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Knights N, Stone N, Nadarzynski T, Brown K, Newby K, Graham CA. Feasibility study of the Home-based Exercises for Responsible Sex (HERS) intervention to promote correct and consistent condom use among young women. Pilot Feasibility Stud 2021; 7:145. [PMID: 34311784 PMCID: PMC8314454 DOI: 10.1186/s40814-021-00885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Male condoms are effective in preventing common sexually transmitted infections (STIs) and unintended pregnancy, if used correctly and consistently. However, condom use errors and problems are common and young people report negative experiences, such as reduced pleasure. The Kinsey Institute Home-Based Exercises for Responsible Sex (KIHERS) is a novel condom promotion intervention for young women, which aims to reduce condom errors and problems, increase self-efficacy and improve attitudes towards condoms, using a pleasure-focussed approach. The study objective was to test the operability, viability and acceptability of an adapted version of the KIHERS intervention with young women aged 16–25 years in the United Kingdom (UK) (Home-Based Exercises for Responsible Sex-UK (HERS-UK). Methods A repeated-measures single-arm design was used, with a baseline (T1) and two follow-up assessments (T2 and T3), conducted 4 weeks and 8 weeks post intervention over a 3-month period. Participants were provided a condom kit containing different condoms and lubricants and were asked to experiment with condoms alone using a dildo and/or with a sexual partner. Ten process evaluation interviews were conducted post intervention. Results Fifty-five young women received the intervention; 36 (65%) completed T2 and 33 (60%) completed T3. Condom use errors and problems decreased, self-efficacy increased and attitudes towards condoms improved significantly. The proportion of participants who reported using a condom for intercourse in the past 4 weeks increased from T1 (20; 47%) to T2 (27; 87%) and T3 (23; 77%) and using lubricant with a condom for intercourse increased from T1 (6; 30%) to T2 (13; 48%)) and T3 (16; 70%). However, motivation to use condoms did not change. Cronbach’s alpha scores indicated good internal consistency of measures used. Qualitative data provided strong evidence for the acceptability of the intervention. Conclusions HERS-UK was implemented as intended and the recruitment strategy was successful within a college/university setting. This feasibility study provided an early indication of the potential effectiveness and acceptability of the intervention, and the benefits of using a pleasure-focussed approach with young women. Measures used captured change in outcome variables and were deemed fit for purpose. Future research should explore cost-effectiveness of this intervention, in a large-scale controlled trial using a diverse sample and targeting young women most at risk of STIs. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00885-1.
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Affiliation(s)
- Nicola Knights
- Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, UK
| | - Nicole Stone
- Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, UK
| | - Tom Nadarzynski
- School of Social Sciences, University of Westminster, London, UK
| | - Katherine Brown
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Katie Newby
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Cynthia A Graham
- Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, UK.
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Freeborn K, Portillo C, Boyer CB, Santos GM. Misclassification of sexual health risks in a self-identified low risk cohort of men who have sex with men (MSM) enrolled in a community based PrEP program. AIDS Care 2019; 32:230-237. [PMID: 31129982 DOI: 10.1080/09540121.2019.1620167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The CDC recommends PrEP for MSM at substantial risk of HIV acquisition, leaving clinicians unsure whether to prescribe PrEP to MSM who do not disclose HIV risk factors. A longitudinal cohort of MSM requesting PrEP despite reporting during a clinical visit either 100% condom use or participation in oral sex only and no other risk factors was followed over 13 months at a community clinic in San Francisco to assess the accuracy of their HIV risk perception. Participants completed a sexual and substance use behavior questionnaire at baseline, outside of the clinical visit and were followed by quarterly HIV/STI testing and condom use change questionnaires. Condomless sex increased from 0% at baseline to 12% at month 1, peaked at 34% at month 7, and then decreased again to 8% at month 13. Rates of pharyngeal GC/CT varied from 7% at baseline to 12% at month 13, while rectal GC/CT decreased from 6% at baseline to 0% at month 13. The rate of syphilis was 1% both at baseline and at month 13, however, 11% and 15% of clients tested positive for syphilis at months 1 and 7 respectively.
