The use of saliva as a lubricant in relation to sexual behavioural patterns in men who have sex with men: an exploratory cross-sectional study

Background We aimed to characterise the sexual practices of MSM who reported using saliva as a lubricant during sexual episodes. Methods A cross-sectional study on sexual practices of MSM was conducted between February 2022 and September 2022 in Xi’an, China. ‘Saliva use as a lubricant’ was used as a strata in a subgroup analysis. Results Among 1142 participants, 225 (19.7%) reported using saliva as a lubricant over the past 3 months. Among them, 114 did so during solo masturbation, whereas 124 did so in 149 sex acts with male partners (45 in providing masturbation, 32 in receiving masturbation, 39 during insertive anal sex and 33 during receptive anal sex). Of the 149 acts, 55.7% (83/149) of participants used their own saliva, whereas 44.3% (66/149) used their partner’s (P = 0.19); 72.4% (108/149) would spit on their hands first before applying to the genitals, whereas only 27.5% (41/149) would spit directly on their own/partners’ genitals (P < 0.001). When comparing sexual practice patterns during the last sexual episode in participants who used saliva as lubricant (213/225) and otherwise (890/917), the former was more likely to solo masturbate (6.0% (13/213) vs 0.8% (7/890), P < 0.001), kiss (9.9% (21/213) vs 27.8% (247/890), P < 0.001) and have more diverse sequential sexual practice (54.9% (117/213) vs 37.4% (333/890), P < 0.001). However, we observed no significant differences in HIV, syphilis, chlamydia and gonorrhoea positivities between the two groups. Conclusion MSM who use saliva as a lubricant are more likely to kiss and solo masturbate, with a preference for using their own saliva and spitting it onto the hands first.