Perceptions and experiences of receptive anal intercourse among women: a systematic review and thematic analysis.

Introduction: Receptive anal intercourse (RAI) is an increasingly reported sexual practice across diverse populations and carries a higher risk of certain health consequences, including HIV and other sexually transmitted infections, anal trauma and anorectal disorders, compared with vaginal intercourse. Despite these risks, research exploring women's experiences, motivations and perceptions of RAI remains limited. Much of the existing literature has focused on gay and bisexual men, leaving women's perspectives comparatively underexamined and their ability to make fully informed sexual-health decisions constrained by this evidence gap. Objectives: This qualitative systematic review and thematic synthesis aimed to explore women's perceptions, motivations and experiences of RAI, including how societal attitudes and gender dynamics shape these experiences. Methods: A qualitative systematic review and thematic analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of PubMed, PsycINFO, CINAHL and Embase identified peer-reviewed qualitative studies published between January 2010 and June 2025 that examined women's views and experiences of RAI. The Sample, Phenomenon of Interest, Design, Evaluation, Research type framework guided study selection, and data extraction captured study characteristics and verbatim qualitative findings for synthesis. Results: 22 studies encompassing 593 women across 12 countries were included. Participants represented diverse ages (14-84 years) and socioeconomic backgrounds. Three overarching themes emerged: (1) motivations for engaging in RAI, often linked to partner expectations, intimacy or curiosity; (2) experiences, spanning pain, discomfort and coercion, but also instances of pleasure and agency and (3) societal views, which reflected both normalisation and enduring stigma. Women's accounts revealed that RAI is negotiated within relational and cultural constraints, where agency and coercion, pleasure and pain, frequently coexist rather than oppose one another. Conclusions: Women's experiences of RAI reveal a complex interplay between sexual agency, bodily autonomy and social meaning. Recognising that pleasure and discomfort can coexist and that decisions are often shaped by relational and cultural dynamics highlights the need for open, non-judgemental discussion of RAI within sexual-health education and clinical practice. Addressing stigma and providing evidence-based guidance can support informed, consensual and safe sexual decision-making for women.