Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

Daniel R Dickstein¹, Collin R Edwards², Catherine R Rowan³, Bella Avanessian^{4

5}, Barbara M Chubak⁶, Christopher W Wheldon⁷, Priya K Simoes⁸, Michael H Buckstein⁹, Laurie A Keefer⁸, Joshua D Safer^{4

10}, Keith Sigel¹¹, Karyn A Goodman⁹, B R Simon Rosser¹², Stephen E Goldstone¹³, Serre-Yu Wong⁸, Deborah C Marshall^{9

14}

Affiliations

¹ Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. daniel.dickstein@mountsinai.org.
² Department of Radiology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA.
³ Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.
⁴ Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵ Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁶ Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁷ Department of Social and Behavioral Sciences, College of Public Health at Temple University, Philadelphia, PA, USA.
⁸ The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁹ Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁰ Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹¹ Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹² Division of Epidemiology and Community Health, School of Public Health at University of Minnesota, Minneapolis, MN, USA.
¹³ Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁴ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

PMID: 38763974
DOI: 10.1038/s41575-024-00932-1

Review

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

Daniel R Dickstein et al. Nat Rev Gastroenterol Hepatol. 2024 Jun.

. 2024 Jun;21(6):377-405.

doi: 10.1038/s41575-024-00932-1. Epub 2024 May 19.

Authors

Affiliations

¹ Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. daniel.dickstein@mountsinai.org.
² Department of Radiology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA.
³ Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.
⁴ Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵ Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁶ Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁷ Department of Social and Behavioral Sciences, College of Public Health at Temple University, Philadelphia, PA, USA.
⁸ The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁹ Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁰ Division of Endocrinology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹¹ Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹² Division of Epidemiology and Community Health, School of Public Health at University of Minnesota, Minneapolis, MN, USA.
¹³ Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁴ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

PMID: 38763974
DOI: 10.1038/s41575-024-00932-1

Abstract

The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable.

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Comment in

Breaking the silence: normalizing receptive anal intercourse for patients, for people and for myself.
Dickstein DR. Dickstein DR. Nat Rev Urol. 2024 Jun;21(6):317-318. doi: 10.1038/s41585-024-00892-w. Nat Rev Urol. 2024. PMID: 38719913 No abstract available.

References

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Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

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Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

Authors

Affiliations

Abstract

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References

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Medical