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Mc Bride's 2010 clinical review on heterosexual anal intercourse and other forms of anal sexual activity, it is suggested that changing norms may affect the frequency of heterosexual anal sex.Mc Bride and her colleagues investigated the prevalence of non-intercourse anal sex behaviors among a sample of men (n=1,299) and women (n=1,919) compared to anal intercourse experience and found that 51% of men and 43% of women had participated in at least one act of oral–anal sex, manual–anal sex, or anal sex toy use.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.

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.

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".

In addition to sexual penetration by the penis, people may use sex toys such as butt plugs or anal beads, engage in fingering, anilingus, pegging, anal masturbation or fisting for anal sexual activity, and different sex positions may also be included.

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