Sexual function after voluntary medical male circumcision for human immunodeficiency virus prevention: Results from a programmatic delivery setting in Botswana

Abstract

Background: Uptake of voluntary medical male circumcision (VMMC) remains modest in Botswana in spite of the government's commitment and service provision availability. Data on sexual function post-VMMC in programmatic settings could help guide messaging tailored to Botswana.Objectives: At 3-month post-VMMC, we evaluated changes in sexual function and satisfaction with the VMMC procedure amongst a cohort of HIV-negative, sexually active men aged 18-49 years who underwent VMMC in a public-sector clinic in Botswana. Methods:We assessed whether each of the following domains of sexual function had improved, stayed the same or worsened since VMMC: sexual desire, ability to use condoms, ease of vaginal penetration, ease of ejaculation, ability to achieve and maintain an erection and hygiene or cleanliness.Results: Data on sexual function were available for 378 men at 3-month post-VMMC. Median age was 27 years -54% had a higher than secondary education, 72% were employed and 27% were married. Nearly all (96%) the men reported improvement in at least one domain of sexual function, while 19% reported improvement in all six domains. One-fourth (91/378, 24%) of the men reported that at least one domain of sexual function worsened post-VMMC. The most frequently reported domain that worsened was sexual desire (11%); in all other domains, < 10% of the men reported worsening. Men who reported any worsening sexual function were 2.3-fold as likely to be less than 'very satisfied' with the VMMC procedure (risk ratio 2.36, 95% confidence interval [CI] 1.66-3.34, p < 0.001). Conclusion:Emphasising improved sexual function experienced after VMMC in demandcreation efforts could potentially increase VMMC uptake in Botswana.

The Contrasting Evidence Concerning the Effect of Male Circumcision on Sexual Function, Sensation, and Pleasure: A Systematic Review

“…28 Pintye et al found in 2020 that at 3 months after VMMC of 378 men in Botswana, 96% reported an improvement in at least one sexual function (sexual desire, ease of vaginal penetration, ease of ejaculation, ability to achieve and maintain an erection, hygiene or cleanliness, and ability to use condoms), while 19% reported an improvement in all 6 parameters. 29 In the limited follow-up period of 3 months, 24% reported worsening of at least one aspect, with lower sexual desire reported by 11%, and one of the others by <10%.…”

Perceptions about male circumcision among HIV vaccine efficacy trial participants in Soweto, South Africa: a qualitative study

“…[32,33] Men reported that circumcision improved their sexual performance, which has been noted as an important demand creation message in other studies with similar outcomes. [34] Multiple factors are known to influence the decision to circumcise males medically or culturally in Africa: family members, female partners, [35] cultural norms, and peer pressure. [36,37] In this study, participants reported that MSM participated in cultural circumcision because their families pressured them.…”