Anal sex (also called anal intercourse) is the insertion and thrusting of the penis into a person's anus for sexual pleasure. Pegging, anilingus, fingering the anus for sexual pleasure, and use of sex toys to penetrate the anus are also anal sex.
While anal sex is commonly associated with male homosexuality, research shows not all gay males engage in anal sex and that it is not uncommon in heterosexual relationships. Types of anal sex can also be a part of lesbian sexual practices. Many people find anal sex pleasurable, and some may reach orgasm through anal penetration – by indirect stimulation of the prostate in men, indirect clitoral/G-Spot stimulation in women, and associated sensory nerves (especially the pudendal nerve). However, many people find anal sex painful as well, sometimes extremely so, which may be primarily due to psychological factors in some cases.
As with most forms of sexual activity, anal sex participants risk contracting sexually transmitted infections (STIs/STDs); anal sex is considered a high-risk sexual practice because of the vulnerability of the anus and rectum. The anal and rectal tissues are delicate and do not provide natural lubrication, so they can easily tear and permit disease transmission, especially if lubricant is not used. Anal sex without protection of a condom is considered the riskiest form of sexual activity, and therefore authorities such as the World Health Organization (WHO) recommend safe sex practices for anal sex.
Anatomy and stimulation 
The abundance of nerve endings in the anal region and rectum makes anal sex pleasurable for many men and women. "The opening and closing of the anus is controlled by the internal and external sphincter muscles (the most important muscles when engaging in anal sex). The sphincter muscle is a sensitive membrane with many nerve endings and thus the source of pleasure or pain."
In a male receiving partner, being penetrated can produce a pleasurable sensation due to the inserted penis rubbing or brushing against the prostate (also known as the "male G-Spot", "P-Spot" or "A-Spot") through the anal wall. This can result in pleasurable sensations and can lead to an orgasm in some cases. Prostate stimulation can produce a "deeper" orgasm, described by some men as more widespread and intense, longer-lasting, and allowing for greater feelings of ecstasy than orgasm elicited by penile stimulation only. The prostate is located next to the rectum and is the larger, more developed male homologue to the Skene's glands (which are believed to be connected to the female G-Spot).
The majority of women (70–80%) require direct clitoral stimulation to achieve orgasm. The clitoris is composed of more than the externally visible glans (head). With its glans or body as a whole estimated to have around 8,000 sensory nerve endings, more than any other part of the human body, the clitoris surrounds the vagina somewhat like a horseshoe and surrounds the urethra and anus as well; the vagina is flanked on each side by the clitoral crura, the internal "legs" of the clitoris, which are highly sensitive and become engorged with blood when sexually aroused. In addition to nerve endings present within the anus and rectum, women may find anal stimulation pleasurable due to these "legs" extending along the vaginal lips (labia minora) back to the anus. Indirect stimulation of the clitoris through anal penetration may also be caused by the shared sensory nerves; especially the pudendal nerve, which gives off the inferior rectal nerves and divides into two terminal branches: the perineal nerve and the dorsal nerve of the clitoris.
The Gräfenberg spot, or G-Spot, is a debated area of female anatomy, particularly among doctors and researchers, but it is described as being located behind the female pubic bone surrounding the urethra and accessible through the anterior wall of the vagina; it is considered to have tissue and nerves that are related to the clitoris. Besides the shared connections of the aforementioned sensory nerves, orgasm by stimulation of the clitoris or G-Spot through anal penetration is made possible because a thin membrane is all that separates the vaginal cavity from the rectal cavity, allowing for indirect stimulation. Only a small percentage of women are able to orgasm from this type of stimulation alone. Direct stimulation of the clitoris, G-Spot, or both, during anal sex can help some women to enjoy the experience and reach orgasm.
Stimulation from anal sex can also be affected by popular belief or exposure to pornographic depictions of the activity; pornography commonly portrays anal sex as desirable and routine, without use of a personal lubricant or a condom, and painless, which can result in couples performing anal sex without care and, especially women as receptive partners, thinking something is wrong if they do not find anal sex pleasurable and instead experience any form of pain during the activity. In contrast, each person's sphincter muscles react to penetration differently, the anal sphincter in general has delicate tissue that can tear, and the rectal mucous membrane provides insufficient lubrication for sexual penetration. Researchers say adequate lubrication, relaxation, and communication between sexual partners are crucial to avoid pain or damage to the anus. Ensuring that the anal area is clean and the bowel is empty, for both aesthetics and practicality, is also recommended.
Research indicates that anal sex occurs significantly less frequently than other sexual behaviors, but its association with dominance and taboo make it an appealing stimulus to people of all sexual orientations.
Male to female 
The anal sphincter is usually tighter than a vagina, which can enhance the sexual pleasure for the inserting male. Unlike the vagina, the anus does not produce natural lubrication, and requires application of some form of personal lubricant during anal intercourse. Dry anal sex can be painful to both partners, but especially to the receptive female.
The attitudes of women as receptive sex partners are diverse: some consider the practice painful or uncomfortable, while others find it pleasurable and some even prefer it to vaginal intercourse. The vaginal walls contain significantly fewer nerve endings than the clitoris and anus, and intense sexual pleasure and orgasm from vaginal-only penetration is less likely to occur than clitoral-only stimulation in most women. This does not, however, imply that anal-only stimulation is more likely to result in orgasm than vaginal-only stimulation; certain nerves and how they interact with other nerves play a role and "total separation between the vagina and clitoris is mostly artificial, and often based on a misunderstanding of what, where, and how big the clitoris really is," as the clitoris also surrounds the vagina and anus (see above).
In a study of heterosexual anal sex, female participants stated that direct stimulation of multiple erogenous zones simultaneously (the clitoris, the G-Spot, the anus, or other erogenous zones) enabled them to enjoy anal intercourse with much less discomfort compared to anal penetration by itself and to orgasm from it. Women who experienced orgasm during anal sex accompanied by direct stimulation of one or more of the other erogenous zones described it as more of a full-body experience compared to orgasm from direct clitoral stimulation alone.
With regard to risks, the risk of pregnancy is greatly reduced during anal sex; anal intercourse alone cannot lead to pregnancy unless sperm is somehow transported to the vaginal opening. Because of this, some couples practice anal intercourse as a form of contraception, often in the absence of a condom. The risk of injury to the receptive partner due to anal intercourse is many times higher than that due to vaginal sex, and the risk of transmission of HIV is higher for anal sex than for vaginal sex. Additionally, if the man moves from anal sex immediately to vaginal sex without a condom or without changing it, infections can arise in the vagina due to bacteria present within the anus; this also applies to the use of sex toys. Therefore, the risk to the woman is greater than the risk to the man during male-to-female anal intercourse.
Female virginity 
Male-to-female anal sex is often viewed as a way of preserving female virginity because it is non-procreative and does not tear the hymen; a female who receives anal sex or engages in other sexual activity with no history of having engaged in vaginal intercourse is often regarded among heterosexuals and researchers as "technically a virgin". Many heterosexuals view anal sex as "fooling around" or as foreplay; this view "dates to the late 1600s, with explicit 'rules' appearing around the turn of the twentieth century, as in marriage manuals defining petting as 'literally every caress known to married couples but does not include complete sexual intercourse'".
In 1992, a study conducted by the U.S. Centers for Disease Control and Prevention found that only 26% of men 18 to 59 and 20% of women 18 to 59 had engaged in heterosexual anal sex; a similar 2005 survey (also conducted by the U.S. Centers for Disease Control and Prevention) found a rising incidence of anal sex relations in the American heterosexual population. The survey showed that 40% of men and 35% of women between 25 and 44 had engaged in heterosexual anal sex. In terms of overall numbers of survey respondents, seven times as many women as gay men said that they engaged in anal intercourse, with this figure reflecting the larger heterosexual population size. According to a study from the National Survey of Sexual Health and Behavior (NSSHB) that was authored by Dr. Debby Herbenick and other researchers, although anal intercourse is reported by fewer women than other partnered sex behaviors, partnered women in the age groups between 18–49 are significantly more likely to report having anal sex in the past 90 days. As of 2011, this survey provides the most up to date data about anal sex at the population level.
In a 2007 report entitled Prevalence and Correlates of Heterosexual Anal and Oral Sex in Adolescents and Adults in the United States, published in the Journal of Infectious Disease, a national survey of Family Growth found that 34% men and 30% women reported ever participating in heterosexual anal sex. The percentage of participants reporting heterosexual anal sex was significantly higher among 20- to 24-year-olds and peaked among 30- to 34-year-olds. Another survey in, 2008, focused on a much younger demographic of teenagers and young adults, aged 15–21. It found that 16% of 1350 surveyed had had this type of sex in the previous 3 months, with condoms being used 29% of the time. However, given the subject matter, the survey hypothesized the prevalence was probably underestimated.
In 2009, Kimberly R. McBride published a clinical report in The Journal of Sex Research which stated that changing norms may affect the frequency of heterosexual anal sex behaviors and suggests that there is a role for the exotic in the sexual repertoires of some heterosexuals" "[F]or a certain number of heterosexuals, anal intercourse is pleasurable, exciting, and perhaps considered more intimate than vaginal sex...". McBride and her colleagues investigated the prevalence of non-intercourse anal sex behaviors among a sample of men (n=1,299) and women (n=1,919) compared to anal intercourse experience and found that 51% of men and 43% of women had participated in at least one act of oral–anal sex, manual–anal sex, or anal sex toy use. McBride and Janssen found that the majority of men (n=631) and women (n=856) who reported heterosexual anal intercourse in the past 12 months were in exclusive, monogamous relationships: 69% and 73%, respectively.
Figures for prevalence can vary amongst different demographics, regions, and nationalities. A 2001 French survey of five hundred female respondents concluded that a total of 29% had engaged in this practice, with one third of these confirming to have enjoyed the experience. In contrast, in a 1999 South Korean survey of 586 women, 3.5% of respondents reported having had this type of sex.
Figures for the prevalence of sexual behavior can also fluctuate over time. Edward O. Laumann's 1992 survey, reported in The Social Organization of Sexuality: Sexual Practices in the United States, found that about 20% of heterosexuals had engaged in male-to-female anal sex. Sex researcher Alfred Kinsey, working in the 1940s, had found that number to be closer to 40% at the time. More recently, a researcher from the University of British Columbia in 2005 put the number of heterosexuals who have engaged in this practice at between 30% and 50%. According to Columbia University's health website Go Ask Alice!: "Studies indicate that about 25 percent of heterosexual couples have had anal sex at least once, and 10 percent regularly have anal penetration." The increase of anal sexual activity among heterosexuals has also been linked to the increase in anal pornography, especially if a person views it more regularly than a person who does not.
Male to male 
Historically, anal sex has been commonly associated with male homosexuality. However, many men who have sex with men do not engage in anal sex. Among men who have anal sex with other men, the insertive partner is called the top and the one being penetrated is called the bottom. Those who enjoy either role are referred to as versatile. Gay men who prefer anal sex may view it as "[their] version of intercourse" and as "the natural apex of sex, a wonderful expression of intimacy, and a great source of pleasure". Psychologist Walt Odets said, "I think that anal sex has for gay men the same emotional significance that vaginal sex has for heterosexuals".
Some men who have sex with men prefer to engage in frot or other forms of mutual masturbation because they find it more pleasurable or more affectionate, to preserve technical virginity, or as safe sex alternatives to anal sex, while other frot advocates denounce anal sex as degrading to the receptive partner and unnecessarily risky.
The prevalence of anal sex among homosexual couples in the West has varied over time. Magnus Hirschfeld, in his 1914 work, The Homosexuality of Men and Women, reported the rate of anal sex among homosexual men surveyed to be 8%, the least favored of all the practices documented. Likewise, some scholars state that oral sex and mutual masturbation are more common than anal stimulation among gay men in long-term relationships, and that, in general, anal intercourse is more popular among homosexual male couples than among heterosexual couples, but that "it ranks behind oral sex and mutual masturbation" among both sexual orientations in prevalence.
By the 1950s in the United Kingdom, it was thought that about fifteen percent of male homosexuals had anal sex.[full citation needed] More recent studies, The Gay Urban Men's Study (P.I. Stall, UCSF) and the Young Men's Study (YMS, PI Osmond/Catania, UCSF), indicate that 50% of the surveyed men who have sex with men engage in anal sex.[full citation needed][full citation needed] The 1994 Laumann study suggests that 80% of gay men practice it and 20% never engage in it at all.
