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ORIGINAL ARTICLE
Open Access

Sexual Satisfaction, Performance, and Partner Response Following Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project

Robert Zulu, Deborah Jones, Ndashi Chitalu, Ryan Cook and Stephen Weiss
Global Health: Science and Practice December 2015, 3(4):606-618; https://doi.org/10.9745/GHSP-D-15-00163
Robert Zulu
aUniversity of Zambia School of Medicine, Lusaka, Zambia
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Deborah Jones
bUniversity of Miami Miller School of Medicine, Psychiatry and Behavioral Sciences, Miami, FL, USA
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Ndashi Chitalu
aUniversity of Zambia School of Medicine, Lusaka, Zambia
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Ryan Cook
bUniversity of Miami Miller School of Medicine, Psychiatry and Behavioral Sciences, Miami, FL, USA
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Stephen Weiss
bUniversity of Miami Miller School of Medicine, Psychiatry and Behavioral Sciences, Miami, FL, USA
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    FIGURE.

    Perceptions of Penile Appearance and Cleanliness Following Voluntary Medical Male Circumcision Among Men (N=256) and Their Partners (N=159)

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    TABLE 1 Demographic Characteristics of Zambian Men Undergoing Voluntary Medical Male Circumcision (N = 257) and Female Partners (N = 159) (Control and Intervention Arms)
    CharacteristicMenWomen
    Age, mean (SD), years26.4 (8.2)26.1 (8.0)
    Employment status, No. (%)
     Employed111 (43%)45 (28%)
     Unemployed146 (57%)114 (72%)
    Annual income,a No. (%)
     ≥ US $100120 (47%)69 (43%)
     < US $100137 (53%)90 (57%)
    Education level, No. (%)
     ≥ 12 years of education190 (74%)90 (57%)
     < 12 years of education67 (26%)69 (43%)
    Relationship status, No. (%)
     Married or cohabitating97 (38%)74 (47%)
     Not married/Not living with partner160 (62%)85 (53%)
    Children, No. (%)
     At least one child88 (34%)82 (52%)
     No children169 (66%)77 (48%)
    Desire for (more) children, No. (%)
     Yes103 (40%)70 (44%)
     No154 (60%)89 (56%)
    • Abbreviation: SD, standard deviation.

    • View popup
    TABLE 2 Growth Curve Analyses of International Index of Erectile Functioning Subscales Among Zambian Men Undergoing Voluntary Medical Male Circumcision
    DomainQuadratic Timea
    b (SE)
    PLinear Time
    b (SE)
    PBaseline Mean Estimateb6-Month Mean Estimate12-Month Mean Estimate
    Erectile functioning-.007 (.004).08.068 (.039).08
    Orgasm functioning-.007 (.002).006.156 (.044)<.0014.124.814.99
    Intercourse satisfaction.004 (.002).09.003 (.017).84
    Overall satisfaction-.002 (.003).42.037 (.013).0077.097.317.53
    Sexual desire-.004 (.002).02.093 (.028).0016.256.676.79
    • Abbreviation: SE, standard error.

    • ↵a All models initially included both quadratic and linear growth curve components (i.e., fixed and random effects for time2 and time); if the quadratic component was not significant, the model was refit using only a linear slope.

    • ↵b Means were estimated using the fitted model for domains that significantly changed over time.

    • Note: Statistically significant parameters are noted in boldface.

    • View popup
    TABLE 3 Post-Voluntary Medical Male Circumcision (Post-VMMC) Sexual Functioning and Satisfaction Among Zambian Men (N = 256)a and Female Partners (N = 159)
    MenFemale Partners
    Sexual Functioning
    Erections
     More67 (26%)
     No change58 (23%)
     Fewer86 (34%)
     No opinion45 (17%)
    Orgasms
     More84 (33%)
     No change50 (20%)
     Fewer85 (33%)
     No opinion37 (14%)
    Time to orgasm
     Increased89 (35%)
     No change41 (16%)
     Decreased91 (35%)
     No opinion35 (14%)
    Sexual Satisfaction
     Increased107 (42%)99 (63%)
     No change40 (15%)25 (16%)
     Decreased56 (22%)21 (13%)
     No opinion54 (21%)14 (8%)
    Appearance
     Better159 (62%)97 (61%)
     No difference52 (20%)24 (15%)
     Worse39 (15%)23 (15%)
     No opinion6 (3%)15 (9%)
    Cleanliness
     Cleaner/easier to keep clean180 (70%)112 (70%)
     No difference33 (13%)22 (14%)
     Less clean/more difficult to keep clean34 (13%)18 (11%)
     No opinion9 (4%)7 (5%)
    • All data are reported as No. (%).

