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Relationships between condoms, hormonal methods, and sexual pleasure and satisfaction: an exploratory analysis from the Women’s Well-Being and Sexuality Study

Jenny A. Higgins A G , Susie Hoffman B C , Cynthia A. Graham D and Stephanie A. Sanders E F

A Office of Population Research, 218 Wallace Hall, Princeton University, Princeton, NJ 08544, USA.

B HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA.

C Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY 10032, USA.

D Oxford Doctoral Course in Clinical Psychology, Warneford Hospital, Headington, Oxford OX3 7JX, England, UK.

E The Kinsey Institute, Indiana University, Bloomington, IN 47405, USA.

F Department of Gender Studies, Indiana University, Bloomington, IN 47405, USA.

G Corresponding author. Email:

Sexual Health 5(4) 321-330
Submitted: 14 March 2008  Accepted: 5 June 2008   Published: 18 November 2008


Background: Little is known about how condoms and other contraceptives influence women’s sexual enjoyment, which could shape use patterns. Methods: Data from an online study of women’s sexual health and functioning were used to examine how three categories of contraceptive use – hormonal method only, condoms primarily, and dual use – could help predict decreased sexual pleasure associated with contraceptive method and overall sexual satisfaction in the past 4 weeks. Results: In analyses controlling for age, relationship length, and other variables, male condoms were most strongly associated with decreased pleasure, whether used alone or in conjunction with hormonal methods. Women who used hormonal methods alone were least likely to report decreased pleasure, but they also had significantly lower overall scores of sexual satisfaction compared with the other two groups. Dual users, or women who used both condoms and a hormonal method, reported the highest sexual satisfaction scores. Conclusions: Because male condoms were viewed by many of these women as decreasing sexual pleasure, sexual risk practices are likely to be affected. Although hormonal only users were highly unlikely to report decreased pleasure, they reported lower sexual satisfaction compared with the other two groups. Dual users, who had the highest sexual satisfaction scores, may have been the most sexually satisfied because they felt more fully protected against unwanted pregnancy and sexually transmissible infections – consistent with previous qualitative documentation of ‘eroticising safety.’ This exploratory study suggests that different contraceptives affect sexuality in various ways, warranting further research into these sexual dimensions and how they influence contraceptive practices.

Additional keywords: contraception, hormonal methods, male condoms, sexual pleasure, sexual satisfaction.


[1]  Philpott A Knerr W Boydell V 2006 Pleasure and prevention: when good sex is safer sex. Reprod Health Matters 14 23 31 doi:10.1016/S0968-8080(06)28254-5

[2]  Philpott A Knerr W Maher D 2006 Promoting protection and pleasure: amplifying the effectiveness of barriers against sexually transmitted infections and pregnancy. Lancet 368 2028 31 doi:10.1016/S0140-6736(06)69810-3

[3]  Moore K , Helzner JF . ‘What’s sex got to do with it?’: challenges for incorporating sexuality into family planning programs. New York: The Population Council; 1996.

[4]  Higgins JA Hirsch JS 2007 The pleasure deficit: revisiting the “sexuality connection” in reproductive health. Perspect Sex Reprod Health 39 240 7 doi:10.1363/3924007

[5]  Amaro H Raj A Reed E 2001 Women’s sexual health: the need for feminist analyses in public health in the decade of behavior. Psychol Women Q 25 324 34 doi:10.1111/1471-6402.00032

[6]  Ehrhardt A, Exner T. The impact of HIV infection on women’s sexuality and gender role. In: Blumenthal SJ, Eichler A, Weissman G, (eds). Women and AIDS: Promoting Healthy Behavior. Rockville: US Department of Health & Human Services; 1991. pp. 36–40.

[7]  Worth D 1989 Sexual decision-making and AIDS: why condom promotion among vulnerable women is likely to fail. Stud Fam Plann 20 297 307 doi:10.2307/1966433

[8]  Blanc A 2001 The effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. Stud Fam Plann 32 189 213 doi:10.1111/j.1728-4465.2001.00189.x

[9]  Exner TM , Hoffman S , Dworkin S , Ehrhardt AA Beyond the male condom: the evolution of gender-specific HIV interventions for women. Annu Rev Sex Res 2003; 14: 114–36. Available online at: (accessed 11 July 2008).

[10]  Sobo EJ 1993 Inner-city women and AIDS: the psycho-social benefits of unsafe sex. Cult Med Psychiatry 17 455 85 doi:10.1007/BF01379310

[11]  Sobo EJ 1995 Finance, romance, social support, and condom use among impoverished inner-city women. Hum Organ 54 115 28

[12]  Hirsch JS. “A courtship after marriage”: Gender, sexuality and love in a Mexican migrant community. Berkeley: University of California Press; 2002.

[13]  Hirsch JS , Higgins J , Nathanson CA , Bentley P Social constructions of sexuality: the meanings of marital infidelity and STD/HIV risk in a Mexican migrant community. Am J Public Health 2002; 92: 1227–37. Available online at: (accessed 11 July 2008).

[14]  Knodel J Pramualratana A 1996 Prospects for increased condom use within marriage in Thailand. Int Fam Plan Perspect 22 97 102 doi:10.2307/2950749

[15]  Holland J, Ramazanoglu C, Sharpe S, Thomson R. The male in the head: young people, heterosexuality and power. London: Turfnell Press; 1998.

[16]  Higgins JA Hirsch JS 2008 Pleasure and power: incorporating sexuality, agency, and inequality into research on contraceptive use and unintended pregnancy. Am J Public Health 98 in press.

[17]  Ehrhardt A Exner TM Hoffman S Silberman I Yingling S Adams-Skinner J et al 2002 HIV/STD risk and sexual strategies among women family planning clients in New York: Project FIO. AIDS Behav 6 1 12

[18]  Schaffir J 2006 Hormonal contraception and sexual desire: a critical review. J Sex Marital Ther 32 305 14 doi:10.1080/00926230600666311

[19]  Sanders SA Graham CA Bass JL Bancroft J 2001 A prospective study of the effects of oral contraceptives on sexuality and well-being and their relationship to discontinuation. Contraception 64 51 8 doi:10.1016/S0010-7824(01)00218-9

[20]  Davis AR , Castano PM Oral contraceptives and libido in women. Annu Rev Sex Res 2004; 15: 297–320. Available online at: (accessed 11 July 2008).

[21]  Hatcher RA. Contraceptive technology. 18th rev. edn. New York: Ardent Media; 2004.

[22]  Anderson-Hunt M, Dennerstein LD, Hatton L, Hunt J, Mahony J, Saregant D et al Hormones and female sexuality: developing a method for research. In: Zeidenstein S, Moore K, (eds). Learning about sexuality: a practical beginning. New York: The Population Council & The International Women’s Health Coalition; 1996. pp. 260–77.

[23]  Dennersetin L. Female sexuality, the menstrual cycle, and the pill. In: Zeidenstein S, Moore K, (eds). Learning about sexuality: a practical beginning. New York: The Population Council & The International Women’s Health Coalition; 1996. pp. 253–9.

[24]  Smit J McFadyen L Zuma K Preston-Whyte E 2002 Vaginal wetness: an underestimated problem experienced by progestogen injectable contraceptive users in South Africa. Soc Sci Med 55 1511 22

[25]  Costello C Hillis SD Marchbanks PA Jamieson DJ Peterson HB 2002 The effect of interval tubal sterilization on sexual interest and pleasure. Obstet Gynecol 100 511 7 doi:10.1016/S0029-7844(02)02042-2

[26]  Solomon H , Yount KM , Mbizvo MT ‘A shot of his own’: the acceptability of a male hormonal contraceptive in Indonesia. Culture, Health & Sex 2007; 9: 1–14. Available online at: (accessed 11 July 2008).

[27]  WHO 1982 Hormonal contraception for men: acceptability and effects on sexuality. World Health Organization Task Force on Psychosocial Research in Family Planning, Special Programme of Research, Development and Research Training in Human Reproduction. Stud Fam Plann 13 328 42

[28]  Oudshoorn N. The male pill: a biography of a technology in the making. Durham: Duke University Press; 2003.

[29]  Mantell JE Hoffman S Weiss E Adeokun L Delano G Jagha T et al 2001 The acceptability of the female condom: perspectives of family planning providers in New York City, South Africa, and Nigeria. J Urban Health 78 658 68 doi:10.1093/jurban/78.4.658

[30]  Neilands TB Choi KH 2002 A validation and reduced form of the Female Condom Attitudes Scale. AIDS Educ Prev 14 158 71 doi:10.1521/aeap.

