Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya

While male circumcision is being promoted as an HIV prevention tool in high-risk heterosexual populations, there is concern about the procedure's effect on sexual function. The researchers undertook the current study to assess how adult male circumcision impacts male sexual function and pleasure.

The subjects were participants in a controlled trial of circumcision to reduce HIV incidence in Kisumu, Kenya. The men were uncircumcised, HIV-negative, sexually active, ages 18 to 24, with a hemoglobin of 9.0 mmol/L or greater. Exclusion criteria included having a foreskin covering less than half the glans, which might unduly increase surgical risks, or a medical indication for circumcision. The participants were randomized 1:1 to receive immediate circumcision (circumcision group) or delayed circumcision after two years (control group). Detailed evaluations were conducted at one, three, six, 12, 18, and 24 months. The main outcome measures were sexual function between circumcised and uncircumcised men; and sexual satisfaction and pleasure over time following circumcision.

From February 2002 to September 2005, 2,784 men were randomized, including 100 excluded from analysis because they crossed over; were not circumcised within 30 days of randomization; did not complete baseline interviews; or were outside the age range.

From baseline to month 24, rates of any reported sexual dysfunction decreased from 23.6 percent to 6.2 percent for the circumcised group, and from 25.9 percent to 5.8 percent for the uncircumcised group. "Changes over time were not associated with circumcision status," the authors noted. Sixty-four percent of the circumcised men rated their penis as "much more sensitive" after the operation, and 54.5 percent rated their ease of reaching orgasm as "much more" at month 24.

"Adult male circumcision was not associated with sexual dysfunction," the authors concluded. "Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm. These data indicate that integration of male circumcision into programs to reduce HIV risk is unlikely to adversely effect male sexual function."

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