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Try out PMC Labs and tell us what you think. Learn More. In-depth interviews were conducted with 81 Black MSM ages 20—39 years who were purposively recruited from four townships. The semi-structured interviews addressed sexual behavior and identity, alcohol use, and safer sex. Pain during RAI was brought up by many participants without specific prompting from the interviewer.

Analysis of the interview transcripts revealed that pain was a common feature of first RAI experiences but was not limited to first-time experiences. The participants attributed pain during RAI to partner characteristics, interpersonal dynamics, lack of lubricant, and alcohol use or non-use. The main strategies participants used to address pain during RAI were setting sexual boundaries and lubricant use; a small of participants reported purposefully consuming alcohol to prevent the pain associated 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, Other causes of pain during anal penetration may be sexually transmitted infections STIs such as herpes, or other anal health issues such as fissures and hemorrhoids Hollows, Experiences of pain during RAI are not uncommon and vary on different dimensions e.

Pain during RAI may be either situational i. In a sample of primarily white, gay-identified men in the U. Such symptoms could result from or precede incidents of painful RAI. In the African context, factors that are unique vulnerabilities for MSM elevate the issue of painful RAI from one of individual to public health ificance. Against the backdrop of the criminalization of homosexuality and high HIV prevalence in many African countries, African MSM face substantial barriers in accessing culturally appropriate and competent sexual health care. In some cases this le men to self-medicate, seek treatment from unqualified health workers, or not be forthright about their symptoms when seeking treatment Okal et al.

African MSM also have restricted access to condom-compatible lubricants Baral et al. Belgian MSM rated the lack of lubrication and of anal foreplay as the most important factors predicting pain during RAI Vansintejan et al. Participants also reported that prevalence and severity of painful RAI decreased as sexual experience increased Vansintejan et al.

Data for this study were from an ethnographic examination of the social organization of same-sex sexual practices and structural and psychosocial correlates of sexual risk behavior among Black MSM in four South African township communities. This ethnographic research, consisting of interviews as well as observations at taverns and with MSM friendship groups, was conducted to lay groundwork for quantitative research with this study population as well as future interventions.

Townships are residential areas that were deated for non-whites during the apartheid era; although residential racial segregation ended inthese areas remain almost entirely segregated today. All four of the townships where research was conducted were formerly deated as residential areas for Blacks.

Aside from the realities of the township geography and infrastructure, the daily lives of MSM may be impacted by the limited social acceptance of homosexuality in South Africa, which has implications for their safety and access to health care Baral et al. Although not originally an a priori focus of our research, many research participants made reference to painful RAI Naughty teens wants black girl sex their discussions of their sexual experiences with men. Given its implications for HIV risk and protective behaviors, as well as for sexual health, pleasure, and relationships more generally, we felt this topic merited closer examination.

In-depth interviews were conducted with 81 Black MSM from four township communities 20 participants each from Atteridgeville, Mamelodi, and Soshanguve, Naughty teens wants black girl sex 21 from Hammanskraal. Biological males who self-identified as Black upon screening, were 20—44 years old, resided in one of the four targeted townships, and who reported oral, anal, or masturbatory sex with at least one male in the preceding year were eligible to participate.

Twenty-five participants reported a lifetime history of sexual experience with women and about half of these participants reported current involvement with female sexual partners. Snowball referrals were also made by interview participants. The Project Manager conducted an initial phone screening with each interested candidate, to ensure that he met the study eligibility criteria and to inform the purposive selection of individuals for interviews. Purposive selection of participants was used to ensure that the sample was diverse in terms of age, sexual orientation self-identification, gender presentation, and choice of sexual partners i.

Trained interviewers used a semi-structured guide to conduct interviews that lasted approximately 90 minutes. As is common among South Africans who live in township communities, discussions were sometimes conducted in more than one language, and most other interviews were conducted in a combination of English and Tswana Setswana or Northern Sotho Sepedi.

A few interviews were conducted completely in Tswana or Northern Sotho. All interviews were transcribed in full; passages or complete interviews that were not in English were translated during transcription. The interview guide covered topics such as sexual and gender identity, MSM social networks, family and community acceptance, alcohol and drug use, sexual practices including safer sex behaviors, and experiences with HIV testing.

