title: Covert use, vaginal lubrication, and sexual pleasure: a qualitative study of urban U.S. Women in a vaginal microbicide clinical trial.
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.
authors.affiliation: 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. sh51@columbia.edu
authors.forename: Susie
authors.initials: S
authors.lastname: Hoffman
authors.forename: Kate M
authors.initials: KM
authors.lastname: Morrow
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Mantell
authors.forename: Rochelle K
authors.initials: RK
authors.lastname: Rosen
authors.forename: Alex
authors.initials: A
authors.lastname: Carballo-Diéguez
authors.forename: Fang
authors.initials: F
authors.lastname: Gai
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000282:Administration, Intravaginal; D000328:Adult; D001741:Black or African American / Q000523:psychology; D019380:Anti-HIV Agents / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D015331:Cohort Studies; D003075:Coitus / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D020010:Heterosexuality / Q000523:psychology; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D054327:Lubricants / Q000008:administration & dosage*; D008297:Male; D063065:Organophosphonates / Q000008:administration & dosage*; D017060:Patient Satisfaction; D057181:Pleasure; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners; D000068698:Tenofovir; D014481:United States; D014505:Urban Population; D014621:Vagina / Q000187:drug effects* / Q000378:metabolism; D014622:Vaginal Creams, Foams, and Jellies / Q000008:administration & dosage
chemical_list: D019380:Anti-HIV Agents; D000891:Anti-Infective Agents, Local; D054327:Lubricants; D063065:Organophosphonates; D014622:Vaginal Creams, Foams, and Jellies; D000068698:Tenofovir; D000225:Adenine