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Young Women’s Use of a Microbicide Surrogate: The Complex Influence of Relationship Characteristics and Perceived Male Partners’ Evaluations

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Abstract

Currently in clinical trials, vaginal microbicides are proposed as a female-initiated method of sexually transmitted infection prevention. Much of microbicide acceptability research has been conducted outside of the United States and frequently without consideration of the social interaction between sex partners, ignoring the complex gender and power structures often inherent in young women’s (heterosexual) relationships. Accordingly, the purpose of this study was to build on existing microbicide research by exploring the role of male partners and relationship characteristics on young women’s use of a microbicide surrogate, an inert vaginal moisturizer (VM), in a large city in the United States. Individual semi-structured interviews were conducted with 40 young women (18–23 years old; 85% African American; 47.5% mothers) following use of the VM during coital events for a 4 week period. Overall, the results indicated that relationship dynamics and perceptions of male partners influenced VM evaluation. These two factors suggest that relationship context will need to be considered in the promotion of vaginal microbicides. The findings offer insights into how future acceptability and use of microbicides will be influenced by gendered power dynamics. The results also underscore the importance of incorporating men into microbicide promotion efforts while encouraging a dialogue that focuses attention on power inequities that can exist in heterosexual relationships. Detailed understanding of these issues is essential for successful microbicide acceptability, social marketing, education, and use.

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Acknowledgements

The authors would like to thank Megan Patterson, Mallory Metzger, and Erin Triplett for their invaluable assistance to the project. This study was funded by a grant from National Institutes of Health (NIH U19 AI 31494) as well as research awards to the first author: Friends of the Kinsey Institute Research Grant Award, Indiana University’s School of HPER Graduate Student Grant-in-Aid of Research Award, William L. Yarber Sexual Health Fellowship, and the Indiana University Graduate and Professional Student Organization Research Grant.

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Authors and Affiliations

  1. Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Room 733, Baltimore, MD, 21205, USA

    Amanda E. Tanner

  2. Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    J. Dennis Fortenberry & Gregory D. Zimet

  3. Department of Applied Health Science, Indiana University, Bloomington, IN, USA

    Michael Reece & Maresa Murray

  4. Oxford Doctoral Course in Clinical Psychology, University of Oxford, Oxford, UK

    Cynthia A. Graham

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  1. Amanda E. Tanner
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  2. J. Dennis Fortenberry
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  3. Gregory D. Zimet
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  4. Michael Reece
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  5. Cynthia A. Graham
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  6. Maresa Murray
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Corresponding author

Correspondence to Amanda E. Tanner.

Appendix 1: Interview Guide

Appendix 1: Interview Guide

Moisturizer Interview Guide

Which VM group were you in? Have you been in other groups before? Which one(s)?

Which did you prefer? Why?

Did you use the vaginal moisturizer? Who did you use it with? Relationship satisfaction?

Had you ever used a vaginal moisturizer before?

Do you feel comfortable with touching you vagina and/or masturbation?

Do you feel comfortable with someone else touching your vagina?

Experience with the moisturizer

How would you describe what it is and what it does?

Is this product similar to any other products that you use? (Like lube, spermicide, etc.)

Please describe the last time you used the vaginal moisturizer. (Narrative)

Probes/follow-up

Who did you use it with? What is your relationship with this person?

Where were you? Is this where you usually have sex?

Did your partner know you were using it?

  • If yes, can you describe the conversation that occurred about use of the product?

  • When did you talk about it (before or after sex)?

  • If no, what made you decide not to tell them?

Do you think it would be easier or more difficult to use the product with a different partner? Why or why not?

Where did you go to apply the moisturizer? Was your partner present? Did he help?

How long do you think you’d have to be with a partner in order to use it in front of them?

Do you think it would be easier or more difficult to use the product in a different place (for example, your house vs. his house)?

For those who brought up the VM within the context of the study, how would they bring it up to partner not using it? Would it be different if it was more than a moisturizer, if it had contraceptive/protective characteristics?

