What do colorectal specialists think about female participation in anal intercourse? An online survey of UK coloproctologists.

Background: Increasing participation in anal intercourse (AI) raises questions about its effects on the female anus. Societal change has moved faster than published literature.

Method: Online survey of Association of Coloproctology of Great Britian & Ireland (ACPGBI) and Association of Surgeons of Great Britain & Ireland (ASGBI) members to document clinical practice regarding female AI; opinion on female AI in causation of anal pathology; barriers to discussing AI; possible harms and harm reduction and public information.

Results: 91% of consultant colorectal surgeons (CCS) agree female AI causes anal fissures. Only 25% usually or always ask young women with fissures about AI and 31% never ask. Enquiry increases with refractory fissures (34%) and vulnerable patients (57%); 48% of CCS cite fear of patient discomfort, and 40% fear what the patient thinks of them as barriers to enquiry. Eighty per cent of CCS and 85% of pelvic floor specialists (PFS) agree AI can cause internal anal sphincter (IAS) damage and 72% and 78% faecal incontinence (FI) in women. Eleven per cent of CCS and no PFS agreed relaxation techniques, and 17% and 14% lubrication, protect the IAS; 97% of CCS think there should be increased public health awareness about female AI.

Conclusions: Experts think participation in AI can cause fissures, IAS damage and FI in women. They are sceptical about the protective value of lubrication and relaxation. Clinical conversations lag behind experts' opinions on the importance and possible consequences of female AI. Concern over patients' feelings are barriers to enquiry. Colorectal specialists think there should be more public health information about female AI.