Medical Male Circumcision Is Associated with Improvements in Pain During Intercourse and Sexual Satisfaction in Kenya

Abstract

BackgroundTwo cohort studies using data from randomized controlled trials in Africa offer the best evidence to date on the effects of voluntary medical male circumcision (VMMC) on male sexual function and satisfaction, suggesting no significant impairments in sexual function or satisfaction and some improvements in sexual function after male circumcision.AimTo assess the effects of VMMC on sexual function and satisfaction in a large population-based cohort of men circumcised as adults and uncircumcised controls in Kenya.MethodsSexual function and satisfaction of young (median age = 20 years) sexually active men (1,509 newly circumcised men and 1,524 age-matched uncircumcised controls after 5% loss to follow-up) were assessed at baseline and 6, 12, 18, and 24 months, with data collected in 2008 to 2012. Self-reported data on lack of sexual interest or pleasure, difficulty getting or maintaining erections, orgasm difficulties, premature ejaculation, pain during intercourse, and satisfaction with sexual intercourse were analyzed with mixed-effect models to detect differences between circumcised and uncircumcised men and changes over time.OutcomesChanges over time in sexual interest, desire and pleasure, erectile and ejaculatory function, and pain during intercourse (dyspareunia) in circumcised and uncircumcised men; group differences in time trends; satisfaction with sexual performance; and enjoyment of sex before and after circumcision.ResultsSexual dysfunctions decreased in the two study groups from 17% to 54% at baseline to 11% to 44% at 24 months (P < .001), except dyspareunia, which decreased only in circumcised men (P < .001). Sexual satisfaction outcomes increased in the two study groups from 34% to 82% at baseline to 66% to 93% at 24 months (P < .001), with greater improvements in circumcised men (P < .001). On average, 97% of circumcised men were satisfied with sexual intercourse and 92% rated sex as more enjoyable or no different after circumcision compared with before circumcision.Clinical TranslationResults are applicable to VMMC programs seeking to increase the acceptability of male circumcision as part of comprehensive HIV prevention.Strengths and LimitationsLarge-scale population-based longitudinal data restricted to sexually active individuals and adjusted for differences in baseline levels of outcomes and potential confounders are used. The questionnaire used, although not a standardized survey instrument, includes all major domains of male sexual function and satisfaction used in the most common standardized tools.ConclusionsResults are consistent with large cohort studies of VMMC using data from randomized controlled trials and indicate that VMMC has no significant detrimental effect or might have beneficial effects on male sexual function and satisfaction for the great majority of men circumcised as adults.Nordstrom MPC, Westercamp N, Jaoko W, et al. Medical Male Circumcision Is Associated With Improvements in Pain During Intercourse and Sexual Satisfaction in Kenya. J Sex Med 2017;14:601–612.

Circumcision in the paediatric patient: A review of indications, technique and complications

“…The relationship between circumcision and sexual function has also been explored in various research studies, with conflicting findings. Some studies indicate that circumcised men have improved penile sensitivity and sexual satisfaction . Some, however, suggest the opposite with decreased penile sensitivity and sexual dysfunction .…”

Critical evaluation of arguments opposing male circumcision: A systematic review

“…This finding contradicts arguments based on low-quality evidence. 120 Nordstrom et al, 124 Kigozi et al, 125,149 Krieger et al 126…”

“…123 A case-control study in Kenya found that circumcised men reported less pain during sexual intercourse than uncircumcised control men during 2 years of follow-up. 124 Other aspects of sexual function did not differ between circumcised and uncircumcised men. Included in each review were 2 RCTs, 125,126 which are regarded as high-quality evidence.…”

“…A UK study of 6293 men and 8869 women added further support . A case‐control study in Kenya found that circumcised men reported less pain during sexual intercourse than uncircumcised control men during 2 years of follow‐up . Other aspects of sexual function did not differ between circumcised and uncircumcised men.…”

“…The purported lubrication provided by "gliding" should reduce pain during intercourse (dyspareunia). However, most studies reported either no difference or less pain in circumcised men, [119][120][121][122][124][125][126][127]165 and their female sexual partners 149,150 (Table 5). Contrary claims appeared to be based on speculation, anecdotes, or low-quality studies.…”