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Milford C, Beksinska M, Smit J, Deperthes B. Lubrication and Vaginal Sex: Lubricant Use and Preferences in General Population Women and Women at Risk of HIV. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2103-2116. [PMID: 32222851 DOI: 10.1007/s10508-020-01673-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
Personal or additional lubricants are used by individuals to enhance sexual experience. Lubrication norms during sex are linked to factors including sociocultural norms, gender dynamics, age, and education. This article provides an overview of literature, exploring thematic areas of interest and relevance to the topic. In some regions/countries, lubricated sex is preferable, and in others, a dry/tight vagina is preferred. Women may use a variety of products to achieve these states. There is little research on lubrication preferences during sex; however, microbicide gel acceptability and adherence studies have provided some insight into these preferences. There is a need for more information on lubrication preferences, including volumes, frequency of use, and site of application. In addition, condom use with lubricants needs further exploration. Context, gender, and individual preferences have implications for acceptability and use of personal additional lubricants and should be taken into account during marketing and dissemination of these products.
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Affiliation(s)
- Cecilia Milford
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Commercial City Building, Durban, 4000, South Africa.
| | - Mags Beksinska
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Commercial City Building, Durban, 4000, South Africa
| | - Jennifer Smit
- MRU (MatCH Research Unit), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Commercial City Building, Durban, 4000, South Africa
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McLellan-Lemal E, Ondeng'e K, Gust DA, Desai M, Otieno FO, Madiega PA, Nyagol B, Makanga EM. Contraceptive vaginal ring experiences among women and men in Kisumu, Kenya: A qualitative study. ACTA ACUST UNITED AC 2017; 2. [PMID: 28845463 PMCID: PMC5568572 DOI: 10.15761/fwh.1000122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Future HIV prevention options for women will likely include Antiretroviral (ARV)-based intravaginal rings. Valuable insights may be gained by examining user experiences with a similar licensed technology, a contraceptive ring, especially in settings where this technology may not be currently available. Methods In-depth interviews with 24 females enrolled in a trial assessing acceptability and use of a contraceptive ring, and 20 male sexual partners were conducted September 2014–April 2015. Elements of ethnography and phenomenological anthropology were used to collect, analyze, interpret, and describe ring users’ experiences. Thematic analysis was completed in MaxQDA-10. Results Experiences with the contraceptive ring reflected a broader Family Planning (FP) paradigm that centered around three themes: latitudes and drawbacks of FP (being free); an FP method needs to be compatible with a woman’s body (feeling normal); and dealing with fertility control uncertainties (how well does it really work). FP intentions and disclosure practices were influenced by partner support, socioeconomic factors, religion, cultural beliefs, and societal norms, including female sexuality. A user-friendly FP design was emphasized. Non-suppression of menstruation was favored by most. Unease with vaginal insertion as well as ring placement issues (slippage, expulsion) created initial challenges requiring clinician assistance and practice for some participants. While minor side-effects were described, concerns centered on ring efficacy, negative effect on a woman’s sexual desire, and future fertility issues. Conclusions Awareness of the multiple contexts in ring users’ experience may inform the development, education, and promotion approaches for future ARV rings.
