Receptive anal intercourse (RAI) involves consensual anal penetration by a partner for sexual pleasure and is practiced by a significant portion of the population, particularly among men who have sex with men and gender-diverse individuals.

While it is often considered a “high-risk” sexual behavior due to the increased risk of spreading sexually transmitted infections (STIs) such as HIV, it holds emotional and sexual benefits for many and is an important part of their sexual and relational well-being.

RAI is motivated by sexual pleasure, due to specific anorectal areas that produce erogenous sensations. However, some individuals experience painful RAI (anodyspareunia), which may be caused by physical or psychological factors.

A new study explored how pelvic sensations during RAI may change with experience. The authors hypothesized that pleasure increases with more RAI experience, while pain and discomfort decrease.

Participants for the study were recruited via social media platforms and word of mouth. All participants were 18+ years of age, were able to read English, had a prostate, and had engaged in RAI in the past 6 months. A total of 975 individuals who fit these criteria completed the survey.

In the survey, the respondents were asked about their experience with RAI through the following question: “Over the course of your lifetime, about how many times have you bottomed? (not the number of sexual partners). For reference, 500 times is about once a week for 10 years.” Their response options included 1) less than 10 times, 2) 11-50 times, 3) 51-200 times, 4) 201-500 times, and 5) >500 times. 

Then, they were asked about the frequency of sensations experienced during RAI including erogenous/pleasurable sensations, pain, urinary urgency (defined as feeling “the urge to pee”), and bowel urgency (feeling the “urge to poop”).

Ultimately, the researchers found that 9% of the participants reported fewer than 10 experiences with RAI, 26% reported 11-50 RAI experiences, 32% reported 51-200 experiences, 16% reported 201-500 experiences, and 18% reported >500 experiences.

As individuals gained more experience with RAI, the occurrence of pleasurable sensations went up significantly. Specifically, the reported frequency of pleasurable sensations increased from 41% for those with fewer than 10 RAI exposures to 92% for those with over 500 exposures.

On the other hand, as the number of RAI experiences increased from less than 10 to over 500 exposures, severe pain with penetration and feelings of bowel urgency decreased from 39% to 13% and from 21% to 6%, respectively. Lastly, urinary urgency symptoms did not change over time in relation to RAI experience.

Overall, the most common sensation experienced with RAI was pleasure. The feelings the participants experienced during RAI seemed to be linked to how many times they had had RAI in their life, regardless of their age.

References:

• Gaither, T.W., Siapno, A.E., Kianian, R., Vincent, N., Williams, K.C., Piquerias, E., Russell, M.M., & Litwin, M.S. (2023). Relationship between pelvic sensations and lifetime exposure to receptive anal intercourse among people with prostates. The Journal of Sexual Medicine, 20(9), 1195-1205. https://doi.org/10.1093/jsxmed/qdad099