Anal sex research: what it tells us about consent, pain and STIs

In 2014, researchers from the London School of Hygiene & Tropical Medicine published a study in BMJ Open, a journal from the BMJ group. They interviewed 130 young people aged 16 to 18 in London, a northern industrial city and the rural south west of England, between 2010 and 2011. They found that:

• anal sex often appeared to be painful, risky and coercive, particularly for women
• young men were often expected to persuade or coerce reluctant partners
• competition between young men, and wanting to tell their friends, played a part
• few young men or women said they found anal sex pleasurable

The researchers called for more open discussion of mutual agreement and consent. They also said anal sex between men and women was largely ignored in sex education, and that young people needed advice on avoiding painful and risky techniques.

Many of the young people in the study said men wanted anal sex because they wanted to copy what they’d seen in porn. But the researchers said this explanation was partial at best. Porn was only one part of the picture, alongside coercion, competition between men and the idea that people must like it if they do it, even though young people also expected it to hurt women.

England’s updated sex education guidance for schools, in force from September 2026, says pupils should learn that porn presents some activities as normal which many people never do, and that some of them can be physically harmful.

What happens in porn isn’t a guide to what a partner wants.

The latest national figures come from Natsal-3, Britain’s national survey of sexual attitudes and lifestyles, carried out between 2010 and 2012. Almost 1 in 5 people aged 16 to 24 had anal sex with an opposite-sex partner in the past year: 19% of men and 17% of women. It was less common in older age groups.

The first results from the next survey, Natsal-4, are due at the end of November 2026.

Most people in every age group hadn’t had anal sex in the past year. Read more in “Natsal: what Britain’s national survey of sexual attitudes found”

Consent means freely agreeing to what happens. It isn’t consent if someone is pressured, feels they have to say yes, is too drunk to decide or hasn’t been asked. Being in a relationship, or having said yes before, isn’t consent either.

Anyone can change their mind at any time, and if either of you wants to stop, you should stop straight away. Pain is a sign to stop and check in with each other.

Anal sex should never be something you feel pressured into. If someone has made you have sex without your consent, support and medical care are available, whether or not you decide to report it to the police.

The lining of the anus and rectum is delicate and can be damaged easily, and unlike the vagina, the anus doesn’t make its own lubrication. Small tears make it easier for infections to pass on. Infections that can pass on through anal sex include:

• HIV, for which receptive anal sex carries the highest risk of any type of sex
• Chlamydia and Gonorrhoea
• Syphilis and Herpes
• HPV, which can cause warts around the anus
• Hepatitis B
• Hepatitis A and Shigella, which can pass on through oral to anal contact (rimming)

Most infections in the bottom cause no symptoms. When they do, they can cause pain, discharge, bleeding or itching. Read more in “Is unprotected anal sex dangerous?”

A few things make anal sex safer and more comfortable:

• talk about it first, and only go ahead if you both want to
• use a condom, and a new one each time, including if you move from anal to vaginal sex
• use plenty of water-based or silicone-based lube, and don’t use oil-based lube with latex condoms
• go slowly, and stop if it hurts
• don’t share sex toys, or wash them and put a new condom on them before anyone else uses them
• use a dental dam for rimming

If you’re at higher risk of HIV, a medicine called PrEP reduces your risk of getting it, although it doesn’t protect against other STIs. Gay, bisexual and other men who have sex with men can also get vaccinated against Hepatitis A and Hepatitis B, and against HPV if they’re 45 or under.

Condoms and plenty of lube are the simplest way to make anal sex safer. Read more in “Can you still get an STI if you wear a condom?”

If you’ve had anal sex without a condom, or the condom split:

• if there’s a chance of HIV, get urgent medical care about PEP, emergency medicine that has to be started within 72 hours
• test for Chlamydia and Gonorrhoea from 2 weeks after sex, with a swab from your bottom if you were the receptive partner
• have a lab HIV test from 45 days after sex
• test for Syphilis, and repeat the test 3 months after sex

A urine test only checks the genitals, so it won’t find an infection in the bottom. UK guidelines recommend urine, throat and rectal tests for all sexually active gay, bisexual and other men who have sex with men. For women, they say rectal tests should depend on your sexual history, so mention anal sex when you book.

If you have symptoms in your bottom, get tested straight away.

Better2Know offers:

• Chlamydia and Gonorrhoea (Rectal Swab): a swab from your bottom for anyone who has had receptive anal sex, from 14 days after sex, with results in 2 days. You can book it at one of our clinics, where you’ll be shown how to take the swab yourself.
• Full Screen: tests for 7 infections, including HIV, Syphilis, Hepatitis B, Chlamydia and Gonorrhoea, from 28 days after sex, with results in 3 days (5 days for the home test). It uses blood and urine samples, so add a rectal swab if you were the receptive partner.
• Confidence Screen: for gay and bisexual men, it tests for 7 infections, including HIV, Syphilis, Hepatitis B, and Chlamydia and Gonorrhoea in urine, throat and rectal samples, from 28 days after sex, with results in 5 days. You can also order a home test kit.

If you test before 45 days, a negative HIV result needs a repeat test. A Syphilis test in the first 3 months after sex can miss the infection, so you may need a repeat test. Not sure which test you need? Our Patient Care Team is available 24/7 on 020 7099 0955.

Is anal sex safe?

It’s safer with consent, a condom and plenty of lube. Without a condom, it carries a higher risk of HIV and other STIs than most other types of sex.

Should anal sex hurt?

No. Pain is a sign to slow down or stop. Feeling anxious makes the muscles harder to relax, and plenty of lube and going slowly can help.

Do I need a test if we used a condom?

Condoms greatly lower the risk, but they don’t cover all the skin, so infections such as Herpes, HPV and Syphilis can still pass on. If you have a new partner, it’s a good idea to test anyway. Read more in “3 STIs you can catch even if you use a condom”

UK research suggests anal sex among young people is often painful and pressured, particularly for young women, and that it needs to be talked about more openly. Consent comes first, and condoms, lube and testing make anal sex safer. If you’ve had anal sex without a condom, a test is the only way to know you’re clear.

Book a rectal swab test at a clinic near you, alongside a Full Screen for HIV and Syphilis. Our Patient Care Team is available 24/7 on 020 7099 0955.

Not in the UK? Choose your country from the selector at the top of the page for local tests and prices.

This article originally appeared on 17 October 2015 and was last updated on 1 October 2026.

This article is general information and not a substitute for personal medical advice.

Sources

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