Research aim: To determine how an online mindful-compassion intervention adjunct withcannabis suppositories might reduce anal pain during sexual intimacy among men who havesex with men. Outcomes are also hoped to increase sexual functioning, well-being andsexual self-efficacy.Research intention: If the combined mindful compassion and cannabis suppositoryintervention reduces anal pain and supports sexual and general well-being, then thisresearch would be repeated on a larger scale targeting psychosexual services.A brief overview of the intervention:Anal pain is pain experienced in the anus during anal penetration with a penis or otherobjects. Most research on anal pain during sexual intimacy has centred on men who havesex with men. Mindfulness has been anecdotally discussed in reducing symptoms of analpain in men who have sex with men. A novel approach to pain management includes medicalcannabis, which can be cannabidiol, tetrahydrocannabinol or both. Anal suppositories donot create a euphoric high in the same way as oral use, including inhalation.Quantitatively, randomisation will be based on whether participants use cannabissuppositories or not. This study does not randomise to cannabis groups owing to thelegalities in the United Kingdom. Participants included fifty-two consentingparticipants. Of these, thirty-three were using cannabis suppositories. The interventionwas delivered for one month, and the follow-up was at twelve weeks. Qualitatively,participants were asked approximately eight open-ended feedback questions throughout thestudy.
Research looking at mindfulness-based interventions or the use of medical cannabis to
support sexual pain is limited, and often, sexual pain goes unreported, which might lead
to compromised psychological well-being. Additionally, sexual problems associated with
pain and related emotional suffering are frequently overlooked in patients with sexual
pain. This research aims to establish the effectiveness of an online mindful compassion
intervention adjunct with cannabis suppositories to help minimise sexual pain and
increase well-being. This research decided to deliver mindful compassion online because
it would economically target a more comprehensive and diverse group. This preliminary
study examined how a mindful compassion intervention combined with cannabis suppositories
might help minimise sexual pain whilst improving sexual function, well-being, and sexual
self-efficacy.
The main exercises included mindfulness, breathing, relaxation techniques, Mindfulness of
the senses and body, and understanding the self. These exercises incorporated the
three-model system of emotions, how to attend to the cognitive and physical patterns
associated with painful sex, and towards acceptance and self-compassion with fewer
symptoms. The mindful-compassion intervention included psychosexual education and anal
pain, the three-model system of emotions and sexual pain, practising mindful compassion
and graded practice and self-care, efficacy, and the relationship with anatomy.
Homework exercises, including education, training, modelling, and enablement, were
encouraged. Feedback and support, along with discussing the educational components,
training, modelling, and enablement, were addressed throughout this study.
The development of mindful compassion intervention has been based on a taxonomy of
behavioural change techniques. This has been used because the taxonomy of behavioural
change techniques has been rigorously tested to evidence the effectiveness in supporting
interventions associated with change behaviour. The 93 behaviour change techniques are
the active ingredients of behaviour change, and each intervention is likely to consist of
more than one behaviour change technique and serve as having more than one function. The
intervention in this study included twelve domains, of which twenty-three out of the 93
behaviour change techniques listed in the behavioural change technique taxonomy were
identified. The selection of these domains used a triangulation process to ensure
consistency in mapping the behaviour change techniques to the intervention.
Randomisation was based on whether participants were already using cannabis suppositories
or not. Those who did use cannabis suppositories as part of their sex life would have
been doing so for at least a month. There was a total of four groups, including a
cannabis suppository-only group, a mindful-compassion-only group, a combined mindful
compassion and cannabis suppository group and a care-as-usual group.
Combination Product: Cannabis suppositories and mindful-compassion for anal pain
This is a combined intervention that includes mindful-compassion and cannabis
suppositories for anal pain
Behavioral: Mindful-compassion
Mindful-compassion
Inclusion Criteria:
- Participants were allocated to cannabis only, and cannabis adjunct groups would
already be using cannabis suppositories.
- Must have engaged in anal sex within the last month
- Must be based in the United Kingdom
- Must have experienced anal sexual pain
- An absence of co-occurring difficulties
- Must be aged 18 years or older
- Must be able to read and write English.
- Patient health screening score must range between 0-9 mild
- Generalised anxiety disorder screening score must range between 0-9, mild
Exclusion Criteria:
- Have not attempted anal intercourse in the last month
- Have co-occurring difficulties
- Aged below 18 years old
- Reading and writing English difficulties
- Not experiencing anal pain during sexual intercourse.
- Patient health screening score ranged between moderate to severe - 10-27
- Generalised anxiety screening score ranged between 10- 21.
Samantha Banbury
London 2643743, United Kingdom
Samantha Banbury, Principal Investigator
London Metropolitan University