Which nationally representative sexual‑behavior surveys include questions on directionality of anal sex (who is the penetrator)?
Executive summary
Most major U.S. nationally representative sexual‑behavior surveys ask about whether respondents have had anal intercourse, but explicit questions that distinguish directionality — who was insertive versus receptive — are rare in the public reporting; the clearest documented example of directionality reporting appears in analyses that reference insertive (men) versus receptive (women) lifetime anal sex from the National Health and Social Life Survey (NHSLS) and its descendant analyses [1] [2]. Available technical notes and publications for the National Survey of Family Growth (NSFG) and the National Survey of Sexual Health and Behavior (NSSHB) confirm measurement of anal intercourse prevalence but do not present clear, explicit, nationally representative question wording that separates penetrator versus receptive roles in their publicly cited summaries [3] [4].
1. National Health and Social Life Survey (NHSLS) — the clearest national source that reports insertive vs. receptive
The NHSLS, the pioneering nationally representative U.S. sexual‑behavior survey from 1991, is cited in later national analyses that report lifetime anal sex with gendered role labels — for example, lifetime anal sex reported as 43% of men (insertive) and 37% of women (receptive) — indicating directionality was captured or at least inferred in analyses drawing from NHSLS or related probability samples [1] [2]. That PLOS One analysis (the “Sexual diversity in the United States” article) explicitly uses the wording “insertive” for men and “receptive” for women when reporting lifetime anal sex prevalence, which is the strongest documented instance in the provided reporting of national survey output treating penetrator role as a distinct variable [1].
2. National Survey of Family Growth (NSFG) — measures anal sex but public reports emphasize prevalence, not penetrator role
CDC/NCHS publications based on NSFG waves list oral and anal sex among behaviors and direct readers to technical notes for question wording, and they aggregate same‑sex and opposite‑sex behaviors in reporting; the public summaries emphasize prevalence and partner sex rather than explicit insertive/receptive directionality questions in the main tables [3]. The NSFG’s technical notes (referenced in the CDC report) may contain more detailed item wording, but the provided source snippets do not present clear evidence that the NSFG publicly reports a direct question asking “who was the penetrator” in anal sex encounters [3].
3. National Survey of Sexual Health and Behavior (NSSHB) — comprehensive on behaviors but not shown to separate penetrative roles
The NSSHB is the largest modern nationally representative probability study of U.S. sexual behavior and documents frequency and prevalence of partnered acts including anal intercourse; its publications emphasize reporting of anal intercourse prevalence, giving/receiving oral sex, and event frequency, but the excerpts provided do not show NSSHB outputs explicitly coding insertive vs. receptive roles for anal sex in the way the NHSLS/PLOS reporting does [4] [5] [6]. NSSHB methodological transparency and wave reports suggest rich behavioral detail, but the available summaries and papers cited here focus on whether anal sex occurred and its timing/frequency rather than explicit role directionality [4].
4. Other national or large surveys and limitations of the public record
Other nationally referenced surveys (e.g., more recent probability samples, SIPS, and several city‑based HIV behavioral studies) routinely ask about anal intercourse prevalence, event‑level characteristics, age of initiation, and risk behaviors, but either have limited geographic scope (not nationally representative) or do not publish penetrator/receptive role in the public summaries provided here [7] [8]. Recent convenience or clinic‑based studies and specialty questionnaires (for example, anatomy/erogenous zone mapping studies) ask detailed receptive‑oriented questions but are not nationally representative probability samples [9] [10].
5. Bottom line and transparency about limits in the sources
Based on the provided reporting, the NHSLS (and analyses derived from nationally representative probability samples that reference it) is the clearest nationally representative source that reports insertive versus receptive counts for anal intercourse; major modern national surveys (NSFG, NSSHB) definitely measure anal intercourse prevalence and related event details but — in the excerpts cited — do not clearly publish a simple “who was the penetrator” item in their public summaries, and the NSFG’s technical notes would need to be inspected directly to confirm whether that specific question exists in current instrument wording [1] [3] [4]. The evidence base in the supplied sources is limited; if exact questionnaire items are required, consulting the NSFG technical documentation and NSSHB questionnaire archives is the next verifiable step [3] [4].