title: Anal Penetrative Intercourse as a Risk Factor for Fecal Incontinence.
abstract: The aim of the study is to investigate the relationship between anal penetrative intercourse (API) and pelvic floor symptoms, specifically, anal incontinence (AI).
  
  
  
  This was an institutional review board-approved, cross-sectional, e-mail survey of women enrolled in the Illinois Women's Health Registry. Participants were anonymously queried about their sexual practices and the effects of these on bowel and bladder symptoms. Urinary symptoms were assessed using the urogenital distress inventory-6 and bowel symptoms with the fecal incontinence severity index (FISI).
  
  
  
  One thousand three women (mean age of 46 ± 15 years) completed the survey. Eighty percent were white, 56% were married, and 99% reported ever being sexually active. Thirty-two percent had API at least once, and 12% considered it "part of their sexual practice." Sixty percent of the cohort reported a bothersome urinary symptom on the urogenital distress inventory-6, 70% reported AI on the FISI, and 15% reported fecal incontinence. Of women who engaged in API, 18% reported it changed their stool consistency, and 10% reported it caused AI. Having engaged in API within the last month was correlated with higher FISI scores (P = 0.05) and with fecal incontinence on the FISI (28.3% vs 14.4%; P = 0.01; odds ratio, 2.48). In addition, API was more commonly practiced among women who reported that vaginal intercourse caused dyspareunia (17% vs 12%, P = 0.05) or changes in bladder symptoms such as urgency or dysuria (44% vs 30%, P < 0.001).
  
  
  
  Self-reported AI and FI (as measured by the FISI scores) are higher in women who have had API, and frequency of API may be important in determining the risk of bowel symptoms.
authors.affiliation: From the Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, IL.
authors.forename: Julia
authors.initials: J
authors.lastname: Geynisman-Tan
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kenton
authors.forename: Alix
authors.initials: A
authors.lastname: Leader-Cramer
authors.forename: Bhumy
authors.initials: B
authors.lastname: Dave
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Bochenska
authors.forename: Margaret
authors.initials: M
authors.lastname: Mueller
authors.forename: Sarah Abbie
authors.initials: SA
authors.lastname: Collins
authors.forename: Christina
authors.initials: C
authors.lastname: Lewicky-Gaupp
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D007087:Illinois; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology