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INTRODUCTION. Anal intercourse is a common practice among both heterosexual and homosexual couples where at least one of the partners is male. Approximately 20of women engage in anal intercourse and among homosexual male populations, anal intercourse is common, yet little is known about the impact of anal intercourse on fecal continence ().Men engaged in anal intercourse may Location: Rockville Pike, Bethesda, MD , , ,   TMI Alert! Teen Mom star Farrah Abraham shared on her Instagram page Saturday photos from her-wait for it-vaginal rejuvenation saintmarkaugusta.net one of the pics, the year-old is

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The internal anal sphincter contributes to the majority of the anal resting pressure. Anal intercourse could dilate and eventually stretch the internal and external anal sphincters leading to damage of these structures, as demonstrated by the lower resting pressure. This lower pressure and possible damage to the internal and external anal sphincters could lead to FI via muscle atrophy and sensory deficits. Smaller clinical cohort studies have found than women with and without FI have lower anal pressures than men 18 We did not see differences in the FISI scores among those with and without the self-report of anal intercourse.

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FI severity, as measured by the FISI scores, only measures the frequency of stool loss and the type of leakage including flatus, mucus, liquid, or solid stool. FISI scores do not take into account fecal urgency or the conditions when FI occurs, such as passive leakage or urgency leakage. Anal intercourse may affect urgency or passive FI more than the type of leakage that occurs. In addition, anal intercourse may only have a small impact on fecal continence so that it lowers the threshold for occurrence without worsening severity.

In addition, we were unable to quantify the frequency of anal intercourse in this population and it is possible that the majority of individuals rarely practice anal intercourse, which would have decreased the impact on FI severity. More data are needed to further test this hypothesis. The strengths of this study include the population-based study design as well as a large sample size.

Prior studies have been limited by gender and we were able to include both genders in this study. Finally, validated questions were used for both FI and stool consistency, which have been shown to be valid and reliable in the assessment of bowel symptoms.

There are several limitations in this work. There are no validated questions for anal intercourse and we were unable to assess the frequency of anal intercourse among women. In addition, the definition utilized in this study for male anal intercourse is imperfect and limited to the questions asked in this NHANES cycle. A sensitivity analysis including only the 69 men who responded positively to both questions, revealed similar results.

Although the definition of anal intercourse for men in this study may overestimate the number of men engaged in anal intercourse, studies have shown that men who report sex with men frequently report at least some experience with anal intercourse We could not distinguish between consensual anal intercourse and non-consensual anal intercourse in this cohort. Both men and women may be reluctant to divulge anal intercourse practices. We have previously found that women are more likely to respond positively to a written questionnaire than oral history taking with regard to FI; although the questions were administered in private, we do not know the concordance between oral and written history taking for anal intercourse When using cross-sectional data sets, such as NHANES, we are not able to prove causality between the outcome of interest FI and the exposure variables.

We also did not adjust our analyses for multiple testing and all the potential confounding variables of the association between anal incontinence and FI may not have been queried in a broad study of health factors such as NHANES.

Lastly, stool consistency assessment was only asked for the usual or most common type and may not represent the more episodic changes in stool consistency that may occur with FI episodes.

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These results provide initial epidemiologic evidence supporting a link between anal intercourse and FI among both men and women.

These results provide evidence to inform discussions between patients and providers with regard to the association between FI and anal intercourse. Future studies evaluating multicomponent interventions to improve FI could consider counseling regarding the association of anal intercourse and FI as part of standard practice.

Risk factors for fecal incontinence that are similar among women and men include comorbidity and loose stool consistency.

Decreased anal sphincter pressures may be related to anal intercourse in small clinical series data. Men who practiced anal intercourse had higher odds of having fecal incontinence than women. Assessment of sexual behaviors may be important consideration among adults with fecal incontinence.

Financial support: This study was supported in part from a Veterans Health Administration Career Development Award CDA-2 to Alayne D. Markland and Camille P. Vaughan 1 IK2 RX Specific author contributions: Conception, initiation, and writing: Alayne D.

Markland; conception, writing and editing of manuscript: Gena C. Dunivan, Camille P. Vaughan and Rebecca G. Rebecca G. Rogers receives royalties from UptoDate and McGraw Hill for educational writings; she is the DSMB chair for the TRANSFORM trial sponsored by American Medical Systems.

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Gena C. Dunivan receives research support from Pelvalon. National Center for Biotechnology InformationU. National Library of Medicine Rockville PikeBethesda M USA.

NCBI Skip to main content Skip to navigation Resources How To About NCBI Accesskeys My NCBI Sign in to NCBI Sign Out. PMC US National Library of Medicine National Institutes of Health.

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Author manuscript; available in PMC Feb 1. PMCID: PMC NIHMSID: NIHMS Alayne D. Marklan DO, MSc, 1, 2, 3 Gena C. DunivanMD, 4 Camille P. VaughanMD, MS, 1, 5 and Rebecca G. RogersMD 4. Markland 1 Birmingham Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA 2 Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Atlanta, Georgia, USA 3 Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, UAB Center for Aging, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA Find articles by Alayne D.

Dunivan 4 Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, New Mexico, USA Find articles by Gena C. Camille P. Vaughan 1 Birmingham Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA 5 Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia, USA Find articles by Camille P.

Rogers 4 Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, New Mexico, USA Find articles by Rebecca G. Author information Copyright and License information Disclaimer. Correspondence: Alayne D. cmbau dnalkrama.

Copyright notice. The publisher's final edited version of this article is available at Am J Gastroenterol.

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See other articles in PMC that cite the published article. RESULTS Overall, 4, adults aged years 2, women and 2, men completed sexual behavior questionnaires and responded to fecal incontinence questions. Joy Villanueva, 15, holds her baby. The slums where her family lived had burned down; they hope to build a new shack to replace the home they lost.

He was tall and handsome, and she liked that he did chores around the house and washed the dishes for his mother. Soon she was living with him.

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For her boyfriend, getting Joy pregnant was a mark of ownership. Joy resisted, but he persuaded her to have sex. By the time she gave birth, he was in jail for theft, and she was raising the baby with help from his mother.

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The day we met, the three of them were living together in a makeshift home of little more than a tarp supported by planks of wood - they had set it up after their slum had burned down a week before.

At 15, Joy dreamed of finishing high school, going to college and becoming a police officer.

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That was what her late father wanted for her when she was a little girl. She said that any day now, she'll move in with her mother, who will take care of the baby while she goes to class.

Joy Villanueva said she hopes to fulfill her father's dream for her and becoming a police officer - but later admitted that's an impossible dream for a poor teenage mom.

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If Joy is able to complete her schooling, she said she wants to own a big house made of concrete with air conditioning and glass windows. She wants to have a nanny to take care of her kids so she can wake up every morning, check her uniform in the mirror and go to work. For 20 minutes, she told me about her plans for the future. But when I said a word of encouragement, Joy went silent, looked away and shook her head. Hindi nashe said.

I can't anymore. It was a game of pretend. She shifted Ashley in her arms. Joy confessed that her mother has disowned her. So she can't go to live with her. Her husband's mother earns just enough to feed her and the baby.

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There's no money for notebooks or uniforms or college. They're trying to gather enough materials to build a shack so they don't have to continue living under a tarp. Girls like Joy are classified among the poor, a vast category that encompasses 20 percent of Filipinos. Among teenage mothers of all income brackets, the poorest girls are the least likely to be able to finish their high school education after having their first child. Likhaan's clinic is a mile and a half down the road from where Joy lives.

The organization advocates for reproductive health and fills the gap in services the government does not provide, like formal sex education, ready access to free contraception like IUDs and birth control implants.

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Diane Vere, a community coordinator, leads workshops for teenagers from the surrounding slums. The topic is sex.

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Inevitably, when Vere turns to the page in the photo workbook that shows an array of penis sizes and shapes, the teenagers break into peals of laughter. They cover their eyes and hide behind one another. Vere fields their questions: Why are some bigger than others? Why is that one crooked? She shows them an uncircumcised penis and tries to dispel the myth that a boy in this condition is dirty or incapable of impregnating women. Before the reproductive health law, there was no formal sex education in the Philippines, and to this day, the rollout remains patchy, fraught and very limited.

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Teenagers cobble together information based on what their parents ventured to tell them, sermons from priests and whispers from one another, often gleaned from the Internet or old wives' tales.

Was it true, the girls at the clinic class asked, that if you wash your face with a girl's first menstruation, it prevents pimples?

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If a girl jumps from the third step of a ladder, would her period only last three days? Does masturbating make boys taller? Can you get pregnant if you have sex only once? While the teenagers were fascinated with the practicalities and hygiene of sex and puberty, they struggled to discuss the process of conception. Bring up the difficulties and cost of raising a child, Vere said, and the teenagers would shut down or quickly change the subject.

Teachers often did not fare better. Some teachers had to be excused from a recent training because they couldn't control their laughter when frank discussions about sexual organs came up. Every acceptable word in Tagalog to describe sex or private parts is a euphemism: peanut, flower, junior, eggplant. Teachers complain that every proper noun in this category is too vulgar to say out loud.

With this combination of discomfort and lack of formal training on teaching sex, it is not surprising that 59 percent of Philippine educators said they had difficulty naming body parts, according to a survey by the United Nations Population Fund. In previous years, sex educators in schools preached abstinence, and anything beyond abstinence was limited to what the teachers knew.

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Often it didn't extend beyond basic science and was heavily inflected with religious and personal beliefs. Basiao-Abella said one teacher told her students that condoms were murderers because they killed sperm.

She said a pastor told congregants that condoms spread AIDS, a mistaken belief reiterated by a sitting senator as recently as Scientifically proven," Sen. Vicente Sotto III erroneously stated during a public argument with another politician. To address gaps in knowledge and uneven information, the Philippine education department is developing a comprehensive sexual education curriculum, which it had begun to roll out in the public school system before schools were closed by the pandemic lockdown.

Much like 's reproductive health law, the process of developing the curriculum has been embattled. Risa Hontiveros believes progress is coming, even if it's in fits and starts. Hontiveros, who sponsored one of the bills to prevent adolescent pregnancy and was at the forefront of the decadelong battle for the law, said the Catholic hierarchy continues to oppose legislation counter to its teaching but with "less of the stridency and less of the hostility than previously demonstrated.

In one of Manila's poor neighborhoods, a midwife prays to her saint, Ina ng Awathe mother of pity or compassion. The carved wood statue hanging on the wall of her home is oily and chipped from age. A string of dried-out jasmine flowers hang from one outstretched hand, and on the other, the saint cradles a baby.

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The midwife believes Ina ng Awa is the patron saint for the women who come to her asking for abortions. In the Philippines, abortions are illegal in all cases.

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Perhaps more powerfully, abortion is considered a sin. The midwife understands all this yet will offer abortions. She asked that her name not be used for fear of arrest or reprisal.

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The women who come to her are too poor to raise another child or unwed and ashamed or so young, she said. She demonstrates her technique for massaging a woman's womb: a scooping motion to lift the uterus, then she grinds down with her fingers to crush the fetus, pressing into a woman's belly until her hands start to cramp.



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