Richard T. Nolan, Ph.D.
(and several colleagues and friends who contributed suggestions and information)
2011 Version
Please send corrections, suggestions, and sources to
[Designed for faculty guidance counselors, this informal report was researched and written at the request of a private secondary school administrator - because of a rise of anal sex among heterosexual students.]

A look ahead: This essay will suggest that at the present time there appears to be no medically based, absolute prohibition of anal sex, but cautionary statements provide significant factors for consideration. 



            1.  “Sexual Ethics”
2.  Sexual Morality and the Law
            3.  Between Consenting Adults
4.  Contemporary Ethical Principles
5.  Harm? Significant Harm?
6.  Harm and Medical Costs
7.  Health As A Moral Obligation
8.  Personal Aesthetics
9.  Religious Considerations 

            1.  Anal Stimulation 

            1.  A Lack of Medical Information
2.  Cautions Regarding Heterosexual and Homosexual Anal Sex
3.  Additional Cautions 






APPENDIX  [additional references]  


1. “Sexual Ethics.”  The terms “sexual ethics” or “sexual morality” can be off putting. They may connote systems of intrusive rules, religious chauvinism, cultural bias, mindless customs, sexual fascism, and the like. This writer is using “sexual ethics” and “sexual morality” in a non-technical way to refer to rightness or wrongness in human sexual behavior.1  To raise the subject another way, one might ask whether there is sexual wrongdoing. Clearly, rape is one example of immoral and illegal sexual behavior.2 Might there be more?  

            The entry “Sexual Ethics” in the Encyclopedia of Bioethics (1995 CD version) observes:
“Contemporary efforts in sexual ethics recognize multiple meanings for human sexuality—pleasure, reproduction, communication, love, conflict, social stability, and so on. Most of those who labor at sexual ethics recognize the need to guide sexual behavior in ways that preserve its potential for good and restrict its potential for evil. Safety, nonviolence, equality, autonomy, mutuality, and truthfulness are generally acknowledged as required for minimal human justice in sexual relationships. Many think that care, responsibility, commitment, love, and fidelity are also required, or at least included as goals. …  …sexual ethics asks, How is it appropriate—helpful and not harmful, creative and not destructive—to live and to relate to one another as sexual beings?” 

2. Sexual Morality and the Law. Other than for sexual victimization (including rape), it seems unnecessary to codify general issues of sexual morality into law. Personal moral choices are just that and in many (most?) cases are not appropriate matters for law enforcement. The state does not have a vital interest in all ethical dimensions of personal life.3 (The June 2003 ruling by the U.S. Supreme Court emphasized the legitimacy of sexual privacy.)  

            If the United States were to enact and reinforce consistently all laws of perceived or proven self-inflicted, harmful behaviors, the resulting laws would launch an intolerable “big brother” police state.  Such laws could absolutely and everywhere prohibit “risky” food consumption and whatever else is understood to be harmful to the mind, or the body, or the common good. Nonetheless, this is not to exclude from the legal realm laws regarding particular forms of incest, pedophilia, ephebophilia, bestiality, etc.4 Moreover, legal actions based on harassment, sexual fraud (e.g., persons with communicable diseases who fail to inform - in advance - their sexual partners about their health status) and sexual-deceit (lying to a sexual partner about one’s sexually transmitted disease status) have successfully found their way into courts.5 A contemporary task is to purge from the law all matters of truly private conscience and behavior as well as to regulate sexual and other behaviors with newfound prudence.     

3. Between Consenting Adults.  Is “between consenting adults” a sufficient ethical standard? One survey of human sexuality notes, “…… if the sexual behavior is not harmful to the participants, if it is carried out by consenting adults who are willing to assume all responsibility for their acts, if it is without any sort of coercion, and if it is out of sight and sound of unwilling observers, the behavior should be considered acceptable, whether or not others would care to participate in similar acts.” 6 The authors propose that qualifiers (such as “not harmful to the participants,” “assume all responsibility,” and “out of sight and sound of unwilling observers”) are needed. (See 5. “Harm and Medical Costs” and 6. “Health as a Moral Obligation” below in this section.) 

            An attorney suggests this revision: “…… if the sexual behavior is not harmful to the participants or (directly or indirectly) to others, if it is carried out by consenting adults who are willing to assume all responsibility for the reasonably foreseeable consequences to themselves and to others of their acts, if it is without any sort of coercion, and if it is out of sight and sound of unwilling observers, the behavior should be considered acceptable, whether or not others would care to participate in similar acts.” 

            When the consequences of an act “between consenting adults” affect others, it is no longer just “between consenting adults.” It involves others, however unintended this result may be. An absolutist split between 'private' and public is untenable. No private act is immune from public scrutiny and moral evaluation if it has direct public consequences. Morality may be regarded as absolutely private only when it undeniably has no effect on others. (See sections 5 “Harm and Medical Costs” and 6 “Health As A Moral Obligation” below.) 

4. Contemporary Ethical Principles.7  Several ethical principles have been widely adopted; they are relevant to “between consenting adults,” because the principles offer practical guidance for discussions of specific moral issues. These broadly stated principles are justified on the grounds that their opposites are repugnant to the cross section of people wrestling with moral dilemmas. At the very least, they function as highly valued guidelines, a framework for most moral explorations. In all instances, their meanings must be interpreted and applied, and more than one resolution may result from their use.  Although their respective bearings on sexual ethics might not be apparent, the customary principles are listed here. 

            Respect for Persons. Human beings should be treated as subjects, not objects; human life is of significant value. Individuals should never be treated as “things” whether in business, medical care, sexual relations, political and economic systems, etc. Degrees of respect may be justified; for example, one is not called upon to submit to an unjust aggressor, also a person.  In sexual ethics, individuals should not be used as things/objects.
           Autonomy. Human beings deserve personal liberty in order to make informed judgments and decisions about their lives. However, degrees of autonomy must be applied to prisoners, military personnel, the mentally ill, children, property owners, employees, etc. In sexual ethics, informed consent to sexual activities should be unambiguous.
            Beneficence. Do good; promote goodness. Criteria of “good” need elaboration.
            Nonmaleficence. Do no harm; prevent harm. Criteria of “harm” need elaboration. “Harm” in sexual ethics, is discussed in the next section (5). 
            Justice. Human beings ought to be provided with what is fair and deserved; goodness should be distributed in fair and equitable ways. Interpretations consider whether the distribution is according to need, merit, or equally. (See the essay’s second paragraph beginning with “The entry sexual ethics …” regarding justice.) 
            Honesty. Telling the truth is the norm; it is essential to promote and maintain respect for persons and for autonomy. However, some would propose a “moral lie” in some circumstances; criteria for such a lie might include protecting someone from likely harm. In sexual ethics a clear violation of this principle occurs when an individual with a communicable illness deliberately fails to disclose the condition to a potential sexual partner; such dishonesty violates the potential partner’s autonomy and is an indication of a serious lack of respect for the potential partner as a person. Such deceptions are immoral.  
            Other Principles. “Informed consent” is the understanding of, and consent to, a procedure or activity in which an individual is to participate. “Confidentiality” is the restriction of information based on the right to privacy. “Double effect” means that the intended good result requires a secondary harmful or bad effect. “Paternalism” involves the interference with an individual's liberty of action.
            Conflicting Principles. Solutions to conflicts among principles relevant in an actual situation are shaped by appealing to the most highly valued principle(s). Disagreements about which is/are the most highly valued may lead to an impasse and, perhaps, an agreement to differ. 

5. Harm? Significant Harm?  A qualifier for “between consenting adults” is, as noted above, “if the sexual behavior is not harmful to the participants.”8 With reference to the “between consenting adults” standard, the issue remains as to whether there should be any moral limitation(s) on sexual conduct between consenting adults. The view from the book quoted above (see endnote 6) implies that any voluntary sexual activity which knowingly results in harm to the body is immoral. 

            Having stated this, we encounter the dilemma of not always being certain about what constitutes physical or mental “harm.” Are there degrees of harm that are morally acceptable? Are there particular activities (such as specific sports, occupations and sexual activities) wherein some degree of harm is likely? What are the criteria for morally acceptable harm? What constitutes “significant harm” that might indicate ethically unacceptable behavior? Are such criteria universal among medical professionals and specialists in ethics and in the law? 

            A leading ethicist has written, “Harm is damage to a person’s interest, for example, in physical integrity, psychological integrity, or reputation. It can be distinguished from ‘hurt’ (a person may be hurt without being harmed). … A related term, ‘injury,’ often refers to specific bodily damage, such as a broken leg, but it has also meant a wrong, an injustice, or a violation of rights…”9 In a related article, he indicates that “… ‘Nonmaleficence’ means not harming or injuring others, and the principle of nonmaleficence establishes the duty not to harm or injure others, or impose the risks of harm on them, at least not without compelling justifications for doing so. This duty is the bedrock of social morality ….. And it is one component of love.”10  

            Another ethics scholar has stated that harm is “bodily injury, or injury to a person’s basic, legitimate interests. Harm is a difficult concept to establish. In its least controversial sense it involves physical injury. Someone who is assaulted, for instance, has suffered harm. In its morally relevant sense, harm carries with it some connotation of seriousness or permanence. … More controversially, harm includes emotional harm, psychological harm, and harm to reputation. These sorts of harm can be more difficult to establish.”11  

            An entry (slightly abbreviated here) in a legal resource provides this information:
harm, n. Injury, loss, or detriment.
            bodily harm.  Physical pain, illness, or impairment of the body.
            grievous bodily harm. Criminal and tort law. Serious impairment of the human body. Typically,
             the fact-finder must decide in any given case whether the injury meets this general standard. –
             Also termed great bodily injury.
            physical harm. Any physical impairment of land, chattels, or the human body.
            social harm
. An adverse effect on any social interest that is protected by the criminal law.12

            Some specific examples of serious or significant harm suggested here and there include: permanent loss, or temporary severe loss, of bodily function; cancer; dermatological disease; communicable disease; musculoskeletal disease; illness caused by exposure to infected material; and, any harm that causes the person harmed to be hospitalized for a period of 48 hours or more commencing within 7 days of the harm’s occurrence.     

            In evaluating an instance of harm, reference to the kind, degree, and duration will be involved along with the probability of its occurrence. Yet, there is a notable tension between harm's undisputed importance in ethics and the numerous contrasting ways in which it is perceived. It appears to this writer that there is no method by which such criteria can be established with universal agreement within matters of health and beyond. Diverse, knowledgeable opinions are inevitable.13 When made a legal issue, the judgment call will be provided by a Court.  

            Therefore, the language of the assumption that “any voluntary sexual activity which knowingly results in significant harm to the body is immoral” is clearly debatable. Advocates of painful activities that draw blood, temporarily or permanently wound tissue(s), or the like might well claim that if sexual pleasure is derived by consenting adults,14  the behavior is morally acceptable. Alternatively, those who regard the physical well-being of an individual’s body as a personal responsibility might maintain that some or all of such activities are morally wrongful. 

6. Harm and Medical Costs.  One might factor into this discussion the possibility of medical costs if consenting adults engage in harmful activities that result in medical expenditures, however small. Such costs will be passed on to others, for example, via an insurance pool or a public or charitable clinic. The patient is not independent and isolated when, as a consequence of personal behavior, others are affected financially or in any other way(s).  

7. Health As A Moral Obligation.  Several years ago this writer, with his coauthor, proposed that one’s health is a moral obligation.15  A digest of those comments follow in the next three paragraphs: 

            The people of our nation are more health conscious today than ever before. They are more aware than their ancestors of nutritional needs, physical fitness, mental health issues, and medical developments and care.16 We suspect, however, that the public views “a sound mind in a sound body” as a morally neutral option; the thought of health as a moral obligation will strike many persons as odd, perhaps an exaggeration of “health fanatics.” One might ask, “Isn't my body my own to do with as I please?”

         We propose that one's health is, to a significant degree, a matter of choice and that health is a matter of moral obligation, not individualistic license or neutrality. Choices that cause illness deny the individual his/her wholeness and - in a ripple effect - the community its fullness (including one’s family and employer); for such choices individuals are responsible and accountable. Good health, to the extent medically possible for each individual, is a moral obligation for insurance reasons, too. The onset of illnesses caused by negligence creates unnecessary expenses for insured people as well as for the unwell individual; insurance rates are raised as medical costs increase. 

         We recognize fully, however, that our proposals will have little or no significance or moral weight to those persons who make contrary assump­tions, such as “My body is my own to do with as I please.” Perhaps people holding this view have not considered their various direct and indirect involvements with others as relevant.   

