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In a 2010 clinical review article of heterosexual anal sex, the term anal intercourse is used to refer specifically to penile-anal penetration, and anal sex is used to refer to any form of anal sexual activity.

The review suggests that anal sex is exotic among the sexual practices of some heterosexuals and that "for a certain number of heterosexuals, anal intercourse is pleasurable, exciting, and perhaps considered more intimate than vaginal sex".

Men may also enjoy the penetrative role during anal sex because of its association with dominance, because it is made more alluring by a female partner or society in general insisting that it is forbidden, or because it presents an additional option for penetration.

While some women find being a receptive partner during anal intercourse painful or uncomfortable, or only engage in the act to please a male sexual partner, other women find the activity pleasurable or prefer it to vaginal intercourse.

Researchers say adequate application of a personal lubricant, relaxation, and communication between sexual partners are crucial to avoid pain or damage to the anus or rectum.

The anal sphincters are usually tighter than the pelvic muscles of the vagina, which can enhance the sexual pleasure for the inserting male during male-to-female anal intercourse because of the pressure applied to the penis.

As a result, we do not know the extent to which anal intercourse differs qualitatively from coitus." According to a 2010 study from the National Survey of Sexual Health and Behavior (NSSHB) that was authored by Debby Herbenick et al., although anal intercourse is reported by fewer women than other partnered sex behaviors, partnered women in the age groups between 18–49 are significantly more likely to report having anal sex in the past 90 days.

Anal sex is considered a high-risk sexual practice because of the vulnerability of the anus and rectum.

By contrast, people also regard anal sex as a natural and valid form of sexual activity that may be as fulfilling as other desired sexual expressions.

They may regard it as an enhancing element of their sex lives or as their primary form of sexual activity.

Vaginal intercourse was practiced more than insertive anal intercourse among men, but 13% to 15% of men aged 25 to 49 practiced insertive anal intercourse.

With regard to adolescents, limited data also exists.

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