Assessing Anorectal Sexual Function: Validity and Clinical Utility of a New Measure.

Abstract

Background: Various conditions can disrupt anorectal sexual function, potentially reducing pleasure or increasing pain. There is currently no standard diagnostic criteria for anorectal sexual dysfunction, including anhedonia and anodyspareunia, despite a described need for better measurement tools.

Objective: To evaluate the Anorectal Sexual Function Index (ASFI) in a clinical sample of people with and without problematic receptive anal intercourse (RAI) and to develop diagnostic cut-off scores for potential classification of sexual dysfunction.

Design: Between July 2024 and January 2025, we conducted a mixed-method, cross-sectional study of a population with mixed sexual function/dysfunction among individuals assigned male at birth.

Participants: We recruited individuals with concerns during RAI, including pain or lack of pleasure in addition to people with known pelvic pathology.

Main measures: All participants completed a clinical interview and a questionnaire, including the ASFI and other health-related quality-of-life measures.

Key results: Among the 122 participants, the mean age was 42 years, the majority (97%) were cis-gender men, and 85% of whom identified as gay. Participants reporting reduced pleasure in the interview scored lower on the pleasure domain (11 vs 17, p < 0.01), while those reporting pain in the interview had higher pain scores (23 vs 13, p < 0.01). Participants with active fissures, IBS, IBD, anal cancer, and chronic prostatitis/pelvic pain syndrome consistently reported higher pain scores and lower pleasure scores. Participants classified with anodyspareunia reported lower sexual satisfaction, reduced erectile frequency during RAI, fewer orgasms during RAI, and higher levels of internalized homophobia. Participants classified with anhedonia reported lower sexual satisfaction, reduced erectile frequency during RAI, fewer orgasms during RAI, and higher prevalence of HIV.

Conclusions: We standardized the diagnosis for anodyspareunia and RAI anhedonia using the ASFI. Respondents with anodyspareunia and RAI anhedonia reported worse patient-reported outcomes than those who did not meet criteria.