醫師不談論肛交可能會使女性處於風險之中
資料來源：梅根 .布魯克斯 / 2022 年 8 月 11 日 / Medscape / 財團法人台灣紅絲帶基金會編譯
兩位來自英國的研究人員在今天發表在英國醫學雜誌上的一篇評論文章中寫道，臨床醫生不願討論肛交的可能危害可能會讓沒有意識到這些風險的年輕一代女性失利。
未能討論這個主題，「會使女性面臨錯失診斷、無效治療以及因缺乏醫療建議而造成的進一步傷害」，英國謝菲爾德教學醫院 NHS 基金會信託基金和北方總醫院的醫學博士 Tabitha Gana 和醫學博士 Lesley Hunt 寫道，。
在他們看來，醫療照護專業人員，特別是一般科、腸胃病學和結直腸外科醫師，「有責任認知圍繞年輕女性肛交的社會變化，並透過中立和非評判性的公開對話來應對這些變化，以確保所有女性都擁有做出明智的性選擇所需的信息」。
他們指出，詢問肛交是泌尿生殖醫學診所的標準做法，但在一般診所和結直腸診所中並不常見。
不再是禁忌
肛交在年輕的異性戀伴侶中變得越來越普遍。在英國，根據全國調查數據，過去幾十年中，16-24 歲人群中異性肛交的參與率從約 13% 上升至 29%。
同樣的情況也在美國發生，研究顯示 30%-44% 的男性和女性報告有肛交。
肛交的個人動機各不相同。年輕女性將愉悅、好奇心、取悅男性伴侶和強迫視為因素。Gana和Hunt說，多達 25% 有肛交經歷的女性表示，她們至少一次曾遭受到壓力去進行肛交。
然而，由於它與酒精、藥物使用和多重性伴侶有關，肛交被認為是一種危險的性行為。
Gana 和 Hunt 指出，這也與特定的健康問題有關。這些包括大便失禁和肛門括約肌損傷，在從事肛交的女性中已有報導。在失禁方面，女性比男性面臨更高的風險，因為她們的解剖結構不同，以及荷爾蒙、懷孕和分娩對骨盆底部的影響。
「與男性相比，女性的肛門括約肌較弱，肛管壓力較低，因此肛門穿透造成的損害更為嚴重」，Gana 和 Hunt 指出。
「女性在肛交後報告的疼痛和出血顯示存在著創傷，如果被強迫肛交，風險可能會增加」，他們補充道。
他們說，了解潛在的風險因素和了解良好的病史是有效管理肛門直腸疾病的關鍵。
Gana 和 Hunt 擔心，受社會禁忌的影響，臨床醫生可能會迴避談論肛交。
目前，NHS 患者關於肛交的信息僅考慮性傳播感染，沒有提及肛門創傷、尿失禁或被脅迫進行肛交的心理後果。
Gana 和 Hunt寫道：「阻止衛生專業人員與年輕女性談論肛交風險可能不僅僅是迴避抑或污名。人們真正擔心的是該等信息可能被視為係具批判性的，甚至被誤解為恐同」。
「然而，透過避免這些討論，我們可能會讓沒有意識到風險的年輕一代女性失利」，他們補充道。
「有了更好的信息，想要肛交的女性將能夠更有效地保護自己以免受到可能的傷害，而那些遲疑於因要符合社會期望或要取悅伴侶而勉強同意肛交的女性，可能會覺得更有能力說不」，” Gana 和 Hunt 說道。
這項研究沒有接愛特定的資金贊助。 Gana 和 Hunt 報告沒有相關資金上的關係。
英國醫學雜誌。 2022 年 8 月 11 日在線發布。社論
Docs Not Talking About Anal Sex May Put Women at Risk
Megan Brooks / August 11, 2022 / Medscape
Clinicians’ reluctance to discuss possible harms of anal sex may be letting down a generation of young women who are unaware of the risks, two researchers from the UK write in an opinion article published today in The BMJ.
Failure to discuss the subject “exposes women to missed diagnoses, futile treatments, and further harm arising from a lack of medical advice,” write Tabitha Gana, MD, and Lesley Hunt, MD, with Sheffield Teaching Hospitals NHS Foundation Trust and Northern General Hospital, Sheffield, United Kingdom.
In their opinion, healthcare professionals, particularly those in general practice, gastroenterology, and colorectal surgery, “have a duty to acknowledge changes in society around anal sex in young women, and to meet these changes with open neutral and non-judgmental conversations to ensure that all women have the information they need to make informed choices about sex.”
Asking about anal sex is standard practice in genitourinary medicine clinics, but it’s less common in general practice and colorectal clinics, they point out.
No Longer Taboo
Anal intercourse is becoming more common among young heterosexual couples. In the UK, participation in heterosexual anal intercourse among people aged 16-24 years rose from about 13% to 29% over the last few decades, according to national survey data.
The same thing is happening in the United States, where research suggests 30%-44% of men and women report having anal sex.
Individual motivation for anal sex varies. Young women cite pleasure, curiosity, pleasing the male partners, and coercion as factors. Up to 25% of women with experience of anal sex report they have been pressured into it at least once, Gana and Hunt say.
However, because of its association with alcohol, drug use, and multiple sex partners, anal intercourse is considered a risky sexual behavior.
It’s also associated with specific health concerns, Gana and Hunt point out. These include fecal incontinence and anal sphincter injury, which have been reported in women who engage in anal intercourse. When it comes to incontinence, women are at higher risk than men because of their different anatomy and the effects of hormones, pregnancy, and childbirth on the pelvic floor.
“Women have less robust anal sphincters and lower anal canal pressures than men, and damage caused by anal penetration is therefore more consequential,” Gana and Hunt point out.
“The pain and bleeding women report after anal sex is indicative of trauma, and risks may be increased if anal sex is coerced,” they add.
Knowledge of the underlying risk factors and taking a good history are key to effective management of anorectal disorders, they say.
Gana and Hunt worry that clinicians may shy away from talking about anal sex, influenced by society’s taboos.
Currently, NHS patient information on anal sex considers only sexually transmitted infections, making no mention of anal trauma, incontinence, or the psychological aftermath of being coerced into anal sex.
“It may not be just avoidance or stigma that prevents health professionals [from] talking to young women about the risks of anal sex. There is genuine concern that the message may be seen as judgmental or even misconstrued as homophobic,” Gana and Hunt write.
“However, by avoiding these discussions, we may be failing a generation of young women, who are unaware of the risks,” they add.
“With better information, women who want anal sex would be able to protect themselves more effectively from possible harm, and those who agree to anal sex reluctantly to meet society’s expectations or please partners, may feel better empowered to say no,” Gana and Hunt say.
This research had no specific funding. Gana and Hunt report no relevant financial relationships.
BMJ. Published online August 11, 2022. Editorial