Nordstrom Monica P C, Westercamp Nelli, Jaoko Walter, Okeyo Timothy, Bailey Robert C
Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA.
Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA.
J Sex Med. 2017 Apr;14(4):601-612. doi: 10.1016/j.jsxm.2017.02.014.
Two cohort studies using data from randomized controlled trials in Africa offer the best evidence to date on the effects of voluntary medical male circumcision (VMMC) on male sexual function and satisfaction, suggesting no significant impairments in sexual function or satisfaction and some improvements in sexual function after male circumcision.
To assess the effects of VMMC on sexual function and satisfaction in a large population-based cohort of men circumcised as adults and uncircumcised controls in Kenya.
Sexual function and satisfaction of young (median age = 20 years) sexually active men (1,509 newly circumcised men and 1,524 age-matched uncircumcised controls after 5% loss to follow-up) were assessed at baseline and 6, 12, 18, and 24 months, with data collected in 2008 to 2012. Self-reported data on lack of sexual interest or pleasure, difficulty getting or maintaining erections, orgasm difficulties, premature ejaculation, pain during intercourse, and satisfaction with sexual intercourse were analyzed with mixed-effect models to detect differences between circumcised and uncircumcised men and changes over time.
Changes over time in sexual interest, desire and pleasure, erectile and ejaculatory function, and pain during intercourse (dyspareunia) in circumcised and uncircumcised men; group differences in time trends; satisfaction with sexual performance; and enjoyment of sex before and after circumcision.
Sexual dysfunctions decreased in the two study groups from 17% to 54% at baseline to 11% to 44% at 24 months (P < .001), except dyspareunia, which decreased only in circumcised men (P < .001). Sexual satisfaction outcomes increased in the two study groups from 34% to 82% at baseline to 66% to 93% at 24 months (P < .001), with greater improvements in circumcised men (P < .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 with before circumcision.
Results are applicable to VMMC programs seeking to increase the acceptability of male circumcision as part of comprehensive HIV prevention.
Large-scale population-based longitudinal data restricted to sexually active individuals and adjusted for differences in baseline levels of outcomes and potential confounders are used. The questionnaire used, although not a standardized survey instrument, includes all major domains of male sexual function and satisfaction used in the most common standardized tools.
Results are consistent with large cohort studies of VMMC using data from randomized controlled trials and indicate that VMMC has no significant detrimental effect or might have beneficial effects on male sexual function and satisfaction for the great majority of men circumcised as adults. Nordstrom MPC, Westercamp N, Jaoko W, et al. Medical Male Circumcision Is Associated With Improvements in Pain During Intercourse and Sexual Satisfaction in Kenya. J Sex Med 2017;14:601-612.
两项利用非洲随机对照试验数据进行的队列研究提供了迄今为止关于男性自愿包皮环切术（VMMC）对男性性功能和满意度影响的最佳证据，表明包皮环切术后性功能或满意度无显著损害，且性功能有所改善。
评估在肯尼亚一个以成年男性包皮环切者和未包皮环切者为对照的大型人群队列中，VMMC对性功能和满意度的影响。
对年轻（中位年龄 = 20岁）性活跃男性（1509名新接受包皮环切术的男性和1524名年龄匹配的未包皮环切对照者，随访失访率为5%）在基线以及6、12、18和24个月时的性功能和满意度进行评估，数据收集于2008年至2012年。使用混合效应模型分析关于缺乏性兴趣或快感、勃起或维持勃起困难、性高潮困难、早泄、性交疼痛以及性交满意度的自我报告数据，以检测包皮环切者和未包皮环切者之间的差异以及随时间的变化。
两组研究对象的性功能障碍从基线时的17%至54%降至24个月时的11%至44%（P <.001），但性交疼痛除外，其仅在包皮环切者中有所下降（P <.001）。两组研究对象的性满意度从基线时的34%至82%增至24个月时的66%至93%（P <.001），包皮环切者的改善更为明显（P <.001）。平均而言，97%的包皮环切者对性交感到满意，92%的人认为包皮环切术后的性生活比术前更愉悦或无差异。
该结果适用于旨在提高男性包皮环切术作为综合HIV预防措施一部分的可接受性的VMMC项目。
使用了基于大规模人群的纵向数据，仅限于性活跃个体，并对结局基线水平差异和潜在混杂因素进行了调整。所使用的问卷虽不是标准化调查工具，但涵盖了最常用标准化工具中男性性功能和满意度的所有主要领域。
研究结果与利用随机对照试验数据进行的VMMC大型队列研究一致，表明VMMC对绝大多数成年接受包皮环切术的男性的性功能和满意度没有显著不利影响，甚至可能有有益影响。诺德斯特龙MPC、韦斯特坎普N、贾奥科W等。《医学男性包皮环切术与肯尼亚性交疼痛改善及性满意度相关》。《性医学杂志》2017年；14：601 - 612。
