Learning how to safely and comfortably engage in anal sex may be especially challenging for MSM, whose needs within the context of sexual practices are rarely addressed in school-based sex education curricula or by parents ( Kubicek, Beyer, Weiss, Iverson, & Kipke, 2010). Pain however may be a normal part of one’s early experiences with RAI. Pain can occur during anal penetration when the external anal sphincter is not relaxed because the anus does not self-lubricate, lubricating substances are also needed to reduce pain from friction ( Hollows, 2007). This study presents findings from qualitative research with Black MSM in South Africa their experiences of and attributions for painful receptive anal intercourse (RAI) are discussed, as are their responses to RAI in terms of HIV risk and protective behaviors. Despite some empirical studies of painful sex experiences in samples of men who have sex with men (MSM) in North America and Europe, and some attention within HIV research among MSM in Africa, our understanding of pain during anal intercourse remains limited, particularly in relation to HIV risk and protective behaviors among MSM. Sexual pain has been studied mainly in the context of heterosexual vaginal sex, and as a consequence, there has been limited study of painful anal intercourse in either women or men ( Sandfort & de Keizer, 2001 Štulhofer & Ajduković, 2011).
Culturally-specific sexual health education, supportive sexual health services, and improved access to condom-compatible lubricants are important components of HIV/STI interventions for this population. Black South African MSM can be supported to reduce pain during RAI in ways that reduce their HIV/STI risk. The main strategies participants used to address pain during RAI were setting sexual boundaries and lubricant use a small number of participants reported purposefully consuming alcohol to prevent the pain associated with RAI. The participants attributed pain during RAI to partner characteristics, interpersonal dynamics, lack of lubricant, and alcohol use or non-use. Analysis of the interview transcripts revealed that pain was a common feature of first RAI experiences but was not limited to first-time experiences. Pain during RAI was brought up by many participants without specific prompting from the interviewer.
The semi-structured interviews addressed sexual behavior and identity, alcohol use, and safer sex. In-depth interviews were conducted with 81 Black MSM (ages 20–39 years) who were purposively recruited from four townships. The purpose of this study was to identify attributions for and responses to painful RAI among Black MSM in South African townships. Little is known about painful receptive anal intercourse (RAI) and its relationship to HIV risk and protective behaviors among men who have sex with men (MSM).