8. Personal Aesthetics.  Personal aesthetics are not at issue here. That an individual finds a particular sexual behavior repulsive is not an adequate reason to condemn the behavior, especially if physical damage is not a factor. Our concern in this exploration is whether the body is harmed in a particular activity and may be reasonably categorized as morally wrong.  

9. Religious Considerations.  Purely religious convictions are generally unhelpful and not persuasive in any effort to determine the degree of harmfulness of an activity to the body. Instead, the matter is one of biology, not theology.17 Furthermore, many religious traditions insist that procreation is an indispensable purpose of all sexual acts (unless “natural” factors, such as post-menopausal maturity, prevent conception); within this procreative view sexual activities that cannot lead to conception are ipso facto illicit.    


            The focus of this essay is heterosexual and homosexual anal sex, particularly the penetration of the anus by the penis, fist, or “sex toys” (dildo, vibrator, etc.).  Although this has been a topic for derisive remarks and remains an unmentionable subject in many quarters, a discussion is timely; medical research, which goes well beyond this cursory exploration, is much needed. Anecdotal accounts are inadequate. As the remainder of this essay will suggest, at the present time there appears to be no medically based, absolute prohibition of anal sex, but cautionary statements provide significant factors to consider.  

Anal Stimulation (quoted from a college textbook)18 

            “Like oral-genital stimulation, anal stimulation may be thought by some to be a homosex­ual act. However, penile penetration of the anus is practiced regularly by about 10% of het­erosexual couples (Voeller, 1991), and an estimated 25% of adults have experienced anal intercourse at least once (Seidman & Rieder, 1994). The anus has dense supplies of nerve endings that can respond erotically. Some women report orgasmic response from anal intercourse (Masters & Johnson, 1970), and heterosexual and homosexual men often expe­rience orgasm from stimulation during penetration. 

            “Individuals or couples may also use anal stimulation for arousal and variety during other sexual activities. Manually stroking the outside of the anal opening or inserting one or more fingers into the anus can be very pleasurable for some people during masturba­tion or partner sex. 

            “Some important health risks are associated with anal intercourse. Anal intercourse is one of the riskiest of all sexual behaviors associated with transmission of the HIV virus, particularly for the receptive partner. For women, the risk of contracting this virus through unprotected anal intercourse is greater than the risk of contraction through unprotected vaginal intercourse (Silverman & Gross, 1997). Heterosexual and gay male couples who wish to reduce their risk of transmitting or contracting this deadly virus should refrain from anal intercourse or use a condom and practice withdrawal prior to ejaculation. Pre­cautions against transmission of the HIV virus are discussed more fully in Chapter 17. 

            “Because the anus contains delicate tissues, special care needs to be taken in anal stim­ulation. A nonirritating lubricant and gentle penetration are necessary to avoid discomfort or injury. It is helpful to use lubrication on both the anus and the penis or object being inserted. The partner receiving anal insertion can bear down (as for a bowel movement) to relax the sphincter. The partner inserting needs to go slowly and gently, keeping the penis or object tilted to follow the direction of the colon (Morin, 1981). 

            “Heterosexual couples should never have vaginal intercourse directly following anal intercourse, because bacteria that are present in the anus often cause vaginal infections. To prevent vaginal infections from this source, a couple should have vaginal intercourse before anal intercourse, or they should use a condom during anal intercourse and wash the man's genitals thoroughly with soap and water before moving on to penile-vaginal or penile-oral contact. Oral stimulation of the anus, known as anilingus (or, in slang, rimming), is very risky; various intestinal infections, hepatitis, and sexually transmitted diseases can be con­tracted or spread through oral-anal contact even with precautions of thorough washing and use of a dental dam.”  


A Lack of Medical Information.  A 2003 letter from a federal public health professional (an M.D. with a Master of Public Health degree) noted: “I am not aware of any scientific information on this subject. I would speculate that it will be difficult to find any scientific information on this subject.” Consistent with this information is a 2001 note from the America Medical Association: “We are not aware of any systematic safety assessments re: the practice of anal sex. A search of the National Guideline Clearinghouse ( revealed a few guidelines noting that anal sex is a risk factor for sexually transmitted diseases, and possibly urinary tract infections in women.  No specialty societies have developed a position paper on the subject.” 

            The following observation is available in an article regarding children (7 to 11 years): “Long called ‘latency,’ these years for most children are not devoid of sexual desire and experience. Masturbation may be the most common sexual activity, but the highest rate of sex play among children occurs between the ages of six and ten years; boys often masturbate in groups. Children often shift from generalized sex play to deliberate pursuit of erotic arousal by the age of eight or nine. An increasing percentage of children under thirteen have had coitus, some of them homosexual anal intercourse, or oral-genital sexual experiences.”19 Furthermore, a secondary educator mentioned to this writer that some teenage heterosexual students are using anal sex naďvely, readily and without precautionary, hygienic measures as a contraceptive process and as an alternative sexual pleasure. The public, indeed many homosexual boys and men themselves, are under the false impression that anal intercourse is expected of and engaged in by all gay males. As a former college ethics professor, this writer has been astounded at the lack of available information; stereotypes abound, and attitudes toward gay males are often based on the false impression that anal sex is an essential, ubiquitous, destructive practice in the homosexual male’s life.20 Solid information about the possible health consequences of anal sex is needed so that informed choices can be made. That pre-teens may need this information seems outrageous, though apparently true!  Clearly, medical research and education should be on professional agendas.    

Cautions Regarding Heterosexual and Homosexual Anal Sex.  The following abstract of a 1991 AIDS-related research project notes not only the lack of discussion of anal intercourse, but also the misconception that anal sex is an exclusively homosexual male practice.21

TITLE: AIDS and heterosexual anal intercourse.
      AUTHORS: Voeller B
      AUTHOR AFFILIATION: The Mariposa Foundation, Topanga, California 90290.
      SOURCE: Arch Sex Behav 1991 Jun; 20(3):233-76.
      CITATION IDS: PMID: 2059146 UI: 91282656
      ABSTRACT: Heterosexual anal intercourse is rarely discussed in the scientific literature. Review of the literature suggests the silence is linked to ethnocentric discomfort about it among researchers and health care providers, coupled with the misconception that anal sex is a homosexual male practice, not heterosexual. Review of surveys of sexual practices suggest that heterosexual anal intercourse is far more common than generally realized, more than 10% of American women and their male consorts engaging in the act with some regularity. Sexually transmitted disease (STD) data, especially where only the rectum is infected with gonorrhea or other STD agents, buttresses survey data. Considerably more heterosexuals engage in the act than do homosexual and bisexual men, not all of whom participate in anal coitus. Anal intercourse carries an AIDS risk for women greater than that for vaginal coitus, just as receptive anal intercourse carries a very high risk for males. Infection with the AIDS virus is increasingly documented in women engaging in anal coitus with infected males, in America, Europe, and Latin America. Women in Western countries are less likely to continue HIV infectivity chains than are males engaging in same-gender anal intercourse.
[Archives of sexual behavior: official publication of the International Academy of Sex Research] 

            The lack of available medical information, other than disease-related, about anal sex is reflected by searching “anal sex” on the Google internet service; a variety of listings emerge: pornography websites, diseases that are transmitted via anal sex, religious condemnations, and “how to” sites sometimes with an evangelical tone!  

