A Preliminary Study Looking at the Use of Mindful Compassion and Cannabis Suppositories for Anodyspareunia among Men Who Have Sex with Men (MSM)
Abstract
:1. Introduction
- There will be a significant effect of time on sexual self-efficacy, mindful compassion, sexual functioning, well-being, and sexual pain during the delivery of mindful compassion among groups using cannabis suppositories and/or mindfulness.
- There will be no significant effect of time for sexual efficacy, mindful compassion, sexual functioning, and well-being in the control group (see methods).
- Levels of anodyspareunia might vary between CBD, THC, and combined CBD/THC suppositories in CS and CSMF groups.
2. Methodology
2.1. Design
- Cannabis-only group (cannabis suppositories used for sexual pain). This could be the control group, but long-term cannabis use has been associated with continuing pain reduction. Though this variable could be controlled, it was decided to have a care-as-usual group as the control [20] [CS].
- Mindful-compassion group [MF].
- Combined group—cannabis (suppositories used for sexual pain) and mindful-compassion group adjunct [CSMF].
- Care as usual (no mindful compassion or cannabis) [CAU].
2.2. Participants
- Identify as MSM;
- Use cannabis suppositories (for CS and CSMF groups), as this study did not prescribe or distribute cannabis to participants;
- Engaged in anal sex (within the last month);
- Based in the UK;
- Experience anodyspareunia;
- Have an absence of co-occurring difficulties;
- Aged 18 years or older;
- Read and write in English;
- Have Patient Health Questionnaire-9 (PHQ-9) score between 0–9 (no/mild depression) [21];
- Have Generalised Anxiety Disorder-7 (GAD-7) score between 0–9 (no/mild generalised anxiety) [22].
- Do not identify as MSM;
- Had not attempted anal intercourse in the last month;
- Had co-occurring difficulties;
- Aged below 18 years;
- Had reading and writing English difficulties;
- Do not experience anodyspareunia;
- Have PHQ-9 score ≥ 10 (moderate to severe depression);
- Have GAD-7 score ≥ 10 (moderate to severe anxiety).
2.3. Mindful-Compassion Intervention
2.4. Structuring of Intervention (Online Once a Week for 1–2 h)
2.5. Self-Report Measures
2.5.1. Preliminary Screening Tool PHQ-9 for Inclusion/Exclusion Criteria
2.5.2. Preliminary Screening Tool GAD-7 for Inclusion/Exclusion Criteria
2.6. Demographic Information
2.7. Anodyspareunia
2.8. Brief Sexual Function Inventory (BSFI) [27]
2.9. Adapted Sexual Self-Efficacy Scale [28]
2.10. The Short Warwick–Edinburgh Mental Wellbeing Scale (SWEMWBS) [29]
2.11. State Self-Compassion Short Form [30]
2.12. Qualitative Measures
2.13. Procedure
2.14. Statistical Analysis
3. Results
3.1. The Impact of Time on Levels of Sexual Pain, Well-Being, Mindful Compassion, Sexual Self-Efficacy, and Sexual Functioning
3.2. Comparisons across Groups
3.3. Levels of Anodyspareunia with the Use of THC, CBD, and Combined THC/CBD Suppositories
3.4. Content Analysis
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Hollows, K. Anodyspareunia: A novel sexual dysfunction? An exploration into anal sexuality. Sex. Relatsh. Ther. 2007, 22, 429–443. [Google Scholar] [CrossRef]
- Nercessian, T.R.; Banbury, S.; Chandler, C. A Systematic Review Looking at Anodyspareunia Among Cisgender Men and Women. J. Sex Marital Ther. 2023, 49, 829–841. [Google Scholar] [CrossRef] [PubMed]