The National Institutes of Health (NIH), with information published in the BMJ, states that two thirds of gay men have anal sex. Other sources suggest that roughly three-fourths of gay men have anal sex at one time or another in their lives, with an equal percentage participating as tops and bottoms. A survey in The Advocate in 1994 indicated that 46% of gay men preferred to penetrate their partners, while 43% preferred to be the receptive partner. A survey conducted from 1994 to 1997 in San Francisco by the Stop AIDS Project indicated that over the course of the study, among men who have sex with men, the proportion engaging in anal sex increased from 57.6% to 61.2%.
Pain during receptive anal sex is formally known as anodyspareunia. One study found that about 12% of gay men find it too painful to pursue, and concluded that the perception of anal sex as painful is just as likely to be psychologically or emotionally based as it is to be physically based. Another study that examined pain during insertive and receptive anal sex in gay men found that 3% of tops (insertive partners) and 16% of bottoms (receptive partners) reported significant pain. Factors predictive of pain during anal sex include inadequate lubrication, feeling tense or anxious, lack of stimulation, as well as lack of social ease with being gay and being closeted. Research has found that psychological factors can in fact be the primary contributors to the experience of pain during anal intercourse and that adequate communication between sexual partners can prevent it, countering the notion that pain is always inevitable during anal sex.
Female to male 
There are little published data on how many heterosexual men would like their anus to be sexually stimulated in a heterosexual relationship. Anecdotally, it is a substantial number. What data we do have almost all relate to penetrative sexual acts, and the superficial contact of the anal ring with fingers or the tongue is even less well documented but may be assumed to be a common sexual activity for men of all sexual orientations.
Advice columnist Dan Savage wrote that he believes all men should try pegging at least once, as it may introduce them to a new enjoyable sexual activity and illuminate them to the receiver's perspective in sex.
Female to female 
Anal stimulation for sexual pleasure is one of the lesbian sexual practices, with acts such as rimming or anilingus, fingering or the use of a dildo or other sex toys, but some lesbians "cannot bear the thought of [anal sex]". There is less research on anal sexual activity among women who have sex with women compared to couples of other sexual orientations. In 1987, a non-scientific study (Munson) was conducted of more than 100 members of a lesbian social organization in Colorado. When asked what techniques and lesbian sexual practices they used in their last ten sexual encounters, lesbians in their 30s were twice as likely as other age groups to engage in anal stimulation (with a finger or dildo). The oral stimulation of the anus, called anilingus, is more rarely practiced.
While author Tom Boellstorff, when particularly examining anal sex among gay and lesbian individuals in Indonesia, stated that he has not heard of oral-anal contact or anal penetration as recognized forms of lesbian sexuality but assume they take place, author Felice Newman cites anal sex as a part of lesbian sexual practices in her book The Whole Lesbian Sex Book. Daniel Villarreal of Queerty.com suggests that lesbians are better equipped to "teach heterosexual women" about anal sex than gay men are. "Firstly, they're women and anal sex feels different for women. Women lack that Giggity-spot called the prostate, so anal-loving [lesbians] know much more how anal sex feels as a woman than gay men ever could", he stated. "Most importantly though, women respond better to women. Ladies can approach the issue by discussing trust, communication, sobriety, HPV-prevention, and knowing your own body."
Health risks 
Anal sex can expose participants to two principal dangers: infections due to the high number of infectious microorganisms not found elsewhere on the body, and physical damage to the anus and the rectum due to their fragility. Increased experimentation with anal sex by people without sound knowledge about risks and what safety measures do and do not work may be linked to an increase in sexually transmitted infections. Judy Kuriansky, a Columbia University professor and author, stated, "It really is shocking how many myths young people have about anal sex. They don't think you can get a disease from it because you're not having [vaginal] intercourse."