Additional Cautions.  However, one book on human sexuality notes:
“In addition to the transmission of venereal disease, recep­tive anal intercourse can irritate the rectal area and sensitive anal membranes, leading to pain, discomfort, fissures, tears, and fecal bacterial infections.
…. Disease transmission by anal sex can be reduced by the use of a condom. Irritation may be minimized by use of a lubricant. The rectal canal, however, is much thinner walled and more eas­ily ruptured than the healthy vagina (which has such versatile musculature that it can contract, or dilate enough to permit the passage of a baby's head).”22  

            Via e-mail a physician specializing in proctology offered the following comment.23
From: Dr. Rick Shacket
To: Richard T. Nolan
Subject: Reply: Anal Intercourse
Date: Wed., 28 March 2001 

“Anal intercourse is potentially physically harmful. It can cause anal fissures (cracks), thereby allowing the quick transfer of blood born diseases such as HIV. There are also other consequences of fissures. I believe that there has been some research that suggests that the rectal wall does not provide much of a barrier to the AIDS virus, and that the recipient of anal intercourse is quite vulnerable to contracting the disease if the penetrator has the disease and ejaculates.


“Feces contains bacteria which can cause a urinary tract infection (urethritis) in men who do not wear condoms. Women can also get urinary tract infections or vaginal infections if the feces laden phallus comes into contact with the female genitalia. Furthermore, the bedding may also become contaminated with this same bacteria if care is not taken to clean up immediately after anal intercourse.


“The anal area is rich with nerve endings. Many people find this to be a pleasurable sexual activity. The difficulty is that the tissue wasn't designed for this sort of use. You may be interested to know there have been reports of ‘fist fucking’ being performed on stage in New York between consenting homosexual participants. The receiving participant reportedly takes a muscle relaxant to allow this violent form of penetration. This is an extreme form of sodomy, which combines violence with sexuality. As you might imagine, the effect on the tissue will have something to do with the level of aggressiveness of the penetrator. Also, different people have different levels of susceptibility to anal problems such as fissures.


“So, I don't think that I can settle whether this is harmful to the body. It would depend upon the care of the participants to ensure that injury was minimized, the susceptibility of the recipient to anal problems, and the disease status of the participants - particularly the disease status of the penetrator. I personally don't think it is a good idea. But that is just an opinion.


“A friend who is an expert on sexual violence said that most rapes involve anal penetration. Since rape is not about sexual pleasure and more about anger and domination, this might give your students some pause regarding the merits of sodomy.  

“Rick A. Shacket, DO
American Osteopathic Board of Proctology”24 

            In the 1970s this writer inquired of the Kinsey Institute about anal sex for his teaching purposes. Although the response was lost or discarded upon retirement, he recalls a cautionary remark regarding regular anal intercourse resulting in the possible weakening or stretching of the sphincter muscle; diminished bowel control and degrees of incontinence might result over a period of time. 

            In addition,  in a recent college textbook’s section on “Behavioral Risk Factors” anal sex with or without a condom is listed as a risky behavior when performed with an infected person.25  This warning is repeated elsewhere: “Avoid anal intercourse, because this is one of the riskiest of all sexual behaviors associated with HIV transmission.”26 “Various surveys have indicated that condom slippage and breakage may be considerably higher during anal intercourse than during vaginal intercourse. Furthermore, condoms manufactured in the United States are generally labeled for vaginal intercourse only, a manufacturer’s caveat that reflects that concerns that condoms designed for use during vaginal intercourse may fail at unacceptably high rates when used during anal intercourse.”27 ,  28 


            Anal sex is a possible activity for heterosexual as well as homosexual individuals. It is not fundamental either to heterosexual or to homosexual orientations. At an uninformed level many individuals - as well as entire past and present cultures29- assume that all homosexual males engage in anal intercourse, and this is not true. Whether the number is a majority or minority is irrelevant. The male who has a homosexual (or bisexual) self-understanding is not “required” to engage in any particular sexual activities. An individual does not select his/her sexual orientation, but specific sexual activities are a matter of personal choice. Furthermore, virtually all sexual behaviors are available to same-sex participants and opposite sex participants, except for penile-vaginal coitus, which for obvious reasons requires a male and female couple. 

            As noted in a book quoted above, “Although anal intercourse is often thought to be the most prevalent sexual behavior between homosexual men, research has shown that fellatio is in fact the most common mode of expression (Lever, 1994). Mutual masturbation is the next most common, and anal intercourse is least common.”30 (This statement may be disputable.)     

            A recent television production “Queer As Folk” [Showtime Cable] seems to make anal sex essential to one’s self-acceptance (and approval by gay subcultures) as a genuinely gay male; furthermore, anal sex is represented as routinely expected by all sexual partners. In its heterosexual equivalent “Sex and the City” [HBO Cable] anal sex is portrayed as appealing to some, but not as a “requirement” for heterosexual people. In one episode of “Queer As Folk” a teenager was having his first homosexual experience as anal penetration when he complained “But it hurts!” His somewhat older mentor declared (something like), “It’s supposed to; you’ll get used to it.” One understanding of the remark is that pain or discomfort will usually be involved in anal intercourse; this is a factor which he must get used to and presumably enjoy.31  That he might prefer other acts to the exclusion of anal intercourse was not scripted.  Sexual fascism is found among some homosexual individuals and groups, too, when this and some other issues of sexual ethics are raised; irrationality is not unique to religiously based convictions about sex.
            One wonders whether some gay men, put off by the prospects of “required” anal sex, marry or partner with the opposite sex as a deterrent to their same-sex feelings. Such relationships are likely to be counterfeit, unless the male is sufficiently bi-sexual to derive adequate satisfaction with their spouses/partners.  Also, one wonders how many gay males uncomfortably endure anal sex, in order to experience sexual warmth.
            In his Sexual Ecology: Aids and the Destiny of Gay Men (1998 edition) - and brief, email correspondence with this writer - Gabriel Rotello noted that historically it was during the post-1950/60s sexual revolution that anal sex, "an acquired taste," increased among the American gay, male population. He refers (p. 75) to an observation that if a gay man didn't participate, he was "thought odd" by other gay males. Apart from the issue of diseases and their transmission, however, other medical hazards are rarely considered openly right through the early years of the 21st century - unless an off-putting sermon is attached.
            It is this writer's hunch that until some prominent family's teenage daughter is seriously injured by heterosexual anal sex, the medical profession will continue to avoid the topic in the public arena.


