Is sexual pleasure the missing link in sexual health programmes?

Focusing on sexual pleasure can improve the impact of sexual health programmes, a new analysis suggests.

What is the research about?

The study assessed 33 interventions that connected safer sex practices with sexual pleasure. (For example, condom or lubricant use as a way to increase sexual enjoyment.)

The interventions took place between 2005 and 2020 and involved around 18,800 people. Most participants had a high risk of getting HIV or a sexually transmitted infection (STI). Twenty-five interventions took place in the USA, two in South Africa, and one each in Brazil, Spain, the UK, Singapore, Nigeria and Mexico.

Why is this research important?

Sexual and reproductive health and rights (SRHR) programmes tend to focus on the negative consequences of unprotected sex (such as getting an STI or unintended pregnancy), not on how SRHR relates to sexual pleasure. But as pleasure is one of the main reasons people have sex, it is useful to understand whether interventions that tap into this is are effective.

What did they find out?

Acknowledging sexual pleasure works. These interventions improved knowledge and attitudes about sexual health and safer sex practices.

One part of the study analysed eight sexual pleasure interventions that focused on condoms (involving around 6,600 people). Overall, these increased condom use.

Eight interventions (around 2,600 participants) involved men who have sex with men. Sexual pleasure was not the main focus of most of these interventions. But the topic was included in discussions about sexual behaviour, for example, how to use lubricants and condoms to increase sexual pleasure. These interventions increased condom use and reduced HIV and STI infections. Online interventions were particularly effective at reaching younger men who have sex with men.

Five interventions (around 2,000 participants) involved people who use drugs. Pleasure was discussed in sessions about harm reduction. Topics included personal sexual rights, positive sexual choices, increasing confidence and pride in one’s body, the right to pleasure, and how safer sexual practices can be erotic. These interventions increased participants’ knowledge about HIV and STIs. One led to a 50% decrease in HIV and STI incidence compared to a control group.

Two interventions (around 3,400 participants) involved adolescents and young people. They focused on empowerment activities and presented sexuality as a positive thing and a source of pleasure. Young people’s SRHR knowledge and motivation to practice safer sex improved, and HIV and STI infections reduced. But, drop-out rates were an issue.

Nine interventions (around 7,400 participants) involved people from racial and ethnic minorities. They addressed negative beliefs about condom use and pleasure, ways to make condom use more pleasurable, and how to make safe sex erotic. The lack of uniformity between the studies made it hard to assess their effectiveness.

What does this mean for HIV services?

If you are working on sexual health and education, it is worth considering including the topic of sexual pleasure in your activities.

The first step is to understand what matters to the groups you work with in relation to sexual pleasure. To do this, involve people from these groups in research to inform your plans. Then involve them in programme design, implementation and evaluation.

Current research on sexual pleasure mainly relates to marginalised groups. It would also be useful to gather evidence on whether other groups, such as heterosexual women, would respond to sexual pleasure SRHR interventions.