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Anal Penetrative Intercourse as a Risk Factor for Fecal Incontinence

Geynisman-Tan, Julia, MD; Kenton, Kimberly, MD, MS; Leader-Cramer, Alix, MD; Dave, Bhumy, MD; Bochenska, Katarzyna, MD; Mueller, Margaret, MD; Collins, Sarah, Abbie, MD; Lewicky-Gaupp, Christina, MD

Female Pelvic Medicine & Reconstructive Surgery: May/June 2018 - Volume 24 - Issue 3 - p 252–255
doi: 10.1097/SPV.0000000000000408
Original Articles

Objective The aim of the study is to investigate the relationship between anal penetrative intercourse (API) and pelvic floor symptoms, specifically, anal incontinence (AI).

Methods This was an institutional review board–approved, cross-sectional, e-mail survey of women enrolled in the Illinois Women's Health Registry. Participants were anonymously queried about their sexual practices and the effects of these on bowel and bladder symptoms. Urinary symptoms were assessed using the urogenital distress inventory-6 and bowel symptoms with the fecal incontinence severity index (FISI).

Results One thousand three women (mean age of 46 ± 15 years) completed the survey. Eighty percent were white, 56% were married, and 99% reported ever being sexually active. Thirty-two percent had API at least once, and 12% considered it “part of their sexual practice.” Sixty percent of the cohort reported a bothersome urinary symptom on the urogenital distress inventory-6, 70% reported AI on the FISI, and 15% reported fecal incontinence. Of women who engaged in API, 18% reported it changed their stool consistency, and 10% reported it caused AI. Having engaged in API within the last month was correlated with higher FISI scores (P = 0.05) and with fecal incontinence on the FISI (28.3% vs 14.4%; P = 0.01; odds ratio, 2.48). In addition, API was more commonly practiced among women who reported that vaginal intercourse caused dyspareunia (17% vs 12%, P = 0.05) or changes in bladder symptoms such as urgency or dysuria (44% vs 30%, P < 0.001).

Conclusions Self-reported AI and FI (as measured by the FISI scores) are higher in women who have had API, and frequency of API may be important in determining the risk of bowel symptoms.

From the Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, IL.

Correspondence: Julia Geynisman-Tan, MD, 250 E Superior Street, Suite 03-2302, Chicago, IL. E-mail:

Kimberly Kenton, MD, MS, has a grant funding from Boston Scientific. The remaining authors have declared they have no conflicts of interest.

Institutional review board approved on August 16, 2016 by the Northwestern University. Institutional review board approval no. STU00203685.

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