- Brotto, L.A.; Bergeron, S.; Zdaniuk, B.; Driscoll, M.; Grabovac, A.; Sadownik, L.A.; Smith, K.B.; Basson, R.A. Comparison of Mindfulness-Based Cognitive Therapy Vs Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia in a Hospital Clinic Setting. J. Sex. Med. 2019, 16, 909–923. [Google Scholar] [CrossRef] [PubMed]
- Rycroft-Malone, J.; Gradinger, F.; Griffiths, H.O.; Crane, R.; Gibson, A.; Mercer, S.; Anderson, R.; Kuyken, W. Accessibility and implementation in the UK NHS services of an effective depression relapse prevention programme: Learning from mindfulness-based cognitive therapy through a mixed-methods study. Health Serv. Deliv. Res. 2017, 5. [Google Scholar] [CrossRef] [PubMed]
- Malpus, Z.; Nazar, Z.; Smith, C.; Armitage, L. Compassion focused therapy for pain management: “3 systems approach” to understanding why striving and self-criticism are key psychological barriers to regulating activity and improving self-care for people living with persistent pain. Br. J. pain 2023, 17, 87–102. [Google Scholar] [CrossRef]
- Saunders, F.; Vosper, J.; Gibson, S.; Jamieson, R.; Zelin, J.; Barter, J. Compassion Focused Psychosexual Therapy for Women Who Experience Pain during Sex. OBM Integr. Complement. Med. 2022, 7, 1–13. [Google Scholar] [CrossRef]
- Barber, S.; Rough, E. Medical Use of Cannabis; Commons Library Research Briefing: 2021. Available online: https://commonslibrary.parliament.uk/research-briefings/cbp-8355/ (accessed on 31 October 2022).
- Excellence NI for H and, C. Cannabis-Based Medicinal Products NICE Guideline [Internet]. 2021. Available online: https://www.nice.org.uk/guidance/ng144 (accessed on 9 July 2024).
- Wilsey, B.; Marcotte, T.; Deutsch, R.; Gouaux, B.; Sakai, S.; Donaghe, H. Low-dose vaporized cannabis significantly improves neuropathic pain. J. Pain 2013, 14, 136–148. [Google Scholar] [CrossRef] [PubMed]
- Wang, L.; Hong, P.J.; May, C.; Rehman, Y.; Oparin, Y.; Hong, C.J.; Hong, B.Y.; AminiLari, M.; Gallo, L.; Kaushal, A.; et al. Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: A systematic review and meta-analysis of randomised clinical trials. Br. Med. J. 2021, 374, n1034. [Google Scholar] [CrossRef]
- Lynn, B.K.; Lopez, J.D.; Miller, C.; Thompson, J.; Campian, E.C. The relationship between marijuana use prior to sex and sexual function in women. Sex. Med. 2019, 7, 192–197. [Google Scholar] [CrossRef]
- Barach, E.; Slavin, M.N.; Earleywine, M. Cannabis and Vulvodynia Symptoms: A Preliminary Report. Cannabis 2020, 3, 139–147. [Google Scholar] [CrossRef]
- Bapir, L.; Erridge, S.; Nicholas, M.; Pillai, M.; Dalavaye, N.; Holvey, C.; Coomber, R.; Hoare, J.; Khan, S.; Weatherall, M.W.; et al. Comparing the Effects of Medical Cannabis for Chronic Pain Patients with and without Co-Morbid Anxiety: A Cohort Study. Expert Rev. Neurother. 2023, 23, 281–295. [Google Scholar] [CrossRef] [PubMed]
- Murphy, M.; Erridge, S.; Holvey, C.; Coomber, R.; Rucker, J.J.; Sodergren, M.H. A Cohort Study Comparing the Effects of Medical Cannabis for Anxiety Patients With and Without Co-Morbid Sleep Disturbance. Neuropsychopharmacol. Rep. 2024, 44, 129–142. [Google Scholar] [CrossRef] [PubMed]
- van Hoogdalem, E.J.; de Boer, A.G.; Breimer, D.D. Pharmacokinetics of rectal drug administration, part I: General considerations and clinical applications of centrally acting drugs. Clin. Pharmacokinet. 1991, 21, 11–26. [Google Scholar] [CrossRef] [PubMed]