            With regard to “sex toys” and their use in anal sex, a medical resource notes:
“Some couples will prefer to use some form of sex aid for insertion into the anus or individuals may use them for solitary sexual stimulation. The same principles apply as for genital insertion in that anal relaxation is more important than pushing. Sex aids must be kept clean and cleaned between use by each partner. Condoms may be placed over sex aids as an additional precaution.

“One additional risk from the use of sex aids in anal sex is that of losing the aid into the rectum. Most medical school pathology museums have a wide selection of novel foreign bodies recovered from the rectums of both men and women, ranging from vibrators to milk bottles. Human ingenuity seems to know no bounds in this area, but it is incredibly foolish to insert potentially breakable objects into the anus and terrible injuries may result. If you do lose a sex aid into the rectum you should attend the Accident and Emergency department of your local hospital as soon as possible, however embarrassing it may be. The situation will only get worse if it is neglected and the object may break or become more difficult to recover.”2


            Anal sex is a voluntary heterosexual and homosexual option, not an obligation. “Voluntary” implies consent wherein a person understands the risks of harm and decides to accept those risks.  

            As a debatable moral matter, one view assumes that any voluntary sexual activity which results in significant damage to the body is morally wrongful; for those individuals who believe (or perhaps know from experience) that anal sex may result in injury to their own bodies and/or that of their sexual partner, anal sex is morally wrongful. (Any form of rape is immoral on the part of the rapist, unless a psychiatric examination shows clearly that the rapist could do no other, that his/her actions were beyond his/her control; in such rare cases, “mentally ill” rather than “immoral” would fit.) 

            Another view assumes that for those individuals confident that engaging in anal sex does NOT result in significant harm to their bodies and/or that of their sexual partner, anal sex is a morally acceptable option. Individuals who are unsure of the consequences of anal sexual behaviors for themselves and their sexual partners should make their decisions after considering available medical information. 

            Whether this issue is an area of strictly private morality or whether it has a public effect will continue to be debated. If found to be of sufficient public effect, should some sort of law be established? (Please see the section “Preliminary Considerations” - 2.  Sexual Morality and the Law.) Would such a law be consistent with other areas of private morality that have a possible public effect, yet are not perceived as legal issues?   

            In any case, given the uncertainties and possible risks for some individuals, the need for realistic public education in these topics is urgent, so that informed decisions may be made!34  


--  Sexual ethics is concerned with moral rightness or wrongness in human sexual behavior.
--  It is unnecessary to codify into law general issues of sexual ethics. This is not to exclude all sexually related laws/issues. 
--  “Between Consenting Adults” as a standard generally includes qualifiers.
--  Widely accepted, contemporary ethical principles are relevant to sexual ethics.
--  Judgments as to what constitutes “harm” or “significant harm” are open to deliberation.
--  An individual is not independent and isolated when, as a consequence of personal behavior, others are affected financially or in any other way(s).    --  One’s health may be viewed as a moral obligation.
--  Personal aesthetics and religious considerations are generally unhelpful to the discussion of this topic.
--  Scientific research about anal sex should be undertaken.                    
--  Anal sex might result in the transmission of diseases and bodily harm; the effects of harm might involve direct or indirect medical costs to others.
--  Anal sex is not a necessary component of homosexual or heterosexual relationships.
--  Evidence shows that anal sex is practiced by some homosexual and some heterosexual persons.
--  “Sex toys” might result in injury.
--  As a debatable moral matter, one view assumes that any voluntary sexual activity which results in significant damage to the body is morally wrongful; for those individuals who believe (or perhaps know from experience) that anal sex may result in injury to their own bodies and/or that of their sexual partner, anal sex is morally wrongful.
(Any form of rape is immoral on the part of the rapist, unless a psychiatric examination shows clearly that the rapist could do no other, that his/her actions were beyond his/her control; in such rare cases, “mentally ill” rather than “immoral” would fit.)
--  Another view assumes that for those individuals confident that engaging in anal sex does NOT result in  significant harm to their bodies and/or that of their sexual partner, anal sex is a morally acceptable option. Individuals who are unsure of the consequences of anal sexual behaviors for themselves and their sexual partners should make their decisions after considering available medical information.
-- Available medical information should be consulted so that individuals can make informed decisions about their participation in anal sexual activities.
--  The need for realistic public education in the primary issues of this essay is urgent, so that informed decisions may be made! 


            This exploratory essay is much more of a first word than a final statement. It is neither gay-bashing nor straight-bashing. Readers are encouraged to consider its contents as in need of ongoing revision. This writer’s hope is that research and further discussion will ensue. Personal decisions are best made when one is informed; our probings are but “grist for the mill” and admittedly with many loose ends.


1) “One is tempted to think: So what? What goes on behind closed doors is nobody's business. This is fatally wrong. Aside from the fact that it's inhumane to remain indifferent while people blithely kill themselves, there is the not-insignificant matter of the enormous cost to the taxpayer and the health-care system. And, much more important, the mutation of HIV into newer and deadlier forms of the virus -- a process aided by sex between HIV-positive men infected by different strains -- has made an AIDS vaccine an even more remote possibility. The unavoidable truth is that male homosexual life has, in some quarters, become a death cult. Yet no one dares to hold gay-male society accountable for the nihilistic, erotomaniacal subculture that sustains the killing and dying. At the beginning of the third decade of the AIDS epidemic, the band, it seems, is still playing on: same song, second sad verse.”35 ,  36

2) TITLE: Anodyspareunia, the unacknowledged sexual dysfunction: a validation study of painful receptive anal intercourse and its psychosexual concomitants in homosexual men.

