Anodyspareunia, the unacknowledged sexual dysfunction: a validation study of painful receptive anal intercourse and its psychosexual concomitants in homosexual men.

This study examines the frequency and duration of pain in same-sex anal intercourse in a sample of 277 adult men who have engaged in, or attempted to engage in, anal intercourse during their lifetime. Whereas estimates of frequency of pain appeared blocked distributed across a 7-point Likert scale, severity of pain appeared positively skewed, with 12% rating it as too painful to continue. Participants rated inadequate lubrication, psychological factors such as not feeling relaxed, and lack of digitoproctic stimulation prior to penetration as the three most important psychophysiological factors predicting pain. Factors associated with a greater amount of pain experienced in anal intercourse were depth and rate of thrusting, lack of social comfort with gay men, being more "closeted," and less concern over becoming old or unattractive as a gay or bisexual man. Pain was also positively related to anxiety. The use of condoms was not rated highly as a factor in receptive anal pain. Based on these findings, the authors define anodyspareunia to denote painful receptive anal intercourse, and suggest clinical criteria similar to that used for other sexual pain disorders.