- Brenneisen, R.; Egli, A.; Elsohly, M.A.; Henn, V.; Spiess, Y. The effect of orally and rectally administered delta 9-tetrahydrocannabinol on spasticity: A pilot study with 2 patients. Int. J. Clin. Pharmacol. Ther. 1996, 34, 446–452. [Google Scholar] [PubMed]
- Maayah, Z.H.; Takahara, S.; Ferdaoussi, M.; Dyck, J.R.B. The molecular mechanisms that underpin the biological benefits of full-spectrum cannabis extract in the treatment of neuropathic pain and inflammation. Biochim. Biophys. Acta (BBA)-Mol. Basis Dis. 2020, 1866, 165771. [Google Scholar] [CrossRef] [PubMed]
- Aviram, J.; Samuelly-Leichtag, G. Efficacy of cannabis-based medicines for pain management: A systematic review and meta-analysis of randomized controlled trials. Pain Physician 2017, 20, E755–E796. [Google Scholar] [CrossRef] [PubMed]
- Boardman, L.A.; Stockdale, C.K. Sexual pain. Clin. Obstet. Gynecol. 2009, 52, 682–690. [Google Scholar] [CrossRef] [PubMed]
- Fisher, E.; Moore, R.A.; Fogarty, A.E.; Finn, D.P.; Finnerup, N.B.; Gilron, I.; Haroutounian, S.; Krane, E.; Rice, A.S.C.; Rowbotham, M.; et al. Cannabinoids, cannabis, and cannabis-based medicine for pain management: A systematic review of randomised controlled trials. Pain 2021, 1, S45–S66. [Google Scholar] [CrossRef] [PubMed]
- Kroenke, K.; Spitzer, R.L.; Williams, J.B. The PHQ-9. J. Gen. Intern. Med. 2001, 16, 606–613. [Google Scholar] [CrossRef]
- Spitzer, R.L.; Kroenke, K.; Williams, J.B.; Löwe, B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch. Intern. Med. 2006, 166, 1092–1097. [Google Scholar] [CrossRef]
- Carey, R.N.; Connell, L.E.; Johnston, M.; Rothman, A.J.; de Bruin, M.; Kelly, M.P.; Michie, S. Behavior Change Techniques and Their Mechanisms of Action: A Synthesis of Links Described in Published Intervention Literature. Ann. Behav. Med. 2019, 53, 693–707. [Google Scholar] [CrossRef] [PubMed]
- Michie, S.; Richardson, M.; Johnston, M.; Abraham, C.; Francis, J.; Hardeman, W.; Eccles, M.P.; Cane, J.; Wood, C.E. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Ann. Behav. Med. 2013, 46, 81–95. [Google Scholar] [CrossRef] [PubMed]
- Banbury, S.; Chander, C.; Lusher, J.; Karyofyllis, Z. A pilot RCT of an online mindfulness-based cognitive intervention for chemsex. Couns. Psychother. Res. 2023, 24, 994–1005. [Google Scholar] [CrossRef]
- Banbury, S.; Jean-Marie, D.; Lusher, J.; Chandler, C.; Turner, J. The impact of a brief online mindfulness intervention to support erectile dysfunction in African Caribbean men: A pilot waitlist controlled randomised controller trial and content analysis. Rev. Psicoter. 2024, 35, 4–12. [Google Scholar] [CrossRef]
- Bandura, A. Self-Efficacy: The Exercise of Control; W H Freeman/Times Books/Henry Holt & Co.: New York, NY, USA, 1997. [Google Scholar]
- Damon, W.; Rosser, B. Anodyspareunia in men who have sex with men: Prevalence, predictors, consequences and the development of DSM diagnostic criteria. J. Sex Marital Ther. 2005, 31, 129–141. [Google Scholar] [CrossRef]
- O’Leary, M.P.; Fowler, F.J.; Lenderking, W.R.; Barber, B.; Sagnier, P.P.; Guess, H.A.; Barry, M.J. A brief male sexual function inventory for urology. Urology 1995, 46, 697–706. [Google Scholar] [CrossRef] [PubMed]
- Libman, E.; Rothenberg, I.; Fichten, C.S.; Amsel, R. The SSES-E: A measure of sexual self-efficacy in erectile functioning. J. Sex Marital Ther. 1985, 11, 233–247. [Google Scholar] [CrossRef]
