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A new study published in the journal Sexual Medicine offers a detailed look at how cisgender men and women experience receptive anal intercourse. Drawing on a large and diverse sample, the researchers identified areas of the rectum that are most frequently associated with pleasure and examined how different groups experience orgasm during anal sex. The findings show that the superficial anterior region of the rectum is commonly identified as pleasurable, and that men are more likely than women to report reaching orgasm from anal stimulation alone.
The researchers conducted the study to address a longstanding gap in sexual health research. While many studies have examined anal sex in terms of health risks such as HIV and sexually transmitted infections, fewer have focused on the positive aspects of anal sexual activity, such as physical pleasure, satisfaction, and orgasm.
Additionally, most existing studies have focused on heterosexual women or men who have sex with men, leaving out the experiences of heterosexual men, lesbian and bisexual women, and other groups. The aim of this study was to better understand how people from a range of backgrounds experience receptive anal intercourse and to help clinicians provide more comprehensive sexual health counseling.
The study was approved by the Cedars-Sinai Medical Center Institutional Review Board and conducted using an online survey distributed through the Qualtrics platform. A total of 498 cisgender women and 466 cisgender men completed the questionnaire in June 2020. Participants were selected to match the demographic distribution of the United States adult population based on 2010 census data, and responses were weighted accordingly. Participants ranged in age from 18 to over 60 years old and identified across a spectrum of sexual orientations, including heterosexual, gay, bisexual, and asexual.
Respondents first answered demographic questions and were asked whether they had ever engaged in receptive anal intercourse. Those who responded yes were shown anatomical diagrams of the rectum divided into four zones: superficial anterior, superficial posterior, deep anterior, and deep posterior. They were asked to indicate which regions they found pleasurable during sex with a partner. Participants were also asked whether they had experienced orgasm from receptive anal intercourse, either on its own or with stimulation of other body parts.
Overall, about one-third of women and one-quarter of men reported having engaged in receptive anal intercourse. Women were significantly more likely than men to report this experience, particularly middle-aged women. Among men, older adults were the least likely to have engaged in receptive anal intercourse. Participants who identified as gay or bisexual were more likely to report having had receptive anal intercourse than heterosexual participants. Notably, bisexual men were especially likely to endorse anal pleasure across different regions of the rectum, while heterosexual men were the least likely to report finding any rectal zone pleasurable.
When asked to identify specific areas of pleasure within the rectum, respondents most often selected the superficial anterior region. This was true for both men and women. This region lies at the front of the rectum, adjacent to the prostate in men, and near other sensitive structures in women such as the internal legs of the clitoris and branches of the pudendal nerve. Both anatomical and neurological explanations may account for why this area is commonly associated with pleasurable sensations. In contrast, the deeper and more posterior regions of the rectum were less frequently endorsed as pleasurable.
In terms of orgasm experiences, men were significantly more likely than women to report reaching orgasm from receptive anal intercourse without any additional stimulation—39% of men compared to 19% of women. About half of respondents from each gender reported that they could achieve orgasm during receptive anal intercourse with co-stimulation elsewhere on the body. Women were twice as likely as men to report never having orgasmed from anal penetration, regardless of whether other stimulation was involved.
These gender differences may reflect both biological and social factors. The prostate has long been considered a potential source of orgasmic pleasure for people assigned male at birth, and its proximity to the anterior rectal wall may explain why many men in the study reported orgasms from receptive anal intercourse alone. Women’s experiences, by contrast, may depend more heavily on clitoral stimulation or other forms of co-stimulation, and cultural expectations or internalized stigma around anal sex may also play a role in shaping sexual response.
Sexual orientation also influenced experiences with receptive anal intercourse. Gay men and bisexual individuals were more likely to engage in the practice and more likely to report pleasure from various regions of the rectum. Heterosexual men, by contrast, were the least likely group to report engaging in receptive anal intercourse or finding it pleasurable. Previous surveys have found that many heterosexual men associate anal pleasure with homosexuality, which may prevent some from exploring or reporting their experiences honestly.
Age also played a role. Middle-aged women were the most likely group to report experience with receptive anal intercourse, while older men were the least likely. Younger adults of both genders were more likely to find one or more rectal zones pleasurable, suggesting that younger generations may be more open to anal play or more attuned to their own pleasure. Cultural shifts, better sex education, and increased representation of diverse sexual practices in media may all be contributing to this generational trend.
The study had several strengths, including its large and demographically representative sample, anonymous format, and detailed anatomical illustrations. It also addressed questions about sexual function and erogenous sensation that are often overlooked in research. However, the authors acknowledge some limitations. As a self-report survey, the study relied on participants’ memory and honesty. It did not gather information about the frequency or context of receptive anal intercourse or about the specific methods used, such as penetration with a penis, finger, or toy.
The study also excluded gender minorities due to low sample size, meaning that the findings may not apply to transgender or nonbinary individuals. Future research could expand on these findings by including more gender-diverse participants and exploring the social and emotional context of anal sexual experiences.
The study, “Anal sex practices and rectal erogenous zone maps among men and women of diverse sexual orientations: an anatomic-map based questionnaire study,” was authored by Michael Zaliznyak, Alice B. Walton, Jenna Stelmar, Dylan Isaacson, Thomas W. Gaither, Gail Knudson, and Maurice M. Garcia.
