Sixty percent of MSM surveyed in South Africa reported ever experiencing some form of rectal trauma (hemorrhoids, fissure, or bleeding Lane, Shade, McIntyre, & Morin, 2008). For example, among MSM surveyed in Senegal, 42% reported ever experiencing bleeding and discharge from the anus and 22% reported ever having sores or pimples around the anus ( Niang et al., 2003). A more recent study of MSM in Belgium found that 59% reported some degree of pain during and after RAI ( Vansintejan, Devroey, & Vandevoorde, 2012).Īmong African MSM, pain related to RAI has not been assessed per se the focus instead has been on related outcomes that are considered indicators of HIV and STI transmission risk. In later studies with demographically similar samples, 24% of participants reported always or nearly always experiencing pain during anal intercourse ( Rosser, Short, Thurmes, & Coleman, 1998), and 14% reported frequent and severe pain during RAI ( Damon & Rosser, 2005). In a sample of primarily white, gay-identified men in the U.S., 61% reported ever experiencing painful RAI and 16% indicated that this was a current problem ( Rosser et al., 1997).
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While many men who engage in RAI are able to do so without any pain, a significant portion report at least some experience with painful RAI ( Rosser, Metz, Bockting, & Buroker, 1997). Pain during RAI may be either situational (i.e., related to circumstances such as lack of sufficient foreplay or lubricant) or chronic ( Damon & Rosser, 2005). Other causes of pain during anal penetration may be sexually transmitted infections (STIs) such as herpes, or other anal health issues such as fissures and hemorrhoids ( Hollows, 2007).Įxperiences of pain during RAI are not uncommon and vary on different dimensions (e.g., frequency, severity).
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Learning how to safely and comfortably engage in anal sex may be especially challenging for MSM, whose needs within the context of sexual practices are rarely addressed in school-based sex education curricula or by parents ( Kubicek, Beyer, Weiss, Iverson, & Kipke, 2010). Pain however may be a normal part of one’s early experiences with RAI. Pain can occur during anal penetration when the external anal sphincter is not relaxed because the anus does not self-lubricate, lubricating substances are also needed to reduce pain from friction ( Hollows, 2007). This study presents findings from qualitative research with Black MSM in South Africa their experiences of and attributions for painful receptive anal intercourse (RAI) are discussed, as are their responses to RAI in terms of HIV risk and protective behaviors. Despite some empirical studies of painful sex experiences in samples of men who have sex with men (MSM) in North America and Europe, and some attention within HIV research among MSM in Africa, our understanding of pain during anal intercourse remains limited, particularly in relation to HIV risk and protective behaviors among MSM. Sexual pain has been studied mainly in the context of heterosexual vaginal sex, and as a consequence, there has been limited study of painful anal intercourse in either women or men ( Sandfort & de Keizer, 2001 Štulhofer & Ajduković, 2011). Culturally-specific sexual health education, supportive sexual health services, and improved access to condom-compatible lubricants are important components of HIV/STI interventions for this population. Black South African MSM can be supported to reduce pain during RAI in ways that reduce their HIV/STI risk.
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The main strategies participants used to address pain during RAI were setting sexual boundaries and lubricant use a small number of participants reported purposefully consuming alcohol to prevent the pain associated with RAI. The participants attributed pain during RAI to partner characteristics, interpersonal dynamics, lack of lubricant, and alcohol use or non-use. Analysis of the interview transcripts revealed that pain was a common feature of first RAI experiences but was not limited to first-time experiences.
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Pain during RAI was brought up by many participants without specific prompting from the interviewer. The semi-structured interviews addressed sexual behavior and identity, alcohol use, and safer sex.
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In-depth interviews were conducted with 81 Black MSM (ages 20–39 years) who were purposively recruited from four townships. The purpose of this study was to identify attributions for and responses to painful RAI among Black MSM in South African townships. Little is known about painful receptive anal intercourse (RAI) and its relationship to HIV risk and protective behaviors among men who have sex with men (MSM).