- Tennant, R.; Hiller, L.; Fishwick, R.; Platt, S.; Joseph, S.; Weich, S.; Parkinson, J.; Secker, J.; Stewart-Brown, S. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): Development and UK validation. Heal. Qual Life Outcomes 2007, 5, 36. [Google Scholar] [CrossRef]
- Raes, F.; Pommier, E.; Neff, K.D.; Van Gucht, D. Construction and factorial validation of a short form of the Self-Compassion Scale. Clin. Psychol. Psychother. 2011, 18, 250–255. [Google Scholar] [CrossRef]
- Hewson, C.; Buchanan, T. (Eds.) Ethics Guidelines for Internet-Mediated Research; The British Psychological Society: Leicester, UK, 2017. [Google Scholar]
- Gelinas, L.; Pierce, R.; Winkler, S.; Cohen, I.G.; Lynch, H.F.; Bierer, B.E. Using Social Media as a Research Recruitment Tool: Ethical Issues and Recommendations. Am. J. Bioeth. AJOB 2017, 17, 3–14. [Google Scholar] [CrossRef]
- UK, LG. Data Protection Act (2018) [Internet]. Available online: https://www.gov.uk/data-protection#:~:text=TheDataProtectionAct2018istheUK’simplementationof,usedfairly%2Clawfullyandtransparently (accessed on 31 January 2023).
- MacCallum, C.A.; Russo, E.B. Practical considerations in medical cannabis administration and dosing. Eur. J. Intern. Med. 2018, 49, 12–19. [Google Scholar] [CrossRef] [PubMed]
- ElSohly, M.A.; Gul, W.; Walker, L.A. Pharmacokinetics and Tolerability of Δ9-THC-Hemisuccinate in a Suppository Formulation as an Alternative to Capsules for the Systemic Delivery of Δ9-THC. Med. Cannabis Cannabinoids 2018, 1, 44–53. [Google Scholar] [CrossRef] [PubMed]
- Bains, S.; Mukhdomi, T. Medicinal Cannabis for Treatment of Chronic Pain; StatPearls: Treasure Island, FL, USA, 2022. [Google Scholar]
- Pernilla, M.; Lance, M.; Johanna, E.; Thomas, P.; JoAnne, D. Women, Painful Sex, and Mindfulness. Mindfulness 2022, 13, 917–927. [Google Scholar] [CrossRef]
- Mücke, M.; Phillips, T.; Radbruch, L.; Petzke, F.; Häuser, W. Cannabis-based medicines for chronic neuropathic pain in adults. Cochrane Database Syst. Rev. 2018, 3, CD012182. [Google Scholar] [CrossRef] [PubMed]
- Bhattacharyya, S.; Morrison, P.D.; Fusar-Poli, P.; Martin-Santos, R.; Borgwardt, S.; Winton-Brown, T.; Nosarti, C.; O’ Carroll, C.M.; Seal, M.; Allen, P.; et al. Opposite effects of delta-9-tetrahydrocannabinol and cannabidiol on human brain function and psychopathology. Neuropsychopharmacology 2010, 35, 764–774. [Google Scholar] [CrossRef] [PubMed]
- Banbury, S.; Lusher, J.; Snuggs, S.; Chandler, C. Mindfulness-based therapies for men and women with sexual dysfunction: A systematic review and meta-analysis. Sex. Relatsh. Ther. 2021, 38, 533–555. [Google Scholar] [CrossRef]
- Lintzeris, N.; Mills, L.; Abelev, S.V.; Suraev, A.; Arnold, J.C.; McGregor, I.S. Medical cannabis use in Australia: Consumer experiences from the online cannabis as medicine survey 2020 (CAMS-20). Harm Reduct. J. 2022, 19, 88. [Google Scholar] [CrossRef] [PubMed]
- Dunkley, C.R.; Brotto, L.A. Psychological Treatments for Provoked Vestibulodynia: Integration of Mindfulness-Based and Cognitive Behavioral Therapies. J. Clin. Psychol. 2016, 72, 637–650. [Google Scholar] [CrossRef]
- Daniels, S.E.A. Cannabis under the Influence of Yoga: The Impact of Mindful Movement on Well-Being Outcomes after Cannabis Use (T) [Internet]. University of British Columbia. 2023. Available online: https://open.library.ubc.ca/collections/ubctheses/24/items/1.0435753 (accessed on 2 March 2023).
