colorectal cancer.
3. And Preventable
Like other forms of cancer fueled by HPV, the available HPV vaccine can likely cut down the risk of developing anal cancer in both men and women.
While HPV vaccination rates still aren’t anywhere near as high as we’d like them to be, there is already evidence that the vaccine has lowered the risk of later cervical cancer in teen girls. And though we don’t have any concrete evidence that the same decline has occurred for anal cancer just yet, there is some showing the vaccine reduced the risk of cells in the anus becoming precancerous in young men who have sex with men.
Both teen boys and girls are now regularly encouraged to get the HPV vaccine, but when it comes to anal cancer, it may benefit women more — two-thirds of new cases are diagnosed in women.
On 18 May 2011 , the prolific dominatrix-turned-pornstar Asa Akira sent her Twitter followers one brief, but provocative message: “Ass is the new pussy.”
Although Akira was not the first to utter this smutty axiom, the tagline has been pegged to her name. That may have made it easy for many to dismiss the concept as nothing more than a shocking, perhaps self-promotional assertion by a savvy performer sometimes known as porn’s ” Ass Queen .” But the starlet wasn’t just blowing smoke out of her buttocks. She was channeling a growing and convincing body of data on the inexorable rise of heterosexual anal play in America.
We can actually track the rise of heterosexual anal sex over the past quarter century thanks to your tax dollars. The Centers for Disease Control and Prevention has released a series of studies in which they asked huge groups of people the same nosey questions about their sex lives— including whether men had ever put their penises “in a female’s rectum or butt” and if women had experienced a man putting his penis in their rectums (or butts) . In 1992, 20 percent of women and 26 percent of men aged 18 to 59 had reached fifth base with an opposite sex partner at least once. In 2005, the figure was 35 percent of women and 40 percent of men aged 25 to 44. In 2011, it was 39 percent of women and 44 percent of men aged 15 to 44. In some smaller age subgroups, the prevalence of anal experimentation was even more common.
The CDC didn’t ask whether people had heterosexual anal sex on the reg (probably because it’s hard to measure what “the reg” means), experimented with other forms of anal play, or tried male-recipient butt stuff. The best numbers we get regarding frequency are studies that look at what proportion of people had heterosexual anal sex in the last year, or the last time they had sex, which is a weak proxy at best. But it give us a sense that recurrent hetero butt sex is on the rise as well as one-off experiments.
A 2010 study also suggests that experimentation with wider forms of anal play may be even more common than experimentation with anal sex amongst heterosexual couplings. Among its subjects, 43 percent of women and 51 percent of men surveyed in heterosexual couples copped to testing out anilingus, anal fingering, or anal toy play at least once. A 2008 study suggests that at least some self-identified heterosexual men are receiving anal pleasure as well (mostly fingering, some anilingus). We have no good data to compare that to in terms of trends. But given the taboos against men receiving anal play, any male-receiver experimentation seems, anecdotally at least, like a pretty big sign of the times.
Yet for all that we’ve collectively bickered, raved, and railed about this widely acknowledged trend, almost no one’s investigated what America’s changing anal inclinations have meant for the sex market— namely brothel owners, pornographers, and toy manufacturers . To find out, I reached out to a few makers and shakers in the sex industry to get a quick look at how America’s smut mongers have responded to the rise of hetero anal sex.
Art by Peter Johann Nepomuk Geiger
PORN IN THE HETERO ANAL-ERA
According to Pornhub, the king of dirty search data, the heterosexual anal revolution correlates with exactly the trends you’d imagine. Anal-relatedporn searches still represent less than 10 percent of all queries on their site. However, anal is a more common term among straight content searches than gay ones and its pervasiveness in hetero searches is rising rapidly. Pornhub crunched the numbers for VICE and found that between 2009 and 2015 , anal-related searches increased by 120 percent in America. That’s significantly higher than the 78 percent increase in anal-related searches globally. The increase was steeper among male than female users, but anal-related tags were still the 18th most searched most searched terms among the site’s female clientele.
(As a side note, Pornhub’s investigation found that users aged 18 to 24 are actually 33 percent less likely to look for anal content than users aged 35 to 44, which is unexpected given how often we talk about hetero-anal as a young person’s game. But that 18 to 24-year-old demographic is 290 percent more likely to search for My Little Pony porn than any other age bracket, which is certainly its own can of worms.)
