title: Anal sphincter structure and function in homosexual males engaging in anoreceptive intercourse.
abstract: OBJECTIVE
  To evaluate the structure and function of the internal (IAS) and external (EAS) anal sphincters in anoreceptive homosexual men and to determine whether anoreceptive intercourse (ARI) is associated with a higher risk of incontinence in this population.
  
  
  METHODS
  We studied 14 anoreceptive homosexual males and 10 age-matched non-anoreceptive heterosexual males in a controlled, prospective cohort study. Subjects underwent evaluation of resting and maximum squeeze anal canal pressures (maximum squeeze pressure obtained over resting pressure) by station pull-through technique, using a manometric perfusion catheter followed by endoanal ultrasonography to evaluate the structure of the IAS and EAS. Manometry also was performed in age-matched male controls. All subjects completed a questionnaire that assessed sexual practices and bowel habits, including fecal incontinence.
  
  
  RESULTS
  Resting pressures were significantly lower in subjects engaging in ARI (70.7 +/- 3.2 mm Hg vs. 91.4 +/- 5.2 mm Hg; mean +/- SEM, p < 0.003), whereas there was no significant difference in the mean maximum squeeze pressures, compared with controls (177.1 +/- 14.1 mm Hg vs. 151.8 +/- 19.6 mm Hg; mean +/- SEM, p = 0.32). No disruptions of the IAS or EAS were identified in either the anoreceptive or control group. Anoreceptive men tended to have thinner anal sphincters than controls, but the difference was not statistically significant. Furthermore, there were no complaints of fecal incontinence by the study subjects.
  
  
  CONCLUSIONS
  Passive ARI is associated with decreased resting anal canal pressures, but total pressures are normal. There were no IAS or EAS defects, as well as no fecal incontinence, in our subjects. Better relaxation of the ARI subjects during anal canal manometry may explain the lower resting pressures.
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Chun
authors.forename: S
authors.initials: S
authors.lastname: Rose
authors.forename: C
authors.initials: C
authors.lastname: Mitrani
authors.forename: A J
authors.initials: AJ
authors.lastname: Silvestre
authors.forename: A
authors.initials: A
authors.lastname: Wald
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000502:physiology; D016022:Case-Control Studies; D002404:Catheterization; D015331:Cohort Studies; D003248:Constipation / Q000209:etiology; D003672:Defecation; D003967:Diarrhea / Q000209:etiology; D016099:Endoscopy, Gastrointestinal; D005242:Fecal Incontinence / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D010146:Pain / Q000209:etiology; D011312:Pressure; D011446:Prospective Studies; D012307:Risk Factors; D012725:Sexual Behavior; D019529:Sexuality; D011795:Surveys and Questionnaires; D014463:Ultrasonography