University of Oxford, Oxford, United Kingdom.
The Pleasure Project, United Kingdom and India.
PLoS One. 2022 Feb 11;17(2):e0261034. doi: 10.1371/journal.pone.0261034. eCollection 2022.
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.
尽管在性与生殖健康和权利（SRHR）方面投入了数十亿美元，但目前尚不清楚将性愉悦（人们进行性行为的主要驱动因素之一）纳入性健康干预措施的效果。我们按照 PRISMA 指南，在 7 个数据库中对 2005 年 1 月 1 日至 2020 年 6 月 1 日期间发表的相关文章进行了系统评价和荟萃分析。我们的系统评价包括 33 项独特的干预措施。有 8 项干预措施报告了避孕套使用结果，我们采用了随机效应模型进行荟萃分析。质量评估通过 Cochrane Collaborations 的 RoB2 工具进行。本研究已在 Prospero 上预先注册（ID：CRD42020201822）。我们确定了 33 项独特的干预措施（基线时 18886 名参与者），这些干预措施均包含愉悦因素。所有纳入的干预措施均以降低 HIV/性传播感染风险为目标，没有一项干预措施发生在预防怀孕或计划生育的背景下。我们发现，大多数干预措施针对的是作者归类为高危人群的人群。我们能够对 8 项研究（基线时 6634 名参与者）进行荟萃分析，这些研究报告了避孕套使用情况作为结果，发现科恩氏 d = 0·37（95%CI 0·20-0·54，p < 0·001；I2 = 48%；τ2 = 0·043，p = 0·06）的总体适度、积极且显著的效果。在 SRHR 干预措施中纳入性愉悦可以改善性健康结果。我们的荟萃分析提供了关于愉悦性干预措施对避孕套使用的积极影响的证据，这对降低 HIV 和性传播感染直接具有重要意义。从质量上看，我们发现证据表明，愉悦感可以对不同的信息和知识型态度产生积极影响。未来需要进一步研究来阐明愉悦感在 SRHR 中的影响，以及在不同结果和人群中的影响。考虑到所有现有证据，我们建议负责性与生殖健康的机构在其规划中考虑纳入性愉悦因素。
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