Image by Paul Avril
Yet, despite this clear demand spike, and the excitement a first-time anal scene can generate for a female performer, anal-focused heterosexual videos make up a small portion of the market. A Pornhub investigation last year revealed that just 7 percent of their straight content has an “anal” tag on it. And it doesn’t seem like porn studios are making any notable move to increase the volume of anal-focused content they create.
“I don’t think the overall production has gone up,” says Holly Kingstown, the editor of Fleshbot and a fixture of the adult industry since 1999 who’s held every job possible save actress. “In your talent pool, there are still [only] a certain number of girls who will do [anal]. And how many of that scene can you do with that girl?”
“There are performers who are willing to do it,” possibly due to industry pressures and consumer demand. “But in terms of the quality, when you’re talking about DVD sales…” she adds, before pausing briefly. “You can get a crappy internet scene or two out of a girl, but if she’s not really good at it, you’re not going to get that too many times. And when you’re talking about a girl who does it just to get a scene, it’s usually not going to be a girl who loves it or does it very well. So she’s not going to get that much work.”
Kingstown does believe that there’s more consumption of the anal-focused content that already exists. But the absolute number of anal-focused titles available for consumers is fairly static.
What has changed, says Kingstown, is the tone and packaging of the anal porn that gets made. Towards the early 2000s, when Kingstown was still working at Buttman Magazine, she and a her colleagues realized that more couples, versus angry men looking for painal (grimacing girls , visibly suffering and un-lubed ass-ramming), were exploring their content. Adjusting to this mass market, pornographers shifted to portraying anal as pleasurable and normal versus painful and sick, which had apparently been the norm for the bulk of anal porn content up to that point.
“You still see the stuff where you’ll see a woman called an ‘anal whore.’ But you also see the tone overall to be a bit more… I want to say woman-positive,” says Kingstown. “For example, I’m looking at my desk and I’ve got James Deen Loves Butt here. This isn’t James Deen Loves Sodomizing Little Girls and Making Them Cry . That title would sell too, but to a whole different audience. There’s Anal Warriors, where women are shown as strong and powerful and in control of the sex that they’re having. There’s a whole ton of these kinds of movies where the women who enjoy anal are shown as strong and powerful.”
But even if movies today portray anal sex as pleasurable, they still don’t paint it realistically. They don’t focus on the time and preparation most (s)experts agree good anal requires . They often show a ramrod, angled experience that wouldn’t be pleasant for more than a few women in the world. Of course, a lack of realistic sexuality is a chronic problem in all niches of fantasy-driven porn.
We’re seeing a lot more prolapses. We’re seeing double anal. It used to be five anal scenes, done, not four anal scenes and a double penetration. They can go further, so they do. –Holly Kingstown
This pleasurable-looking anal, says Kingston, is now treated like a run-of-the-mill aspect of porn rather than a specialty act. Whereas in the past, you might stuff all your anal content into one niche film, nowadays directors think nothing of nonchalantly inserting an anal scene into a larger project. The overall amount of anal content remains the same—it’s just not as clustered into niche markets and individual movies. Yet, as anal becomes a normal part of heterosexual porn for a wider audience, a small audience craving painful or extreme porn, for whom anal is now too passé and mainstream, has started demanding more physically taxing and (Kingston believes) potentially dangerous ass play acrobatics from the limited actress pool.
“You see a lot more circus stuff than you used to,” says Kingstown. “We’re seeing a lot more prolapses. We’re seeing double anal. It used to be five anal scenes, done, not four anal scenes and a double penetration. They can go further, so they do. And physically, there’s only so far that you can go with your body [as a performer].”
SEX TOYS IN THE HETERO-ANAL ERA
“Anal sex has always been a frequent topic of conversation with our [mostly heterosexual] customers,” Claire Cavanah, co-founder of Babeland, told VICE when we asked for data on anal-related sex toy sales. The Seattle-based outfit with three outlets in New York is often hailed as one of the most accessible and acclaimed sex toy shops in America—a profile that lends it a large consumer base. “The ‘How to Have Butt Sex’ content on Babeland.com is the number one viewed piece of our [editorial] content. It has almost double the number of eyes on it as the ‘How to Give a Blow Job’ article, which is the second most viewed [item]. We don’t have data before 2009, but it’s always been number one.”
A Babeland survey of 18,412 customer respondents in 2009 (not a reliable sample, due to self-reporting issues, but still one of the better pieces of data you can find on this subject matter) also found that, 60.5 percent of men and 40.1 percent of women had tried using a butt plug, 56.8 percent of men and 31.7 percent of women had tried using an anal dildo, 51.8 percent of men and 29.2 percent of women had tried using an anal vibrator, and 37.4 percent of men and 27.8 percent of women had tried using anal beads.
