Abstract
Sexual pleasure is a key determinant of condom use. We developed and validated a male, event-level sexual pleasure scale (EMSEXpleasure) among a sample of condom-using men in the U.S. in order to facilitate improved measurement of sexual pleasure. Based on an expert panel process, a 12-item scale was developed. An online sample of 169 men who have sex with men and 162 men who have sex with women were recruited. Factor analysis yielded a two-factor solution that matched domains identified a priori by the expert panel, general pleasure and condom-specific pleasure, indicating internal validity of the instrument. One item was deleted from the scale due to poor validity performance. The overall EMSEXpleasure scale, and each subscale, had high (> 0.8) Cronbach’s alpha coefficients, indicating internal reliability. The scale demonstrated convergent validity, with theoretically related constructs associated both with individual scale items and with scale totals. Overall relationship quality (b 3.0, 95% CI 2.0, 4.0), sexual relationship quality (b 2.9, 95% CI 2.0, 4.0), foreplay quality (b 7.5, 95% CI 2, 13), positive feelings about condoms (b 18.8, 95% CI 15, 23), and erection problems while using condoms (b − 17.9, 95% CI − 22, − 14) were associated with the EMSEXpleasure scale in expected directions. The validated EMSEXpleasure event-level scale may be advantageous for future assessments of the ephemeral experience of sexual pleasure, including clinical trials of condoms and other interventions, because it can be used immediately after sex, potentially limiting recall error.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Arnow, B. A., Desmond, J. E., Banner, L. L., Glover, G. H., Solomon, A., Polan, M. L., … Atlas, S. W. (2002). Brain activation and sexual arousal in healthy, heterosexual males. Brain, 125(Pt. 5), 1014–1023.
Beksinska, M., Smit, J., Mabude, Z., Vijayakumar, G., & Joanis, C. (2006). Performance of the Reality® polyurethane female condom and a synthetic latex prototype: A randomized crossover trial among South African women. Contraception, 73(4), 386–393. https://doi.org/10.1016/j.contraception.2005.07.015.
Bill annd Melinda Gates Foundation. (2013). Develop the next generation of condom (Round 11). Retrieved from https://gcgh.grandchallenges.org/challenge/develop-next-generation-condom-round-11.
Brown, L. K., DiClemente, R., Crosby, R., Fernandez, M. I., Pugatch, D., Cohn, S., … Schlenger, W. E. (2008). Condom use among high-risk adolescents: Anticipation of partner disapproval and less pleasure associated with not using condoms. Public Health Reports, 123(5), 601–607.
Byers, E. S., & MacNeil, S. (2006). Further validation of the interpersonal exchange model of sexual satisfaction. Journal of Sex and Marital Therapy, 32(1), 53–69.
Calabrese, S. K., Reisen, C. A., Zea, M. C., Poppen, P. J., & Bianchi, F. T. (2012). The pleasure principle: The effect of perceived pleasure loss associated with condoms on unprotected anal intercourse among immigrant Latino men who have sex with men. AIDS Patient Care STDS, 26(7), 430–435. https://doi.org/10.1089/apc.2011.0428.
Carballo-Dieguez, A., Ventuneac, A., Dowsett, G. W., Balan, I., Bauermeister, J., Remien, R. H., … Mabragana, M. (2011). Sexual pleasure and intimacy among men who engage in “bareback sex”. AIDS and Behavior, 15(Suppl. 1), S57–65. https://doi.org/10.1007/s10461-011-9900-7.
Centers for Disease Control and Prevention. (2016). Sexually transmitted disease surveillance 2015. Retrieved from https://www.cdc.gov/std/stats15/STDSurveillance-2015-print.pdf.
Cook, L., Nanda, K., & Taylor, D. (2001). Randomized crossover trial comparing the eZ·on™ plastic condom and a latex condom. Contraception, 63(1), 25–31.
Crosby, R. A., Graham, C. A., Yarber, W. L., & Sanders, S. A. (2004). If the condom fits, wear it: A qualitative study of young African-American men. Sexually Transmitted Infections, 80(4), 306–309. https://doi.org/10.1136/sti.2003.008227.
Crosby, R. A., Graham, C. A., Yarber, W. L., Sanders, S. A., Milhausen, R. R., & Mena, L. (2016). Measures of attitudes toward and communication about condom use: Their relationships with sexual risk behavior among young black men who have sex with men. Sexually Transmitted Diseases, 43(2), 94–98. https://doi.org/10.1097/olq.0000000000000392.