      AUTHORS: Rosser BR; Short BJ; Thurmes PJ; Coleman E
      AUTHOR AFFILIATION: Department of Family Practice and Community Health,
     Medical School, University of Minnesota, Minneapolis, USA.
      SOURCE: J Sex Marital Ther 1998 Oct-Dec;24(4):281-92.
      CITATION IDS: PMID: 9805288 UI: 99022104
      ABSTRACT: This study examines the frequency and duration of pain in same-sex anal intercourse in a sample of 277 adult men who have engaged in, or attempted to engage in, anal intercourse during their lifetime. Whereas estimates of frequency of pain appeared blocked distributed across a 7-point Likert scale, severity of pain appeared positively skewed, with 12% rating it as too painful to continue. Participants rated inadequate lubrication, psychological factors such as not feeling relaxed, and lack of digitoproctic stimulation prior to penetration as the three most important psychophysiological factors predicting pain. Factors associated with a greater amount of pain experienced in anal intercourse were depth and rate of thrusting, lack of social comfort with gay men, being more "closeted," and less concern over becoming old or unattractive as a gay or bisexual man. Pain was also positively related to anxiety. The use of condoms was not rated highly as a factor in receptive anal pain. Based on these findings, the authors define anodyspareunia to denote painful receptive anal intercourse, and suggest clinical criteria similar to that used for other sexual pain disorders. 

3) Editorial Reviews of A Guide to America’s Sex Laws (related to endnote 26), courtesy of

From Booklist

Compilations of laws on a particular topic are useful to lawyers, of course, but they are also valuable to social analysts, ethicists, individuals wanting to protect their lives from public inquiry, and the merely curious. This particular one is interesting because it focuses on a subject that is important to almost everyone, and it covers sometimes emotional topics objectively. The authors are a judge and a law school professor; their approach is thorough, documented, and thought-provoking.

Seventeen chapters summarize American laws covering rape, age of consent, abuse of position of trust or authority, incest, bestiality, and voyeurism, among others. It is interesting to note that 33 states have no statutes dealing with fornication, while 17 others make it a misdemeanor or a felony. One wonders why incest is a felony in 48 states but only a misdemeanor in Virginia and not even worth a statute in Rhode Island. Prostitution is only a misdemeanor in most states--but those laws require more pages than any other sex-related issues. The strongest language ("unnatural," "lascivious," "crime against nature") is reserved for sodomy laws, but 23 states have no statutes related to it.

Each chapter begins with an introduction and relevant definitions and then summarizes each jurisdiction's statutes, using the original language for flavor. The authors limited the work to state, federal, and District of Columbia statutes (not local ordinances or common law). They focus on statutes that impose criminal penalties for personal (i.e., not entrepreneurial) sexual activity. A glossary defines some terms not readily apparent to a nonlawyer, such as curtesy (the legal right a man aquires in his wife's estate by virtue of marriage) and per os (through the mouth, or oral sex). Citations to landmark decisions are provided, making this a useful tool for anyone who wishes to do further study--to prepare a case, draft a scholarly study, or be certain that what is legal in one state won't be a problem in another! --This text refers to the Hardcover edition.

4) Law and Morality37 

There are, then, a number of differing systematic approaches to the question of which aspects of morality should be enforced legally. In addition to those systematic approaches, various authors and courts have suggested additional considerations that must be weighed in deciding whether legally to enforce moral standards. Among the most prominent of the considerations are the following.

1.  Respect for differing views in a pluralistic society. In the 1973 discussion of abortion statutes in Roe v. Wade, the U.S. Supreme Court suggested that legislation enforcing a moral viewpoint is inappropriate when those who are experts in the relevant area disagree as to the legitimacy of that viewpoint. This principle is in keeping with a wider movement against legislating disputed moral positions. A number of important considerations support this mode of thought. To begin with, people seem to have a right to follow their own conscience rather than to be compelled to follow the conscience of the rest of society. Moreover, there are tremendous detrimental consequences for a society when many of its citizens feel that the law is being used to coerce them into following the moral views of others. Such considerations are even more important in societies where there are substantial moral disagreements among the citizens. One author who has particularly stressed the importance of respecting differing views in a pluralistic society is H. Tristram Engelhardt, Jr. (1986).

2.  Respect for privacy. There are laws that cannot be enforced without infringing the privacy of the citizens involved. Following a long tradition that appealed to this point, the U.S. Supreme Court suggested (in Griswold v. Connecticut, 1965), that such laws are illegitimate because of the inability to enforce them in an acceptable fashion. For that reason, the Court declared unconstitutional a Connecticut law prohibiting the use (and not merely the production) of contraceptive devices. It has also been argued that laws regulating the patient-doctor relation are inappropriate because they can be enforced only by the state's entering into and examining a relation that must be private. Many authors have criticized the U.S. "Baby-Doe" law (P.L. 98-457, 1984), which limits on moral grounds the decision-making authority of parents and physicians with regard to severely disabled newborns, because it involves state intrusion into a private relation.

3.  The consequences of passing such a law. It is sometimes argued that certain moral positions ought not to be enforced legally because the laws that codify them will be violated anyway, and their surreptitious violation will lead to many tragic results. Thus, it has been argued that laws prohibiting abortion only result in women's seeking unsafe, illegal, and very dangerous abortions. Again, it has been argued that laws prohibiting voluntary euthanasia or allowing to die only result in surreptitious acts of voluntary euthanasia and in informal decisions to "let the patient die," acts and decisions that can be abused. Many studies of such abuses (by, e.g., Bedell and Delbanco, 1984; Evans and Brody, 1985) led in the 1980s to more formal policies governing such decisions. 

Considerations 1-3 are reasons why certain actions should not be illegal, whether or not they are immoral. Most authors would agree that these legitimate considerations must be balanced against others that argue for the criminalization of the acts in question. These include the extent of the harmful consequences of the actions in question and the extent to which they involve infringements of the rights of others. 

There are, in addition, considerations for making actions illegal even if they are not immoral. Two deserve special notice:

4.  The difficulty of distinguishing between fraudulent and legitimate cases. Suppose that there are no moral objections to voluntary euthanasia. Some have argued that it would will be wise legally to prohibit such killings because it is difficult to distinguish cases of honest requests from cases of consent obtained by subtle fraud or duress. Again, some have argued that despite the moral permissibility of experimenting upon consenting adults, there should be laws prohibiting experiments conducted upon prison inmates, because one cannot tell when the consent of such inmates is truly voluntary. 

