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Heterosexual Anal and Oral Sex in Adolescents and Adults in the United States, 2011–2015

Habel, Melissa A. MPH; Leichliter, Jami S. PhD; Dittus, Patricia J. PhD; Spicknall, Ian H. PhD; Aral, Sevgi O. PhD

doi: 10.1097/OLQ.0000000000000889
Original Study

Background Heterosexual anal and oral sex are related to the acquisition and transmission of sexually transmitted diseases (STDs). As common reportable STDs (chlamydia, gonorrhea, and syphilis) in the United States are increasing, it is important to understand recent oral and anal sexual behaviors.

Methods We examined the prevalence and correlates of heterosexual anal and oral sex, associated condom use, and having multiple partners among men and women aged 15 to 44 years.

Results Approximately one third of women and men had ever engaged in anal sex, including 11% of adolescents (15–19 years). Most women and men had ever received or given oral sex (at >75%). Six percent and 7% of women and men, respectively, used a condom at last oral sex compared with 20% and 30% who used a condom at last anal sex. Having multiple sex partners in the past year was most common among adolescents, never or formerly married persons, and those who had a nonmonogamous partner. Less than 10% reported multiple anal sex partners in the past year. A substantial minority had multiple oral or anal sex partners; black women and men had the highest reports of oral sex partners by race/ethnicity.

Conclusions Anal and oral sex are common sexual practices. Given the low rates of condom use during these behaviors, it is important that recommendations for sexual risk assessments are followed. Tailored messaging regarding risk for STD and human immunodeficiency virus acquisition during oral and anal sex may benefit adolescents, singles, and divorced individuals. Future discussions regarding the benefits of extragenital STD testing for heterosexuals may be useful.

In the United States, approximately one third of heterosexual men and women (15–44 years) have ever engaged in anal sex, and over 75% have ever given or received oral sex.

From the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA

Acknowledgment: The 2011-2013 and 2013-2015 National Survey of Family Growth (NSFG) was conducted by the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC). Interviewing and other tasks were carried out by the University of Michigan’s Institute for Social Research (ISR), under a contract with NCHS. The authors are grateful to study participants and to the research staff at ISR.

Conflicts of Interest and Sources of Funding None declared.

Correspondence: Melissa A. Habel, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop E-04, Atlanta, GA 30329. E-mail:

Received for publication March 12, 2018, and accepted June 25, 2018.

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© Copyright 2018 American Sexually Transmitted Diseases Association