"For Me, It's Having Something Meaningful": Women's Emotional Understandings of Sex and the Sexual Acceptability of Contraception

A reliable and valid tool to assess the sexual acceptability of contraceptive methods

Introduction

Adequate identification of the sexual acceptability of contraceptive methods is key for designing health promotion interventions, assessing their impacts, and increasing their effectiveness. This study aimed to develop and validate a questionnaire to explore the preferences of women depending on their epidemiological characteristics and their partner relationships-the Sexual Acceptability of Contraceptive Methods Questionnaire [in Spanish, Aceptabilidad Sexual de los Métodos Anticonceptivos (ASMA)].

Methods

Psychometric validation was conducted using Exploratory Factorial Analysis (EFA) and confirmatory factor analysis (CFA). The reliability of the final version of the questionnaire was explored using Cronbach's alpha and McDonald omega to estimate internal consistency.

Results

A three-factor model was identified. Factor 1 (explaining 28.32% of the model) corresponds to questions concerning the use and placement of the contraceptive and includes 6 items; Factor 2 (explaining 24.23%) corresponds to other factors that affect the relationship such as bleeding and side effects of the contraceptive method and includes 10 items; and Factor 3 (explaining 18.94%) corresponds to the couple relationship and includes 8 items.

Conclusion and implications

The ASMA questionnaire provides a valid and reliable tool for assessing the sexual acceptability of various contraceptive methods. This instrument gathers data that provide information on various aspects of women's sexuality, health, education, and beliefs, all of which can determine the preference for one contraceptive method over another. Moreover, the tool can help to identify profiles of women who have different preferences when selecting a particular method.

Understanding how young cisgender heterosexual men navigate sexual health conversations and practices during casual sex: a qualitative study

BACKGROUND

Young cisgender heterosexual men in Australia are the least likely population group to undergo testing for sexually transmissible infections (STI) and ensuring barrier method use during casual sex with cisgender women who have sex with men, with rates of STIs increasing among this group. This research examines how these men navigate sexual health conversations and practices during casual sexual encounters.

METHODS

A total of 30 semi-structured interviews with young cisgender heterosexual men living in Australia during 2021 were conducted. Participants were asked questions about their dating and sexual practices, including sexual health knowledge, how they learned to have sex, and navigating sexual health conversations with partners, such as STI testing, and barrier method and hormonal contraceptive use. Findings were analysed using reflexive thematic analysis techniques.

RESULTS

Findings note that men use various strategies of avoidance including sustaining the erotic moment, and assuming women's responsibility. Participants also noted limited relationality, in which they highlighted individualised concerns for their own sexual health wellbeing but not that of their partners.

CONCLUSIONS

This research highlights that despite increased awareness and promotion of STI prevention and contraceptive responsibility, young cisgender heterosexual men continue to forego their responsibilities regarding their own and other's sexual health during casual sexual encounters. Findings highlight a need to include gender transformative approaches to sexual health promotion and practice to address continuing gender inequities.

Norms, Trust, and Backup Plans: U.S. College Women's Use of Withdrawal with Casual and Committed Romantic Partners

This study integrates research on contraceptive prevalence with research on contraceptive dynamics in hookup culture to examine college women's use of withdrawal with sexual partners. Drawing on in-depth interviews with 57 women at a midwestern U.S. university, we analyzed women's explanations for using withdrawal for pregnancy prevention and framed our study within the research on gender norms, sexual scripts, and power dynamics. Findings showed withdrawal was normalized within collegiate hookup culture, and that women frequently relied on withdrawal as a secondary or backup method or when switching between methods. Women often followed up with emergency contraceptives if using withdrawal alone. With casual partners, women advocated for their own preferences, including for partners to withdraw. In committed relationships, women prioritized their partner's desires for condomless sex, but also linked withdrawal with trust and love. Thus, women in relationships may be disadvantaged by hookup culture norms suggesting sex is freely available, putting pressure on them to acquiesce to withdrawal. Many women used withdrawal despite acknowledging it was not the most desirable or effective method, emphasizing the need for a sexual health approach that acknowledges these tensions and strives to help women and their partners safely meet their sexual and contraceptive preferences.

Measuring the Sexual Acceptability of Contraception: Psychometric Examination and Development of a Valid and Reliable Prospective Instrument

BACKGROUND

People's sexual experiences have a strong association with contraceptive satisfaction and continuation, but no measures exist to specifically assess contraceptive-related sexual acceptability.

AIM

This study developed and examined the psychometric properties of reliability, separation, and item fit of a new Contraceptive Sexual Acceptability (CSA) instrument.

METHODS

Enrolled participants initiating a new contraceptive method from the HER Salt Lake longitudinal cohort study contributed baseline survey responses for scale development. The study included the Female Sexual Function Index, the New Sexual Satisfaction Scale, measures of physical and mood-related side effects, and self-reported perceptions of contraception's sexual impacts. Items from these measures' served as the basis for analyses. We analyzed responses using descriptive techniques and modeled using exploratory factor (EFA) and bifactor analyses (BFA). The Masters' Partial Credit Rasch method modeled reliability, separation, and item fit statistics. Here we evaluate (i) the reproducibility of relative measure location on the modeled linear latent variable, (ii) the number of statistically unique performance levels that can be distinguished by the measure, and (iii) the discrepancy between item responses and expectations of the model. Psychometric findings and theoretical models informed item reduction and final scale development.

OUTCOMES

We developed a 10-item Contraceptive Sexual Acceptability scale that exceeded the thresholds and sufficiently covered domains for use in contraceptive research and clinical settings.

RESULTS

Starting with data on 39-items from 4,387 individuals, we identified 10-items that best measured the CSA latent construct. The Rasch model included a total of 5 calibrations. We reduced items based on bifactor analysis and surpassed unidimensionality thresholds (OH = 0.84, ECV = 0.74) set a priori. The final items included questions with scaled responses about pleasure and orgasm (orgasm quality, orgasm frequency, giving partner pleasure), physical (arousal and function) and psychological (emotional connection, surrender) components, general questions of satisfaction and frequency, and a measure of perceived impact of contraception on sexual experiences in the previous 4 weeks.

CLINICAL IMPLICATIONS

The 10-item CSA instrument covers physical and psychological aspects of contraceptive sexual acceptability and can be used in clinical settings.

STRENGTHS & LIMITATIONS

The unidimensional CSA instrument offers a brief, yet comprehensive assessment of sexual acceptability. Given the limited diversity of the sample, implementation of this scale in contraceptive research and clinical interactions should be evaluated and validated in more diverse settings.

CONCLUSION

Attuning to sexual acceptability could ultimately help contraceptive clients find methods that better meet their needs and preferences. Sanders JN, Kean J, Zhang C, et al. Measuring the Sexual Acceptability of Contraception: Psychometric Examination and Development of a Valid and Reliable Prospective Instrument. J Sex Med 2022;19:507-520.