Crosby, R. A., Milhausen, R. R., Mark, K. P., Yarber, W. L., Sanders, S. A., & Graham, C. A. (2013). Understanding problems with condom fit and feel: An important opportunity for improving clinic-based safer sex programs. Journal of Primary Prevention, 34(1–2), 109–115. https://doi.org/10.1007/s10935-013-0294-3.
Crosby, R., Milhausen, R., Yarber, W. L., Sanders, S. A., & Graham, C. A. (2008). Condom ‘turn offs’ among adults: An exploratory study. International Journal of STD and AIDS, 19(9), 590–594. https://doi.org/10.1258/ijsa.2008.008120.
Davis, M., & Flowers, P. (2011). Love and HIV serodiscordance in gay men’s accounts of life with their regular partners. Culture, Health & Sexuality, 13(7), 737–749. https://doi.org/10.1080/13691058.2011.552986.
Edwards, W. M., & Coleman, E. (2004). Defining sexual health: A descriptive overview. Archives of Sexual Behavior, 33(3), 189–195. https://doi.org/10.1023/B:ASEB.0000026619.95734.d5.
Emetu, R. E., Marshall, A., Sanders, S. A., Yarber, W. L., Milhausen, R. R., Crosby, R. A., & Graham, C. A. (2014). A novel, self-guided, home-based intervention to improve condom use among young men who have sex with men. Journal of American College Health, 62(2), 118–124. https://doi.org/10.1080/07448481.2013.856914.
Fennell, J. (2014). “And isn’t that the point?”: Pleasure and contraceptive decisions. Contraception, 89, 264–270. https://doi.org/10.1016/j.contraception.2013.11.012.
Finlayson, T. J., Le, B., Smith, A., Bowles, K., Cribbin, M., Miles, I., … Dinenno, E. (2011). HIV risk, prevention, and testing behaviors among men who have sex with men–National HIV Behavioral Surveillance System, 21 U.S. cities, United States, 2008. MMWR Surveill Summ, 60(14), 1–34.
Flynn, K. E., Lin, L., Cyranowski, J. M., Reeve, B. B., Reese, J. B., Jeffery, D. D., … Weinfurt, K. P. (2013). Development of the NIH PROMIS (R) Sexual Function and Satisfaction measures in patients with cancer. Journal of Sexual Medicine, 10(Suppl. 1), 43–52. https://doi.org/10.1111/j.1743-6109.2012.02995.x.
Georgiadis, J. R., & Kringelbach, M. L. (2012). The human sexual response cycle: Brain imaging evidence linking sex to other pleasures. Progress in Neurobiology, 98(1), 49–81. https://doi.org/10.1016/j.pneurobio.2012.05.004.
Glorfeld, L. W. (1995). An improvement on Horn’s parallel analysis methodology for selecting the correct number of factors to retain. Educational and Psychological Measurement, 55(3), 377–393.
Graham, C. A. (2012). Condom use in the context of sex research: A commentary. Sexual Health, 9(1), 103–108. https://doi.org/10.1071/sh11103.
Graham, C. A., Crosby, R., Yarber, W. L., Sanders, S. A., McBride, K., Milhausen, R. R., & Arno, J. N. (2006). Erection loss in association with condom use among young men attending a public STI clinic: Potential correlates and implications for risk behaviour. Sexual Health, 3(4), 255–260.
Hensel, D. J., Rosenberger, J. G., Novak, D. S., & Reece, M. (2012a). Sexual event-level characteristics of condom use during anal intercourse among HIV-negative men who have sex with men. Sexually Transmitted Diseases, 39(7), 550–555. https://doi.org/10.1097/OLQ.0b013e31824f1da4.
Hensel, D. J., Stupiansky, N. W., Herbenick, D., Dodge, B., & Reece, M. (2012b). Sexual pleasure during condom-protected vaginal sex among heterosexual men. Journal of Sexual Medicine, 9(5), 1272–1276. https://doi.org/10.1111/j.1743-6109.2012.02700.x.
Hernandez-Romieu, A. C., Sullivan, P. S., Sanchez, T. H., Kelley, C. F., Peterson, J. L., Del Rio, C., … Rosenberg, E. S. (2014). The comparability of men who have sex with men recruited from venue–time–space sampling and facebook: A cohort study. JMIR Research Protocols, 3(3), e37. https://doi.org/10.2196/resprot.3342.
Higgins, J. A., & Hirsch, J. S. (2007). The pleasure deficit: Revisiting the “sexuality connection” in reproductive health. Perspectives on Sexual and Reproductive Health, 39(4), 240–247. https://doi.org/10.1363/3924007.
