Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

• Published in: Nature reviews. Gastroenterology & hepatology 2024-06, Vol.21 (6), p.377-405
• Main Authors: Dickstein, Daniel R., Edwards, Collin R., Rowan, Catherine R., Avanessian, Bella, Chubak, Barbara M., Wheldon, Christopher W., Simoes, Priya K., Buckstein, Michael H., Keefer, Laurie A., Safer, Joshua D., Sigel, Keith, Goodman, Karyn A., Rosser, B. R. Simon, Goldstone, Stephen E., Wong, Serre-Yu, Marshall, Deborah C.
• Format: Article
• Language: English
• Subjects: 692/4020/1503/1298; 692/4020/1503/1504; 692/4020/1503/1581; 692/4020/1503/257; 692/700/784; Anus; Anus Diseases - diagnosis; Anus Diseases - etiology; Anus Diseases - physiopathology; Anus Diseases - therapy; Arousal; Biomedicine; Blood flow; Body image; Colon; Colonic Diseases - etiology; Colonic Diseases - physiopathology; Colonic Diseases - therapy; Gastroenterology; Gastrointestinal diseases; Hepatology; Humans; Hypertonicity; Medical treatment; Medicine; Medicine & Public Health; Patients; Pleasure - physiology; Rectal Diseases - diagnosis; Rectal Diseases - etiology; Rectal Diseases - physiopathology; Rectal Diseases - therapy; Rectum; Review Article; Sexual Behavior - physiology; Sexual Dysfunction, Physiological - etiology; Sexual Dysfunction, Physiological - physiopathology; Sexual Dysfunction, Physiological - therapy; Sexual health; Sphincter
• ISSN: 1759-5045; 1759-5053; 1759-5053
• DOI: 10.1038/s41575-024-00932-1

The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI — encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable. Receptive anal intercourse (RAI) is an important consideration in gastrointestinal disorders and cancers. This Review discusses the anorectum as a sexual organ, providing an overview of pleasurable and problematic RAI and how gastrointestinal disease itself and associated treatments (such as surgery) can affect RAI. Strategies to manage problematic RAI to improve sexual health are also described. Key points Receptive anal intercourse (RAI) is common worldwide. Pleasurable RAI occurs through stimulation of the perianal or anal nerves and prostate or paraurethral glands, inducing vasodilation, erectile tissue engorgement, anopelvic tissue sensitization, and anal sphincter and pelvic muscular contractions. Patients with a stoma and anorectal stump should be counselled on hygiene and dilator use to minimize infections, maintain anorectal patency, and prevent a permanent stoma, promoting RAI restoration. Antidiarrhoeals, anti-flatulence medications, fibre supplements, lower residue diet to control regularity, avoiding sp