Yet even with a high baseline of anal interest, Babeland has seen an increase in anal-related sales. Between 2012 and 2015, the genre averaged about 5 percent growth per year. As of 2015, Cavenah estimates that such toys, specifically made with anal in mind, make up about 16 percent of Babeland’s sales.
What’s more significant to Cavenah and company, they say, is how they’ve witnessed the tone and level of openness their customers use when talking to them about purchases and proclivities evolve. The hushed voices and seedy aura customers once took into transactions has faded away. And as people get more open, comfortable, and explicit with their anal sex toy needs, toy makers have responded to their feedback with a deluge of new, specifically anal-targeted sex toys , including smaller models marketed towards anal beginners. Babeland’s also noticed more luxury anal sex toys coming onto the market—products made of metal or glass, substances with higher price points—which suggests the emergence of a fair number of swankier, less bashful customers.
“We’ve definitely seen a shift in more interesting, innovative, and high-qualitybutt toys from some of the leading sex toy companies,” says Cavenah. “Je Joue debuted a remote-controlled vibrating prostate stimulator this spring. Anal toys come with vibrators, apps, and magnetic resistance that creates a pulsating sensation. There are also lubricants, such as Sliquid [Naturals] Sassy , that are marketed specifically for anal use.”
The objects and people children play with as early as toddlerhood may provide clues to their eventual sexual orientation, reveals the largest study of its kind. The investigation, which tracked more than 4500 kids over the first 15 years of their lives, seeks to answer one of the most controversial questions in the social sciences, but experts are mixed on the findings.
“Within its paradigm, it’s one of the better studies I’ve seen,” says Anne Fausto-Sterling, professor emerita of biology and gender studies at Brown University. The fact that it looks at development over time and relies on parents’ observations is a big improvement over previous studies that attempted to answer similar questions based on respondents’ own, often unreliable, memories, she says. “That being said … they’re still not answering questions of how these preferences for toys or different kinds of behaviors develop in the first place.”
The new study builds largely on research done in the 1970s by American sex and gender researcher Richard Green, who spent decades investigating sexuality. He was influential in the development of the term “gender identity disorder” to describe stress and confusion over one’s sex and gender, though the term—and Green’s work more broadly—has come under fire from many psychologists and social scientists today who say it’s wrong to label someone’s gender and sexuality “disordered.”
In the decades since, other studies have reported that whether a child plays along traditional gender lines can predict their later sexual orientation. But these have largely been criticized for their small sample sizes, for drawing from children who exhibit what the authors call “extreme” gender nonconformity, and for various other methodological shortcomings.
Seeking to improve on this earlier research, Melissa Hines, a psychologist at the University of Cambridge in the United Kingdom, turned to data from the Avon Longitudinal Study of Parents and Children. The study includes thousands of British children born in the 1990s. Parents observed and reported various aspects of their children’s behavior, which Hines and her Cambridge colleague, Gu Li, analyzed for what they call male-typical or female-typical play.
An example of stereotypical male-typical play, as defined by the study, would include playing with toy trucks, “rough-and-tumble” wrestling, and playing with other boys. Female-typical play, on the other hand, would include dolls, playing house, and playing with other girls.
Hines and Li looked at parental reporting of children’s play at ages 2.5, 3.5, and 4.75 years old, and arranged them on a scale of one to 100, with lower scores meaning more female-typical play and higher scores more male-typical play. They then compared those results to the participants’ self-reported responses as teenagers to a series of internet-administered questions about their sexuality.
Beginning with the 3.5-year-old age group, the team found that children who engaged mostly in “gender-conforming” play (boys who played with trucks and girls who played with dolls, as an example) were likely to report being heterosexual at age 15, whereas the teenagers who reported being gay, lesbian, or not strictly heterosexual were more likely to engage in “gender-nonconforming” play. The same pattern held true when they expanded the teenagers’ choices to a five-point spectrum ranging from 100% heterosexual to 100% homosexual.
Teens who described themselves as lesbian scored on average about 10 points higher on the gender-play scale at age 4.75 (meaning more stereotypically male play) than their heterosexual peers, and teens who described themselves as gay men scored about 10 points lower on the scale than their peers, the researchers report in Developmental Psychology. Questions of transgender identity were not addressed in the study.
