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

Abstract

Background: Two 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.

Aim: To 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.

Methods: Sexual 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.

Outcomes: Changes 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.

Results: Sexual 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 translation: Results are applicable to VMMC programs seeking to increase the acceptability of male circumcision as part of comprehensive HIV prevention.

Strengths and limitations: Large-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.

Conclusions: Results 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.

Keywords: Erectile Dysfunction; HIV Infection; Male Circumcision; Orgasm; Premature Ejaculation; Sexual Dysfunction.

Figure 1

Proportions of reported sexual function outcomes among sexually active men, by group and follow-up visit. P values for the effects of time (overall trend), group (VMMC at baseline, compared to control group) and time-by-group interaction are based on unadjusted analyses. For lack of pleasure during sex (E), despite the significant overall time trend, groups only differed significantly at the 18-month follow-up visit. VMMC = voluntary medical male circumcision.

Figure 2

Proportions of reported sexual satisfaction outcomes among sexually active men, by group and follow-up visit: (A) Satisfaction with sexual intercourse, (B) Satisfaction with level of sexual desire, (C) Satisfaction getting erections, (D) Satisfaction maintaining erections, (E) Satisfaction with interval between erections, (F) Satisfaction with ease of ejaculation and (G) Satisfaction with level of pain during intercourse. P values for the effects of time (overall trend), group (VMMC at baseline, compared to control group) and time-by-group interaction are based on unadjusted analyses. VMMC = voluntary medical male circumcision.

Figure 2

Proportions of reported sexual satisfaction outcomes among sexually active men, by group and follow-up visit: (A) Satisfaction with sexual intercourse, (B) Satisfaction with level of sexual desire, (C) Satisfaction getting erections, (D) Satisfaction maintaining erections, (E) Satisfaction with interval between erections, (F) Satisfaction with ease of ejaculation and (G) Satisfaction with level of pain during intercourse. P values for the effects of time (overall trend), group (VMMC at baseline, compared to control group) and time-by-group interaction are based on unadjusted analyses. VMMC = voluntary medical male circumcision.