When you think of prevention in sexual health, what comes to mind? Most of us would think about risk, danger, and disease. But what if we changed that narrative to focus on pleasure? That is what Anne Philpott has been championing for the last two decades. It all started when she had a realization at an AIDS conference in Barcelona 20 years ago that the discussions were mostly about risk and disease, with little talk about the real reason most people have sex - PLEASURE.
So, she founded The Pleasure Project aiming to challenge the stigma around pleasure and to celebrate the importance of discussing pleasure.
"I really think that condoms are sex toys, and we really have missed a trick during this epidemic in not celebrating them and instead focusing on the risk elements of condom promotion," said Philpott at the HIVR4P conference in Lima, Peru, during a plenary session titled Building on Success.
"... There's been a recent WHO report, which has flagged the big increase in other STI infections, which just highlights the fact that there's still a million more people every day getting an STI... So, we need to still focus on the fact that we need to keep emphasizing the importance of condoms and choice," she said.
One of the most exciting aspects of Philpott's work has been promoting the female or internal condom. When inserted, it provides not only protection but also pleasure - a soft ring that rubs against the clitoris or other erogenous zones, making safe sex feel not just safer but better. This kind of "bump and grind" as Philpott calls it, is what she believes should be at the heart of sexual health education - celebrating pleasure rather than stigmatizing it.
Philpott's journey led to groundbreaking research with the World Health Organization and UN bodies, conducting the first meta-analysis that examined whether including pleasure in sexual and reproductive health interventions led to better outcomes. The answer was a big yes.
One standout example was Trans Equity in Uganda
Interventions that included pleasure saw an improvement in condom use and other health behaviors.
"...We recommend that agencies responsible for sexual and reproductive health consider incorporating sexual pleasure considerations within their programming...If we had not silenced or ignored pleasure in our intervention since the beginning of the HIV epidemic, we would have saved many more lives. Pleasure is not the icing on the cake, but it should be an essential part of interventions that should be implemented from now," according to Philpott.
The Pleasure Project has developed "Pleasure Principles", an operational guide for health practitioners to integrate pleasure into their sexual health programming. It's been endorsed by over 60 organizations worldwide, including the International Planned Parenthood Federation (IPPF).
The IPPF in Africa launched an intervention called "Treasure Your Pleasure" - a digital sex education campaign focused on pleasure. "They reached 9 million young people and saw an increase in services accessed via a pleasure-focused digital sex education campaign," said Philpott. The campaign, conducted in three languages, leveraged regional influencers to drive engagement.
"They saw a much higher uptake in services because the approach was honest and non-stigmatizing."
The evaluation of this campaign, now available on their website, simplified into accessible quick tips on how to deliver pleasure-centered digital sex education.
Another initiative, funded by AmplifyChange, saw eight organizations incorporate pleasure-based sexual health into their programs. "These organizations included the Midwife Association in the DR Congo, Young and Alive in Tanzania that works with young people, a youth-focused organization in Lesotho, faith-based groups in Rwanda, Trans Equity in Uganda, and the National Sex Worker Federation in India."
One standout example was Trans Equity in Uganda, which hosted a Valentine's Day event about love. "...they really liked the opportunity to focus on what they wanted to get from relationships and love, and how trans people can love, because they said they were so fed up of being always told about disease risks," said Philpott. This intervention highlights why a pleasure-centered approach works - "It's about addressing what people actually want to hear, and then integrating how to stay safe in those contexts."
"As I often say, we don't teach people how to cook by saying, 'Oh no, you're going to hurt yourself, you're going to get burns, you're going to kill people.' What we say is, 'This is how you should do it, and you might really enjoy this recipe. Here's how you can bake, but just be careful not to get burnt, and it's important that you do that,'" said Philpott.
This spotlights the importance of balancing enjoyment and safety.
"The discussion at this conference has also been rich, focusing on new prevention options like the vaginal ring and PrEP," she said while stressing that new products should build on past experiences and offer users the opportunity to make informed, complex decisions in their sexual lives.
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"In one of the initial vaginal ring studies, participants spontaneously mentioned they found the ring 'hot' and 'sexy,' yet pleasure wasn't discussed as part of the results," said Philpott, expressing disappointment that this important part of sexual health is often overlooked.
PrEP is fantastic, offering a condom-less future for many
"I hope pleasure is something that gets asked about more in future research."
"In some of the early microbicide trials, when they were testing ways to deliver vaginal microbicides, participants were hoarding the tubes of lubricant," said Philpott.
"Lube is like the unsung heroine of sex - it makes everything feel better!" She emphasized that this highlights how we should be talking about pleasure in sexual health, asking people how they want to enjoy their sexual experiences.
"PrEP is fantastic, offering a condom-less future for many, especially with condom fatigue being real for people who've spent their entire sex lives using them during this epidemic. But there's no magic bullet of a new product," she said.
"We need to avoid any kind of oppositional politics or narratives around products, and really think about layering those options for choices."
