The current study has limitations worth noting. First, as with many qualitative approaches, the sample size was small. This, and the fact that the majority of participants were ethnic minority women recruited through community-based HIV testing and outpatient drug treatment programs, limits the generalizability of the findings. However, given the statistics on HIV incidence and prevalence in minority women, the sample was also a strength of the study as these are the women who are most at risk for HIV infection from unprotected heterosexual anal intercourse. Malamuth NM. The attraction to Sexual Aggression Scale: I (1989) Journal of Sex Research. 1989; 26:26–49. doi: 10.1080/00224498909551491. [ CrossRef] [ Google Scholar] Boily MC, Baggaley RF, Wang L, Masse B, White RG, Hayes RJ, Alary M. Heterosexual risk of HIV-1 infection per sexual act: Systematic review and meta-analysis of observational studies. Lancet. 2009; 9:118–129. doi: 10.1016/S1473-3099(09)70021-0. [ PMC free article] [ PubMed] [ CrossRef] [ Google Scholar] Bogart L, Kral A, Scott A, Andersen R, Flynn N, Gilbert N. Sexual risk among injection drug users recruited from syringe exchange programs in California. Sexually Transmitted Diseases. 2005; 32:27–34. doi: 10.1097/01.olq.0000148294.83012.d0. [ PubMed] [ CrossRef] [ Google Scholar] In other cases, the women themselves offered to have anal intercourse in an attempt to please their partner:

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Mosher WD, Chandra A, Jones J. Sexual behavior and selected health measures: Men and women 15–44years of age, United States, 2002. Advance Data. 2005; 15:1–55. [ PubMed] [ Google Scholar] The current study sought to understand why heterosexual women engage in anal intercourse, their perceptions of risks associated with anal intercourse, and their physical and emotional reactions to anal intercourse. Results from a series of four focus groups with women recruited from a community-based HIV and STI testing program and an outpatient drug treatment program suggested that women had a wide range of views on anal intercourse with a man and motivations for having anal intercourse. Among these motivations were (1) because they were high; (2) the women’s own desire for anal intercourse; (3) a desire to please their partner, (4) in quid pro quo (exchange) situations; (5) because they wanted to avoid vaginal sex; (6) and because they did not consent, either because they did not realize they had to ability to refuse or because they were coerced.

Javanbakht M, Guerry S, Gorbach PM, Stirland A, Chien M, Anton P, Kerndt PR. Prevalence and correlates of heterosexual anal intercourse among clients attending public sexually transmitted disease clinics in Los Angeles County. Sexually Transmitted Diseases. 2010; 37:369–376. doi: 10.1097/OLQ.0b013e3181bcd3e7. [ PubMed] [ CrossRef] [ Google Scholar] Another reason for engaging in anal intercourse occurred in exchange situations (12/32; 37.5% of participants). For example, some of the women agreed to have anal intercourse in exchange for money: While some of the women simply expressed discomfort or distaste for anal intercourse, others described specific circumstances that contributed to their dislike of anal intercourse. For example, five of the women (5/32; 15.6% of participants) described male partners who were so focused on their own pleasure that they failed to consider the women’s experiences: Powis B, Griffiths P, Gossup M, Strang J. Heterosexual anal intercourse, health risks and drug use: A review with special attention to drug users. Drug and Alcohol Review. 1995; 14:223–229. doi: 10.1080/09595239500185281. [ PubMed] [ CrossRef] [ Google Scholar] Harawa NT, Leng M, Kim J, Cunningham WE. Racial/ethnic and gender differences among older adults in nonmonogamous partnerships, time spent single, and HIV testing. Sexually Transmitted Diseases. 2011; 38:1110–1117. doi: 10.1097/OLQ.0b013e31822e614b. [ PMC free article] [ PubMed] [ CrossRef] [ Google Scholar]Kalichman SC, Pinkerton SD, Carey MP, Cain D, Mehlomakulu V, Carey KB, et al. Heterosexual anal intercourse and HIV infection risks in the context of alcohol serving venues, Cape Town, South Africa. BMC Public Health. 2011; 11:807–812. doi: 10.1186/1471-2458-11-807. [ PMC free article] [ PubMed] [ CrossRef] [ Google Scholar] Focus groups are well suited to identifying the range and limits of a specific experience. In the current study, we were able to capture a wide range of reasons for engaging in anal intercourse, factors related to the perception of risk, and contexts related to women’s enjoyment of anal intercourse. But it is important to remember the limits of focus group data. While focus groups are very good at uncovering the range of experience, they are not good at uncovering how common any one experience might be. This is because not every person was asked or required to answer every question. A participant’s silence does not necessarily mean that they did not have the experience. Participation was also limited to English-speaking women, and participants were low-income women. Additionally, the women were willing to discuss a stigmatized behavior in a focus group setting. Therefore, this study does not necessarily represent the views of women who may feel uncomfortable discussing anal intercourse in a group setting. I know that anal sex is, uh, I don’t know, for me, it was like I loved it when I was high. (White, Group 3) DePadilla L, Windle M, Wingood G, Cooper H, DiClemente R. Condom use among young women: Modeling the theory of gender and power. Health Psychology. 2011; 30:310–319. doi: 10.1037/a0022871. [ PMC free article] [ PubMed] [ CrossRef] [ Google Scholar]