Unprotected penile-anal penetration, colloquially known as "barebacking", carries a higher risk of passing on sexually transmitted infections (STIs/STDs) because the anal sphincter is a delicate, easily-torn tissue that can tear and provide an entry for pathogens. The high concentration of white blood cells around the rectum, together with the risk of tearing and the rectum's function to absorb fluid, places those who engage in such sexual activity at high risk of STIs. Use of condoms, ample lubrication to reduce the risk of tearing, and other safer sex practices reduce the risk. However, a condom can break or come off during anal sex, so both sex partners must remain watchful during sex and there is still some risk if one or both partners carries a sexually transmissible infection. The use of the same sex toys by more than one person increases the risk of transmitting such infections.
Unprotected receptive anal sex is considered the sex act most likely to result in HIV transmission. Other infections that can be transmitted by unprotected anal sex are human papillomavirus (HPV) (which can increase risk of anal cancer and typhoid fever), amoebiasis; chlamydia; cryptosporidiosis; E. coli infections; giardiasis; gonorrhea; hepatitis A; hepatitis B; hepatitis C; herpes simplex; Kaposi's sarcoma-associated herpesvirus (HHV-8); lymphogranuloma venereum; Mycoplasma hominis; Mycoplasma genitalium; pubic lice; salmonellosis; shigella; syphilis; tuberculosis; and Ureaplasma urealyticum.
Anal cancer is relatively rare, accounting for about 1 percent of gastrointestinal malignancies, but as many as 4,000 new cases can be diagnosed within a year in the United States, according to the American Cancer Society. Most cases of anal cancer are related to infection with the human papilloma virus (HPV). Anal sex alone does not cause anal cancer; the risk of anal cancer through anal sex is attributed to HPV infection, which is often contracted through unprotected anal sex. The incidence of the disease has jumped 160% in men and 78% in women in the last thirty years, according to a 2004 American study. The increase is attributed to changing trends in sexual behavior (such as a history of multiple sex partners, fifteen or more, or receptive anal sex) and smoking. If a current smoker, there is a fourfold increase in risk, though independent of other behavioral risk factors, such as sexual activity. Receptive anal sex increases the incidence sevenfold. Among the female control group studied, 21.5 percent had reported practicing anal sex, a significant increase from a previous case-control study by epidemiologist Janet Daling (PhD, member of Fred Hutchinson's Public Health Sciences Division) and her colleagues, published in 1987, in which 11 percent of female controls had reported ever having anal sex. This and other studies also indicate that gay or bisexual sex among men is on the rise, which may account for the increase in anal cancer. "The sharpest increase was among African American men, whose incidence of anal cancer has more than doubled in the past three decades. Black men also had a lower survival rate from the disease." The study reported that the five-year survival rate for black men with early stage disease was 62 percent as compared to 79 percent for white men with localized cancer. However, the survey also reported that black men were more likely than white men to report having had intercourse with another male in the last year. Regarding all the increases, whether or not sexual practices have changed, Daling, concluded, "[I]t also could be that people are just more likely to discuss their sexual behavior these days".
Physical damage 
Physical damage to the rectum and anus can manifest as generalized ano-rectal trauma, anal fissures, rectal prolapse, and exacerbating hemorrhoids. Adequate lubrication and preparation reduces the risk of physical trauma, while the risk increases with use of alcohol or other drugs that dull sensitivity.
Loss of bowel control is not a highly likely result of anal sex, but may be caused by repeated injury or the insertion of large objects.[full citation needed] Kegel exercises have been recommended to maintain muscle tone by a speaker at the Society for the Scientific Study of Sexuality and the American Association of Sex Educators, who noted he had never personally observed "loosening" in any of his patients.
A 1993 study published in the Journal of the Royal Society of Medicine found that fourteen out of a sample of forty men receiving anal intercourse experienced episodes of frequent anal incontinence. However, a 1997 study published in the American Journal of Gastroenterology found no difference in levels of incontinence between homosexual men who engaged in anal sex and heterosexual men who did not, and criticized the earlier study for its inclusion of flatulence in its definition of incontinence.
Cultural issues 
Historically, a number of cultures have recorded the practice of anal intercourse between men.
