title: Anal heterosex among young people and implications for health promotion: a qualitative study in the UK.
abstract: OBJECTIVE
  To explore expectations, experiences and circumstances of anal sex among young people.
  
  
  METHODS
  Qualitative, longitudinal study using individual and group interviews.
  
  
  METHODS
  130 men and women aged 16-18 from diverse social backgrounds.
  
  
  METHODS
  3 contrasting sites in England (London, a northern industrial city, rural southwest).
  
  
  RESULTS
  Anal heterosex often appeared to be painful, risky and coercive, particularly for women. Interviewees frequently cited pornography as the 'explanation' for anal sex, yet their accounts revealed a complex context with availability of pornography being only one element. Other key elements included competition between men; the claim that 'people must like it if they do it' (made alongside the seemingly contradictory expectation that it will be painful for women); and, crucially, normalisation of coercion and 'accidental' penetration. It seemed that men were expected to persuade or coerce reluctant partners.
  
  
  CONCLUSIONS
  Young people's narratives normalised coercive, painful and unsafe anal heterosex. This study suggests an urgent need for harm reduction efforts targeting anal sex to help encourage discussion about mutuality and consent, reduce risky and painful techniques and challenge views that normalise coercion.
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Marston
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D003068:Coercion; D004739:England; D004882:Erotica / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D020010:Heterosexuality / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D036301:Qualitative Research; D012309:Risk-Taking; D012737:Sex Factors; D012725:Sexual Behavior / Q000523:psychology* / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology; D047568:Unsafe Sex / Q000523:psychology / Q000706:statistics & numerical data
keywords: Anal sex; Qualitative Research; Sexual health; Young adults