Sexual Pleasure and Function, Coital Trauma, and Sex Behaviors After Voluntary Medical Male Circumcision Among Men in the Dominican Republic.

BACKGROUND: Voluntary medical male circumcision (VMMC) is effective in decreasing the risk of HIV acquisition. As men resume sexual activity after circumcision, it will be important to study their satisfaction with the procedure, sexual pleasure and function, coital trauma, and risk compensation (RC), which can hamper or facilitate the long-term success of VMMC programs. AIM: To assess men's satisfaction with VMMC, sexual pleasure and function, coital trauma, and RC after VMMC. METHODS: This is a cohort study of circumcised men who presented for follow-up 6 to 24 months after VMMC. Logarithmic binomial regression was performed to explore factors associated with any increase in the number of sex partners after VMMC as a measurement of RC. MAIN OUTCOME MEASURES: (i) Men's satisfaction with their VMMC; (ii) sexual pleasure and function after VMMC; (iii) coital trauma; and (iv) RC. RESULTS: Of 454 circumcised men, 362 (80%) returned for a follow-up visit 6 to 24 months after VMMC. Almost all (98%) were satisfied with the outcome of their VMMC; most (95%) reported that their female partners were satisfied with their circumcision. Two thirds (67%) reported enjoying sex more after VMMC and most were very satisfied or somewhat satisfied (94%) with sexual intercourse after VMMC. Sexual function improved and reported sex-induced coital injuries decreased significantly in most men after VMMC. There was an increase in the proportion of men who reported at least two sexual partners after VMMC compared with baseline. In multivariate analysis, having sex with a woman they met the same day (adjusted relative risk = 1.7, 95% CI = 1.2-2.4) and having at least two sexual partners at baseline (adjusted relative risk = 0.5, 95% CI = 0.3-0.8) were associated with the outcome of any increase in the number of partners after VMMC. CLINICAL IMPLICATIONS: VMMC can be offered to Dominican men for HIV prevention without adversely affecting sexual pleasure or function. The procedure substantially reduces coital trauma. STRENGTHS & LIMITATIONS: This is the first report of long-term overall satisfaction, sexual pleasure/function and sex behaviors in the context of VMMC outside of Africa. Limitations of the study included the reliance on self-reported sex behaviors, the lack of physiologic measurement of penile sensitivity and the lack of follow up data beyond 24 months, which precludes the assessment of longer term RC. CONCLUSION: The study confirmed men's long-term satisfaction with the outcome of their VMMC. VMMC improved sexual pleasure and function for most men and significantly decreased coital injuries. There was mixed evidence of RC. Brito MO, Khosla S, Pananookooln S, et al. Sexual Pleasure and Function, Coital Trauma, and Sex Behaviors After Voluntary Medical Male Circumcision Among Men in the Dominican Republic. J Sex Med 2017;14:526-534.

Popular perceptions of circumcision among Colombian men who have sex with men.

Male circumcision has received increased attention for its potential to reduce sexual transmission of HIV. Research on the acceptability of circumcision as a means of HIV prevention among men who have sex with men is limited. Men who have sex with men in Bogotá, Colombia, either participated in a focus group in which they shared information regarding their perceptions of circumcision or completed a survey that assessed circumcision experiences, attitudes, beliefs and willingness. Few participants reported they were circumcised, yet most participants reported knowing something about the procedure. Overall, attitudes towards circumcision were mixed: although circumcision was viewed as safe, it was also viewed as unnatural and cruel to babies. Beliefs that circumcision could improve sexual functioning and protect against STIs and HIV were not widely endorsed by survey participants, although focus-group participants discussed the potential impacts of circumcision on the availability of sexual partners and sexual performance. Some focus-group participants and many survey participants reported a hypothetical willingness to get circumcised if strong evidence of its effectiveness could be provided, barriers removed and recovery time minimised.

Attitudes and decision making about neonatal male circumcision in a Hispanic population in New York City.

OBJECTIVE: To understand attitudes and decision making regarding neonatal male circumcision. METHODS: Parents (n = 150) with a son 3 years old were interviewed regarding demographics, communication with a medical provider, attitudes, and process by which the neonatal circumcision decision was made. RESULTS: Thirty-three percent of sons were circumcised. In univariate analyses, choosing male circumcision was associated with parents being interviewed in English, the father being circumcised, positive attitudes, being informed of the advantages of circumcision, making a decision before birth, and being offered a choice. In the final model, parents who came from a culture and family that believed in circumcision and who believed that it was not too risky were more likely to circumcise their sons. CONCLUSIONS: Decisions regarding circumcision appear to be influenced by values, risk perceptions, and medical providers. Future research should address ways of ensuring that families have the opportunity to make an informed decision.

Male circumcision, attitudes to HIV prevention and HIV status: a cross-sectional study in Botswana, Namibia and Swaziland.

