Factors Associated With Fecal Incontinence After Receptive Anal Intercourse in Men Who Have Sex With Men

Fecal incontinence, or the involuntary leakage of stool, is an anorectal dysfunction that can affect men and women of all sexual orientations. Though it is a condition that can negatively impact a person’s quality of life, it is thought to be underreported due to patients’ embarrassment and the historically taboo nature of the topic.

Many studies have focused on infectious conditions that can be transmitted during receptive anal intercourse (RAI), but few have been devoted to assessing RAI and fecal incontinence. As such, the authors of a new study published in the Journal of Sexual Medicine aimed to determine the prevalence of fecal incontinence in a large sample of men who have sex with men (MSM) who engage in RAI. Furthermore, they strived to identify risk factors associated with fecal incontinence in this population.

For this research, the authors leveraged an anonymous, online self-administered survey originally developed by Public Health France (the French health ministry) to assess HIV prevention strategies in MSM in France called the “Enquête Rapport Au Sexe” (ERAS). This study included one question related to fecal incontinence: “During the last month, have you experienced any involuntary leakage of stools?”

Participants were recruited to take the ERAS survey through digital banners on gay dating sites, apps, and news sites. A total of 24,308 individuals participated in the survey, and 21,762 individuals were included in the present analysis. (Because the aim of this study was to assess fecal incontinence in MSM, participants who had never had sex with a man or who did not respond to the question about stool leakage were excluded from this sample).

Of the 21,762 participants included, 1,734 (8%) reported leaking stool in the previous month. Overall, these respondents were slightly older than those who had not reported leaking stool in the previous month (a median age of 38.5 years versus a median age of 32 years). This group also had a higher proportion of unemployed and retired individuals (8.2% versus 5.4% unemployed, 11.9% versus 6.3% retired).

The men who responded that they engaged in RAI several times a week showed a 12.7% prevalence of fecal incontinence compared to a 5.7% prevalence for those not engaging in RAI. Those who participated in chemsex (using psychoactive substances during sexual activity) had significantly higher rates of fecal incontinence than those who did not (21.4% versus 7.2%), as did those who engaged in fisting or hard BDSM practices (18.1% versus 7.2%).  

Given these results, the authors identified high-frequency RAI, age, lower socioeconomic status, chemsex, and fisting or hard BDSM practices as factors related to fecal incontinence for MSM. On the other hand, those who engaged in what the authors called “simple RAI” (RAI once a week without chemsex or fisting) did not demonstrate a significantly increased risk of fecal incontinence.

Resources:

Garros, A., Bourrely, M., Sagaon-Teyssier, L., Sow, A., Lydie, N., Duchesne, L., Higuero, T., Damon, H., Velter, A., & Abramowitz, L. (2021) Risk of Fecal Incontinence Following Receptive Anal Intercourse: Survey of 21,762 Men Who Have Sex With Men. The Journal of Sexual Medicine, 18(11), 1880-1890. DOI: https://doi.org/10.1016/j.jsxm.2021.07.014