Breaking Down the Dams: An Ecological Systems Lens on Dental Dams Using Qualitative Methods

Abstract Introduction Although dental dams can protect people with vaginas during oral sex, women rarely use them. Frequencies of use have been reported, though few studies address the multiple individual, relational, and structural factors that explain why women do not use dental dams. The purpose of this qualitative secondary analysis was to investigate ecological influences on women’s attitudes toward dental dams. Methods We conducted a secondary analysis of a qualitative study investigating how women make decisions about safer sex with same-sex and other-sex partners. Participants were women living in the USA in 2021 who had sex with partners with vaginas, partners with penises, or both. The analytic sample includes 26 cisgender women (27% heterosexual, 77% White, mean age = 22.86 years, age range = 18–29). Results Using thematic analysis and Bronfenbrenner’s ecological systems lens, five themes were generated: a lack of awareness and education surrounding dental dams; women are open to using dental dams if sexual partners want to; norms for oral sex do not include using any type of barrier; dental dams are inaccessible; and dental dams are perceived as undesirable or unpleasurable. Conclusion The results indicated that attitudes were not based solely how participants viewed dental dams, but also on the way that sexual partners view dental dams, barrier method norms during oral sex, and messages received from media, school-based sexual education, and other large structural influences. Policy Implications Findings provide two options moving forward: large systematic changes in order to change norms about dental dam use, or refocusing prevention emphasis on alternative, more widely accepted safer sex strategies.