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).Conclusion:Data from a large, nationally representative British survey suggest that circumcision is not associated with men's overall sexual function at a population level.
Highlights
The WHO states that there is compelling evidence to show that male circumcision reduces the risk of heterosexually acquired HIV and recommends that it is promoted as part of a comprehensive HIV prevention package [1]
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
Data from a large, nationally representative British survey suggest that circumcision is not associated with men’s overall sexual function at a population level
Summary
The WHO states that there is compelling evidence to show that male circumcision reduces the risk of heterosexually acquired HIV and recommends that it is promoted as part of a comprehensive HIV prevention package [1]. There is concern that circumcision leads to reduced sexual satisfaction and a greater likelihood of experiencing sexual function problems, including erectile difficulties [2]. In 2013, a systematic review of male circumcision and its association with sexual function, sensitivity, and satisfaction found, from 36 articles, reporting data from 40 473 men, no difference between circumcised and uncircumcised men in terms of penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, ejaculatory latency, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration [3]. We report analyses of data from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a large national probability survey, which used a new, comprehensive, validated measure of sexual function, the Natsal-SF [6,7], allowing us to take into account sexual response and the relationship context and men’s overall level of satisfaction, to examine the association between circumcision and sexual function among sexually active men in Britain
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