Sexual Pleasure and Function, Coital Trauma, and Sex Behaviors After Voluntary Medical Male Circumcision Among Men in the Dominican Republic

Abstract

Background Voluntary medical male circumcision (VMMC) is effective in decreasing the risk of HIV acquisition. As men resume sexual activity after circumcision, it will be important to study their satisfaction with the procedure, sexual pleasure and function, coital trauma, and risk compensation (RC), which can hamper or facilitate the long-term success of VMMC programs. Aim To assess men's satisfaction with VMMC, sexual pleasure and function, coital trauma, and RC after VMMC. Methods This is a cohort study of circumcised men who presented for follow-up 6 to 24 months after VMMC. Logarithmic binomial regression was performed to explore factors associated with any increase in the number of sex partners after VMMC as a measurement of RC. Main Outcome Measures (i) Men's satisfaction with their VMMC; (ii) sexual pleasure and function after VMMC; (iii) coital trauma; and (iv) RC. Results Of 454 circumcised men, 362 (80%) returned for a follow-up visit 6 to 24 months after VMMC. Almost all (98%) were satisfied with the outcome of their VMMC; most (95%) reported that their female partners were satisfied with their circumcision. Two thirds (67%) reported enjoying sex more after VMMC and most were very satisfied or somewhat satisfied (94%) with sexual intercourse after VMMC. Sexual function improved and reported sex-induced coital injuries decreased significantly in most men after VMMC. There was an increase in the proportion of men who reported at least two sexual partners after VMMC compared with baseline. In multivariate analysis, having sex with a woman they met the same day (adjusted relative risk = 1.7, 95% CI = 1.2–2.4) and having at least two sexual partners at baseline (adjusted relative risk = 0.5, 95% CI = 0.3–0.8) were associated with the outcome of any increase in the number of partners after VMMC. Clinical Implications VMMC can be offered to Dominican men for HIV prevention without adversely affecting sexual pleasure or function. The procedure substantially reduces coital trauma. Strengths & Limitations This is the first report of long-term overall satisfaction, sexual pleasure/function and sex behaviors in the context of VMMC outside of Africa. Limitations of the study included the reliance on self-reported sex behaviors, the lack of physiologic measurement of penile sensitivity and the lack of follow up data beyond 24 months, which precludes the assessment of longer term RC. Conclusion The study confirmed men's long-term satisfaction with the outcome of their VMMC. VMMC improved sexual pleasure and function for most men and significantly decreased coital injuries. There was mixed evidence of RC.

Critical evaluation of arguments opposing male circumcision: A systematic review

“…Each RCT found no adverse effect on any aspect of sexual function by the 2‐year post‐MC follow‐up point. Coital injuries were significantly lower in circumcised men …”

“…Evaluation of these identified multiple flaws . Other studies, including RCTs, found MC had no adverse effect. In fact, the RCTs found a net increase in sexual pleasure in men and their female partners.…”

“…Two high‐quality studies, a RCT in Kenya and a cohort study in the Caribbean, found that most sexually experienced men reported improved sexual pleasure and function after circumcision. A meticulously conducted systematic review of all studies found that, overall, MC had no adverse effect on penile sensitivity, sexual arousal, sexual sensation, or pleasure .…”

“…Coital injuries were significantly lower in circumcised men. [127][128][129] Sexual dysfunction is common in men. 130 There is now strong evidence that MC is not responsible, as we will present below.…”

“…[131][132][133][134][135][136][137] Evaluation of these identified multiple flaws. 119,[138][139][140][141][142][143][144] Other studies, [145][146][147][148] including RCTs, [125][126][127]149 found MC had no adverse effect. In fact, the RCTs found a net increase in sexual pleasure in men and their female partners.…”