“I think it’s remarkable that childhood gender-typed behavior measured as early as age 3.5 years is associated with sexual orientation 12 years later,” wrote Li in an email. “The findings help us to understand variability in sexual orientation and could have implications for understanding the origins of this variability.”
The paper “is just a well-done study in terms of getting around some of the problems that have plagued the field,” says Simon LeVay, a retired neuroscientist whose 1991 paper in Science sparked interest in brain differences associated with sexual identity. “It shows that something is going on really early in life and points away from things like role modeling and adolescent experiences as reasons for becoming gay.”
Others dispute the paper’s methods and significance. Parents’ own beliefs and biases about gender almost certainly influence how they described their children’s gendered play, which could skew their reporting, says Patrick Ryan Grzanka, a psychologist who studies sexuality and multicultural issues at the University of Tennessee in Knoxville. But more worrisome to him are the cultural assumptions underlying the study itself. The authors appear to regard gender nonconformity as the primary marker of gayness, which doesn’t align with current research suggesting that your individual preferences for either stereotypically male or female behaviors and traits has little to do with your sexual orientation, he says.
Grzanka is also dismayed that the paper fails to critique the history of similar research that investigated whether childhood behaviors lined up with eventual sexual orientation. It wasn’t long ago that such research was used to stigmatize and pathologize gender-nonconforming children, he says. “I think it’s important to ask why we’re so invested in this purported link [between gender conformity and sexuality] in the first place.”
People have turned to mindfulness to make them happier, less stressed and even more able to deal with their mental health conditions such as anxiety or depression – but could it improve your sex life too?
Being mindful essentially means being present and aware of both yourself and your surroundings. The brain is trained to deal with negative and anxious or depressive thoughts through breathing and meditation exercises all stemming in part from ancient Buddhist philosophy.
While therapists are increasingly using it as part of their individual counselling, sex and relationship therapists have also adopted the advice.
“In its broad terms, mindfulness means focusing on the present moment so with couples, because they are often so distracted, stressed and over-committed, it can lead to lots of couples’ mind being elsewhere. A classic complaint is that a partner is distracted,” Krystal Woodbridge, a psychosexual therapist and a trustee of the college of relationship and sexual therapists says. “Mindfulness can mean you are really present with your partner and actually experiencing them in the moment and really paying attention to them.”
This in turn can then lead to better sex – because when partners really feel like they are being listened to, focused on and paid attention to is when better trust is going to be built so they are more likely to be intimate with someone.
“Really being in the moment, noticing their partners body language, facial expressions, tone of voice and what is actually being said is hard to do but it is being present,” Woodbridge says. “… It builds rapport. It you don’t have rapport, you don’t have trust. If you don’t have trust you are not going to be intimate with that person as you are not going to allow yourself tp be vulnerable with them.”
When clients put mindfulness into practice with each other, even if it is a struggle because they are so used to being distracted, it often has a “massive impact on their relationship and sex lives”, Woodbridge says.
Additionally, if someone is struggling with an issue in their sex life such as a performance issue like impotence or the inability to orgasm, mindfulness can also help in this aspect.
“In a sexual scenario what can happen is ‘spectatoring’, which is when a person is not paying attention to arousal or enjoyment and are instead observing and over-analysing themselves fearing the worst. If it is an erectile problem they will be hoping it does not fail or will feel anxious about whether their partner is enjoying it,” Woodbridge explains. “Spectatoring is often quite self-fulfilling so the person might not be able to maintain their erection, will experience sexual pain or they will just feel completely unconfident so they get into a horrible cycle.”
Sex therapists will therefore instruct the client to be mindful and to notice how they are feeling, even if that feeling is anxiety. Once they are aware they feel anxious or nervous they can focus on bringing the mind back to the physical feelings, such as arousal, and divert their focus to this instead.
“Mindfulness gets the person to notice when they are ‘spectatoring’, notice that they are distracted and not focusing on their arousal and physical sensations. It is hard in that moment as the person is anxious but if you don’t the mind will wander and go elsewhere,” Ms Woodbridge explains.
Ammanda Major, a trained sex therapist and head of service quality and clinical practice at Relate told The Independent they regularly introduce mindfulness to their sex therapy sessions for couples.
“We use mindfulness in sex therapy to help people experience more pleasure by being able to relax and stay focused and present in the moment. Mindfulness can also benefit our relationships as a whole by relieving stress, building intimacy and enhancing inner peace. This in turn allows us to have more positive interactions with our partners,” she said.
She says couples can try mindfulness exercises at home, such as the following:
“Set some time aside every day to focus on your breathing. It doesn’t have to be long to begin with – maybe start with just five minutes a day and work your way up to 20.
