Factors associated with self-reported unprotected anal sex among male sex workers in Mombasa, Kenya. For example, Mosegi described how what began as a consensual sexual encounter ended in rape when he withdrew consent during an attempt at intercourse that was painful: Although we make comparisons to other studies with some caution, given that participants in this study were not asked directly about painful RAI, we note that no participants in this study reported limiting their behavior to insertive anal intercourse in response to pain in the receptive role, although this has been found among MSM in the U. So I will tell him to think of something. Some participants set sexual boundaries specifically related to lubricant use, saying that they would not engage in anal intercourse if lubricant was not available. Despite these limitations, the fact that participants in this study discussed painful RAI in relation to sexual practices and decisions without direct questioning by the study interviewers, further suggests it is an issue that many MSM prioritize. These concerns were echoed by key informants e. The ways in which these men are already coping with this issue also suggest several opportunities for effective sexual health and HIV prevention educational interventions. How big it is…? And so why did he end up beating you up? As Tumelo explained, when describing how drinking affected his sexual behavior, the numbing effect of alcohol during a sexual encounter could sometimes have consequences later: Okay, what was painful about the sex? Setting sexual boundaries Several participants described setting personal boundaries regarding what they would and would not do sexually as a response to experiences of painful RAI and to avoid anal pain. Six participants reported that their first same-sex sexual experience, beyond being painful, involved serious anorectal trauma.