5.  Slippery-slope arguments. It is often argued that legalizing certain morally acceptable actions would later lead to irresistible pressures for legalizing immoral actions, and that the only way to avoid sliding down this slippery slope is to prohibit even the acceptable actions. Thus, it has been argued that voluntary euthanasia should be illegal, even if morally acceptable, as a way of ensuring against the later legalization of involuntary euthanasia. Naturally, both of these factors must be weighed against the possible desirable results of legalizing the morally acceptable actions.

It is clear, then, that there are no easy answers to questions about the relation between law and morality. There are strong considerations favoring legal positivism, but there are other considerations favoring a natural-law doctrine. And even if one is a legal positivist, there are conflicting considerations that one has to weigh in deciding on the appropriate relation between one's moral code and society's legal code. 


Some Urge Type of Pap Test to Find Cancer in Gay Men


Some doctors and researchers at major medical centers have started to recommend that gay men undergo regular anal Pap smears to screen for cell changes that could lead to anal cancer.


Although anal cancer is rare in the general population, the risk for men with a history of anal intercourse can be more than 30 times as great, published studies have shown.


Researchers from the University of California at San Francisco, Stanford, the Harvard School of Public Health and elsewhere have also reported that gay men with H.I.V. are at even more significant risk.


An anal Pap smear, which involves taking a swab of cell tissue from the rectum, is similar to the Pap tests that women receive to screen for precancerous cells in the cervix.


Cervical and anal cancers can be fatal if they are not caught early enough. The cancers — as well as cell abnormalities called dysplasia, which can progress to cancer — are linked to infection with the human papillomavirus, or HPV.


"This is something we really need to be paying attention to," said Dr. Joel Palefsky, a professor of medicine at the University of California at San Francisco.


HPV is a widespread, though often asymptomatic, sexually transmitted disease. More than 20 million Americans are believed to be infected with it.


Gay men themselves often have not heard of anal cancer. David Maxim, 57, a San Francisco artist, knew nothing about it — until his was diagnosed two years ago. "I didn't know about HPV, about anal Pap smears, and when I told gay male friends of mine, they didn't know about it either," he said.



question from Nolan: Are women who engage in anal sex as receivers immune from this health problem?




"Vaccine Approved For Anal Cancer Prevention" (Dec. 22, 2010)



1 See “Sexuality, Philosophy of” in the Concise Routledge Encyclopedia of Philosophy (2000), pp. 823f. Additionally, “sexual ethics” is listed as an area within “Applied Ethics,” The Internet Encyclopedia of Philosophy at Many college and university courses in sexual ethics are offered, including the University of Maryland’s HUMN 442 Contemporary Sexual Ethics “An inquiry into ethical considerations of contemporary sexual behavior. Topics include the changing dynamics between male and female (modes, expectations, and codes); the increase of sexual activity and freedom (premarital, postmarital, and extramarital); laws, such as those concerning abortion, homosexuality, and rape (whether outside or within marriage); the sexual rights of women; and speculations as to ethical dimensions of human sexual activity in the future.”
Rape would be considered as immoral, unless a psychiatric examination shows clearly that the rapist could do no other, that his/her actions were beyond his/her control and decision making capacities; in such rare cases, “mentally ill” (criminally insane) or the like rather than “immoral” would fit.
3 “Conservatives say that they are for individual liberty, and they say they are against governmental interference in the economic sphere. They have consistently defended the free market and entrepreneurial enterprise as the basis of a prosperous society. Many liberals and moderates now agree with this. But the conservatives have little compunction about regulating moral freedom, or enacting laws against pornography, abortion, consenting adult sexual behavior, and euthanasia, and they are willing at times to undermine civil liberties in the process.” – Paul Kurtz , “The ‘Culture Wars’ Intensify,” in
Free Inquiry, Winter 1994 v15 n1 p4(3). See also #4 “Law and Morality” in the Appendix.
For the range of sex laws in effect in the mid-1990s, see Richard A. Posner and Katharine B. Silbaugh, A Guide to America’s Sex Laws (University of Chicago Press, 1996).  Comments on the book are at #3 “Editorial Reviews” in the Appendix.
Our Sexuality, p. 521. 
Stephen P. McCary and James Leslie McCary, Human Sexuality – Third Brief Edition (1984), p. 218. 
Richard T. Nolan and Frank G. Kirkpatrick, Living Issues In Ethics (2000 reprint), p. 2. (accessible via the textbooks subsite of
In the “All Handouts” subsite of an item entitled “Sexual Ethics” outlines a possible lecture or workshop in sexual ethics. Outline number “7 B” raises the question: “Are there sexual acts morally wrong in themselves?” In this regard “7 B i” provides for a discussion of medical factors, which would involve interpretations of “harmful.”
James F. Childress, “Harm” in The Westminster Dictionary of Christian Ethics (1986), pp. 260f.
Childress, “Nonmaleficence” in The Westminster Dictionary of Christian Ethics, p. 425.
Susan Neiburg Terklel and R. Shannon Duval, eds., “Harm” in the Encyclopedia of Ethics (1999).
Bryan A. Garner, ed., Black’s Law Dictionary, 7th ed. (1999), p. 722.
See “Harm” in the Encyclopedia of Bioethics - 1995 CD edition.
The age at which one becomes an adult capable of choosing competently one’s sexual activities is another matter for discussion. Various interpretations range globally from 12 to 18, in the U.S.A. 14 to 18, depending on the genders of the participants. See and
See chapter 8 “Mental and Physical Health” in Living Issues in Ethics.
16 However, the prevalent instances of obesity indicate a paradox within the national consciousness.
17 Some gay orthodox Jews propose that certain biblical prohibitions are focused on anal sex. See, for example, and This is supported by Jerome T. Walsh’s “Leviticus 18:22 and 20:13: Who Is Doing What to Whom?” in the Journal of Biblical Literature (Vol. 120, No. 2; summer 2001) at (pages 201-209); see summary in section III on pages 208-9.
Robert Crooks and Karla Baur, Our Sexuality (8th ed., 2002), p. 252. In the 10th edition (2008, p. 228) the following paragraph introduces the "Anal Stimulation" section:
An estimated 25% of all adults have experienced anal intercourse at least once (Seidman & Reider, 1994), and anal intercourse may be growing more common among young people. A study of 813 women enrolled in a college women's health course found that 32% had engaged in anal intercourse (Flannery et al., 2003). Among gay men, anal stimulation is less common than oral sex and mutual masturbuation (Lever, 1994).
“Sexual Development” in the Encyclopedia of Bioethics - 1995 CD edition [“some of them …” underlined for emphasis]
Bruce Bawer, A Place At The Table (1993), pp. 74 f.

