In a prevalence study of 526 consecutive gynecologic patients, a history of heterosexual anal intercourse (AI) was elicited in 25% and was a regular means of sexual gratification in 8% and was thus deemed active, pleasurable, and intercourse (APAI). The prevalence of AI and APAI was similar in patients of Mexican-American, Black-American and Anglo-American background and in patients older or younger than 30 years. The APAI participants were evenly distributed between cancer detection, family planning, free clinic and private consultant populations. The goals of the APAI group associated with heterosexual anal intercourse were pleasure, orgasm and contraception. The reported complications were infrequent and were related to infectious diseases, local irritation and trauma. Although the average duration of APAI was two years, no unusual pelvic or rectal characteristics were noted in these patients.