Erectile function in circumcised men: Lusaka, Zambia
Thesis (MMed)--Stellenbosch University, 2013.
Introduction: Evidence from 3 randomized controlled trials in South Africa, Uganda and Kenya showing that male circumcision can reduce heterosexual transmission of HIV from infected females to their male sexual partners by up to 60% has led to a dramatic increase in the demand for circumcision in most African countries hard-hit by the HIV pandemic. Among communities where circumcision is not routinely practiced, this has created anxieties around possible deleterious effects of circumcision on erectile function. Most studies that have been conducted to explore the relationship between male circumcision and erectile function have yielded conflicting results (6-8, 14, 15). This study aimed to compare erectile function in circumcised and uncircumcised men in Lusaka, Zambia. Aim/objectives: To compare erectile function in circumcised and uncircumcised adult men aged 18 years and above in Lusaka, Zambia. Methods: Design: In this cross sectional survey, a total of 478 participants (242 circumcised and 236 uncircumcised) comprising patients, health workers and other men visiting the 4 study sites between 1/6/13 and 30/9/13 were handed the IIEF-5 questionnaire to complete. Information about participants’ age, relationship status, education level, smoking, alcohol use and medication use was also collected. The study included sexually active men older than 18 years living in Lusaka, Zambia. Males younger than 18 years, those lacking sexual experience and, those with serious mental and physical conditions were excluded from the study. Setting: Outpatient departments of 4 primary health care facilities in Lusaka, Zambia. Main Outcome Measure: Erectile function scores were calculated for the 2 groups. Normal erectile function was defined as an IIEF-5 score ≥22 (out of a possible maximum score of 25) points. Results: Circumcised men had higher average erectile function scores compared to their uncircumcised counterparts, U=23062.50, Z=3.64, p<0.001. The prevalence of ED was lower in circumcised men (56%) compared to that in uncircumcised ones (68%), 2 (N182) =7.52, df=1, p<0.05. Erectile function scores were similar in those circumcised in childhood compared to those circumcised in adulthood, 2 (N242) =0.29, df=1, p=0.59. The groups did not differ significantly in age, relationship status, smoking, alcohol use and medication use. However, a statistically significant difference was observed in education levels with the circumcision group showing higher levels, 2 (N478)=19.05, df=6, p<0.005. Conclusion: The higher erectile function scores in circumcised men observed in this study show that circumcision does not confer adverse effects on erectile function in men. Circumcision can thus be considered without concern about worsening erectile function. However, a prospective study in a similar cultural context is needed to confirm these findings.