What is the added value of incorporating pleasure in sexual health interventions? A systematic review and meta-analysis

Abstract

Despite billions of dollars invested into Sexual and Reproductive Health and Rights (SRHR) efforts, the effect of incorporating sexual pleasure, a key driver of why people have sex, in sexual health interventions is currently unclear. We carried out a systematic review and meta-analysis following PRISMA guidelines across 7 databases for relevant articles published between 1 January 2005–1 June, 2020. We included 33 unique interventions in our systematic review. Eight interventions reporting condom use outcomes were meta-analyzed together with a method random effects model. Quality appraisal was carried out through the Cochrane Collaborations’ RoB2 tool. This study was pre-registered on Prospero (ID: CRD42020201822). We identified 33 unique interventions (18886 participants at baseline) that incorporate pleasure. All included interventions targeted HIV/STI risk reduction, none occurred in the context of pregnancy prevention or family planning. We find that the majority of interventions targeted populations that authors classified as high-risk. We were able to meta-analyze 8 studies (6634 participants at baseline) reporting condom use as an outcome and found an overall moderate, positive, and significant effect of Cohen’s d = 0·37 (95% CI 0·20–0·54, p < 0·001; I2 = 48%; τ2 = 0·043, p = 0·06). Incorporating sexual pleasure within SRHR interventions can improve sexual health outcomes. Our meta-analysis provides evidence about the positive impact of pleasure-incorporating interventions on condom use which has direct implications for reductions in HIV and STIs. Qualitatively, we find evidence that pleasure can have positive effects across different informational and knowledge-based attitudes as well. Future work is needed to further elucidate the impacts of pleasure within SRHR and across different outcomes and populations. Taking all the available evidence into account, we recommend that agencies responsible for sexual and reproductive health consider incorporating sexual pleasure considerations within their programming.

Increasing incidence rates of sexually transmitted infections from 2010 to 2019: an analysis of temporal trends by geographical regions and age groups from the 2019 Global Burden of Disease Study

“…Therefore, improving the quality rather than quantity of primary health care is particularly important. For example, incorporating sexual pleasure or security considerations within programming may have a positive impact on condom use, which has direct implications for reductions in STIs [ 35 ]. Moreover, the screening and testing of some high-risk populations, including men, transgender female sex workers, bisexual people, and other men who have sex with men are important regardless of self-reported sites of potential exposure [ 36 , 37 ].…”

Condom Use Beliefs Differ According to Regulatory Focus in Sexuality: A Multi-Method Study in Portugal and Spain

“…For instance, sexual health interventions that incorporate sexual pleasure discussions significantly improve condom use (Zaneva et al, 2022). Certain specific beliefs also emerged from our analyses.…”

Effects of gender-transformative relationships and sexuality education to reduce adolescent pregnancy (the JACK trial): a cluster-randomised trial

“…11 Although RSE specialists have called for the inclusion of a discourse of pleasure to enhance a more holistic view of sexual wellbeing and other aspects of positive sexuality, 11,18 the measurement of these outcomes is "conspicuous by their absence" 11 in previous randomised trials of RSE, especially in relation to pregnancy prevention. 30 We found that If I Were Jack, a school-based, teacherdelivered intervention, could be cost-effective over the long term, even with modest increases in contraceptive use among sexually active adolescents, with no effects on rates of sexual initiation. These results are consistent with the findings of a pioneering health economic evaluation of school-based RSE in the USA 31 and support the latest UNESCO report 13 on the cost of delivering school-based RSE.…”