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Affiliation(s)
- Kellie Freeborn
- Division of Global Women's Health, Department of Obstetrics and Gynecology, The University of North Carolina, Chapel Hill, NC, USA
| | | | - Cherie B Boyer
- San Francisco Division of Adolescent and Young Adult Medicine, Department of Pediatrics UCSF Benioff Children's Hospital San Francisco, University of California, San Francisco, CA, USA
| | - Glen Milo Santos
- School of Nursing, Department of Community Health Systems, University of California San Francisco, San Francisco, CA, USA
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Siegler AJ, Boos E, Rosenberg ES, Cecil MP, Sullivan PS. Validation of an Event-Level, Male Sexual Pleasure Scale (EMSEXpleasure) Among Condom-Using Men in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1745-1754. [PMID: 29392486 PMCID: PMC6035083 DOI: 10.1007/s10508-017-1103-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/28/2017] [Accepted: 10/16/2017] [Indexed: 05/31/2023]
Abstract
Sexual pleasure is a key determinant of condom use. We developed and validated a male, event-level sexual pleasure scale (EMSEXpleasure) among a sample of condom-using men in the U.S. in order to facilitate improved measurement of sexual pleasure. Based on an expert panel process, a 12-item scale was developed. An online sample of 169 men who have sex with men and 162 men who have sex with women were recruited. Factor analysis yielded a two-factor solution that matched domains identified a priori by the expert panel, general pleasure and condom-specific pleasure, indicating internal validity of the instrument. One item was deleted from the scale due to poor validity performance. The overall EMSEXpleasure scale, and each subscale, had high (> 0.8) Cronbach's alpha coefficients, indicating internal reliability. The scale demonstrated convergent validity, with theoretically related constructs associated both with individual scale items and with scale totals. Overall relationship quality (b 3.0, 95% CI 2.0, 4.0), sexual relationship quality (b 2.9, 95% CI 2.0, 4.0), foreplay quality (b 7.5, 95% CI 2, 13), positive feelings about condoms (b 18.8, 95% CI 15, 23), and erection problems while using condoms (b - 17.9, 95% CI - 22, - 14) were associated with the EMSEXpleasure scale in expected directions. The validated EMSEXpleasure event-level scale may be advantageous for future assessments of the ephemeral experience of sexual pleasure, including clinical trials of condoms and other interventions, because it can be used immediately after sex, potentially limiting recall error.
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Affiliation(s)
- Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
| | | | - Eli S Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | | | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
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Milhausen RR, McKay A, Graham CA, Sanders SA, Crosby RA, Yarber WL, Wood J. Do Associations Between Pleasure Ratings and Condom Use During Penile-Vaginal Intercourse Vary by Relationship Type?: A Study of Canadian University Students. JOURNAL OF SEX RESEARCH 2018; 55:21-30. [PMID: 28358218 DOI: 10.1080/00224499.2017.1298713] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Research suggests the relationship between pleasure and condom use during penile-vaginal intercourse (PVI) is associated with relationship status. This online study examined pleasure ratings and condom use at last PVI, stratifying by partner type, among a national sample of Canadian university students. Participants were 715 undergraduates (60.7% women, 39.3% men) who reported on their most recent sexual experience. Condom use decreased with level of relationship commitment, whereas ratings of pleasure increased. Overall, participants were more likely to rate their most recent PVI as Very pleasurable when condoms were not used compared to when condoms were used. However, when stratified by partner type, these differences largely disappeared. For women, with one exception, there were no differences in pleasure between PVI with and without condoms across most partner-type categories. Women in committed dating relationships were more likely to report their last PVI as very pleasurable if condoms were not used than women in these same relationships who had used condoms. Across relationship categories, men who did and did not use condoms did not differ in terms of their pleasure ratings. The results of this study suggest relationship context should be taken into account when assessing condom use experiences.