Ancient and non-Western cultures 
The term Greek love has long been used to refer to the practice, and in modern times, "doing it the Greek way" is sometimes used as slang for anal sex. However, homosexual anal sex was far from a universally accepted practice in Ancient Greece. It was the target of jokes in surviving comedies; Aristophanes mockingly alludes to the practice, claiming that "Most citizens are europroktoi (wide-arsed) now". While pedagogic pederasty was an essential element in the education of male youths, these relationships, at least in Athens and Sparta, were expected to steer clear of penetrative sex of any kind. There are very few works of pottery or other art that display anal sex between older men and boys, let alone with adult men. Most such works depict fondling or intercrural sex, which was not condemned for violating and feminizing the boys. Other sources make it clear that the practice was criticized as shameful, and seen as a form of hubris.[full citation needed]
In later Roman-era Greek poetry, anal sex became a common topos, represented as taking place with "eligible" youths: those who had attained the proper age but had not yet become adults. Seducing children into the practice was considered very shameful for the adult, and having such relations with a male who was no longer adolescent was considered more shameful for the young male than for the one mounting him. Greek courtesans, or hetaerae, are said to have frequently practiced heterosexual anal intercourse as a means of preventing pregnancy. The acceptability of anal sex thus varied with the time-period and the location, as Ancient Greece spanned a long time and stretched over three continents and two major seas.
For a male citizen to take the passive (or receptive) role in anal intercourse was condemned in Rome as an act of impudicitia (immodesty or unchastity). Free men, however, frequently took the active role with a young slave, known as a catamite or puer delicatus. In fact the Romans thought of anal sex as something specifically "Greek", although Roman men often availed themselves of their own slaves or others in this way.[full citation needed]
In Japan, records (including detailed shunga) show that at least some men in relationships with other men did engage in penetrative anal intercourse.
Evidence suggestive of widespread heterosexual anal intercourse in a pre-modern culture can be found in the erotic vases, or stirrup-spout pots, made by the Moche people of Peru; in a survey of a collection of these pots, it was found that 31 percent of them depicted heterosexual anal intercourse, more by far than any other sex act. Moche pottery of this type belonged to the world of the dead, which was believed to be a reversal of life. Thus the reverse of common practices was often portrayed. The Larco Museum houses an erotic gallery in which this pottery is showcased.
The 19th century anthropologist Richard Francis Burton theorized that there is a geographical Sotadic zone wherein penetrative intercourse between men is particularly prevalent and accepted; moreover he was one of the first writers to advance the premise that such an orientation is biologically determined.
Western cultures 
In many Western countries, anal sex has generally been taboo since the Middle Ages when heretical movements were sometimes attacked by accusations that their members practised anal sex among themselves. At that time the mainstream Christian clergy was not celibate, but the highest orders of some heretical sects were, leading to rumors that their celibacy was a sign of their attraction to members of the same sex. The term buggery originated in medieval Europe as an insult used to describe the rumoured same-sex sexual practices of the heretics from a sect originating in Bulgaria, where its followers were called bogomils; when they spread out of the country they were called buggres (from the ethnonym Bulgars). Another term for the practice, more archaic, is "pedicate" from the Latin pedicare, with the same meaning.
While men who engaged in homosexual relationships were generally suspected of engaging in anal sex, many such individuals did not. Among these, in recent times, have been André Gide, who found it repulsive;[full citation needed] and Noël Coward, who had a horror of disease, and asserted when young that "I'd never do anything – well the disgusting thing they do – because I know I could get something wrong with me".[full citation needed]
In religion 
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The Mishneh Torah, a text considered authoritative by Orthodox Jewish sects, states “since a man’s wife is permitted to him, he may act with her in any manner whatsoever. He may have intercourse with her whenever he so desires and kiss any organ of her body he wishes, and he may have intercourse with her naturally or unnaturally [traditionally, this refers to anal and oral sex], provided that he does not expend semen to no purpose. Nevertheless, it is an attribute of piety that a man should not act in this matter with levity and that he should sanctify himself at the time of intercourse.”
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In Christian countries,[clarification needed] anal sex is sometimes referred to euphemistically as the peccatum contra naturam (the sin against nature, after Thomas Aquinas) or Sodomitica luxuria (sodomitical lusts, in one of Charlemagne's ordinances), or peccatum illud horribile, inter christianos non-nominandum (that horrible sin that among Christians is not to be named).