Higgins, J. A., & Hirsch, J. S. (2008). Pleasure, power, and inequality: Incorporating sexuality into research on contraceptive use. American Journal of Public Health, 98(10), 1803–1813. https://doi.org/10.2105/ajph.2007.115790.
Holmes, K. K., Levine, R., & Weaver, M. (2004). Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization, 82(6), 454–461.
Jannini, E. A., & Lenzi, A. (2005). Ejaculatory disorders: Epidemiology and current approaches to definition, classification and subtyping. World Journal of Urology, 23(2), 68–75. https://doi.org/10.1007/s00345-004-0486-9.
Lawrance, K. A., & Byers, E. S. (1995). Sexual satisfaction in long-term heterosexual relationships: The Interpersonal Exchange Model of Sexual Satisfaction. Personal Relationships, 2(4), 267–285.
Macaluso, M., Blackwell, R., Jamieson, D. J., Kulczycki, A., Chen, M. P., Akers, R., … Duerr, A. (2007). Efficacy of the male latex condom and of the female polyurethane condom as barriers to semen during intercourse: A randomized clinical trial. American Journal of Epidemiology, 166(1), 88–96. https://doi.org/10.1093/aje/kwm046.
McNaghten, A., Kearns, R., Siegler, A. J., Phaswana-Mafuya, N., Bekker, L. G., Stephenson, R., … Sullivan, P. S. (2014). Sibanye methods for prevention packages program project protocol: Pilot study of HIV prevention interventions for men who have sex with men in South Africa. JMIR Research Protocols, 3(4), e55. https://doi.org/10.2196/resprot.3737.
Opperman, E., Braun, V., Clarke, V., & Rogers, C. (2014). “It feels so good it almost hurts”: Young adults’ experiences of orgasm and sexual pleasure. Journal of Sex Research, 51(5), 503–515. https://doi.org/10.1080/00224499.2012.753982.
Philpott, A., Knerr, W., & Maher, D. (2006). Promoting protection and pleasure: Amplifying the effectiveness of barriers against sexually transmitted infections and pregnancy. Lancet, 368(9551), 2028–2031. https://doi.org/10.1016/s0140-6736(06)69810-3.
Pinkerton, S. D., & Abramson, P. R. (1997). Effectiveness of condoms in preventing HIV transmission. Social Science and Medicine, 44(9), 1303–1312.
Potter, W. D., & de Villemeur, M. (2003). Clinical breakage, slippage and acceptability of a new commercial polyurethane condom: A randomized, controlled study. Contraception, 68(1), 39–45.
Randolph, M. E., Pinkerton, S. D., Bogart, L. M., Cecil, H., & Abramson, P. R. (2007). Sexual pleasure and condom use. Archives of Sexual Behavior, 36(6), 844–848. https://doi.org/10.1007/s10508-007-9213-0.
Sanders, S. A., Herbenick, D., Reece, M., Schick, V., Mullinax, M., Dodge, B., & Fortenberry, J. D. (2013). The development and validation of a brief Quality of Sexual Experience (QSE) scale: Results from a nationally representative sample of men and women in the United States. Journal of Sexual Medicine, 10(10), 2409–2417. https://doi.org/10.1111/jsm.12198.
Sanders, S. A., Hill, B. J., Crosby, R. A., & Janssen, E. (2014). Correlates of condom-associated erection problems in young, heterosexual men: Condom fit, self-efficacy, perceptions, and motivations. AIDS and Behavior, 18, 128–134. https://doi.org/10.1007/s10461-013-0422-3.
Scott-Sheldon, L. A., & Johnson, B. T. (2006). Eroticizing creates safer sex: A research synthesis. Journal of Primary Prevention, 27(6), 619–640. https://doi.org/10.1007/s10935-006-0059-3.
Scott-Sheldon, L. A., Marsh, K. L., Johnson, B. T., & Glasford, D. E. (2006). Condoms + pleasure = safer sex? A missing addend in the safer sex message. AIDS Care, 18(7), 750–754. https://doi.org/10.1080/09540120500411073.
Siegler, A. J., Mbwambo, J. K., McCarty, F. A., & DiClemente, R. J. (2012). Condoms “contain worms” and “cause HIV” in Tanzania: Negative Condom Beliefs Scale development and implications for HIV prevention. Social Science and Medicine, 75(9), 1685–1691. https://doi.org/10.1016/j.socscimed.2012.07.010.
Siegler, A. J., Voux, A., Phaswana-Mafuya, N., Bekker, L. G., Sullivan, P. S., Baral, S. D., … Stephenson, R. (2014). Elements of condom-use decision making among South African men who have sex with men. Journal of the International Association of Providers of AIDS Care, 13(5), 414–423. https://doi.org/10.1177/2325957414535979.
