Incorporating Sexual Pleasure in Educational Sexual Health Programs Can Improve Safe Sex Behaviors

Summary: A meta-analysis study reports interventions targeting STI/HIV infection risk education could benefit from including a focus on sexual pleasure and desire.

Source: PLOS

Sexual health programs that include sexual desire and sexual pleasure can improve knowledge and attitudes around sex, as well as condom use compared to those that do not, according to research published in PLOS ONE.

The meta-analysis of research literature from 2005-2020 finds that incorporating pleasure in such programs can have positive effects on attitudes and safer sex behavior and recommends revisiting sexual education and health intervention approaches that do not acknowledge that sexual experiences can be pleasurable.

Billions of dollars are spent around the world each year on sexual and reproductive health and rights services and programs. Yet with fewer than ten years to achieve the UN Sustainable Development Goals, which target sexual and reproductive health and reproductive rights, there is still a huge global burden of sexually transmitted diseases and HIV.

Researchers from The Pleasure Project, WHO’s Department of Sexual and Reproductive Health and Research and colleagues review 33 unique interventions targeting STI/HIV risk reduction that incorporate pleasure, and meta-analyze eight.

They find evidence that including pleasure can have significant positive effects across information- and knowledge-based attitudes, including participants’ self-belief in behavior change, and motivation to use condoms, as well as in behavior and condom use.

While the authors searched for interventions across a spectrum of sexual health interventions (including contraception and family planning interventions), the review ultimately included only STI/HIV-related programs targeting populations traditionally considered ‘vulnerable’.

The authors note that future work is needed to incorporate and evaluate pleasure-inclusive interventions in the reproductive health space and for general populations.

The team argues that continuing to avoid pleasure in sexual health and education risks misdirecting or ineffectively using resources. The researchers call for a fundamental rethink of how programs are oriented.

The authors add: “Pleasure has been over-looked and stigmatized in health promotion and sex education, despite its obvious connection to sexual health and well-being. Our systematic review and meta-analysis, the first of its kind, shows that including sexual pleasure considerations in sexual and reproductive health services improves condom use and so may also improve sexual and reproductive health outcomes.

“Policymakers and program managers should more readily acknowledge that pleasure is a key driver of sexual behavior, and that incorporating it in sexual and reproductive health services can reduce adverse outcomes.

“Eight years out from the Sustainable Development Goal deadline, innovative strategies that can accelerate progress towards SRHR targets, including for STI and HIV prevention, are urgently needed.

“Programs adopting a sex-positive and pleasure-inclusive approach is one such innovation that should be urgently considered.”

Abstract

What is the added value of incorporating pleasure in sexual health interventions? A systematic review and meta-analysis

Despite billions of dollars invested into Sexual and Reproductive Health and Rights (SRHR) efforts, the effect of incorporating sexual pleasure, a key driver of why people have sex, in sexual health interventions is currently unclear.

We carried out a systematic review and meta-analysis following PRISMA guidelines across 7 databases for relevant articles published between 1 January 2005–1 June, 2020. We included 33 unique interventions in our systematic review.

Eight interventions reporting condom use outcomes were meta-analyzed together with a method random effects model. Quality appraisal was carried out through the Cochrane Collaborations’ RoB2 tool.

This study was pre-registered on Prospero (ID: CRD42020201822). We identified 33 unique interventions (18886 participants at baseline) that incorporate pleasure. All included interventions targeted HIV/STI risk reduction, none occurred in the context of pregnancy prevention or family planning.

We find that the majority of interventions targeted populations that authors classified as high-risk. We were able to meta-analyze 8 studies (6634 participants at baseline) reporting condom use as an outcome and found an overall moderate, positive, and significant effect of Cohen’s d = 0·37 (95% CI 0·20–0·54, p < 0·001; I² = 48%; τ² = 0·043, p = 0·06). Incorporating sexual pleasure within SRHR interventions can improve sexual health outcomes.

Our meta-analysis provides evidence about the positive impact of pleasure-incorporating interventions on condom use which has direct implications for reductions in HIV and STIs. Qualitatively, we find evidence that pleasure can have positive effects across different informational and knowledge-based attitudes as well.

Future work is needed to further elucidate the impacts of pleasure within SRHR and across different outcomes and populations.

Taking all the available evidence into account, we recommend that agencies responsible for sexual and reproductive health consider incorporating sexual pleasure considerations within their programming.