title: Circumcision and reduced risk of self-reported penile coital injuries: results from a randomized controlled trial in Kisumu, Kenya.
abstract: OBJECTIVE
  Injuries to the penis during intercourse represent a hypothesized mechanism by which uncircumcised men are at increased risk for HIV. There are no published, systematically collected data regarding mild penile coital trauma to our knowledge. We identified risks of self-reported penile coital injuries in men 18 to 24 years old in a randomized trial of circumcision to prevent HIV in Kisumu, Kenya.
  
  
  METHODS
  Each participant underwent standardized interview, medical history and physical examination at baseline, and 6, 12, 18 and 24 months after enrollment. Self-reported penile coital injuries were assessed at each visit, and were defined as penis feels sore during sex, penis gets scratches, cuts or abrasions during sex, and skin of the penis bleeds after sex. Generalized estimating equation analysis estimated odds ratios for penile coital injuries.
  
  
  RESULTS
  From February 2002 to September 2005, 2,784 participants were randomized. At baseline 1,775 (64.4%) men reported any coital injury including 1,313 (47.6%) soreness, 1,328 (48.2%) scratches, abrasions or cuts and 461 (16.7%) bleeding. On multivariable analysis coital injury risk was lower for circumcised than for uncircumcised men with soreness (OR 0.71, 95% CI 0.64-0.80), scratches/abrasions/cuts (OR 0.52, 95% CI 0.46-0.59), bleeding (OR 0.62, 95% CI 0.51-0.75) and any coital injury (OR 0.61, 95% CI 0.54-0.68). Other significant risks included increasing age, multiple recent sex partners, HSV-2 seropositivity and genital ulcers (p <0.05). Condom use, cleaning the penis soon after intercourse and being married/cohabiting were protective (p <0.05, each).
  
  
  CONCLUSIONS
  Self-reported penile coital injuries were common in these healthy young men. Circumcised men were at lower risk for coital injuries. Verifying penile coital injuries, the mechanism of acquisition and the association with HIV risk is needed.
authors.affiliation: Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, USA. supriyad@uic.edu
authors.forename: Supriya D
authors.initials: SD
authors.lastname: Mehta
authors.forename: John N
authors.initials: JN
authors.lastname: Krieger
authors.forename: Kawango
authors.initials: K
authors.lastname: Agot
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.forename: Jeckoniah O
authors.initials: JO
authors.lastname: Ndinya-Achola
authors.forename: Corette
authors.initials: C
authors.lastname: Parker
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bailey
mesh_terms: D000293:Adolescent; D002944:Circumcision, Male; D003075:Coitus; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007630:Kenya; D008297:Male; D010413:Penis / Q000293:injuries*; D012725:Sexual Behavior; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult