A Prospective Study of Sexual Function and Satisfaction among Circumcised and Uncircumcised Men in Kenya
Nordstrom, Monica PC
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This study was conducted to assess the effects of VMMC on sexual function and satisfaction in a population-based cohort (18-35 y.o.) of men circumcised as adults and uncircumcised controls in Kenya. Data on sexual function and satisfaction were collected, at baseline and four follow-up visits, from men seeking circumcision through the VMMC program in Kenya (baseline N=1588) and community controls (baseline N=1598). Changes in outcomes and group differences through 24 months of follow-up were assessed using mixed effect models. Main outcomes measured include sexual interest, desire and pleasure, erectile and ejaculatory function, pain during intercourse (dyspareunia) in circumcised and uncircumcised men and satisfaction with sexual performance and enjoyment of sex before and after circumcision. Sexual dysfunctions decreased in both study groups, from 17-54% at baseline to 11-44% at 24 months (p<0.001), except dyspareunia, which decreased only in circumcised men (p<0.001). Sexual satisfaction outcomes increased in both study groups from 34-82% at baseline to 66-93% at 24 months (p<0.001) with greater improvements in circumcised men (p<0.001). On average, 97% of circumcised men were satisfied with sexual intercourse and 92% rated sex as more enjoyable or no different after circumcision compared to before circumcision. Medical male circumcision was associated with improvements in pain during intercourse and sexual satisfaction, and was not associated with any other sexual dysfunction. These results are applicable to VMMC programs seeking to increase the acceptability of male circumcision as part of comprehensive HIV prevention.