Medical Examiner

Putting the Sexy in Safe Sex

Experts have long been calling for education programs to include the pleasures of sex. A new meta-analysis looks at the effects of doing so.

A man opens a condom as his partner watches beside him lying in bed
Mike Watson Images/moodboard via Getty Images Plus

“Don’t have sex, because you will get pregnant and die,” goes a famous line from the 2004 film Mean Girls. The scene is a send-up of abstinence-only sex education, the dominant form of sex ed in the U.S. In it, North Shore High’s Coach Carr encourages a gym full of teenagers to refrain from sex altogether. “Don’t have sex in the missionary position, don’t have sex standing up. Just don’t do it, promise?” he says, before offering the class a plastic bin full of “rubbers.”

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In a recent episode of Netflix’s Sex Education, the vibe is quite different. “You shouldn’t be shamed for having sexual desires,” says Maeve Wiley, a character who co-runs a sex therapy clinic at her high school to help peers with their sexual frustrations and problems. “You make sex sound terrifying, but it doesn’t have to be,” she says to a school official trying to preach abstinence-based education. “It can be fun and beautiful and teach you things about yourself and your body.”

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Sex Education has been applauded for its sex-positive attitude, especially because programs that teach safe sex, whether to tweens or to adults, still often take a more Coach Carr approach. It’s not always easy to get people on board with the idea that sex ed should teach that sex is fun. In Rhode Island, state Rep. Rebecca Kislak recently introduced legislation that would require sex education to “affirmatively recognize pleasure based sexual relations.” The proposal was met with criticism earlier this month from lawmakers, teachers, and parents. One parent called it “disgusting.” It would certainly represent a shift: “When it comes to sex, it’s been an almost exclusive focus on the dangers and the harms that can happen,” says Anne Philpott, director of the Pleasure Project, an international education and advocacy organization that “puts sexy into safer sex,” as she puts it, by promoting pleasure-based education.

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Putting the sexy into safer sex isn’t just fun. Playing up the positives of sex, à la the characters on Sex Education, can actually make people more likely to take precautions against sexually transmitted infections. Philpott has data to prove it, presented in a study titled “Incorporating Sexual Pleasure in Educational Sexual Health Programs Can Improve Safe Sex Behaviors,” published Friday in the journal PLOS One. The study is a collaboration between Philpott and the Pleasure Project team, in conjunction with researchers at Oxford, the Case for Her, and the World Health Organization’s Department of Sexual and Reproductive Health and Research.

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Philpott and her colleagues analyzed past studies that looked at pleasure-inclusive sexual health interventions around the world from 2005 to 2020. Pleasure-based sex education can take a number of forms, but at its core is devoted to normalizing sexual activity and teaching individuals that sex is supposed to (and should) be an enjoyable experience. “Programs that deal with pleasure are going to be more comprehensive and provide, in addition to conversations about pleasure, skills around communication, negotiation, and refusal,” Leslie Kantor, professor and chair of Rutgers’ Department of Urban-Global Public Health, explains.

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Philpott’s team cast a wide net at first, screening thousands of experimental research studies on sexual and reproductive outcomes of sex intervention programs. “We then had to trawl through all of that and narrow it down to all the abstracts that were experimental trials and then look for any of those that were pleasure-inclusive,” as defined by the World Association for Sexual Health in its 2019 declaration. There weren’t many. Just 33 unique interventions fit the pleasure criteria and measured the impact on sexual health outcomes.

Out of the 33 interventions, the research team narrowed its focus to eight studies that reported condom use as an outcome. These studies tested the effectiveness of many different sexual interventions, from sex education in Brazil’s public schools to community-based HIV prevention workshops in Atlanta. After analyzing the data from all eight studies, the team found that pleasure-based programs had an overall moderate, positive, and significant effect on condom use—that is, the sex-haver was more likely to use one—in comparison to interventions that did not also teach about the role of pleasure in sex.

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“This study helps support the idea that a focus on pleasure is correlated to sex that’s less risky,” says Rosara Torrisi, founding director of the Long Island Institute of Sex Therapy, who was not involved in the work. “Correlation doesn’t mean causation. But it’s a great place to start and keep exploring.”

The meta-analysis backs up what experts have long been arguing about pleasure-based education methods: that they can provide students with a feeling of autonomy around sex. According to CUNY Graduate Center’s Michelle Fine, who was one of the first to recognize the missing discourse way back in 1988, centering pleasure is “the portal to entitlement,” as it allows individuals to have control over their sexual decisions and sexual experiences. “It’s a way to envision how can I engage this sphere of social life in a way where I have a voice, I have opinions, I have choice, I can control, I can say yes, I can say no, I can say who,” she says. “If you don’t engage desire, all you’re left with is fear or victimization, and those are very vulnerable positions.”

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When people feel comfortable discussing their wants, they are more likely to broach the topic of safety measures. Teaching people to articulate “what they’re interested in and whether or not they liked what’s happened previously, that’s pleasure-based and skill-based,” Torrisi says. It can open the door for people to have conversations with their partners “around how to actually have safer sex.”

Fine, who was also not involved in the study, pointed to the study’s sample diversity as an indication that pleasure is a broadly useful component of sex ed. Participants in the programs the researchers analyzed varied in age, nationality, and structural vulnerabilities they had experienced, she noted. “This heterogeneity adds to the robust findings that an incorporation of pleasure/design into sex education projects has positive effects on learning, attitude, and behaviors.”

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And Philpott hopes that her work will lead to more funding for pleasure-based education. “Not only does this mean we have more real conversations about sexual health and sex education, but it actually makes those interventions more effective and more cost-effective,” she explains. She hopes that an increased focus on pleasure-based interventions—the pleasure wave, as she calls it—will only get stronger. “For a long time we’ve been advocating for the why we need to do this, and now with the evidence, we need to move to the how, and get people to the next stage.”

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