title: Sexual Satisfaction, Performance, and Partner Response Following Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project.
abstract: BACKGROUND
  Voluntary medical male circumcision (VMMC) is an important HIV prevention strategy, particularly in regions with high HIV incidence and low rates of male circumcision. However, 88% of the Zambian male population remain uncircumcised, and of these 80% of men surveyed expressed little interest in undergoing VMMC.
  
  
  METHODS
  The Spear and Shield study (consisting of 4 weekly, 90-minute sexual risk reduction/VMMC promotion sessions) recruited and enrolled men (N = 800) who self-identified as at risk of HIV by seeking HIV testing and counseling at community health centers. Eligible men tested HIV-negative, were uncircumcised, and expressed no interest in VMMC. Participants were encouraged (but not required) to invite their female partners (N = 668) to participate in the program in a gender-concordant intervention matched to their partners'. Men completed assessments at baseline, post-intervention (about 2 months after baseline), and 6 and 12 months post-intervention; women completed assessments at baseline and post-intervention. For those men who underwent VMMC and for their partners, an additional assessment was conducted 3 months following the VMMC. The ancillary analysis in this article compared the pre- and post-VMMC responses of the 257 Zambian men who underwent circumcision during or following study participation, using growth curve analyses, as well as of the 159 female partners.
  
  
  RESULTS
  Men were satisfied overall with the procedure (mean satisfaction score, 8.4 out of 10), and nearly all men (96%) and women (94%) stated they would recommend VMMC to others. Approximately half of the men reported an increase or no change in erections, orgasms, and time to achieve orgasms from pre-VMMC, while one-third indicated fewer erections and orgasms and decreased time to achieve orgasms post-VMMC. Nearly half (42%) of the men, and a greater proportion (63%) of the female partners, said their sexual pleasure increased while 22% of the men reported less sexual pleasure post-VMMC. Growth curve analysis of changes in sexual functioning and satisfaction over time revealed no changes in erectile functioning or intercourse satisfaction, but there were increases in orgasm functioning, overall sexual satisfaction, and sexual desire. The majority (61% to 70%) of men and women thought penile cleanliness and appearance had improved post-VMMC. Of the 69% of men who reported having sexual intercourse at least once between having the procedure and their 3-month post-VMMC assessment, the large majority (76%) waited at least 6 weeks before resuming sex. Sexual intercourse prior to the 6-week healing period was associated with adverse events and lower levels of post-VMMC sexual satisfaction.
  
  
  CONCLUSIONS
  Both men and their partners can generally expect equal or improved sexual satisfaction and penile hygiene following VMMC. Future studies should consider innovative strategies to assist men in their efforts to abstain from sexual activities prior to complete healing.
authors.affiliation: University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Robert
authors.initials: R
authors.lastname: Zulu
authors.affiliation: University of Miami Miller School of Medicine, Psychiatry and Behavioral Sciences, Miami, FL, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Jones
authors.affiliation: University of Zambia School of Medicine, Lusaka, Zambia.
authors.forename: Ndashi
authors.initials: N
authors.lastname: Chitalu
authors.affiliation: University of Miami Miller School of Medicine, Psychiatry and Behavioral Sciences, Miami, FL, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Cook
authors.affiliation: University of Miami Miller School of Medicine, Psychiatry and Behavioral Sciences, Miami, FL, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male; D003075:Coitus; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D006920:Hygiene; D008297:Male; D009948:Orgasm; D010410:Penile Erection; D010413:Penis; D010549:Personal Satisfaction; D057181:Pleasure; D040242:Risk Reduction Behavior; D012747:Sexual Partners; D055815:Young Adult; D015024:Zambia