[31]  Artz L , Macaluso M , Brill I , Kelaghan J , Austin H , Fleenor M , et al Effectiveness of an intervention promoting the female condom to patients at sexually transmitted disease clinics. Am J Public Health 2000; 90: 237–44. Available online at: (accessed 11 July 2008).

[32]  Penman-Aguilar A Hall J Artz L Crawford MA Peacock N van Olphen J et al 2002 Presenting the female condom to men: a dyadic analysis of effect of the woman’s approach. Women Health 35 37 51 doi:10.1300/J013v35n01_03

[33]  Telles Dias PR Souto K Page-Shafer K 2006 Long-term female condom use among vulnerable populations in Brazil. AIDS Behav 10 67 75 doi:10.1007/s10461-006-9139-x

[34]  Grady WR Klepinger DH Nelson-Wally A 1999 Contraceptive characteristics: the perceptions and priorities of men and women. Fam Plann Perspect 31 168 75 doi:10.2307/2991589

[35]  Severy LJ Newcomer S 2005 Critical issues in contraceptive and STI acceptability research. J Soc Issues 61 45 65 doi:10.1111/j.0022-4537.2005.00393.x

[36]  Higgins JA 2007 Sexy feminisms and sexual health: theorizing heterosex, pleasure, and constraint for a public health research agenda. Atlantis (Montr) 31 72 81

[37]  Chandra A, Martinez GM, Mosher WD, Abma JC, Jones J. Fertility, family planning, and reproductive health of US women: Data from the 2002 National Survey of Family Growth. National Center for Health Statistics Vital and Health Statistics. Hyattsville: US Department of Health and Human Services; 2005. Available online at: (verified 23 June 2008).

[38]  Mosher WD Martinez GM Chandra A Abma JC Wilson SJ 2004 Use of contraception and use of family planning services in the United States, 1982–2002. Adv Data 350 1 36

[39]  Prause N Graham CA 2007 Asexuality: classification and characterization. Arch Sex Behav 36 341 56

[40]  Carballo-Dieguez A Miner M Dolezal C Rosser BR Jacoby S 2006 Sexual negotiation, HIV-status disclosure, and sexual risk behavior among Latino men who use the internet to seek sex with other men. Arch Sex Behav 35 473 81 doi:10.1007/s10508-006-9078-7

[41]  Gosling SD Vazire S Srivastava S John OP 2004 Should we trust web-based studies? A comparative analysis of six preconceptions about internet questionnaires. Am Psychol 59 93 104 doi:10.1037/0003-066X.59.2.93

[42]  Birnbaum MH 2004 Human research and data collection via the Internet. Annu Rev Psychol 55 803 32 doi:10.1146/annurev.psych.55.090902.141601

[43]  Pequegnat W Rosser BR Bowen AM Bull SS DiClemente RJ Bockting WO et al 2007 Conducting Internet-based HIV/STD prevention survey research: considerations in design and evaluation. AIDS Behav 11 505 21 doi:10.1007/s10461-006-9172-9

[44]  Catania JA Kegeles SM Coates TJ 1990 Towards an understanding of risk behavior: an AIDS risk reduction model (ARRM). Health Educ Q 17 53 72

[45]  Yarber WL Crosby RA Graham CA Sanders SA Hartzell R Butler S 2007 ‘Do you know what you’re doing?’ College students’ experiences with condoms. Am J Health Educ 38 322 31

[46]  Crosby RA Graham CA Yarber WL Sanders SA 2004 If the condom fits, wear it: a qualitative study of young African-American men. Sex Transm Infect 80 306 9

[47]  Thomsen S Stalker M Toroitich-Ruto C 2004 Fifty ways to leave your rubber: how men in Mombasa rationalise unsafe sex. Sex Transm Infect 80 430 4 doi:10.1136/sti.2004.010421

[48]  UNAIDS. Men and AIDS – a gendered approach. Geneva: UNAIDS; 2000 Contract No.: Document Number.

[49]  Graham CA Ramos R Bancroft J Maglaya C Farley TM 1995 The effects of steroidal contraceptives on the well-being and sexuality of women: a double-blind, placebo-controlled, two-centre study of combined and progestogen-only methods. Contraception 52 363 9 doi:10.1016/0010-7824(95)00226-X

[50]  Graham CA Bancroft J Doll HA Greco T Tanner A 2007 Does oral contraceptive-induced reduction in free testosterone adversely affect the sexuality or mood of women? Psychoneuroendocrinology 32 246 55 doi:10.1016/j.psyneuen.2006.12.011

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