How Anal Sex Stigma Shapes Health, Pleasure, and Care

Anal sex is often treated as a taboo topic, even for those who engage in it and, at times, amongst healthcare professionals. And this stigma has real consequences.

Anal sex has been practiced for centuries, can be intensely pleasurable, and is common across genders and sexual orientations. Yet negative attitudes and silence around the topic continue to shape how people experience and talk about it. When this stigma goes unchallenged, it can undermine individuals’ ability to access accurate information, communicate with partners, and seek medical care.

In this blog, we’re highlighting two recent studies that explore how anal sex stigma affects men who have sex with men (MSM) and what can be done to address it.

Anal Sex and Stigma

Stigma surrounding anal sex can be experienced, anticipated, and/or internalized (Kutner et al., 2021). One major driver of this stigma is the lack of comprehensive sexual health education that addresses anal pleasure and safety. Many people (along with their partners and even healthcare providers) receive little guidance beyond HIV prevention, leaving them without practical knowledge about comfort, communication, or injury prevention. As a result, stigma becomes more than social discomfort; it discourages honest disclosure, promotes secrecy, and interferes with health-seeking behavior among MSM.

In a series of interviews with 10 key informants and 25 MSM, Kutner and colleagues (2021) found that stigma contributed to both psychological distress and physical discomfort. Many participants also reported hiding their sexual concerns and behaviors, even from supportive partners, friends, and clinicians.

Men in this study described stigma in several ways:

• Being exposed to messages that frame anal sex as “deviant” or “unhealthy”

• A lack of accessible information about anal pleasure and safety

• Internalized shame and fear of judgment

• Limited knowledge and skills among healthcare workers

• Providers’ discomfort or unwillingness to discuss anal health

These dynamics made open conversations difficult, both in intimate relationships and in medical settings. Many participants said they learned about anal sex through trial and error, which increased their risk of pain and injury. Some even came to view discomfort during this activity as “normal” and avoided discussing problems with doctors out of fear of further stigmatization.

Validating the Anal Sex Stigma Scale Among Black Men with HIV

A new study in the Journal of Sex Research sought to validate the Anal Sex Stigma Scale (ASSS) among 650 Black sexual minority men living with HIV (Dangerfield II et al., 2025). The researchers identified two core dimensions of this stigma:

1.) Self and provider stigma (i.e., internalized shame and expectations of judgment from healthcare providers)

2.) Peer and knowledge-based stigma (i.e., negative attitudes from social networks and lack of accurate information).

Having a validated tool like this is important because it allows researchers and clinicians to measure how stigma affects mental health, relationships, and engagement in care. It also helps identify where education and provider training are most needed.

The study also found that higher levels of anal sex stigma were strongly linked to several negative outcomes, including:

• Greater internalized homophobia

• More symptoms of depression

• Higher HIV-related stigma

• Lower perceived social support

Stigma Impacts Sexual Health

Anal sex stigma is a barrier to wellbeing, pleasure, and healthcare. When people feel ashamed or fear judgment, they are less likely to seek information, advocate for their needs, or talk openly with partners and clinicians. The result can be unnecessary pain, untreated health concerns, and social isolation.

Reducing this stigma requires better sexual health education that goes beyond risk avoidance to include pleasure, communication, and bodily autonomy. It also necessitates that healthcare providers become more comfortable discussing anal health without assumptions or bias. There is still much that can be done to create spaces where people feel safe to seek care, share experiences, and enjoy their bodies without shame.

To learn more about anal sex, check out our podcast episodes:

• How to Have Pleasurable Anal Sex
• Common Myths About Anal Sex, Debunked
• The Ins and Outs of Anal Sex
• Everything You Ever Wanted to Know About Anal Sex, But Were Afraid to Ask

If you have a sex question of your own, record a voicemail at speakpipe.com/sexandpsychology to have it answered on the blog or the podcast. 

Want to learn more about Sex and Psychology? Click here for more from the blog or here to listen to the podcast. Follow Sex and Psychology on Facebook, Twitter (@JustinLehmiller), Bluesky, or Reddit to receive updates. You can also follow Dr. Lehmiller on YouTube and Instagram.

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References:

Kutner, B. A., Simoni, J. M., Aunon, F. M., Creegan, E., & Balán, I. C. (2021). How stigma toward anal sexuality promotes concealment and impedes health-seeking behavior in the U.S. among cisgender men who have sex with men. Archives of Sexual Behavior, 50(4), 1651–1663. https://doi.org/10.1007/s10508-019-01595-9

Dangerfield II, D. T., Turpin, R., Thorpe Jr, R., & Hickson, D. A. (2025). Validating the Anal Sex Stigma Scale among Black sexual minority men living with HIV. The Journal of Sex Research, 1–9. https://doi.org/10.1080/00224499.2025.2537763