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

doi:10.9745/GHSP-D-15-00163

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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)

Characteristic	Men	Women
Age, mean (SD), years	26.4 (8.2)	26.1 (8.0)
Employment status, No. (%)
Employed	111 (43%)	45 (28%)
Unemployed	146 (57%)	114 (72%)
Annual income,^a No. (%)
≥ US $100	120 (47%)	69 (43%)
< US $100	137 (53%)	90 (57%)
Education level, No. (%)
≥ 12 years of education	190 (74%)	90 (57%)
< 12 years of education	67 (26%)	69 (43%)
Relationship status, No. (%)
Married or cohabitating	97 (38%)	74 (47%)
Not married/Not living with partner	160 (62%)	85 (53%)
Children, No. (%)
At least one child	88 (34%)	82 (52%)
No children	169 (66%)	77 (48%)
Desire for (more) children, No. (%)
Yes	103 (40%)	70 (44%)
No	154 (60%)	89 (56%)

Abbreviation: SD, standard deviation.

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TABLE 2 Growth Curve Analyses of International Index of Erectile Functioning Subscales Among Zambian Men Undergoing Voluntary Medical Male Circumcision

Domain	Quadratic Time^a b (SE)	P	Linear Time b (SE)	P	Baseline Mean Estimate^b	6-Month Mean Estimate	12-Month Mean Estimate
Erectile functioning	-.007 (.004)	.08	.068 (.039)	.08
Orgasm functioning	-.007 (.002)	.006	.156 (.044)	<.001	4.12	4.81	4.99
Intercourse satisfaction	.004 (.002)	.09	.003 (.017)	.84
Overall satisfaction	-.002 (.003)	.42	.037 (.013)	.007	7.09	7.31	7.53
Sexual desire	-.004 (.002)	.02	.093 (.028)	.001	6.25	6.67	6.79

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.

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TABLE 3 Post-Voluntary Medical Male Circumcision (Post-VMMC) Sexual Functioning and Satisfaction Among Zambian Men (N = 256)^a and Female Partners (N = 159)

	Men	Female Partners
Sexual Functioning
Erections
More	67 (26%)
No change	58 (23%)
Fewer	86 (34%)
No opinion	45 (17%)
Orgasms
More	84 (33%)
No change	50 (20%)
Fewer	85 (33%)
No opinion	37 (14%)
Time to orgasm
Increased	89 (35%)
No change	41 (16%)
Decreased	91 (35%)
No opinion	35 (14%)
Sexual Satisfaction
Increased	107 (42%)	99 (63%)
No change	40 (15%)	25 (16%)
Decreased	56 (22%)	21 (13%)
No opinion	54 (21%)	14 (8%)
Appearance
Better	159 (62%)	97 (61%)
No difference	52 (20%)	24 (15%)
Worse	39 (15%)	23 (15%)
No opinion	6 (3%)	15 (9%)
Cleanliness
Cleaner/easier to keep clean	180 (70%)	112 (70%)
No difference	33 (13%)	22 (14%)
Less clean/more difficult to keep clean	34 (13%)	18 (11%)
No opinion	9 (4%)	7 (5%)

All data are reported as No. (%).
↵a 1 male participant was missing all post-VMMC data.

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TABLE 4 Agreement Between Zambian Partners on Sexual Satisfaction, Appearance, and Cleanliness Following Voluntary Medical Male Circumcision

Women	Men		Kappa (95% CI)
Women	Increased (or Better)/ No Change	Decreased (or Worse)	Kappa (95% CI)
Sexual satisfaction^a			0.25 (0.04, 0.45)
Increased/no change	80 (68%)	18 (15%)
Decreased	10 (9%)	9 (8%)
Appearance^a			0.10 (-0.09, 0.28)
Better/no change	104 (73%)	15 (11%)
Worse	18 (13%)	5 (3%)
Cleanliness^a			0.20 (-0.01, 0.42)
Increased/no change	119 (80%)	11 (7%)
Decreased	13 (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.

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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/χ²	P Value
Demographic Characteristics
Age, mean (SD), years	28.3 (8.4)	26.4 (8.5)	1.3	.20
Education level, No. (%)			2.1	.15
High	103 (76%)	28 (65%)
Low	32 (24%)	15 (35%)
Married/cohabitating, No. (%)			1.8	.18
Yes	66 (49%)	16 (37%)
No	69 (51%)	27 (63%)
Wants (more) children, No. (%)			2.9	.09
Yes	64 (47%)	14 (33%)
No	71 (53%)	29 (67%)
HIV risk category,^b No. (%)			6.7	.01
High	12 (10%)	11 (27%)
Low	105 (90%)	30 (73%)
Adverse Events
Post-VMMC infection or tearing, No. (%)			11.8	<.001
Yes	27 (20%)	20 (47%)
No	108 (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)		.71^c
Misinformation, mean (SD)	5.5 (2.2)	6.0 (2.4)		.20^c

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.