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A Mixed-Methods Exploration of Women’s Experiences of Anal Intercourse: Meanings Related to Pain and Pleasure


The aim of this mixed-methods study was to document and analyze the dimensions and meanings of anoreceptive pain and pleasure among heterosexual women. An online survey was carried out on a convenience sample of 1,893 women aged 18–60 years. Qualitative data were collected using open-ended questions mailed to women who expressed interest in continuing participation in the study; narratives from 68 women who had experienced anal intercourse were collected and analyzed for pain themes. Most surveyed women had experienced anoreceptive intercourse. A majority of women (79.1 %) reported their first anal intercourse to be painful, but for most of them the intensity and duration of pain/discomfort substantially diminished over time. Less than a third (27.7 %) of participants who regularly engaged in anoreceptive intercourse in the past 12 months stated that they rarely or never experience pain/discomfort with the practice. Nevertheless, most women who continued to practice anal intercourse (58.1 %) reported it to be very arousing and pleasurable. The pleasure associated with anoreceptive intercourse was best predicted by masturbatory frequency and orgasmic ability (with sexual intercourse). The qualitative assessment pointed to a wide range of personal experiences with and meanings attached to pain/discomfort associated with anoreceptive intercourse. Three broad pain themes emerged: (1) pain as insurmountable obstacle, (2) strategic management of pain, and (3) pain eroticization. The study findings suggested that the successful inclusion of anal intercourse into a couple’s sex life is often dependent on a specific learning process.

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  1. Similarly to the experience of pain associated with anal intercourse, abrasions and fissures of the rectal tissue (which facilitate STI transmission) are more likely when anal sphincters are not relaxed and anal penetration is attempted without adequate lubrication.

  2. A majority (70 %) of the Cosmopolitan magazine readership in Croatia, which is almost exclusively female, are between 15 and 34 years of age and live in an urban setting (75 %). Over a half of the readers are employed (55 %). In regard to their educational status, most readers have high school education (64 %), followed by college (20 %). In comparison to the general population, the cohort is younger, more urban, and better educated.

  3. As the two indicators were strongly correlated (r = .71, p < .001), this suggests that participant were not able to clearly distinguish the two concepts; thus, only the latter measure was used in the following analyses.


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The authors would like to thank Sophie Bergeron for her comments and suggestions.

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Correspondence to Aleksandar Štulhofer.

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Štulhofer, A., Ajduković, D. A Mixed-Methods Exploration of Women’s Experiences of Anal Intercourse: Meanings Related to Pain and Pleasure. Arch Sex Behav 42, 1053–1062 (2013).

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  • Anal intercourse
  • Pain
  • Sexual pleasure
  • Women