CS | MF | CSMF | CAU | |||||
---|---|---|---|---|---|---|---|---|
Week | M | SD | M | SD | M | SD | M | SD |
Pain | ||||||||
0 | 6.42 | 0.793 | 3.14 | 0.900 | 6.11 | 1.231 | 3.17 | 0.983 |
4 | 7.00 | 1.04 | 4.00 | 1.118 | 6.78 | 1.093 | 3.00 | 1.095 |
12 | 7.17 | 1.193 | 4.67 | 1.033 | 7.00 | 1.549 * | 3.17 | 0.983 |
Sexual function | ||||||||
0 | 11.53 | 2.031 | 7.22 | 0.972 | 11.11 | 2.111 | 9.3 | 1.497 |
4 | 11.6 | 2.028 | 8 | 1.732 | 13.44 | 2.791 | 9.28 | 0.976 |
12 | 17.08 | 2.021 | 15.57 | 2.299 ** | 17.33 | 2.024 ** | 9.83 | 1.169 |
Mindful compassion | ||||||||
0 | 22.8 | 5.545 | 25.67 | 5.385 | 23.39 | 6.05 | 26.3 | 5.458 |
4 | 23.47 | 5.527 | 35.56 | 3.575 | 23.56 | 5.261 | 26.3 | 5.458 |
12 | 22.17 | 5.606 | 37.57 | 3.552 ** | 28.2 | 4.459 * | 25.67 | 3.67 |
Sexual self-efficacy | ||||||||
0 | 16.53 | 3.502 | 14.33 | 2.55 | 16.28 | 3.25 | 14.5 | 2.461 |
4 | 16.93 | 3.474 | 45.33 | 5.701 | 16.94 | 3.28 | 15.3 | 2.312 |
12 | 17.08 | 3.801 * | 59.14 | 5.928 ** | 17.60 | 3.542 * | 14.83 | 2.317 |
Well-being | ||||||||
0 | 18.4 | 3.924 | 12. | 3.775 | 17.50 | 4.134 | 12.1 | 3.573 |
4 | 18.93 | 3.674 | 27.56 | 2.007 | 18.84 | 3.506 | 12.4 | 3.438 |
12 | 27.42 | 1.505 ** | 27.86 | 1.773 ** | 27.4 | 4.459 ** | 10.5 | 2.168 |
Week 12: | ||||
Category/Themes of words used by: | ||||
CS group, % | CSMF group, % | |||
Question 1: | How is your sexual pain at follow-up? | |||
Unsure | 28.6 | The same | 40.0 | |
More manageable | 28.6 | Alright | 33.3 | |
A bit better | 28.6 | A bit better | 26.7 | |
No better | 14.3 | |||
Question 2: | Any thoughts about whether you will continue to practise mindfulness to help your sexual pain? | |||
Sometimes if stressed | 57.1 | Using mindfulness increases cannabis | 53.3 | |
Yes, for sexual experiences | 14.3 | Yes | 33.3 | |
Probably not | 14.3 | Unlikely | 13.3 | |
Unsure/do not know | 14.3 | |||
Question 3: | If you could receive this intervention again, would you prefer it delivered online or in person? | |||
In person | 42.9 | Only if THC suppositories are available | 40.0 | |
Online or in person | 28.6 | Either | 33.3 | |
Online | 14.3 | Unsure | 26.7 | |
Neither | 14.3 | |||
Question 4: | What were your overall experiences of receiving this intervention? | |||
Fun | 28.6 | Relaxed | 33.3 | |
Positive | 28.6 | Pleasant | 26.7 | |
Enjoyed | 28.6 | Interesting | 26.7 | |
Not bad | 14.3 | Helped with partner | 13.3 | |
Question 5: | It was noticed that condoms do not tend to be used with cannabis suppositories. Is there any reason for this? | |||
PrEP | 42.9 | Lack of information | 66.7 | |
Lack of information | 42.9 | PrEP | 33.3 | |
Do not like using condoms | 14.3 | |||
Question 6: | Is there anything else you would like to add about your experiences with this intervention? | |||
Mindfulness is great for relaxation | 42.9 | Cannabis is a natural form of mindfulness | 40.0 | |
Mindfulness is less effective for pain | 28.6 | Mindfulness is less effective for pain | 33.3 | |
