There are a range of critical questions about male circumcision for HIV prevention and its impact on male sexuality. These include:
How does male circumcision affect men's sexual identity? Are there changes in sexual satisfaction before and after the procedure is performed? How can programmes providing male circumcision for HIV prevention work with and complement traditional circumcision ceremonies that are included in rites of passage for young men? How does male circumcision affect individual and community-level ideas of masculinity and male sexuality?
There are a range of concerns and beliefs about how circumcision status affects sexual function and pleasure. Over two years of follow-up, the 4,500 men enrolled in a recent trial of male circumcision for HIV prevention in Uganda were asked to report on their sexual functioning and satisfaction. About half of the men were circumcised; the other half were not. The responses from these men were that circumcision did not have any effect on sexual desire or satisfaction, erectile function, ability to achieve penetration, or pain with intercourse. Over 98 percent of participants reported sexual satisfaction, no difficulty with penetration, and no pain during intercourse, regardless of whether or not they were circumcised.1
Participants in the Kisumu, Kenya, study were also followed up and here too, circumcision status was not associated with any sexual dysfunction (premature ejaculation, pain during intercourse, erectile dysfunction, inability to ejaculate, or lack of pleasure during intercourse).2 Data from studies of male circumcision done in other contexts unrelated to prevention of HIV infection also provide information on men's sexual function and satisfaction pre- and post-surgery.3,4,5,6,7 The studies to date include different findings, with some studies reporting shifts in satisfaction or function and others reporting no difference. As medical male circumcision for HIV prevention scales up, it will be possible to gather additional data on these topics in the specific context of HIV prevention programming.
These data, however, are just the beginning of what can and should be studied as programmes offering male circumcision for HIV prevention roll out. Many advocates, anthropologists, and social scientists have identified the need to develop research components that gather, analyse, and propose responses to information on the interface between male sexuality and male circumcision. This information will change over time and will vary by culture, community, and geography—as well as with the age at which the surgery is performed.
For more information on male sexuality and circumcision, read the section of the behavioural and social science page that addresses this topic.
Kigozi G, Watya S, Polis CB, et al. The effect of male circumcision on sexual satisfaction and function: results from a randomized trial of male circumcision for human immunodeficiency virus prevention, Rakai, Uganda. BJU Int 2008;10(1):65-70.
Krieger JN, Mehta SD, Bailey RC, et al. Adult male circumcision: effects on sexual function and sexual satisfaction in Kisumu, Kenya. J Sex Med 2008;5(11):2610-22.
Payne K, Thaler L, Kukkonen BA, et al. Sensation and sexual arousal in circumcised and uncircumcised men. J Sex Med 2007;4(3):667-674.
Fergusson DM, Boden JM, Horwood LJ. (Abstract only) Circumcision status and risk of sexually transmitted infection in young adult males: an analysis of a longitudinal birth cohort. Pediatrics 2006;118(5):1971-77.
Kim D, Pang MG. The effect of male circumcision on sexuality. BJU Int 2007;99(3):619-622.
Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int 2007;99(4):864-869.
Senkul T, Iserl C, sen B, et al. (Abstract only) Circumcision in adults: effect on sexual function. Urology 2004;63(1):155-158.