See also C. W. Henderson, “Women Report More Anal Sex than Expected” in Women's Health Weekly, Nov 23, 2000, p23.
N. Blakemore and N. Blakemore, Jr., Series Editors in collaboration with the specialty editors, The Serious Sides of Sex (1991), p. 34.  
See Anal Sexual/Intercourse in the “Proctology Clinic” at for this correspondence.
“Sodomy” has many meanings that may refer to heterosexual and homosexual oral and anal sexual activities.
Dennis Coon, Introduction to Psychology: Exploration and Application, 8th ed. (1998), p. 506.
Our Sexuality, p. 513.
Our Sexuality, p. 519.

28 Also, see

29 In some groups and settings the male receiver is perceived as homosexual, while the male penetrator might be viewed as heterosexual; moreover, such receivers sometimes assume “feminine” mannerisms.

30 Our Sexuality, p. 254. The Lever reference is to J. Lever’s “Sexual Revelations” in The Advocate August 23, 1994, pp. 17-24.

31 See in the Appendix: 2) TITLE: Anodyspareunia and 5) Excerpted From The New York Times Article. 

32 “Anal Sex” in

33 The chapter “Sexual Ethics” in Living Issues in Ethics provides a general orientation to the basic issues in sexual ethics.

34 “By 2001, the omissions in abstinence-only education seem to have left a fair number of teens believing that anal intercourse carried no risk. Such "prevention" of sex prevents real prevention--of disease. Young people die.” – from Judith Levine, “Promoting pleasure: what's the problem?” in SIECUS Report, April-May 2002 v30 i4 p19(4).

35 Rod Dreher, “Beds, Bathhouses and Beyond: ‘The Return of Public Sex’” in The National Review, August 12, 2002 v54 i14pNA

36 For an additional commentary, see Troy Suarez and Jeffrey Miller, “Negotiating Risks in Context: A Perspective on Unprotected Anal Intercourse and Barebacking Among Men Who Have Sex With Men – Where Do We Go From Here?” in Archives of Sexual Behavior, June 2001 v30 i3 p. 287.

37 Excerpted from “Law and Morality” in the Encyclopedia of Bioethics  - 1995 CD edition.



By Dr. John Corvino, columnist,
04.08.2011 8:23am EDT

This column is about anal sex. So if you don’t like reading about such things, stop reading now.

Many years ago I lived next door to a young born-again-Christian rock singer. (He probably would dislike reading about anal sex. Glad you’re still here, though.) While Jason strongly disapproved of my gayness, he was also fascinated by it, and he constantly asked me questions.

One day I revealed to him that I had never had anal sex. His face brightened. “That’s awesome!” he shouted.

“Why, pray tell, is it awesome?” I asked.

“Because maybe you’ll try it, and then realize you don’t like it, and then you won’t be gay.”

For Jason, being gay meant liking anal sex. He found it odd that the equation had never occurred to me.

For me, being gay means that I like GUYS. It means that I LIKE guys—I have crushes on them, I fall in love with them, I want to “get physical” with them. It doesn’t specify how I should do this.

I might not find Jason’s view so troubling if its prevalence were limited to born-again-Christian rock singers, or others with presumably “sheltered” backgrounds. But over the years I’ve met plenty of gay men who insist that anal sex is the only “real” gay sex, and that preference for other kinds betrays prudishness or neurosis or worse.

This insistence is just dumb. Either that, or it’s an obnoxious way of pressuring sexual partners into acts they don’t want. (“But baby, if you liked me, you’d be willing to do the real thing.”) Here’s a familiar conversation from my younger single days:

Interested Guy: “Are you a top or a bottom?”

Me: “No.”

Interested Guy: “What do you mean, ‘No’?”

Me: “I mean I’m neither a top nor a bottom.”

Somewhat Less Interested Guy: “That means you’re a bottom.”

What—so “bottom” is the default setting now? As one friend told me: “If he says he’s a top, he’s versatile. If he says he’s versatile, he’s a bottom. If he says he’s a bottom, he’s honest.”

Let me be clear: I’m not trying to discourage people from trying new things—quite the opposite. And I don’t doubt that some people have hang-ups about anal sex as a result of heterosexist brainwashing.

But surely it’s possible for a gay man simply not to like anal sex—either topping or bottoming—as a matter of personal preference, without thereby being “less gay” as a result.

Indeed, if anything smacks of heterosexist brainwashing, it’s the view that anal sex is the only “real” gay sex. For that view is premised on the idea that in order for sex to be “real,” a man needs to be putting his penis in some orifice below the waist.

On this view, oral sex—or mutual masturbation or frottage (look it up)—become “mere foreplay,” the sort of thing one might do with a teenaged girlfriend or a White House intern without overly threatening anyone’s sense of chastity.

Calling such practices “foreplay” suggests that they have to lead to something else—“real” sex—rather than being satisfactory in themselves for some people. It also implies, oddly, that most (all?) lesbian sex isn’t “real.”

I’ll say it again: this is just dumb.

If you want to make a baby sexually, then it’s important to put a penis into some orifice below the waist—specifically, a vagina.

But if you’re not having sex to make babies, then you should do what’s mutually satisfying to you and your partner (within safe guidelines).

If that’s anal sex, great. If that’s oral sex, great. If it’s dressing in furry costumes and chasing each other around the bedroom, awesome. Knock yourselves out.

Or maybe you just want to kiss and cuddle and “spoon.” That’s fine too.

Just make your preferences clear, be attentive to your partner’s preferences, and be safe.

Opponents of gay equality do more than enough to denigrate our sexual practices. The last thing we need is to impose hierarchies amongst ourselves about which sex acts count as “real.”

John Corvino, Ph.D. is a writer, speaker, and philosophy professor at Wayne State University in Detroit. Read more or watch clips from his talks at


"Anal Sex" - Wikipedia (Feb. 2011).

Anal Sex Safety and Health Concerns from WebMD (2011)

Journal of Sexual Medicine Nov. 2011

New Report: Gay Life Without Anal Intercourse 2012