Liwat, or the sin of Lot's people, is officially prohibited by most Islamic sects. There are parts of the Qur'an which talk about smiting on Sodom and Gomorrah, and this is thought to be a reference to unnatural sex, and so there are hadith and Islamic laws which prohibit it. Same sex male practitioners of anal relations are called luti or lutiyin in plural and are seen as criminals in the same way that a thief is a criminal, meaning that they are giving in to a universal temptation.
The most common formulation of Buddhist ethics is the Five Precepts. These precepts take the form of voluntary, personal undertakings, not divine mandate or instruction. The third of the Precepts is "To refrain from committing sexual misconduct". However, "sexual misconduct" (Sanskrit: Kāmesu micchācāra literally "sense gratifications arising from the 5 senses"") is subject to interpretation relative to the social norms of the followers. In fact, Buddhism, in its fundamental form, does not define what is right and what is wrong in absolute terms for lay followers. Therefore the interpretation of what kinds of sexual activity are acceptable for a layman is not a religious matter as far as Buddhism is concerned.
See also 
- Dr. John Dean and Dr. David Delvin. "Anal sex". Netdoctor.co.uk. Archived from the original on May 7, 2010. Retrieved April 29, 2010.
- Barry R. Komisaruk, Beverly Whipple, Sara Nasserzadeh, Carlos Beyer-Flores (2009). The Orgasm Answer Guide. JHU Press. pp. 108–109. ISBN 978-0-8018-9396-4. Retrieved November 6, 2011.
- See pages 270–271 for anal sex information, and page 118 for information about the clitoris. Janell L. Carroll (2009). Sexuality Now: Embracing Diversity. Cengage Learning. p. 629. ISBN 978-0-495-60274-3. Retrieved December 19, 2010.
- "Not all gay men have anal sex". Go Ask Alice!. May 10, 1996 (Last Updated/Reviewed on June 13, 2008). Retrieved April 26, 2010.
- Bell, Robin (February 1999). "ABC of sexual health: Homosexual men and women". BMJ (National Institutes of Health/BMJ) 318 (7181): 452–5. PMC 1114912. PMID 9974466.
- Felice Newman (2004). The Whole Lesbian Sex Book: A Passionate Guide For All Of Us. Cleis Press. pp. 376 pages. ISBN 978-1-57344-199-5. Retrieved November 6, 2011.
- "The male hot spot — Massaging the prostate". Go Ask Alice!. September 27, 2002 (Last Updated/Reviewed on March 28, 2008). Retrieved April 21, 2010.
- See page 3 for women preferring anal to vaginal, and page 15 for reaching orgasm through indirect stimulation of the G-Spot. Tristan Taormino (1997). The Ultimate Guide to Anal Sex for Women. Cleis Press. pp. 282 pages. ISBN 978-1-57344-221-3. Retrieved November 6, 2011.
- "Pain from anal sex, and how to prevent it". Go Ask Alice!. April 26, 2002 (Last Updated/Reviewed on June 26, 2009). Retrieved April 7, 2011.
- See page 273 for pain due to psychological factors. Joel J. Heidelbaugh (2007). Clinical men's health: evidence in practice. Elsevier Health Sciences. pp. 608 pages. ISBN 978-1-4160-3000-3. Retrieved October 14, 2011.
- Damon, W; B.R. Rosser (Mar–Apr 2005). "Anodyspareunia in Men Who Have Sex With Men: Prevalence, Predictors, Consequences, and the Development of DSM Diagnostic Criteria". Journal of Sex and Marital Therapy 31 (2): 129–141. PMID 15859372.
- World Health Organization, Department of Reproductive Health and Research Global strategy for the prevention and control of sexually transmitted infections: 2006–2015. Breaking the chain of transmission, 2007, ISBN 978-92-4-156347-5
- Centers for Disease Control and Prevention Sexually Transmitted Disease Surveillance, 2008. Atlanta, GA: U.S. Department of Health and Human Services; November 2009.Fact Sheet
- "Anal Health". sexualhealthchannel.com. Retrieved April 22, 2010.