In efficacy trials male circumcision (MC) protected men against HIV infection. Planners need information relevant to MC programmes in practice. In 2008, we interviewed 2915 men and 4549 women aged 15-29 years in representative cluster samples in Botswana, Namibia and Swaziland, asking about socio-economic characteristics, knowledge and attitudes about HIV and MC and MC history. We tested finger prick blood samples for HIV. We calculated weighted frequencies of MC knowledge and attitudes, and MC history and HIV status. Multivariate analysis examined associations between MC and other variables and HIV status. In Botswana, 11% of young men reported MC, 28% in Namibia and 8% in Swaziland; mostly (75% in Botswana, 94% - mostly Herero - in Namibia and 68% in Swaziland) as infants or children. Overall, 6.5% were HIV positive (8.3% Botswana, 2.6% Namibia and 9.1% Swaziland). Taking other variables into account, circumcised men were as likely as uncircumcised men to be HIV positive. Nearly half of the uncircumcised young men planned to be circumcised; two-thirds of young men and women planned to have their sons circumcised. Some respondents had inaccurate beliefs and unhelpful views about MC and HIV, with variation between countries. Between 9 and 15% believed a circumcised man is fully protected against HIV; 20-26% believed men need not be tested for HIV before MC; 14-26% believed HIV-positive men who are circumcised cannot transmit the virus; and 8-34% thought it was "okay for a circumcised man to expect sex without a condom". Inaccurate perceptions about protection from MC could lead to risk compensation and reduce women's ability to negotiate safer sex. More efforts are needed to raise awareness about the limitations of MC protection, especially for women, and to study the interactions between MC roll out programmes and primary HIV prevention programmes.

The feasibility and acceptability of male circumcision among men, women, and health providers of the Altagracia Province, Dominican Republic.

BACKGROUND: Male circumcision (MC) is an effective strategy to reduce the risk of HIV acquisition in men. The objective of the present study was to evaluate the feasibility of introducing MC in the Altagracia Province and to qualitatively assess the knowledge and acceptability of MC among men, women, and health providers. METHODS: Two surveys were administered to providers. The first, assessed their experience and knowledge of MC and the second, a "Health Facility Profile," included an inventory of available surgical materials in the clinics. Fourteen focus group discussions were conducted to evaluate the acceptability of MC. RESULTS: Forty-three providers were interviewed at 37 clinics. Median age was 33 years (range 23-55 years). Most were physicians (91%) employed by the government. Only 23% had experience with MC. Almost universally (95%), providers knew that MC has health benefits. All agreed that MC improves hygiene and 67% knew that MC decreases the risk of HIV infection. Only six clinics provided HIV counseling and testing and most lacked adequate surgical facilities and equipment. Findings of the qualitative study showed that about half the men and the majority of women were accepting of MC. CONCLUSIONS: Men, women, and providers in the Dominican Republic may be accepting of MC. Education about the benefits of the procedure is needed in the community.

Attitudes towards male circumcision among attendees at a sexually transmitted Infection Clinic in Kingston, Jamaica / Actitudes hacia la circuncisión masculina entre los asistentes a la Clínica de Infecciones transmitidas sexualmente en Kingston, Jamaica

OBJECTIVE: To describe the attitudes of Sexually Transmitted Infection (STI) clinic attendees towards male circumcision. DESIGN AND METHODS: A convenience sample of attendees at the main STI clinic in Kingston was interviewed using a structured questionnaire in June 2008. RESULTS: One-hundred men and 98 women were interviewed. Over 90% of the men were not circumcised. Although 60% of men and 67% of women reported that they had heard of circumcision, the research nurse assessed that 28% of men and 40% of women actually understood what circumcision was. When asked about the benefits of circumcision, 32% of men and 41.8% of women said that circumcision makes it easier to clean the penis while 13% of men and 20.4% of women said that circumcision lessens the likelihood of STI. Twenty-two per cent of men and 13.3% of women said that the foreskin offers protection while 18% of men and 10.2% of women said that the penis looks more attractive when uncircumcised. When informed that research showed that circumcision reduced the risk of HIV, 35% of men said that they were willing to be circumcised and 67.3% of women said that they would encourage their spouse to be circumcised (p < 0.001) while 54% of men and 72.4% of women said that they would circumcise their sons (p = 0.057). CONCLUSION: Knowledge of circumcision and its benefits were limited among STI clinic attendees. Significantly more women than men were in favour of circumcision when informed that it reduced the risk of HIV infection.

