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Covert Use, Vaginal Lubrication, and Sexual Pleasure: A Qualitative Study of Urban U.S. Women in a Vaginal Microbicide Clinical Trial

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Abstract

Using data from a U.S. clinical safety trial of tenofovir gel, a candidate microbicide, we explored the intersection of sexual pleasure and vaginal lubrication to understand whether and under what circumstances women would use a microbicide gel covertly with primary partners. This study question emerged from acceptability research in diverse settings showing that even though future microbicides are extolled as a disease prevention method that women could use without disclosing to their partners, many women assert they would inform their primary partner. Participants (N = 84), stratified by HIV-status and sexual activity (active vs. abstinent), applied the gel intra-vaginally for 14 days. At completion, quantitative acceptability data were obtained via questionnaire (N = 79) and qualitative data via small group discussions (N = 15 groups, 40 women). Quantitatively, 71% preferred a microbicide that could not be noticed by a sex partner and 86% experienced greater vaginal lubrication with daily use. Based on our analysis of the qualitative data, we suggest that women’s perception that their primary partners would notice a microbicide gel is a more important reason for their caution regarding covert use than may previously have been recognized. Our findings also showed that women’s assessment of the possibility of discreet, if not covert, use was strongly related to their perception of how a microbicide’s added vaginal lubrication would influence their own and their partner’s pleasure, as well as their partner’s experience of his sexual performance. A microbicide that increases pleasure for both partners could potentially be used without engendering opposition from primary partners.

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Acknowledgments

This study was supported by the HIV Prevention Trials Network (HPTN) and sponsored by the National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, National Institute on Drug Abuse, National Institute of Mental Health, and Office of AIDS Research, of the National Institutes of Health, U.S. Department of Health and Human Services (U01-AI-46749, U01-AI-48016, U01-AI-48040, U01-AI-48014, U01-AI-47972, U01-AI-46702 and U01-AI-46745). Study product was supplied by Gilead Sciences, Inc., Foster City, California. Drs. Hoffman, Mantell, and Carballo-Dieguez were additionally supported by a center grant from the National Institute of Mental Health to the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University (P30-MH43520; Principal Investigator: Anke A. Ehrhardt, Ph.D.). The content of this publication does not necessarily reflect the views or policies of the National Institute of Allergy and Infectious Diseases or the HIV Prevention Trials Network, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. We thank Jenny Higgins for insightful comments on earlier drafts. The Acceptability Team acknowledges the important roles played by Teresa Costello and Dana Fry in data collection, and gratefully thanks the women who participated in this study for sharing their experiences.

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Authors and Affiliations

  1. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA

    Susie Hoffman, Joanne E. Mantell & Alex Carballo-Diéguez

  2. Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA

    Susie Hoffman

  3. The Miriam Hospital, Providence, RI, USA

    Kate M. Morrow & Rochelle K. Rosen

  4. The Warren Alpert Medical School of Brown University, Providence, RI, USA

    Kate M. Morrow

  5. Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Fang Gai

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  1. Susie Hoffman
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  2. Kate M. Morrow
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  3. Joanne E. Mantell
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  4. Rochelle K. Rosen
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  5. Alex Carballo-Diéguez
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  6. Fang Gai
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Correspondence to Susie Hoffman.

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Hoffman, S., Morrow, K.M., Mantell, J.E. et al. Covert Use, Vaginal Lubrication, and Sexual Pleasure: A Qualitative Study of Urban U.S. Women in a Vaginal Microbicide Clinical Trial. Arch Sex Behav 39, 748–760 (2010). https://doi.org/10.1007/s10508-009-9509-3

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