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Affiliation(s)
- Robin R Milhausen
- a Department of Family Relations and Applied Nutrition, University of Guelph; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University; and the Rural Center for AIDS/STD Prevention , Indiana University
| | | | - Cynthia A Graham
- c Department of Psychology, University of Southampton; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University ; and the Rural Center for AIDS/STD Prevention, Indiana University
| | - Stephanie A Sanders
- d Department of Gender Studies , Indiana University; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University; and the Rural Center for AIDS/STD Prevention, Indiana University
| | - Richard A Crosby
- e Department of Health Behavior, College of Public Health , University of Kentucky; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University; and the Rural Center for AIDS/STD Prevention, Indiana University
| | - William L Yarber
- f Department of Applied Health Science, Indiana University; Department of Gender Studies , Indiana University; The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University; and the Rural Center for AIDS/STD Prevention, Indiana University
| | - Jessica Wood
- g Department of Psychology , University of Guelph
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Mavhandu-Mudzusi AH, Asgedom TT. The prevalence of risky sexual behaviours amongst undergraduate students in Jigjiga University, Ethiopia. Health SA 2016. [DOI: 10.1016/j.hsag.2015.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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The intimate link: a systematic review of highly effective reversible contraception and women's sexual experience. Clin Obstet Gynecol 2015; 57:777-89. [PMID: 25264699 DOI: 10.1097/grf.0000000000000058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Contraception is expressly designed for nonprocreative sexual activity, but we know little about how methods shape women's sexual experience. To systematically review the literature on highly effective reversible contraception (HERC) and sexual experiences. MEDLINE, SCOPUS, and Google Scholar were searched for relevant literature. Eleven studies met the inclusion criteria; all were conducted outside of the United States. All studies reviewed found either improvements or no change in sexual experience and function outcomes with HERC use. A need exists for more prospective studies with a wider range of measures to assess HERC methods' impact on women's sexual experiences.
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Fennell J. "And Isn't that the point?": pleasure and contraceptive decisions. Contraception 2013; 89:264-70. [PMID: 24332430 DOI: 10.1016/j.contraception.2013.11.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 11/13/2013] [Accepted: 11/15/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Previous survey research indicates that women and men experience reduced sexual pleasure when using condoms, especially compared to nonbarrier family planning methods. This study seeks to explore those experiences of reduced pleasure in-depth and how they affect contraceptive method decisions and use. STUDY DESIGN In-depth interviews with 30 men and 30 women between the ages of 18 and 36 years in the United States about their contraceptive decisions and use were analyzed. RESULTS Both men and women complained about the way that condoms interfered with their sexual pleasure. Several women (and no men) complained that condoms actually hurt them, and the majority of couples had at least one member who reported disliking condoms. For hormonal methods and intrauterine devices, general side effects were usually one of the most important reasons that women continued or discontinued methods, but few sexual side effects were reported. CONCLUSIONS Interfering with sexual pleasure appears to be the most important reason that both men and women do not use condoms, and public health practitioners should recognize the limitations of condoms as a contraceptive technology. Despite problems with general side effects, most women (and men) prefer hormonal methods to condoms. IMPLICATIONS This study provides in-depth descriptions showing that young adult men and women in the United States use condoms less because condoms interfere with their sexual pleasure. Although women often say they experience general negative side effects from hormonal birth control, they usually perceive few sexual side effects from hormonal birth control. Since young heterosexual adults usually perceive themselves to be at much greater risk for pregnancy than sexually transmitted infections, they mostly perceive hormonal birth control to be a greatly superior contraceptive option compared to condoms.
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Higgins JA, Fennell JL. Providing for women's pleasure in the next generation of condoms. J Sex Med 2013; 10:3151-3. [PMID: 23981853 DOI: 10.1111/jsm.12299] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Crosby RA, Cates W. Condom use: still a sexual health staple. Sex Health 2012; 9:1-3. [PMID: 22348626 DOI: 10.1071/sh11111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 09/01/2011] [Indexed: 11/23/2022]
Abstract
This article introduces and summarizes the contents of this special edition. Given the exceptional potential of condoms to avert epidemics of sexually transmitted infections and teen or unintended pregnancy - even in low-resource environments - this in-depth examination of current knowledge, practice, and issues with condoms and their use is an important asset for educators and practitioners worldwide.
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