Qualitative data were coded for purposes of this study in two stages, concept-driven and data-driven coding Gibbs, First, three coders completed concept-driven coding by independently applying a set of a priori codes to the interview transcripts, using Atlas. Initially, each transcript was coded by two coders, who met to reach consensus on the coding and produce reconciled, coded transcripts 37 of the 81 interview transcripts.

After consensus about the coding process was reached, the remaining 44 transcripts were coded by one of three coders. It became clear during the process of concept-driven coding, and upon review of the quotations associated with some of the concept-driven codes e. For purposes of this investigation, a second round of data-driven coding was undertaken in order to organize all the material related to painful anal intercourse in consensual sexual encounters.

Data-driven coding was completed by the first author and reviewed by a co-author. Experiences of rape or other sexual violence were excluded from this analysis except in one case where painful RAI precipitated a rape a total of 17 participants disclosed that they were victims of sexual violence. Clear descriptions of sexual role preferences were provided by 74 of the 81 study participants the remaining participants did not wish to disclose this information, indicated they did not care for anal intercourse, or had not engaged in anal intercourse.

Of those participants who engaged in RAI because it was their exclusive preference, or because they were versatile, nearly all identified as gay. Most of these participants saw themselves as more feminine than masculine. With the exception of one who did not like anal sex, all the participants who identified as transgender or drag queens also reported a preference for RAI.

Descriptions of personal experience with painful RAI therefore come primarily from gay-identified MSM in this study, as the straight-identified MSM and the majority with either a bisexual self-identification or bisexual attractions preferred insertive AI only.

Table 1 provides a listing and description of all participants who are directly quoted in the following sections. Of all 81 study participants, only those quoted in the text are included in this table. Participants reported on their first same-sex sexual experiences and how old they were at the time. Sixteen participants indicated that their first same-sex sexual experience occurred before the age of 16; 44 participants were aged 16—19; and 17 had their first experiences after age 20; this data was missing from four respondents.

Most participants who were able to recall when they first experienced same-sex attractions reported that they experienced such attractions prior to their first same-sex sexual encounter. More than three-quarters Naughty teens wants black girl sex participants described first same-sex sexual experiences that involved anal intercourse.

Participants commonly described these experiences as painful. A smaller group of men described them as both painful and pleasurable. Six participants reported that their first same-sex sexual experience, beyond being painful, involved serious anorectal trauma.

Four of these participants reported bleeding during or after the encounter, and one reported having hemorrhoids piles at the time of first RAI. The story shared by Tlotliso exemplified the potential vulnerability of MSM in their first sexual encounters, which could be amplified by the need or desire for secrecy about engaging in same-sex sexual behavior.

This participant, who had his first same-sex sexual experience at age 16, described several unexpected consequences, one of which was the disclosure of his sexual behavior to his mother:. So around 11 a. It was pain from behind. It was painful but I ignored it. The pain alerted me to go to the toilet, I felt like defecating. I went to the toilet and defecated, and as I was busy, blood dripped in the toilet. Afterwards I told my friend, and my friend explained to me what was happening. After some time I felt better and I took a bath and came home; when I got there I told myself that the pain would not happen again.

On Monday, when I went to the toilet again, the same thing happened and my mom was at home. When I got there, the doctor told me to climb on the bed and he inspected me and when he was done he told my mother that I am being naughty and that I know what I did and that I will tell her what I did. So my mother asked me what I did and I told her. This quotation illustrates a range of negative outcomes that could possibly have been prevented had Tlotliso received some advance education about how to avoid or address such outcomes.

Participants were asked about subsequent same-sex sexual experiences i. Twenty-one participants referred in their interviews to personal experiences with painful RAI, and we focus here on these descriptions. Additional participants made reference to anal sex as painful, though they were not necessarily describing personal experiences i.

The gay-identified men in our sample tended to have more same-sex sexual experience than their bisexual- or straight-identified counterparts. It gets difficult because you have to tell him what to do, where to penetrate, what not to do, things like that. Participants described other attributions for painful RAI that seemed to arise during the sex act: positions or encounters that were uncomfortable, encounters that did not go as planned, partners whose desires did not align with their own. Several participants reported experiencing pain as a result of anal intercourse that, although consensual, was either too rough, too fast, or too slow.

Sizwe shared the following story about a negative sexual experience:. But he was my boyfriend, my steady boyfriend, so like I had to just, you know, end the relationship because of that sex.

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“This Will Not Enter Me”: Painful Anal Intercourse among Black Men Who Have Sex with Men in South African Townships