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Fact check: Are there any notable risks or drawbacks to pegging for men's physical health?
Executive Summary
Pegging (anal penetration of a man by a partner) carries both reported benefits—enhanced intimacy, communication, and pleasure—and measurable physical risks documented in sexual-health research. Recent studies and large surveys link receptive anal intercourse with pain, anal-related pelvic floor disorders, and an increased prevalence of fecal incontinence, while STI risk for insertive partners remains a documented concern; qualitative work emphasizes the importance of consent and technique to mitigate harms [1] [2] [3] [4] [5].
1. Why some researchers flag physical harms — and what the data says
Anal penetrative intercourse is associated with anodyspareunia (anal pain) and pelvic floor disorders, according to a 2024 analysis that reports pain in a substantial minority of men and a larger share of women engaging in anal sex, framing penetrative activity as a risk factor for pelvic dysfunction and fecal leakage [1]. A separate large survey of 21,762 men who have sex with men found an 8% prevalence of fecal incontinence, with higher rates among those reporting frequent receptive anal intercourse, chemsex, and vigorous practices, indicating that frequency and intensity of activity influence outcomes [2]. These quantitative signals show clinically relevant risks that merit prevention and screening.
2. How common these problems are — putting prevalence into perspective
The 21,762-person survey provides the most concrete prevalence estimate in the set: 8% reporting fecal incontinence, with elevated prevalence tied to behavioral factors that increase mechanical strain or reduce control. The 2024 pelvic-floor-focused study documents 15% of men reporting some degree of anal pain related to penetrative encounters, contrasting with higher rates in women, and underscores that not everyone experiences harm but that a meaningful minority do [2] [1]. These figures suggest that while pegging is not uniformly harmful, clinicians and participants should treat the activity as carrying nontrivial population-level risk.
3. Sexually transmitted infection concerns — where insertive vs receptive roles matter
STI risk varies by role and practice. A 2024 cross-sectional study found insertive anal sex was a leading risk factor for urethral gonorrhea among men who have sex with men, while specific lubricant practices (saliva for masturbation) showed no association [3]. This implies that pegging can carry STI transmission risk for the insertive partner, and safe-sex measures such as barrier methods, testing, and partner screening remain important for reducing microbial hazards separate from mechanical injury [3]. The data highlight that STI prevention and mechanical-injury prevention require different mitigation strategies.
4. Where qualitative research highlights benefits and perceived safety
Qualitative studies from 2023 emphasize that pegging often occurs within communicative, trust-based relationships and is associated with novelty and heightened psychosexual arousal; many participants report increased intimacy and mutual pleasure without necessarily mentioning physical harm [4] [5]. These reports demonstrate that for many people pegging is a positive sexual practice when partners negotiate consent, technique, and pacing. The qualitative evidence therefore frames pegging less as inherently risky and more as an activity whose safety is shaped by communication, preparation, and mutual respect [4] [5].
5. What’s missing from the evidence — gaps that matter for interpretation
The available studies vary in scope: large surveys quantify incontinence and correlate it with behaviors, while qualitative work focuses on experience and relationship effects; few studies isolate pegging specifically or control for lifetime anal sex exposure, lubricant use, prosthesis size, or preexisting pelvic-floor conditions. The 2024 pelvic-floor paper and the 21,762-person survey document associations but cannot fully determine causality, and several qualitative studies do not report physical-outcome data, leaving uncertainty about which practices, frequencies, and anatomies drive risk [1] [2] [4].
6. Practical, evidence-aligned harm-reduction steps to lower physical risk
The literature implies concrete mitigation strategies: gradual progression, ample lubrication, communication on pain thresholds, pelvic-floor training, and routine STI screening. The pelvic-floor study recommends education and physical therapy for prevention and treatment, while surveys link harm to frequent, intense practices, suggesting reduced frequency/intensity and attention to technique can lower risk [1] [2]. These measures match the dual nature of risks—mechanical versus infectious—and align with findings across both qualitative and quantitative sources.
7. Bottom line for clinicians, partners, and policymakers
Combine evidence of nontrivial physical risks (pain, pelvic-floor disorders, fecal incontinence, role-specific STI exposure) with consistent reports of relationship and sexual benefits to conclude pegging is neither uniformly dangerous nor universally safe. Research gaps remain, especially studies that isolate pegging practices and quantify dose–response effects; meanwhile, clinical guidance should stress assessment, education, and pelvic-floor support for those experiencing symptoms, while sexual-health messaging should promote negotiated consent, safer-sex practices, and regular testing [1] [2] [3] [4].