    • ↵a 1 male participant was missing all post-VMMC data.

    • View popup
    TABLE 4 Agreement Between Zambian Partners on Sexual Satisfaction, Appearance, and Cleanliness Following Voluntary Medical Male Circumcision
    WomenMenKappa (95% CI)
    Increased (or Better)/ No ChangeDecreased (or Worse)
    Sexual satisfactiona0.25 (0.04, 0.45)
     Increased/no change80 (68%)18 (15%)
     Decreased10 (9%)9 (8%)
    Appearancea0.10 (-0.09, 0.28)
     Better/no change104 (73%)15 (11%)
     Worse18 (13%)5 (3%)
    Cleanlinessa0.20 (-0.01, 0.42)
     Increased/no change119 (80%)11 (7%)
     Decreased13 (9%)5 (4%)
    • All data are reported as No. (%).

    • Abbreviation: CI, confidence interval.

    • ↵a The sample size of couples differed across items because some participants did not provide an opinion on all items. For sexual satisfaction, the sample size was 117 couples; for appearance, 142 couples; and for cleanliness, 148 couples.

    • View popup
    TABLE 5 Factors Associated With Early Resumption of Sex Following Voluntary Medical Male Circumcision (VMMC), by Timing of Resumption of Sex (N = 178)a
    Waited at Least 6 Weeks (n = 135)Did Not Wait at Least 6 Weeks (n = 43)t/χ2P Value
    Demographic Characteristics
    Age, mean (SD), years28.3 (8.4)26.4 (8.5)1.3.20
    Education level, No. (%)2.1.15
     High103 (76%)28 (65%)
     Low32 (24%)15 (35%)
    Married/cohabitating, No. (%)1.8.18
     Yes66 (49%)16 (37%)
     No69 (51%)27 (63%)
    Wants (more) children, No. (%)2.9.09
     Yes64 (47%)14 (33%)
     No71 (53%)29 (67%)
    HIV risk category,b No. (%)6.7.01
     High12 (10%)11 (27%)
     Low105 (90%)30 (73%)
    Adverse Events
    Post-VMMC infection or tearing, No. (%)11.8<.001
     Yes27 (20%)20 (47%)
     No108 (80%)23 (53%)
    Sexual Satisfaction
    Erectile functioning, mean (SD)17.6 (6.5)17.7 (5.5)0.1.94
    Orgasm functioning, mean (SD)5.8 (3.5)3.3 (3.4)4.1<.001
    Intercourse satisfaction, mean (SD)7.4 (2.4)7.7 (1.7)0.7.48
    Overall satisfaction, mean (SD)8.3 (2.2)6.5 (3.2)3.4.001
    Sexual desire, mean (SD)6.9 (1.8)6.2 (2.1)2.0.05
    VMMC Knowledge
    Correct knowledge, mean (SD)11.8 (2.4)11.9 (2.5).71c
    Misinformation, mean (SD)5.5 (2.2)6.0 (2.4).20c
    • Abbreviation: SD, standard deviation.

    • ↵a Among men reporting at least one instance of sexual intercourse between the VMMC procedure and their 3-month post-VMMC assessment.

    • ↵b The sample size of men with HIV risk designation comprised only 158 men because of missing items on the sexual risk behavior questionnaire.

    • ↵c Wilcoxon’s test.

    • Note: Statistically significant differences are noted in boldface.

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Global Health: Science and Practice: 3 (4)
Global Health: Science and Practice
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December 01, 2015
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Sexual Satisfaction, Performance, and Partner Response Following Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project
Robert Zulu, Deborah Jones, Ndashi Chitalu, Ryan Cook, Stephen Weiss
Global Health: Science and Practice Dec 2015, 3 (4) 606-618; DOI: 10.9745/GHSP-D-15-00163

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Sexual Satisfaction, Performance, and Partner Response Following Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project
Robert Zulu, Deborah Jones, Ndashi Chitalu, Ryan Cook, Stephen Weiss
Global Health: Science and Practice Dec 2015, 3 (4) 606-618; DOI: 10.9745/GHSP-D-15-00163
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