Promoting safer sex in the context of heterosexual anal intercourse: A scoping review

Joanne Stewart, Gillian Douglas, Tammy O'Rourke, Carolyn Gammel

Research output: Contribution to journalReview articlepeer-review

7 Citations (Scopus)


Aims and objectives: To locate and summarise existing literature regarding safer sex practices specific to heterosexual anal intercourse and identify promising health promotion strategies. Background: Much of the literature regarding anal intercourse and safer sex is related to men who have sex with men. However, some studies suggest there are more women than men engaging in unprotected receptive anal intercourse. The risks associated with this sexual practice have been well documented, although many healthcare providers fail to ask about anal intercourse while addressing safer sex in the heterosexual population. Design: The study was based on Arksey and O’Malley's 2005 five-step methodology. Methods: A search was conducted of MEDLINE; CINAHL; PsycInfo; Cochrane; and PubMed. Databases were searched from 1990–2020. The 72 studies selected were classified according to their main area of focus. A grey literature search was also included. This scientific submission has been assessed for accuracy and completeness using the PRISMA-ScR guideline criteria (File S1). Results: The literature in this area is heterogeneous in terms of method and topic. Prevalence and incidence (n = 26) in addition to sexually transmitted infection risks (n = 26) related to heterosexual anal intercourse are well understood. However, there is limited information on condom use (n = 6), factors that influence heterosexual anal intercourse (n = 10) and health promotion strategies for this population and practice (n = 4). Two websites that mentioned heterosexual anal intercourse risk reduction activities were included. Conclusions: Although heterosexual anal intercourse appears to be an increasingly common sexual practice, very little is known about health promotion strategies nurses might use for encouraging safer sex in this population. Relevance to clinical practice: Increased awareness of the prevalence and risks of heterosexual anal intercourse could enhance nurses’ harm reduction strategies. Screening for sexually transmitted infections may be based on incorrect assumptions about sexual practices or due to stigma linked with anal intercourse. Reducing unprotected heterosexual anal intercourse will reduce sexually transmitted infections and their long-term sequelae.

Original languageEnglish
Pages (from-to)2111-2130
Number of pages20
JournalJournal of Clinical Nursing
Issue number15-16
Publication statusPublished - Aug. 2021


  • anal intercourse
  • anal sex
  • heterosexual anal intercourse
  • safer sex
  • scoping review


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