Understanding the Experience of Receptive Anal Intercourse in Patients with Chronic Pelvic Pain Syndrome.

Balcazar JA, Gaither TW, Anderson M, Russell MM, Litwin MS. Understanding the Experience of Receptive Anal Intercourse in Patients with Chronic Pelvic Pain Syndrome. Urology. 2025 Jun 12 DOI: 10.1016/j.urology.2025.06.015.

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Abstract:

OBJECTIVE: To identify Chronic pelvic pain syndrome (CPPS) correlates in receptive anal intercourse (RAI)-engaging individuals and their association with the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) scores. CPPS, or category III prostatitis, causes pelvic pain, urinary symptoms, and sexual dysfunction. Its etiology remains unclear, but may involve visceral crosstalk, where dysfunction in one pelvic organ affects another. METHODS: We conducted an online cross-sectional survey (July 2022-January 2023) of individuals assigned male at birth who engaged in RAI in the past six months. Participants completed the NIH-CPSI and Anorectal Sexual Function Index to assess pain, urinary and bowel symptoms. Mental health symptoms, childhood trauma, and urologic, gastrointestinal, and anorectal conditions were also assessed. NIH-CPSI severity groups: non-mild ( < 10), moderate (10-18), and severe ( > 18). Analyses included Kruskal-Wallis and chi-squared tests. RESULTS: Among 408 participants, 117 (28.7%) had moderate/severe CPPS. Higher NIH-CPSI scores correlated with decreased pleasure (p = 0.001), increased pain (p < 0.001), and greater urinary/bowel symptoms. Lower RAI exposure ( < 50 times) correlated with higher NIH-CPSI scores (p = 0.01). Comorbid urologic, gastrointestinal, and anorectal conditions, childhood trauma, and mental health symptoms were associated with CPPS severity (p < 0.001). CONCLUSIONS: These findings highlight the interplay between CPPS severity, sexual function, and comorbid conditions in RAI-engaging individuals. Visceral crosstalk may contribute to anorectal symptom overlap, while mental health and childhood trauma align with the central sensitization models of chronic pain. The inverse relationship with CPPS severity suggests pelvic floor dysfunction or desensitization mechanisms, thus multidimensional management is essential.