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Affiliation(s)
- E McLellan-Lemal
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia-USA
| | - K Ondeng'e
- Kenya Medical Research Institute, Kisumu, Kenya
| | - D A Gust
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia-USA
| | - M Desai
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia-USA
| | - F O Otieno
- Nyanza Reproductive Health Society, Kisumu, Keny
| | - P A Madiega
- Kenya Medical Research Institute, Kisumu, Kenya
| | - B Nyagol
- Kenya Medical Research Institute, Kisumu, Kenya
| | - E M Makanga
- Kenya Medical Research Institute, Kisumu, Kenya
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Best C, Tanner AE, Hensel DJ, Fortenberry JD, Zimet GD. Young women's contraceptive microbicide preferences: associations with contraceptive behavior and sexual relationship characteristics. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2014; 46:15-22. [PMID: 24325312 PMCID: PMC4183361 DOI: 10.1363/46e0114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
CONTEXT In time, microbicides may provide women with dual prevention against pregnancy and STDs. Although several microbicide dimensions have been evaluated, little is known about women's preferences for contraceptive microbicides and correlates of these preferences. METHODS Acceptability of a hypothetical contraceptive microbicide cream or jelly was examined among a -clinic-based sample of 266 women in Indianapolis from 2004 (when participants were aged 14-22) to 2008. Group conjoint analyses and individual conjoint analyses were used to compare preferences with respect to four microbicide -dimensions: contraceptive ability, efficacy in relation to condoms, timing of use and texture. Pearson's product moment correlations were used to examine the relationship between preferences for a contraceptive microbicide and selected characteristics of the women. RESULTS Overall, the top-rated microbicide dimensions were efficacy in relation to that of condoms and contraceptive ability (importance scores, 40.0 and 35.4 out of 100.0, respectively). When all dimension levels were compared, contraceptive ability was the most strongly preferred (part-worth utility score, 8.9), and lower efficacy than that of -condoms was the least strongly preferred (-11.9). Preference for contraceptive microbicides was positively -associated with current contraceptive use, sexual agency, partner communication, commitment to avoiding pregnancy and -perceived partner agreement about avoiding pregnancy (coefficients, 0.07-0.18). It was negatively associated with current or past nonuse of contraceptives, seeking pregnancy and perceived partner agreement about seeking -pregnancy (-0.08 to -0.14). CONCLUSIONS Microbicides with dual prevention properties may be attractive to young women. Microbicide development and subsequent clinical trials should incorporate contraceptive microbicides.
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Affiliation(s)
- Candace Best
- Candace Best is assistant professor, Department of Psychology, Georgia Regents University, Augusta
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Auslander BA, Catallozzi M, Davis G, Succop PA, Stanberry LR, Rosenthal SL. Adolescents' and young women's use of a microbicide surrogate product when receiving oral sex. J Pediatr Adolesc Gynecol 2014; 27:37-40. [PMID: 24315715 PMCID: PMC4365499 DOI: 10.1016/j.jpag.2013.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 08/29/2013] [Accepted: 08/31/2013] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE Genital herpes, which can be spread through oral sex, is an important target for microbicides. We examined episode-specific predictors of young women's receptive oral sex and of microbicide surrogate use. DESIGN Longitudinal study. SETTING Participants were recruited to participate in a microbicide acceptability study from adolescent clinics and local colleges and through snowballing. PARTICIPANTS Young women (ages 14 to 21 y) who reported sexual contact on at least 1 weekly phone interview (n = 181) were included from the larger sample of 208 young women. MAIN OUTCOME MEASURES On weekly diary phone interviews, participants reported whether or not their last sexual contact included receptive oral sex and whether or not their last sexual contact included use of a microbicide surrogate. RESULTS AND CONCLUSIONS Participants reported a total of 1042 episodes of sexual contact of which 311 included receptive oral sex and 354 included microbicide surrogate use. Being older, having sex for the first time with a partner, and having given oral sex were associated with having received oral sex during a sexual episode. Being older, being African American, and having discussed the microbicide surrogate with their partner were associated with having used the microbicide surrogate use during a sexual episode. These results indicate that oral sex should be considered in the design of clinical trials. Future studies need to evaluate ways to promote consistent microbicide use in the context of receiving oral sex as well as those factors (eg, taste, pleasure) which may serve as a barrier.
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Affiliation(s)
- Beth A Auslander
- Department of Pediatrics and Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, TX.