Smith, D. K., Herbst, J. H., Zhang, X., & Rose, C. E. (2015). Condom effectiveness for HIV prevention by consistency of use among men who have sex with men in the United States. Journal of Acquired Immune Deficiency Syndromes, 68(3), 337–344. https://doi.org/10.1097/qai.0000000000000461.
Snell W. E. (1998). The multidimensional sexual self-concept questionnaire. Handbook of Sexuality-Related Measures (2nd ed.)., 521–524.
Steiner, M. J., Cates, W., & Warner, L. (1999). The real problem with male condoms is nonuse. Sexually Transmitted Diseases, 26(8), 459–462.
Stulhofer, A., Busko, V., & Brouillard, P. (2010). Development and bicultural validation of the new Sexual Satisfaction Scale. Journal of Sex Research, 47(4), 257–268. https://doi.org/10.1080/00224490903100561.
Sullivan, P. S. (2016). Condom performance in a longitudinal enhanced assessment of user experiences (C-PLEASURE). Retrieved from https://clinicaltrials.gov/show/NCT02753842.
Sullivan, P. S., Carballo-Dieguez, A., Coates, T., Goodreau, S. M., McGowan, I., Sanders, E. J., … Sanchez, J. (2012). Successes and challenges of HIV prevention in men who have sex with men. Lancet, 380(9839), 388–399. https://doi.org/10.1016/s0140-6736(12)60955-6.
Sullivan, P. S., Jones, J., Kishore, N., & Stephenson, R. (2015a). The roles of technology in primary HIV prevention for men who have sex with men. Current HIV/AIDS Reports, 12(4), 481–488. https://doi.org/10.1007/s11904-015-0293-5.
Sullivan, P. S., Rosenberg, E. S., Sanchez, T. H., Kelley, C. F., Luisi, N., Cooper, H. L., … Peterson, J. L. (2015b). Explaining racial disparities in HIV incidence in black and white men who have sex with men in Atlanta, GA: A prospective observational cohort study. Annals of Epidemiology, 25(6), 445–454. https://doi.org/10.1016/j.annepidem.2015.03.006.
Tepper, M. S. (2000). Sexuality and disability: The missing discourse of pleasure. Sexuality and Disability, 18(4), 283–290. https://doi.org/10.1023/A:1005698311392.
Thomsen, S., Stalker, M., & Toroitich-Ruto, C. (2004). Fifty ways to leave your rubber: How men in Mombasa rationalise unsafe sex. Sexually Transmitted Infections, 80(6), 430–434. https://doi.org/10.1136/sti.2004.010421.
Tracy, J. K., & Junginger, J. (2007). Correlates of lesbian sexual functioning. Journal of Women’s Health, 16(4), 499–509. https://doi.org/10.1089/jwh.2006.0308.
U.S. Food and Drug Administration (FDA). (1995). Testing guidance for male condoms made from new material (Non-Latex). Retrieved from http://www.fda.gov/medicaldevices/deviceregulationandguidance/guidancedocuments/ucm080618.htm.
Walsh, T. L., Frezieres, R. G., Peacock, K., Nelson, A. L., Clark, V. A., & Bernstein, L. (2003). Evaluation of the efficacy of a nonlatex condom: Results from a randomized, controlled clinical trial. Perspectives on Sexual and Reproductive Health, 35(2), 79–86.
Whipple, B., & Komisaruk, B. R. (1985). Elevation of pain threshold by vaginal stimulation in women. Pain, 21(4), 357–367.
WHO Education. (1975). Treatment in sexuality: The training of health professionals. Geneva: World Health Organization.
Zwick, W. R., & Velicer, W. F. (1986). Comparison of five rules for determining the number of components to retain. Psychological Bulletin, 99(3), 432–442.
Acknowledgements
The authors want to thank the external review committee, comprised of Drs. Richard Crosby, Jeffrey Parsons, William Potter, Stephanie Sanders, and Maria Cecilia Zea, for providing substantial input into the development of the scale and conceptualization of validation approach. Funding was provided by Eunice Kennedy Shriver National Institute of Child Health and Human Development (Grant Nos. R43HD078154, R44HD078154). The study was facilitated by the Emory Center for AIDS Research P30AI050409. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Siegler, A.J., Boos, E., Rosenberg, E.S. et al. Validation of an Event-Level, Male Sexual Pleasure Scale (EMSEXpleasure) Among Condom-Using Men in the U.S.. Arch Sex Behav 47, 1745–1754 (2018). https://doi.org/10.1007/s10508-017-1103-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-017-1103-5