- Johnson, Ramon. "The 6 Secrets of Gay Anal Sex: What You Should Know and What You Should Look Out For". About.com. Archived from the original on May 28, 2010. Retrieved April 26, 2010.
- Rosenthal, Martha (2012). Human Sexuality: From Cells to Society. Cengage Learning. pp. 133–135. ISBN 978-0-618-75571-4. Retrieved September 17, 2012.
- The A-Spot, Talk Sex with Sue Johanson, 2005. Retrieved April 29, 2007.
- Alice Kahn Ladas, Beverly Whipple, John D. Perry (1982 (Digitized October 31, 2008)). The G spot and other recent discoveries about human sexuality. Holt, Rinehart, and Winston. p. 236. ISBN 978-0-03-061831-4. Retrieved April 26, 2011.
- Jones, Nicola (July 2002). "Bigger is better when it comes to the G spot". New Scientist. Archived from the original on April 13, 2010. Retrieved April 21, 2010.
- "'I Want a Better Orgasm!'". WebMD. Archived from the original on 2009-01-13. Retrieved August 18, 2011.
- Joseph A. Flaherty, John Marcell Davis, Philip G. Janicak (1993, Digitized October 29, 2010). Psychiatry: Diagnosis & therapy. A Lange clinical manual. Appleton & Lange (Original from Northwestern University). p. 217. ISBN 978-0-8385-1267-8. "The amount of time of sexual arousal needed to reach orgasm is variable — and usually much longer — in women than in men; thus, only 20–30% of women attain a coital climax. b. Many women (70–80%) require manual clitoral stimulation..."
- Mah, Kenneth; Binik, Yitzchak M (January 7, 2001). "The nature of human orgasm: a critical review of major trends". Clinical Psychology Review 21 (6): 823–856. doi:10.1016/S0272-7358(00)00069-6. PMID 11497209. "Women rated clitoral stimulation as at least somewhat more important than vaginal stimulation in achieving orgasm; only about 20% indicated that they did not require additional clitoral stimulation during intercourse."
- Kammerer-Doak, Dorothy; Rogers, Rebecca G. "Female Sexual Function and Dysfunction". Obstetrics and Gynecology Clinics of North America 35 (2): 169–183. doi:10.1016/j.ogc.2008.03.006. PMID 18486835. "Most women report the inability to achieve orgasm with vaginal intercourse and require direct clitoral stimulation ... About 20% have coital climaxes..."
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Further reading 
- Bentley, Toni The Surrender: An Erotic Memoir, Regan Books, 2004.
- Brent, Bill Ultimate Guide to Anal Sex for Men, Cleis Press, 2002.
- DeCitore, David Arouse Her Anal Ecstasy (2008) ISBN 978-0-615-39914-0
- Hite, Shere The Hite Report on Male Sexuality
- Houser, Ward Anal Sex, Encyclopedia of Homosexuality Dynes, Wayne R. (ed.), Garland Publishing, 1990. pp. 48–50.
- Manning, Lee The Illustrated Book Of Anal Sex, Erotic Print Society, 2003. ISBN 978-1-898998-59-4
- Morin, Jack Anal Pleasure & Health: A Guide for Men and Women, Down There Press, 1998. ISBN 978-0-940208-20-9
- Sanderson, Terry The Gay Man's Kama Sutra, Thomas Dunne Books, 2004.
- Strong, Bill with Lori E. Gammon Anal Sex for Couples: A Guaranteed Guide for Painless Pleasure Triad Press, Inc.; First edition, 2006. ISBN 978-0-9650716-2-8
- Tristan Taormino The Ultimate Guide to Anal Sex for Women, Cleis Press, 1997, 2006. ISBN 978-1-57344-028-8
- Underwood, Steven G. Gay Men and Anal Eroticism: Tops, Bottoms, and Versatiles, Harrington Park Press, 2003
- Webb, Charlotte Masterclass: Anal Sex, Erotic Print Society, 2007.
|Wikimedia Commons has media related to: Anal sex|
- Anal Intercourse and Analingus – from alt.sex FAQ
- William Saletan. The Riddle of the Sphincter: Why do women who have anal sex get more orgasms? Slate, October 11, 2010.