Hot on the heels of COVID-19, Monkeypox is in the news for an alarming spread among people who engage in risky sexual behavior, because it is transmitted primarily through direct contact with infectious sores, scabs, or body fluids.

Healthcare professionals, particularly those in general practice, gastroenterology, and colorectal surgery, are going to need to discuss sexual behavior to make patients better informed. A new analysis of survey results finds that applies to young heterosexual women as well.

Surgeons Tabitha Gana and Lesley Hunt argue that physicians“have a duty to acknowledge changes in society around anal sex in young women, and to meet these changes with open neutral and non-judgemental conversations to ensure that all women have the information they need to make informed choices about sex.”

In the USA, 30 percent of men and women report having anal sex while in Britain, the National Survey of Sexual Attitudes and Lifestyle shows people who admit participation in heterosexual anal intercourse (16 to 24 year-olds) rose from 12.5 percent to 28.5 percent over the last few decades. Anal intercourse has been considered a risky sexual behavior because of its association with alcohol, drug use and multiple sex partners. But it is also associated with specific health concerns, explain the authors. Women are at a higher risk of incontinence than men, due to their different anatomy, and anal intercourse can lead to increased rates of fecal incontinence and anal sphincter injury. Along with another avenue for spreading disease.

Effective management of anorectal disorders requires understanding of the underlying risk factors, and good history taking is key, they say. Yet clinicians may shy away from these discussions. In Britain, NHS patient information on anal sex considers only sexually transmitted diseases, making no mention of anal trauma, or incontinence.

“It may not be just avoidance or stigma that prevents health professionals talking to young women about the risks of anal sex. There is genuine concern that the message may be seen as judgmental or even misconstrued as homophobic,” the authors note. “However, by avoiding these discussions, we may be failing a generation of young women, who are unaware of the risks.”