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Try out PMC Labs and tell us what you think. Learn More. Male circumcision is being promoted for HIV prevention in high-risk heterosexual populations. However, there is a concern that circumcision may impair sexual function. Exclusion criteria included foreskin covering less than half the glans, a condition that might unduly increase surgical risks, or a medical indication for circumcision. Participants were randomized to either immediate circumcision or delayed circumcision after 2 years control group.

Detailed evaluations occurred at 1, 3, 6, 12, 18, and 24 months. Between February and September2, participants were randomized, including the excluded from this analysis because they crossed over, were not circumcised within 30 days of randomization, did not complete baseline interviews, or were outside the age range.

For the circumcision and control groups, respectively, rates of any reported sexual dysfunction decreased from Changes over time were not associated with circumcision status. Compared to before they were circumcised, Adult male circumcision was not associated with sexual dysfunction. 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.

Male circumcision is now being promoted in many areas, particularly in eastern and southern Africa, as a public health measure to reduce HIV risk. Possible mechanisms by which male circumcision may protect against HIV infection include that circumcised men have more penile cornification, lower rates of penile injury during intercourse, fewer HIV receptors, and lower rates of inflammation and of some sexually transmitted infections STIs [ 1 — 3 ]. The clinical trials documented acceptable surgery-related adverse event rates [ 1 — 3 ], and the World Health Organization now recommends male circumcision as one element of HIV prevention programs [ 5 ].

Neonatal circumcision reduces urinary tract infection rates substantially [ 6 — 8 ], and other data suggest that male circumcision is associated with lower rates of STIs [ 9 — 15 ]. Circumcised males do not develop phimosis or para-phimosis, and they are at lower risk for balanitis, human papilloma virus infection [ 16 ], and penile cancer [ 17 — 19 ]. In addition, female sexual partners of circumcised men have been shown to have reduced risk of cervical cancer [ 13 ] and chlamydial infection [ 20 Women looking at cocks Howe.

Despite these benefits, there is a concern that male circumcision may decrease male sexual function and satisfaction. Ritualistic male circumcision has been practiced in West Africa and the Middle East for over 4, years [ 21 ]. In the West, circumcision started to be promoted in the late 19th century for a wide variety of public health reasons, from the reduction of syphilis risk to the prevention of masturbation [ 2223 ].

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studies have described variable and inconsistent effects of circumcision on male sexual function. Some case control studies have reported reduced sexual sensation, Women looking at cocks Howe pleasure, and sexual enjoyment among circumcised men compared with uncircumcised men [ 2628 ], but higher fine-touch pressure thresholds in the glans among circumcised men compared with uncircumcised men [ 29 ]. Some before and after studies of men circumcised as adults have reported decreased penile sensitivity [ 2731 ], while others have reported no change in penile sensitivity and satisfaction [ 32 ].

One before and after study found an increased ejaculatory latency time after circumcision, which was deemed an advantage [ 30 ]. A probability sample of 10, men in Australia aged 16—59 years found circumcised men were less likely to report trouble keeping an erection or physical pain during intercourse [ 33 ].

Payne and associates found no difference during genital sensory testing as a function of sexual arousal between 20 circumcised and 20 uncircumcised men [ 34 ]. In the U. A recent randomized clinical trial found that circumcised adult men experienced no clinically ificant adverse effects on sexual satisfaction or sexual function [ 36 ].

To better understand the risks and benefits of circumcision, we prospectively evaluated sexual function and sexual satisfaction among adult men participating in a randomized, controlled clinical trial of adult male circumcision to prevent HIV infection in Kisumu, Kenya.

The trial de, circumcision technique, adverse events, and primary outcome HIV infection have been described [ 23738 ]. Briefly, participants were recruited from sexually transmitted disease clinics, workplaces, social events, and youth organizations. Interested men were given an appointment for randomization and possible circumcision within 1 week of screening. Exclusion criteria included foreskin covering less than half of the glans, a bleeding disorder, keloid formation, other conditions that might unduly increase the risks of elective surgery, or a medical indication for circumcision.

Following written informed consent, the participants were randomized to either immediate circumcision or delayed circumcision after a 2-year follow-up period the control group. The men in both groups were counseled extensively on STIs and HIV risk reduction, and were provided unlimited supplies of free condoms. After outlining the incision with a marking pen, a Kocher clamp was applied below the planned incision, taking care to avoid injury to the glans.

The prepuce was excised by cutting above the Kocher clamp, which was then removed. Skin and mucosal incisions were approximated using interrupted 3—0 and 4—0 chromic sutures. Follow-up visits were scheduled on postoperative days 3, 8, and Detailed evaluations were conducted at 1, 3, 6, 12, 18, and 24 months from randomization for both the circumcision and the control groups.

At each visit, the participants underwent a standardized medical history and physical examination, plus a personal interview to obtain sociodemo-graphic and health information, and to assess behavioral risk factors. Trained counselors interviewed the participants in their language of choice English, Dholuo, or Kiswahili.

Data for this analysis were collected as part of a randomized, controlled trial deed to assess the effect of male circumcision on reducing HIV seroconversion. The data presented here include the follow-up through October Data collection and management procedures have been described in detail ly [ 23738 ]. We conducted two primary analyses here. The first compared sexual function over time between the circumcised and uncircumcised groups.

There were five measures of sexual dysfunction Table 1. The second analysis assessed sexual satisfaction and pleasure over time among circumcised men only. As secondary analyses, we compared the Women looking at cocks Howe clinical assessments by circumcision status, and penile complaints after circumcision among circumcised men. Predicted odds were used to quantify relative change in sexual satisfaction and pleasure from baseline among the men who were circumcised. Generally, time baseline, 6- and month follow-ups for sexual dysfunction, and 6- and month follow-ups for sexual satisfaction and pleasure was included as in the models.