OBJETIVO: Describir las actitudes de los asistentes a la clínica de infecciones de transmisión sexual (ITS) hacia la circuncisión masculina. DISEÑO Y MÉTODOS: Una muestra de conveniencia de asistentes a la clínica principal de ITS en Kingston fue encuestada mediante un cuestionario estructurado en junio de 2008. RESULTADOS: Se entrevistaron 100 hombres y 98 mujeres. Más del 90% de los hombres no estaban circuncidados. Aunque el 60% de los hombres y el 67% de las mujeres informaron que habían oído hablar de la circuncisión, la enfermera de la investigación evaluó que el 28% de los hombres y el 40% de las mujeres realmente entendían que era la circuncisión. Cuando se les preguntó acerca de los beneficios de la circuncisión, el 32% de los hombres y el 41.8% de las mujeres dijeron que la circuncisión facilita la limpieza del pene, mientras que el 13% de los hombres y el 20.4% de las mujeres dijeron que la circuncisión disminuye la probabilidad de ITS. El veintidós por ciento de los hombres y el 13.3% de las mujeres dijo que elprepucio ofreceprotección, mientras que el 18% de los hombres y el 10.2% de las mujeres dijeron que el pene parece más atractivo cuando está incircunciso. Cuando se les informó que las investigaciones mostraban que la circuncisión reducía el riesgo de VIH, el 35% de los hombres dijeron que querían ser circuncidados y el 67.3% de las mujeres dijeron que estimularían a sus esposos a quefueran circuncidados (p < 0.001), mientras que el 54% de los hombres y el 72.4% de las mujeres dijeron que harían circuncidar a sus hijos (p = 0.057). CONCLUSIÓN: El conocimiento de la circuncisión y sus beneficios eran limitados entre los asistentes a la clínica de ITS. Un número significativamente mayor de mujeres en comparación con los hombres, estuvieron a favor de la circuncisión cuando se dio la información de que reducía el riesgo de infección de VIH.

Attitudes towards male circumcision among attendees at a sexually transmitted infection clinic in Kingston, Jamaica.

OBJECTIVE: To describe the attitudes of Sexually Transmitted Infection (STI) clinic attendees towards male circumcision. DESIGN AND METHODS: A convenience sample of attendees at the main STI clinic in Kingston was interviewed using a structured questionnaire in June 2008. RESULTS: One-hundred men and 98 women were interviewed. Over 90% of the men were not circumcised. Although 60% of men and 67% of women reported that they had heard of circumcision, the research nurse assessed that 28% of men and 40% of women actually understood what circumcision was. When asked about the benefits of circumcision, 32% of men and 41.8% of women said that circumcision makes it easier to clean the penis while 13% of men and 20.4% of women said that circumcision lessens the likelihood of STI. Twenty-two per cent of men and 13.3% of women said that the foreskin offers protection while 18% of men and 10.2% of women said that the penis looks more attractive when uncircumcised. When informed that research showed that circumcision reduced the risk of HIV 35% of men said that they were willing to be circumcised and 67.3% of women said that they would encourage their spouse to be circumcised (p < 0.001) while 54% of men and 72.4% of women said that they would circumcise their sons (p = 0.057). CONCLUSION: Knowledge of circumcision and its benefits were limited among STI clinic attendees. Significantly more women than men were in favour of circumcision when informed that it reduced the risk of HIV infection.

[Trying to regain control: preschool boys' experience in the post-operative stage of circumcision]. / Tentando readquirir o controle: a vivência do pré-escolar no pós-operatório de postectomia.

This study was carried out with 3 to 6 year-old boys undergoing circumcision, with a view to understanding the meaning of the interactions they experienced them during the post-operative period as well as identifying their strategies while experiencing the surgery. Symbolic Interactionism was used as a theoretical reference framework, and Grounded Theory as a methodological framework. Due to these children's verbal development characteristics, the interview was mediated by therapeutic play. Their mothers were also interviewed as informers of their children's experience. Data were analyzed up to the point of categorization of the meanings, revealing the following category of concepts: Trying to regain control. Understanding the whole experience offers important elements to rethink nursing care to preschool boy who undergo circumcision, as well as to his family.

[Should circumcision be performed in childhood?]. / Debe realizarse circuncisión en la infancia?

OBJECTIVE: To evaluate prepuce development and retractibility in a group of boys. To point out the value of circumcision and prepucial forced dilation during childhood. METHODS: Prepuce development and retractibility were evaluated in 400 boys ages between 0-16 year old. RESULTS: In boys under 1 year prepuce retractibility (assessed only in children who did not undergo forced dilation previously) was type I (non retractile) in 71.5% whereas type V (completely retractile) was only 5.5%. In adolescent boys type I prepuce was observed in 1 boy only, 1.6%, whereas type V was observed in 82.3%. Furthermore, it was observed that at the time of examination for the study 106 boys who had undergone forced dilation at an earlier age had balano-prepucial adhesions again, which demonstrates that prepuce adheres again to glans penis in many boys after a forced dilation is performed. Only 11 boys were considered in need for circumcision, three of them for prepucial orifice stenosis, which prevented normal micturition, causing a prepucial sac, one case due to a constrictive ring below the prepucial edge that would have prevented ulterior retractability, two cases with repetitive balanopostitis, and five cases secondary to xerosol balanitis, accounting for 2.7% of all examined boys. CONCLUSIONS: Incomplete separation between prepuce and glans penis is normal and common among new-borns, progressing until adolescence to spontaneous separation, at which time it is complete in the majority of boys. Accordingly to the criteria we have sustained for years and present study's findings, circumcision has few indications during childhood, as well as forced prepucial dilation.