News Release

Unhealthy culture around anal sex encouraging coercion and pain

Greater openness needed to challenge harmful attitudes and expectations about anal sex between men and women

Peer-Reviewed Publication

London School of Hygiene & Tropical Medicine

Young men are not always concerned about getting consent from young women to have anal sex, and pain for women is considered normal, according to new research published in BMJ Open.

Researchers from the London School of Hygiene & Tropical Medicine say more open discussion is needed to challenge the culture and attitudes around anal sex – a subject that is often seen as unmentionable. In a new study looking at the expectations, attitudes and experiences of anal intercourse between opposite-sex partners and any implications these might have for health, researchers interviewed 130 men and women aged 16 to 18 from across England.

Young people talked to interviewers about an oppressive environment where some men compete with each other to have anal sex with women, even if they expect women to find it painful. Women also reported they were repeatedly asked for anal sex by their male partners. Their accounts also raise the real possibility of coercion for young women – who are sometimes put in situations where they are penetrated anally without their explicit consent.

Lead author Dr Cicely Marston, Senior Lecturer in Social Science at the London School of Hygiene & Tropical Medicine, said: "Our findings suggest an urgent need to act to reduce harms associated with anal sex, particularly to challenge views that normalise coercion. Teachers, parents and wider society must discuss anal sex with young people openly and, specifically, highlight the importance of "mutuality" – both partners listening and responding to each others' desires and concerns."

Previous research has shown that a significant minority of young people have had anal sex. The new study, published today in BMJ Open, suggests even those not having anal sex may nevertheless be talking about it with friends.

While the interviewees mentioned young men wanting to copy what they saw in porn as an explanation for anal sex, the interviews suggest other factors are more important, the researchers note. These include in some cases a lack of concern about young women's consent, or the levels of pain they might experience, and competition among young men to have anal sex with women.

However, the researchers note that not all men coerce their partners, that some young women may wish to have anal sex and that both partners may find it pleasurable.

Dr Marston added: "Current debates about young people's sex lives often seem to focus narrowly on the impact of porn. But our study suggests we need to think more widely about the lack of importance society places on women's rights, desires and concerns."

Study co-author Dr Ruth Lewis, Research Fellow at the London School of Hygiene & Tropical Medicine, said: "While anal sex might not be the easiest topic to raise, we cannot afford to ignore attitudes that help normalise coercion and negatively affect both women and men. Anal sex is part of some young people's sexual lives, and we believe our study makes a powerful case for more open discussion."

The findings come from the sixteen18 project, a wider piece of research on the sex lives of 16 to 18 year olds. The authors note that study participants spanned diverse locations and social groups, and the findings are likely to be relevant to a wide range of young people across England.


The research was funded by the Economic and Social Research Council.

C Marston, R Lewis. Anal heterosex among young people and implications for health promotion: a qualitative study in the UK. BMJ Open. DOI: 10.1136/bmjopen-2014-004996

For more information, to request a copy of the paper or arrange interviews with the authors, please contact Katie Steels at the London School of Hygiene & Tropical Medicine press office on +44 (0) 2079272802 / +44 (0) 7714138401 or


  • This study focuses on anal heterosex i.e. with an opposite sex partner.
  • Figures from last year's National Survey of Sexual Attitudes and Lifestyles (Natsal) found almost one in five 16-24 year olds (19% of men, 17% of women) reported having had anal intercourse with an opposite-sex partner in the previous year. The Natsal study, published in The Lancet in November 2013, was led by the London School of Hygiene & Tropical Medicine in partnership with University College London (UCL) and NatCen Social Research. Over 15,000 adults aged 16-74 participated in interviews between September 2010 and August 2012.

About the Sixteen18 Project The sixteen18 project is a qualitative study of young people's sexual practices in the UK. Researchers interviewed 130 men and women aged 16-18 from across England, individually and in groups. The project is based at the London School of Hygiene & Tropical Medicine, and is funded by the UK Economic and Social Research Council. It aims to identify and understand expectations and experiences of sexual practices among young people aged 16-18. Results from the project are intended to improve our understanding of young people's sexuality, help inform sex education, and help sexual health professionals and others give more effective advice to young people.

About the London School of Hygiene & Tropical Medicine The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 3,900 students and more than 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and was recently cited as the world's leading research-focused graduate school. Our mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.