However, additional models were run using orthogonal polynomials to assess trends with time and ing for the same parameter space as in the models with time treated categorically fourth-order polynomials for sexual dysfunction, and third-order polynomials for sexual satisfaction and pleasure. The generalized estimating equations GEE extension of generalized linear models was used to incorporate the within-subject correlation among the repeated measures, assuming binomial distributions with log link.

Standard errors were obtained using an exchangeable correlation structure with robust empirical estimate of standard error.

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This GEE method takes into the incomplete follow-up experience because of the early stop of the trial under the assumption that the data are missing at random. No consideration was given to multiple test issues. Between February and September2, participants were randomized, including 1, in the circumcision group and 1, in the control group. Screening and reasons for exclusion and nonparticipation in the main trial have been reported [ 239 ]. There were no differences in the timing of the follow-up visits by group [ 2 ]. Among the 2, men enrolled, were excluded from this analysis: 5 who did not complete the baseline interview, 3 who were outside the age range, 16 control participants who were circumcised, 57 men who were randomized to circumcision but were not circumcised, and 19 men randomized to circumcision but were not circumcised within 30 days of randomization.

The median age at first sex was 16 years, and the median of years being sexually active was five. The two study arms were well balanced in terms of sociodemographic characteristics and sexual behaviors [ 239 ]. Selected sociodemographic and behavioral characteristics are shown in Table 3. Selected baseline sociodemographic characteristics and behaviors by circumcision status. Among the 2, participants, 2, answered all five questions about sexual dysfunction at baseline, and These included men Baseline reports of other sexual dysfunction measures did not differ between the treatment arms.

During the 2-year period from randomization, the circumcision group and the control group both experienced dramatic decreases in reported sexual dysfunction Table 1Figure 1A—F. For the circumcision and control groups, respectively, the percent reporting any of the five sexual dysfunction items decreased from Percent reporting sexual dysfunctions by circumcision status and study visit.

A Inability to ejaculate; B premature ejaculation; C pain during intercourse; D sex is not pleasurable; E difficulty achieving or maintaining erection; and F reporting any sexual dysfunction. GEE was used to model sexual dysfunction by treatment and visit, taking into the correlation of repeated measures on individual participants Table 4.

Changes from baseline in reports of any sexual dysfunction, or with any of the five individual sexual dysfunction items, did not differ by circumcision status test for interaction was not ificant on any measure. At 6 months, there were fewer reports of premature ejaculation among the men who were circumcised, but this difference was related to an imbalance at baseline, and the change from baseline was not ificantly different by circumcision status. Adjusted odds ratios of sexual dysfunctions for circumcision vs.

During their follow-up evaluations, Women looking at cocks Howe all circumcised men reported that their erections felt normal, that their penis did not deviate with erection, that they had little or no difficulty inserting their penis during intercourse, and that they had little or no difficulty achieving erection because their skin was too tight Table 1. On physical examination, no circumcised man had painful lumps along the suture line, ificant scarring, twisting of the penis, or penile pain.

Almost all men were satisfied with their circumcisions as reported by Of the 1, uncircumcised men, 9 0. None of these findings were detected by physical examination among the circumcised men. Based on follow-up time, the rate of symptomatic balanitis among uncircumcised men was 0. At their 6- and month visits, the circumcised men were asked six questions to assess sexual function and pleasure compared to before being circumcised Table 2. At their 6-month follow-up, At 6 months, Few men reported ever avoiding sex because of being circumcised.

We examined the possibility that increased penile sensitivity might be related to premature ejaculation, by conducting an analysis relating penile sensitivity to premature ejaculation status and time GEE, binomial distribution, and log link.

Additionally, we examined text comments provided by the few men reporting dissatisfaction with circumcision. One dissatisfied man reported reduced sensation, and one reported difficulty maintaining erection. Other reasons for dissatisfaction were related to the circumcision procedure itself e.

The one remaining man did not report a reason for Women looking at cocks Howe. Adult male circumcision was not associated with sexual dysfunction in this study. We found no ificant difference between circumcised and uncircumcised men with respect to the frequency of erectile dysfunction, inability to ejaculate, pain during intercourse, lack of pleasure with inter-course, or these dysfunctions combined. On careful clinical evaluation over 2 years of follow-up, the circumcised men did not have evidence of penile deformities or long-term surgical complications.

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Our findings support and substantially extend findings from another randomized trial of adult male circumcision that also found no ificant difference in sexual function between circumcised men and uncircumcised controls [ 36 ]. These critical findings are reassuring in view of current efforts to promote male circumcision to prevent HIV infections in some countries, particularly in eastern and southern Africa [ 40 ].

We hope that these data can be used to inform public health recommendations for male circumcisions in other settings. Women looking at cocks Howe, Few studies have examined sexual dysfunction in young men. Thus, the rate of sexual dysfunction in our study is generally comparable with the rates in young men surveyed in the United States [ 41 ], Britain [ 42 ], and most other countries [ 4344 ]. Besides documenting that circumcision had no ificant adverse effect on male sexual function, our data suggest potential changes in sexual pleasure for some circumcised men.

The circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm, subjective findings that may be considered to be either a potential benefit or an adverse effect by individual men. The circumcised men had progressively higher rates of sexual satisfaction over time, as well as a lower rate of balanitis. Reduced rates of reported sexual dysfunction in both the circumcised and control men over the course of the study may have a of different interpretations, including regression to the mean, increased familiarity with the study questions, or another effect of repeated assessment.

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