A good way to start is on your own with no distractions. Close your eyes, relax and start to become aware of how you’re breathing. Breathe in slowly through your nose and exhale through your mouth. Repeat this and gradually become aware of sensations in your body. Recognise and welcome them and then allow those thoughts to drift away to be replaced with other feelings as they arise. Notice what you’re experiencing and feeling. The aim is to let go: rather than reject intrusive thoughts, just let them drift away.”
With a partner:
“Once you’ve practised the breathing exercise a few times on your own, why not with your partner? Sit facing and look into each other’s eyes. Breathe slowly in through your nose and exhale through your mouth as before but this time synchronise your breathing. Do this for several minutes – it may feel a little strange at first but stick with it and it can have powerful results, increasing feelings of relaxation and intimacy.”
Although Valentine’s Day is often criticised as a cynical creation by florists and the greeting cards industry, it is a useful focal point for considering love and sexuality as elements of human wellbeing that often escape attention in healthcare.
This neglect is most marked in later life, when popular discourse on late life romance is dominated by simple notions of asexuality or by ribald jokes
There are many reasons why healthcare professionals need to learn more about human love and sexuality, not least of which is a fuller understanding of the nature and meaning of ageing.
exuality is a core element of human nature, encompassing a wide range of aspects over and above those related to genital functions, and the medical literature has rightly been criticised for taking too narrow a vision of sexuality.
We need to open up to the continuing significance of love and sexuality into later life
This narrow vision is paralleled by a steady trend in the neurosciences of “neuroreductionism”, an over-simplistic analysis of which parts of the brain light up in sophisticated scanners on viewing photos of a loved one.
We need to open up to the continuing significance of love and sexuality into later life, understanding that sexuality includes a broad range of attributes, including intimacy, appearance, desirability, physical contact and new possibilities.
Numerous studies affirm sexual engagement into the extremes of life, with emerging research on the continuing importance of romantic love into late life. There is also reassuring data on the persistence of romantic love in long-term relationships, unsurprisingly associated with higher levels of relationship satisfaction.
A growing literature sheds light on developing new relationships in later life, with a fascinating Australian study on online dating which subverts two clichés – that older people are asexual and computer illiterate.
The challenge in ageing is best reflected in the extent to which we enable and support intimacy and sexuality in nursing homes. Although for many this is their new home, the interaction of institutional life (medication rounds, meals), issues of staff training and lack of attention to design of spaces that foster intimacy can check the ability to foster relationships and express sexuality.
For example, is the resident’s room large enough for a sofa or domestic furnishings that reflects one’s style, personality and sense of the romantic? Are sitting spaces small and domestic rather than large day rooms? Do care routines allow for privacy and intimacy? Is there access to a selection of personal clothes, make-up and hairdressing?
Granted, there can also be complicated issues when residents with dementia enter new relationships and the need to ensure consent in a sensitive manner, but these should be manageable with due training and expertise in gerontological nursing and appropriate specialist advice.
A medical humanities approach can provide useful supports in education from many sources, ranging from literature ( Love in the Time of Cholera), film ( 45 Years or the remarkable and explicit Cloud 9 from 2009) or opera (Janácek’s Cunning Little Vixen, a musical reflection of the septuagenarian composer’s passion for the younger Kamila Stösslová).
We, as present and future older Irish people, also need to take a step back and consider if we are comfortable with a longer view on romance and sexuality.
The Abbey Theatre did us considerable service in 2015 with a wonderful version of A Midsummer Night’s Dream set in a nursing home. We were struck by a vivid sense of the inner vitality of these older people, suffused with desire, passion and romance.
This contemporary understanding of companionship and sexuality in later life was enhanced by casting Egeus as a son exercised about his mother’s romantic choices instead of a father at odds with his daughter.
We can also take heart from an early pioneer of ageing and sexuality, the late Alex Comfort. Best known for his ground-breaking The Joy of Sex, he was also a gerontologist of distinction, and wrote knowledgeably about the intersection of both subjects with characteristic humour.
He wrote that the things that stop you having sex with age are exactly the same as those that stop you riding a bicycle: bad health, thinking it looks silly or having no bicycle, with the difference being that they happen later for sex than for the bicycle.
His openness and encouragement for our future mirror Thomas Kinsella’s gritty poem on love in later life, Legendary Figures in Old Age, which ends with the line: ‘We cannot renew the Gift but we can drain it to the last drop.’