Why putting pleasure first improves sexual and reproductive health

Focusing on the pleasures of sex, rather than the downsides, can encourage safer sex, reduce sexual harms and improve wellbeing, evidence from Africa and India suggests. 

What is the research about? 

The research looked at pleasure-based sexual and reproductive health (SRH) programmes. These are programmes that are positive about sexual pleasure and the many benefits of sex. In this study, eight organisations in Central, East and Southern Africa and India that implement pleasure-based SRH programmes were surveyed. The organisations also took part in focus groups with funders and technical experts. 

Why is this research important? 

Pleasure is one of the main reasons why people have sex. But SRH programmes often ignore this and focus on negative outcomes, like sexually transmitted infections or unplanned pregnancy. There is growing evidence that focusing on pleasure improves SRH outcomes, and this study adds to it. 

What did they find out? 

Despite working in different countries and with different groups, all organisations reported benefits to taking a pleasure-based approach to SRH.  

Implementers said people enjoyed talking about pleasure, and this helped them engage with SRH issues. This was even true of groups that are sometimes seen as unwilling to talk about sexual pleasure, such as women in tribal communities.  

Taking a pleasure-based approach led to more open discussions about sex. It also increased people’s self-confidence. And their confidence to talk to partners about things like safer sex and consent. People were able to better understand their bodies and how to talk about their needs and boundaries. As one implementer said: “Once you know what you want from a relationship – transactional or romantic, it increases your power.”  

People also felt able to discuss sensitive topics like masturbation and premature ejaculation.  

One of the biggest barriers to taking a pleasure approach is the fact that some people feel ashamed about sex. Organisations dealt with this by providing friendly, non-judgemental ‘safe spaces’, which encouraged people to open up.  

Some implementers said that discussing pleasure in a group can create a bond between people, which can help people feel more comfortable to discuss sex. Breaking down the idea of sex into smaller things like desires, touches and sensation can also make it easier to discuss sexual pleasure. 

Gender norms need to be considered when discussing pleasure. For instance, the sexist view that women are there to provide pleasure to men but do not need sexual pleasure themselves, is a barrier that needs to be challenged. In mixed groups, young women also found it more difficult to discuss pleasure than young men. 

What does this mean for HIV services? 

Including pleasure in SRH programmes can be effective if it is done correctly. The study provides practical tips on how to do this.  

• Approach groups and individuals with an open mind. 

• Do not make assumptions about people’s experiences or views on sexual pleasure. 

• Allow participants to guide how language is used and how a pleasure approach should be introduced.  

• Training for SRH facilitators should acknowledge anxiety or shame around pleasure, including their own.  

It is also worth reading The Pleasure Principles. This informed the work of the organisations in the study, all of which were implementing an SRH programme led by the Pleasure Project and AmplifyChange.