Want to try cannabis suppositories | 28.6 | Cannabis should be legalised | 26.7 | |
Week 12: | ||||
Category/Themes of words used by: | ||||
CS group, % | CAU group, % | |||
Question 1: | How is your sexual pain at follow-up? | |||
The same | 66.6 | The same | 66.6 | |
Bit better | 33.3 | Sometimes worse | 33.3 | |
Question 2: | Any thoughts about whether you will continue to practise mindfulness to help your sexual pain? | |||
Nice to chat | 41.7 | Nice to chat | 33.3 | |
Okay | 41.7 | Alright | 33.3 | |
No point | 16.6 | Would prefer mindfulness | 33.3 | |
Question 3: | Should this study become available again, would you be interested in receiving mindful compassion and/or cannabis suppositories for sexual pain? | |||
Cannabis reduces pain | 75.0 | If cannabis suppositories do not cause sleepiness or have side effects | 33.3 | |
Maybe | 16.7 | Mindfulness online | 33.3 | |
No mindfulness | 8.3 | Mindfulness in person | 16.7 | |
Mindfulness and suppositories | 16.7 | |||
Question 4: | It was noticed that condoms do not tend to be used with cannabis suppositories. Is there any reason for this? | |||
PrEP | 50.0 | No information on oil friendly condoms | 66.7 | |
Condoms will not work | 16.7 | PrEP | 33.3 | |
Lack of information | 8.3 | |||
Question 5: | Is there anything else you would like to add about being the control group in this study? | |||
Cannabis should be available in NHS | 75 | There should be options available to reduce sexual pain | 50.0 | |
Nothing to add | 25 | Talking about this is important | 33.3 | |
It was nice to chat about this | 16.7 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Banbury, S.; Chandler, C.; Erridge, S.; Olvera, J.d.R.; Turner, J.; Lusher, J. A Preliminary Study Looking at the Use of Mindful Compassion and Cannabis Suppositories for Anodyspareunia among Men Who Have Sex with Men (MSM). Psychoactives 2024, 3, 384-399. https://doi.org/10.3390/psychoactives3030024
Banbury S, Chandler C, Erridge S, Olvera JdR, Turner J, Lusher J. A Preliminary Study Looking at the Use of Mindful Compassion and Cannabis Suppositories for Anodyspareunia among Men Who Have Sex with Men (MSM). Psychoactives. 2024; 3(3):384-399. https://doi.org/10.3390/psychoactives3030024
Chicago/Turabian StyleBanbury, Samantha, Chris Chandler, Simon Erridge, Javier del Rio Olvera, John Turner, and Joanne Lusher. 2024. "A Preliminary Study Looking at the Use of Mindful Compassion and Cannabis Suppositories for Anodyspareunia among Men Who Have Sex with Men (MSM)" Psychoactives 3, no. 3: 384-399. https://doi.org/10.3390/psychoactives3030024
APA StyleBanbury, S., Chandler, C., Erridge, S., Olvera, J. d. R., Turner, J., & Lusher, J. (2024). A Preliminary Study Looking at the Use of Mindful Compassion and Cannabis Suppositories for Anodyspareunia among Men Who Have Sex with Men (MSM). Psychoactives, 3(3), 384-399. https://doi.org/10.3390/psychoactives3030024