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Anal intercourse is becoming more common among heterosexual couples. Within popular culture it has moved from the world of pornography to mainstream media. 1 It is no longer considered an extreme behaviour but increasingly portrayed as a prized and pleasurable experience. 2 In Britain, the National Survey of Sexual Attitudes and Lifestyle shows participation in heterosexual anal intercourse among 16 to 24 year olds rose from 12.5% to 28.5% over the past few decades. 3 Similar trends are seen in the US, where 30-44% of men and women report experience of anal sex. 4

Individual motivation varies. Young women cite pleasure, curiosity, pleasing male partners, and coercion as factors. 5 6 Up to 25% of women with experience of anal sex report they have been pressured into it at least once. 7 Hit television shows such as Sex and the City and Fleabag may unwittingly add to the pressure, as …