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY; Department of Population and Family Health, Columbia University Medical Center-Mailman School of Public Health and New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Gray Davis
- Gray Davis Consulting, Raleigh-Durham, NC
| | - Paul A Succop
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lawrence R Stanberry
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY; Department of Psychiatry, Columbia University Medical Center - College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
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MacCarthy S, Rasanathan JJK, Ferguson L, Gruskin S. The pregnancy decisions of HIV-positive women: the state of knowledge and way forward. REPRODUCTIVE HEALTH MATTERS 2013. [PMID: 23177686 DOI: 10.1016/s0968-8080(12)39641-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Despite the growing number of women living with and affected by HIV, there is still insufficient attention to their pregnancy-related needs, rights, decisions and desires in research, policy and programs. We carried out a review of the literature to ascertain the current state of knowledge and highlight areas requiring further attention. We found that contraceptive options for pregnancy prevention by HIV-positive women are insufficient: condoms are not always available or acceptable, and other options are limited by affordability, availability or efficacy. Further, coerced sterilization of women living with HIV is widely reported. Information gaps persist in relation to effectiveness, safety and best practices regarding assisted reproductive technologies. Attention to neonatal outcomes generally outweighs attention to the health of women before, during and after pregnancy. Access to safe abortion and post-abortion care services, which are critical to women's ability to fulfill their sexual and reproductive rights, are often curtailed. There is inadequate attention to HIV-positive sex workers, injecting drug users and adolescents. The many challenges that women living with HIV encounter in their interactions with sexual and reproductive health services shape their pregnancy decisions. It is critical that HIV-positive women be more involved in the design and implementation of research, policies and programs related to their pregnancy-related needs and rights.
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Affiliation(s)
- Sarah MacCarthy
- The Miriam Hospital and Alpert Medical School of Brown University, Providence, RI, USA.
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Tanner AE, Roof KA, Katz BP, Katschke A, Fortenberry JD, Zimet GD. A comparison of young women's actual and assigned timing of use of a microbicide surrogate. Sex Health 2012; 9:299-303. [PMID: 22877587 DOI: 10.1071/sh11063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 10/10/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE This study examined young women's actual timing of use of a microbicide surrogate gel (vaginal moisturiser (VM)) compared with assigned timing conditions. METHODS Participants used a VM with coitus during 4-week cycles over a 3-year period in random timing sequences: 1h before coitus, 10 min before coitus and 10 min after coitus. Daily diaries collected information related to coital behaviours, VM use and timing, and participants' and partners' VM assessments. Descriptive and mixed-effects model analyses were conducted. RESULTS At least three VM timing conditions were completed by 109 women aged 18-22 years old. Of 17?772 diary days collected, coitus was reported on 2128 (1252 with VM use; 59%). Median times between VM application and coitus were: 60 min before coitus (mean=68.2; s.d.=76.9) for the 1-h pre-coital group, 13.5 min before coitus (mean=44.9; s.d.=117.1) for the 10-min pre-coital group and 5 min before coitus (mean=24.5; s.d.=205.1) for the 10-min post-coital group. Women reported that the VM was very easy to use (68%), it was somewhat messy (61%), they were very wet during sex (81%), sex was very good (80%) and their partners liked using the VM (38%). CONCLUSIONS Overall, the VM was rated positively. There was substantial deviation in application time across timing conditions, with significantly greater variability in the post-coital group. These findings contribute to understanding of how VMs are accepted and used, with implications for HIV prevention with microbicides requiring specific application timing.
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Affiliation(s)
- Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC 27401, USA
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Alexander KA, Coleman CL, Deatrick JA, Jemmott LS. Moving beyond safe sex to women-controlled safe sex: a concept analysis. J Adv Nurs 2011; 68:1858-69. [PMID: 22111843 DOI: 10.1111/j.1365-2648.2011.05881.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a conceptual analysis of women-controlled safe sex. BACKGROUND Women bear disproportionate burdens from sexually related health compromising outcomes. Imbalanced societal gender and power positions contribute to high morbidities. The expression, women-controlled safe sex, aims to empower women to gain control of their sexual lives. Few researchers focus on contextualized socio-cultural definitions of sexual safety among women. DATA SOURCES The sample included scientific literature from Scopus, CINAHL, PubMed, PsychINFO and Sociological Abstracts. Papers were published 2000-2010. REVIEW METHODS Critical analyses of literature about women-controlled safe sex were performed in May 2011 using Rodgers' evolutionary concept analysis methods. The search focused on social and cultural influences on sexual practices aimed at increasing women's control over their sexual safety. RESULTS The analysis uncovered five attributes of women-controlled safe sex: technology; access to choices; women at-risk; 'condom migration' panic; and communication. Three antecedents included: male partner influence; body awareness; and self-efficacy. Consequences were categorized as positive or negative. Nine surrogate terms included: empowerment; gender power; female-controlled sexual barrier method; microbicides; diaphragm; sexual negotiation and communication; female condom; women-initiated disease transmission prevention; and spermicides. Finally, a consensus definition was identified: a socio-culturally influenced multi-level process for initiating sexual safety by women deemed at-risk for sexually related dangers, usually sexually transmitted infections and/or HIV/AIDS. CONCLUSION This concept analysis described current significance, uses, and applications of women-controlled safe sex in the scientific literature. The authors clarified its limited nature and conclude that additional conceptual refinement in nursing is necessary to influence women's health.
