Sexual Anal Pain in Gay and Bisexual Men: In Search of Explanatory Factors

Background: Sexual anal pain-or anodyspareunia-in gay and bisexual men is a scientifically and clinically neglected topic. More understanding of its origins and correlates is needed. Aim: To search for correlates of painful anal intercourse with the inclusion of minority stress processes. Methods: The analysis is based on data collected in an Internet study on the sexuality of Polish gay, bisexual, and straight men. Multiple ordinal regression analysis was used to search for the correlates of painful receptive anal intercourse in a group of 1,443 nonheterosexual men who declared practicing this type of intercourse within the last 12 months. The investigated correlates included demographics, sexual patterns and experiences, experiencing minority stress, sexual problems, and mental and physical health. To assess the level of minority stress, we used the Sexual Minority Stress Scale based on Ilan Meyer's Minority Stress Model, with its subscales relating to internalized homophobia, expectation of rejection, concealment, and sexual minority negative events. Sexual problems were measured with single-item questions adapted from the National Health and Social Life Survey. Data on the remaining correlates were obtained using a survey that we developed. Main Outcome Measures: The intensity of pain during receptive anal sexual intercourse as rated on a 5-point Likert scale was a dependent variable. Results: Age (odds ratio [OR]: 0.97; P <.001), performance anxiety (OR: 1.94; P <.001), and internalized homophobia (OR: 1.04; P <.001) were the only statistically significant predictors of the intensity of pain during receptive anal sexual intercourse. Clinical Implications: Clinicians addressing sexual anal pain should consider performance anxiety, internalized homophobia, and younger age as possible operating factors. Strengths & Limitations: The major strengths of the study include the provision of additional data on this neglected topic derived from a large sample of participants from the little recognized Central European cultural context and the major limitations are the nonrepresentative sampling, retrospective data collection, crosssectional design, Internet methodology, and lack of information on the clinical relevance of experienced pain, that is, distress or help-seeking, as well as its recurrent or persistent character. Conclusion: Painful sexual anal activity requires further investigation. Copyright (C) 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.