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Does PrEP = better sex? The important question nobody is asking about sexual health

Are gay and bisexual men happy with their sex lives? And is anybody even asking about it?

The answers to both of these questions might be more important than you think. Recent initiatives like the European MSM Internet Survey (EMIS) are showing that sexual satisfaction for gay and bisexual guys is about much more than how much you’re getting.

We had a chat to Dr Adam Bourne from the Australian Research Centre in Sex, Health & Society, to see why sexual satisfaction is so important, and what it has to do with new HIV-prevention strategies like PrEP.

First of all, why does it matter if people are happy with their sex lives?

“A better question would be ‘why doesn’t it matter?’” says Bourne. “When people are having sex, the thing first and foremost in their minds is having sex that’s enjoyable. It’s the reason they’re having sex.”

The World Health Organisation (WHO) agrees. In its definition of sexual health, it includes “the possibility of having pleasurable and safe sexual experiences” as a crucial element.

“…sexual health means more than avoiding disease — as human beings we need to have a sex life that is enjoyable, and it’s very important to us.”

Bourne discussed this definition at a presentation at the 2017 Australasian HIV & AIDS Conference. “Sexual satisfaction is something guys very rarely discuss with their doctor as part of their sexual health. As health professionals, doctors are most concerned about STIs: whether you have one, whether you’re at risk, how they can help you avoid one. But sexual health means more than avoiding disease — as human beings we need to have a sex life that is enjoyable, and it’s very important to us. So, in the sexual health clinic, you often end up with a situation where the doctor and patient are speaking very different languages.”

What does ‘satisfied with your sex life’ mean? What does a good sex life look like?

Turns out that quality is better than quantity after all.

“Most men seem to want similar things out of their sex lives,” says Bourne. “EMIS surveyed over 13,000 men in Europe and asked them to name the most important thing they wanted from sex. The most common response was some kind of emotional and intimate connection with their partner. A lot of sex with a lot of people wasn’t the main goal; they wanted pleasure and intimacy, often with a regular partner.”

And how many of us are actually having the sex we enjoy?

Not as many as you might think. “The EMIS survey results showed that, in Europe, 47 per cent of men who have sex with men were unhappy with their sex lives,” said Bourne.

That’s a lot by anyone’s standards – nearly half of us! But of particular interest to researchers, and doctors like Bourne, is what a more recent European study showed about guys on PrEP. 76 per cent of the guys on PrEP reported being ‘happy or very happy’ with their sex lives, compared with 54 per cent of the men who were not on PrEP.

So, guys on PrEP are more likely to be enjoying their sex lives?

“Yes, there is data showing that men who are using PrEP are reporting much more satisfying sex lives.”

“Seventy-six per cent of the guys on PrEP reported being ‘happy or very happy’ with their sex lives, compared with 54 per cent of the men who were not on PrEP.”

And no, it’s not because they’re suddenly all doing it bareback. “It’s likely because they’re not worried about HIV anymore,” says Bourne. “Most gay men have lived with the fear of HIV in the back of their mind throughout their entire lives. Even when they’re using condoms or doing other things to reduce their risk, many still report a great deal of anxiety about HIV that is always there. With PrEP, that fear and anxiety is gone. That’s kind of remarkable.”

But does that mean they’ve stopped being safe?

PrEP is a means of being safe. It reduces your chance of contracting HIV by over 99 per cent — at least as much as a condom — but of course it doesn’t protect against other STIs.

“Although, we are seeing some degree of stigma around PrEP use as well,” says Bourne. “The idea that you might want to have sex without condoms is perceived as irresponsible by some people. There’s a suggestion that you must be wildly promiscuous, or involved in chemsex — there must be something high-risk happening for you to be on PrEP. The desire for a better sex life, one where you’re less anxious or worried, is somehow not considered valid. We’d like to encourage guys to look at that differently – the fact that PrEP improves your enjoyment of sex doesn’t make it any less effective at preventing HIV!”

Long story short: enjoyable sex is important. PrEP has already proven to be a very effective tool in the fight to end HIV, and it’s not just a responsible choice, it turns out for many, it is an enjoyable choice as well.

“the fact that PrEP improves your enjoyment of sex doesn’t make it any less effective at preventing HIV!”

PrEP is one of many tools you can use to stay healthy. Keeping condoms in the mix alongside taking PrEP will help protect you from other STIs like chlamydia, gonorrhea and syphilis. Getting tested regularly (which is required for a PrEP prescription in Australia) and treated if necessary is one of the best ways to help stop the spread of STIs — which means more enjoyable sex for everyone.

Obviously we all want to have better sex, with minimal risk. Is PrEP the way forward?

“PrEP is one step closer to achieving a much better, more satisfying experience of sexual health. I’d like to see pleasure talked about as a natural part of sexual health, given it’s the reason most of us have sex,” says Bourne. “The notion of ‘the best sex with the least harm’ is something I think we should move towards, which is something they’re promoting in the UK.”

It isn’t just about personal fulfillment either. “Being able to talk about pleasure as something important will open up a lot of conversations. Openly discussing safe sex options with your partner or having an honest talk with your doctor are all part of staying healthy too.”

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