AD is defined as the pain experienced during or after receptive anal intercourse (RAI), even though there is no consensus about clinical definitions or diagnostic criteria for AD. This is an underreported concern among GB-MSM. This study aimed to investigate the prevalence and associated factors of AD within this population, shedding light on the experiences of pain and its implications.
The findings revealed that 85% of GB-MSM participants experienced pain during RAI at some point in their lives, and 10.4% of them rated it high or very high. Since 80% of the survey population has reported involvement in RAI within the past 6 months, the proportion of pain should not be dismissed. These results are consistent with previous research indicating that pain during anal intercourse is of common occurrence among GB-MSM [2, 10–14]. Even though, we cannot clearly say they all suffered from AD since there are controversies about the magnitude of pain that must be experienced to define it as AD [14, 16], this high prevalence underscores the significance of addressing AD as a critical health issue for GB-MSM. Damon et al stated a prevalence of AD of 14% [13], considering only those individuals that had a severe and frequent pain. With that definition of AD, we would have not considered the 37% of men that, in our survey, reported having a low or moderate level of pain, and still they ceased engaging in RAI. We believe that any pain that prevents the patient of engaging in RAI should be taken into consideration.
There is a diverse spectrum of pain experiences within this population, with a notable subset experiencing severe discomfort. The magnitude of the pain could not be considered solely since there are other factors yet to be explained. Such as the fact that 3% of the individuals experiencing severe pain continued engaging in RAI. We cannot forget the importance of erotization of pain in sexual behaviour, which may play a role in explaining this last finding[17].
Furthermore, when examining pain experiences within the past 6 months, it was notable that 66.8% had experienced any degree of pain during RAI and 50.1% after RAI. The lower prevalence of pain during RAI among older age groups and the increased likelihood of younger groups reporting moderate to high discomfort may be attributed to multifactorial reasons. These could include greater sexual experience, improved sexual practices, psychological well-being, physiological changes, and partner selection [10].
Although the relationship between AD and sexual satisfaction has been considered a controversial issue, our data indicated that individuals reporting pain during RAI were more likely to experience higher levels of sexual dissatisfaction. This suggests that addressing AD may contribute to improving overall sexual satisfaction among GB-MSM. Additionally, the willingness of most participants (80%) to seek medical attention if it could alleviate their pain emphasizes the potential for healthcare professionals and proctologists to play a pivotal role in managing and mitigating AD in this population.
Exploring the healthcare-seeking behaviour of participants who experienced AD revealed that a significant proportion (70%) had never sought medical help for their pain. This raises questions about the accessibility of appropriate healthcare services for GB-MSM experiencing AD. Strategies to improve access to specialized care and raise awareness among GB-MSM about the availability of such services are warranted.
The most prevalent pathologies diagnosed in the study population were haemorrhoidal disease and anal fissure. While we cannot ascertain whether they are cause or consequence, this data could provide valuable insights into the underlying factors that contribute to AD in this population, potentially guiding future research and treatment approaches.
This study has the potential interest according to the large sample size and the detail of responses of the participants. However, this research also presents certain limitations that should be considered when interpreting the results. Firstly, there is a potential sampling bias as the survey was conducted online. Eligible subjects were limited to those GB-MSM with frequent access to the internet and may not fully represent the broader GB-MSM population. Moreover, relying heavily on self-reported data introduces the risk of recall bias and social desirability bias, which could lead to underreporting or overreporting of certain experiences or behaviours. The cross-sectional design of the study also limits the ability to establish causal relationships between variables, and for a more comprehensive understanding of temporal dynamics, longitudinal studies would be necessary. Additionally, clinical information is based on self-diagnoses of proctological pathologies, which may lack clinical confirmation. Lastly, we have not explored psychological factors such as internalized homophobia that could impact on AD and lack of help-seeking.
Notwithstanding these limitations, the study boasts notable strengths. It addresses a pressing and underexplored issue: AD in GB-MSM. By shedding light on this subject, the research contributes to our comprehension of sexual health and well-being within this population. The ample participant sample provides a robust statistical foundation for analysing AD within the GB-MSM community in Spain. Furthermore, the collection of detailed data on pain experiences, sexual satisfaction, healthcare-seeking behaviour, and diagnoses of proctological pathologies allows for a nuanced examination of AD.
The study's findings have practical implications for healthcare professionals and policymakers, highlighting the high prevalence of AD and the willingness of many participants to seek medical help and the need to enhance healthcare services as well as awareness campaigns addressing this issue. In summary, despite its limitations, this study constitutes a valuable starting point for future research in the field of AD among GB-MSM, providing crucial insights for intervention areas and the development of healthcare services tailored to this population.
In conclusion, AD is a prevalent concern among GB-MSM, with significant implications for sexual satisfaction and behaviour. This study contributes valuable insights into the prevalence, intensity, associated factors, and healthcare-seeking behaviour related to AD within this population. This study highlights the challenge AD presents to modern proctology and the pressing need for specialized interventions. The high prevalence of AD and the willingness of many participants to seek medical help manifest the necessity of enhancing access to proctological care tailored to the unique needs of GB-MSM.