How do you like the moisturizer?

Did it feel too greasy? (Didn’t like it) Did it feel good/lubed you up? (Did like it)

Probes/follow-up

Did it make the sex feel better? Feel worse?

Do you like sex more or less with the moisturizer? Why or why not?

Do you think your partner likes it more or less? Why or why not?

Did you use the product while you were having your period? How was it different? Did you prefer to use the moisturizer when you were having or not having your period? How would it be easier to use while having your period?

Do you have sex at all when you are having your period?

(Check diaries to see when used)

Experience not using the moisturizer

Please describe the times that you did not use the moisturizer as assigned. (Narrative)

What were the reasons for not using the moisturizer? For instance, did you just not use it or did you have a conversation about using it, etc.

Probes/follow-up

How were times you didn’t use the moisturizer different from the times you did use it?

For example, the location, the partner, the relationship with the partner, etc.

How difficult or easy did you think the product was to use?

If you were going to tell others about this to get the word out, what would you say?

Probes/follow-up

How would you describe it? What would you tell them it does?

If you were going to tell your friends about the moisturizer, what would say about it?

Acceptability

Do you think that if this product prevented pregnancy and sexually transmitted infections, that you would have used it more frequently?

(This is especially relevant to women who are assigned to the post-coital group)

Covert use

When comparing this to other products that you’ve used in the past, like condoms, the shot, etc., do you think that you would be likely to use a microbicide? Why or why not?

Sexual scripts

Intrapsychic

What you think are the best things about having sex?

Do you get turned on easily?

In general, what do you think are the worst things about having sex?

What are 3–5 word you would use to describe sex?

Probes/follow-up

Is it something that you really like?

Is it something that you do because your partner wants to?

Do you think that men or women like sex more? Why?

Interpersonal

What order do you think that sexual behavior occurs?

Please draw a map of the sequence of sexual activity. You have a line drawn on a card anchored by “beginning” and “end” of sex and you can ask how long that interval usually lasts, and where things occur.

(flirting, kissing, hugging, touching breasts, touching your genitals, touching his genitals, going down on him/blow job, him going down on you, intercourse, anal sex, other)

What are your favorite/least favorite parts?

Where do you usually get really aroused?

How long does the interaction usually take?

How do you and your partner agree to have sex?

Is it communicated? Signaled? Scheduled? Do you have a code?

Probes/follow-up

Does kissing come before sexual intercourse? What other behaviors occur in-between? What behaviors vary in their placement or never happen (i.e., for some women oral sex)?

Are there any parts that you especially like or dislike?

How long does it take for you to become sexually involved? (Approximate range)

Cultural

How many of your friends are having sex?

How many of your friends do not have sex?

How many of your friends have kids? Don’t have kids?

Probes/follow-up

How old were they when they started having sex?

Do they use/have they used anything for protection, like condoms, the shot, etc.?

Have they ever had a sexually transmitted infection?

Who do you think influences people’s sexual behavior?

What do your friends and family think about you having sex? an STI? or a child?

Does the church how you feel about sexuality? Sex? and sexually transmitted disease?

What kind of [music, television, movies, etc.] do you usually [listen to, watch, read]?

What kind of message do you get about sex from these media?

(Try to get specific examples)

Probes/follow-up

What are the messages you receive from television, movies, music, etc.?

What do you learn from each about what sexual behaviors are okay/not okay?

Do they talk about an order that behavior typically progresses? If yes, what is that order? Is it similar to what you and your friends do? How or how not?

Do you have any questions for me? Leave my phone number, if have any questions later.

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Tanner, A.E., Fortenberry, J.D., Zimet, G.D. et al. Young Women’s Use of a Microbicide Surrogate: The Complex Influence of Relationship Characteristics and Perceived Male Partners’ Evaluations. Arch Sex Behav 39, 735–747 (2010). https://doi.org/10.1007/s10508-008-9464-4

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