title: Examining the association between male circumcision and sexual function: evidence from a British probability survey.
abstract: OBJECTIVE
  Despite biological advantages of male circumcision in reducing HIV/sexually transmitted infection acquisition, concern is often expressed that it may reduce sexual enjoyment and function. We examine the association between circumcision and sexual function among sexually active men in Britain using data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Natsal-3 asked about circumcision and included a validated measure of sexual function, the Natsal-SF, which takes into account not only sexual difficulties but also the relationship context and overall level of satisfaction.
  
  
  METHODS
  A stratified probability survey of 6293 men and 8869 women aged 16-74 years, resident in Britain, undertaken 2010-2012, using computer-assisted face-to-face interviewing with computer-assisted self-interview for the more sensitive questions. Logistic regression was used to calculate odds ratios (ORs) to examine the association between reporting male circumcision and aspects of sexual function among sexually active men (n = 4816).
  
  
  RESULTS
  The prevalence of male circumcision in Britain was 20.7% [95% confidence interval (CI): 19.3-21.8]. There was no association between male circumcision and, being in the lowest quintile of scores for the Natsal-SF, an indicator of poorer sexual function (adjusted OR: 0.95, 95% CI: 0.76-1.18). Circumcised men were as likely as uncircumcised men to report the specific sexual difficulties asked about in Natsal-3, except that a larger proportion of circumcised men reported erectile difficulties. This association was of borderline statistical significance after adjusting for age and relationship status (adjusted OR: 1.27, 95% CI: 0.99-1.63).
  
  
  CONCLUSIONS
  Data from a large, nationally representative British survey suggest that circumcision is not associated with men's overall sexual function at a population level.
authors.affiliation: aCentre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, London, UK bDepartment of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Virginia
authors.initials: V
authors.lastname: Homfray
authors.forename: Clare
authors.initials: C
authors.lastname: Tanton
authors.forename: Kirstin R
authors.initials: KR
authors.lastname: Mitchell
authors.forename: Robert F
authors.initials: RF
authors.lastname: Miller
authors.forename: Nigel
authors.initials: N
authors.lastname: Field
authors.forename: Wendy
authors.initials: W
authors.lastname: Macdowall
authors.forename: Kaye
authors.initials: K
authors.lastname: Wellings
authors.forename: Pam
authors.initials: P
authors.lastname: Sonnenberg
authors.forename: Anne M
authors.initials: AM
authors.lastname: Johnson
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012737:Sex Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult