Page 148 - HIVMED_v21_i1.indb

Page 3 of 8 Original Research

prevalence was not rare (e.g. > 10%). 24,25 The primary outcome for socio-economic status in this setting. The most common
of our Poisson regression models was reporting any worsening relationship status was dating and not living together (53%),
of sexual function in any domain since the VMMC procedure followed by being married and/or living together (28%).
at 3-month post-VMMC (yes or no). We included all men with Over one-third (37%) of the men reported having ≥ 6 drinks
3-month follow-up data in our primary models regardless of at one time at least four times a month. The median age of
engaging in sexual activity or not, because sexual dysfunction sexual debut was 19 years (IQR 17–20), 20% of the men
could influence sexual activity. In a sensitivity analysis, we reported having ≥ 2 sexual partners in the previous month
restricted our models to only men who reported sexual and 21% reported ≥ 10 lifetime sexual partners. Almost half
activity after undergoing VMMC. We also reran our primary (47%) reported that HIV prevention was their primary reason
models with the outcome excluding hygiene or cleanliness. for becoming circumcised.
We used Stata 15/SE (Stata Corporation, College Station, TX)
to perform statistical analyses. Overall, 378/519 (73%) men had data available on sexual
function at 3-month post-VMMC and were included in the
Ethical consideration final analysis (Figure 1). Of the 141 men without 3-month
sexual function data, 82% attended a prior follow-up visit at
Ethical approvals were obtained from the Health Research and 7 days or 6 weeks post-VMMC. Compared with men without
Development Committee at the Botswana Ministry of Health data available, men with 3-month post-VMMC sexual
and Wellness (reference number: 00699) as well as the function data less frequently had higher than secondary
University of Washington Institutional Review Board (reference education (54% vs. 66%, p = 0.005). There were no differences
number: 42047). All participants provided written informed in any other baseline characteristics between those who did
consent for participation in the study in addition to the consent have and who did not have 3-month data available (Table 1).
obtained by the clinic staff for the circumcision procedure.
Sexual function after voluntary medical male
Results circumcision
Baseline characteristics Amongst men with sexual function data available at 3-month

In total, 519 who were enrolled in the parent study underwent post-VMMC (n = 378), the majority (88%) reported having
VMMC (Figure 1). Median age was 27 years (interquartile sex in the last 90 days. Amongst men who were sexually
range [IQR] 23–31), 57% had completed secondary education active in the last 90 days (n = 326), the median time since last
or higher and 86% had electricity in the household, a proxy sex was 7 days (IQR 7–14). Nearly all (96%) men reported
better sexual function in at least one domain; 19% reported
improvement in all six domains. The most frequently
reported domain with improvement was hygiene/cleanliness
Enrolled in parent study
n = 519 (93%), followed by ease of vaginal penetration (57%); 44% –
50% of the men reported improvement in all other
Did not a end 7-day visit categories (Figure 2). One-fourth (91/378, 24%) of the men
n = 34 reported worsening sexual function post-VMMC in at
least one domain. The most frequently reported domain to
Returned for follow-up at 7-days
n = 485 worsen was sexual desire (11%); for all other domains, less
than 10% of the men reported any worsening (Figure 2). No
Did not a end 6-week visit change was reported by 36% – 44% of the men across all
n = 36 domains except for hygiene/cleanliness (5%). No baseline

Returned for follow-up at 6-weeks
n = 449 Be er than pre-VMMC No change Worse than pre-VMMC
Sexual desire 48
Did not a end 3-month visit (n = 377) 41
n = 45 11
Ease of vaginal penetra on 57
(n = 371) 7 36
Returned for follow-up at 3-months 44
n = 404 Ability to put on condom 10 46
(n = 373)
Did not have data on sexual Percentage Ease of ejacula on 50
func on or sa sfac on (n = 372) 8 42
n = 26 Achieve and maintain 49
erec on (n = 372) 45
Data available on sexual func on 6 93
and sa sfac on at 3-months Hygiene/cleanliness
n = 378 (n = 372) 2 5
FIGURE 1: Study flowchart for men who underwent voluntary medical male VMMC, voluntary medical male circumcision.
circumcision and were enrolled in the parent study between November 2013 FIGURE 2: Sexual function at 3 months after voluntary medical male circumcision
and October 2015. amongst men uninfected by the human immunodeficiency virus (n = 378).

http://www.sajhivmed.org.za 140 Open Access