In both the IDIs and FGDs women and men widely acknowledged the intravaginal use of a variety of products. In their first interview, 47 of the 63 trial participants said they knew that women in the community used intravaginal insertions. The majority of participants in 14 of the 15 FGDs were also familiar with the topic. Knowledge about the use of insertions was based on rumours in the community, seeing products sold on the street, stories from neighbours, friends or female family members using products and, occasionally, personal experience. Other reasons for using intravaginal insertions were reported but are not included in this analysis, including cleaning the vagina, maintaining good health and as a ‘love potion’ to attract or retain a sexual partner.
Intravaginal insertions were reportedly used in a variety of ways to enhance sexual pleasure
Of the 63 trial participants interviewed, only 7 reported ever using intravaginal insertions themselves for sexual pleasure before joining the trial. None of the participants reported use during the trial. Female community members not enrolled in the trial were not asked directly about their own personal use of insertions because this information was collected in FGDs, but a similar proportion spontaneously described using insertions themselves. There was no age differentiation in women’s knowledge of product use. The majority of all female and male respondents said this was an age-old practice as articulated by Nozipho who had experience of selling and using intravaginal insertions:
We were using them [insertions] a long time ago, even our mothers were using them. (Nozipho, 50-year-old female FGD participant)
Respondents said they were aware of a number of products that were used as intravaginal insertions to increase sexual pleasure. These included a range of medications and general personal hygiene products, such as Disprin (Asprin), Inza (Ibupofen), Colgate toothpaste, Blue Stone (copper sulphate, used locally to clean wounds) and bath salts. There were also commercial products such as snuff (crushed tobacco), alum (hydrated-aluminium-potassium-sulphate) and Knorrox cubes (South African food seasoning), as well as complementary medicines such as Tiger Balm (an anodyne and anti-itching remedy used for colds, headaches or insect bites), Entressdruppels (an oral remedy to relieve nervousness, restlessness and sleeplessness) and Staaldruppels (an oral treatment for iron deficiency anaemias and stopping bleeding). Other general items infrequently reported to be inserted vaginally included whisky, newspaper after being softened by rubbing, water after boiling rice in it and water after soaking a type of jelly fish (also renowned for treating asthma and arthritis when taken orally). There was a range of sexual stimulants that were designed to be taken orally, but were sometimes inserted vaginally, such as Silver Bullets (tablets crushed before insertion) and Love Drops (liquid). In addition there was a range of traditional medicines (locally called muthi [singular] or mithi [plural]). Generally respondents were unaware of the actual names or contents of the mithi, but some were mentioned such as imbulu oil (oil and fat of a water monitor), ‘mamlambo’ snake oil, hippopotamus fat and umganu tree bark (soaked and then water inserted vaginally). Overall, the most commonly reported intravaginal insertions were snuff, alum and a range of mithi.
Some products were diluted in water and then used for intravaginal cleansing (particularly alum) or inserted and either left to ‘dissolve’ (e.g. Tiger Balm or Blue Stone) or inserted and the remnants removed prior to sex (e.g. traditional herbs and snuff). There were only two references to muthi for sexual pleasure being administered via razor cuts made in the skin in the genital area (gcaba: a common way to administer traditional medicine) (Henderson 2005 ; Jolles and Jolles 2000 ). Respondents reported that these products were readily available from pharmacies, shops and traditional healers.