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Affiliation(s)
- Kamila A Alexander
- Center for Health Equity Research University of Pennsylvania School of Nursing, Pennsylvania, USA.
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Giguere R, Carballo-Diéguez A, Ventuneac A, Mabragaña M, Dolezal C, Chen BA, Kahn JA, Zimet GD, McGowan I. Variations in microbicide gel acceptability among young women in the USA and Puerto Rico. CULTURE, HEALTH & SEXUALITY 2011; 14:151-66. [PMID: 22084840 PMCID: PMC3265079 DOI: 10.1080/13691058.2011.630099] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In a multi-site study of vaginal microbicide acceptability conducted with sexually active young women, quantitative assessments revealed significant differences in acceptability by site. Participants in Puerto Rico rated the gel more favourably than mainland US participants in terms of liking the gel and likelihood of future use. To explain these differences, we examined responses to qualitative behavioural assessments. Young women in mainland USA associated gel leakage with uncomfortable sensations experienced during menstruation, while young women in Puerto Rico had positive associations of gel use with douching. These negative or positive associations affected assessments of the gel's physical qualities. In addition, young women's perceptions of primary partners' support for microbicide use influenced sexual satisfaction with the gel and, ultimately, product acceptability. Finally, geographic HIV-risk context contributed to heightened HIV-risk perception, which influenced likelihood of future microbicide use, even for women in stated monogamous relationships. Future microbicide acceptability studies should take into account potential differences in acceptability by site such as HIV-risk perception based on local HIV prevalence, popularity of vaginal hygiene products in a specific area and male attitudes in different cultures concerning women's use of HIV protection strategies.
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Affiliation(s)
- Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA.
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The Impact of Gender Expectations on Meanings of Sex and Sexuality: Results from a Cognitive Interview Study. SEX ROLES 2009. [DOI: 10.1007/s11199-009-9723-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tanner AE, Short MB, Zimet GD, Rosenthal SL. Research on adolescents and microbicides: a review. J Pediatr Adolesc Gynecol 2009; 22:285-91. [PMID: 19616456 PMCID: PMC2739269 DOI: 10.1016/j.jpag.2008.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 08/13/2008] [Accepted: 08/20/2008] [Indexed: 10/20/2022]
Abstract
Adolescents are an important target for microbicide research, as they are disproportionately affected by sexually transmitted infections and currently are underrepresented in the microbicide research literature. Furthermore, adolescents are psychosocially and biologically different from adults, and findings from adult research cannot be assumed to apply universally to adolescents. Adolescents, to date have rarely been included in clinical trials and acceptability research for microbicides, in part because their participation requires attention to unique developmental issues, including parental consent and confidentiality. Despite these challenges, adolescents should be included in microbicide clinical research. If adolescents are ultimately expected to use microbicides, it is essential that we understand the developmental, contextual, and relationship variables that may influence use and acceptability. Accordingly, the goal of this paper was to examine the issues affecting the inclusion of adolescents in microbicide clinical research as well as review the existing adolescent-specific microbicide research, which highlights the various factors that may influence use and acceptability. It is hoped that this review can provide guidance for future work with this important, specialized population.
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Affiliation(s)
- Amanda E Tanner
- Department of Health, Behavior, & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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