"I Feel Like More of a Man": A Mixed Methods Study of Masculinity, Sexual Performance, and Circumcision for HIV Prevention

Ethnographic studies from numerous societies have documented the central role of male circumcision in conferring masculinity and preparing boys for adult male sexuality. Despite this link between masculinity, sexuality, and circumcision, there has been little research on these dynamics among men who have been circumcised for HIV prevention. 

We employed a mixed methods approach with data collected from recently circumcised men in the Dominican Republic (DR) to explore this link. We analyzed survey data collected six to 12 months post-circumcision (N = 293) as well as in-depth interviews conducted with a subsample of those men (n = 30).

We found that 42% of men felt more masculine post-circumcision. In multivariate analysis, feeling more masculine was associated with greater concern about being perceived as masculine, feeling more potent erections post-circumcision, and reporting increased ability to satisfy their partners post-circumcision. 

In qualitative interviews, these factors were all related to masculine norms of sexually satisfying one's partner, and men's experiences of circumcision were shaped by social norms of masculinity. 

This study highlights that circumcision is not simply a biomedical intervention and that circumcision programs need to incorporate considerations of masculine norms and male sexuality into their programming.

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By:  Fleming PJ1,2, Barrington C2,3, Pearce LD4, Lerebours L5, Donastorg Y6, Brito MO7.

• 1 Division of Global Public Health , University of California , San Diego.
• 2 Department of Health Behavior , Gillings School of Global Public Health, University of North Carolina at , Chapel Hill.
• 3 Carolina Population Center , University of North Carolina at , Chapel Hill.
• 4 Carolina Population Center and the Department of Sociology , University of North Carolina at , Chapel Hill.
• 5 Clinica de Familia , La Romana , Dominican Republic.
• 6 HIV Vaccine Trials Unit , Instituto Dermatológico y Cirugía de Piel , Santo Domingo , Dominican Republic.
• 7 Division of Infectious Diseases , University of Illinois at Chicago. 

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Evaluation of the Treatment of Congenital Penile Curvature Including Psychosexual Assessment

Below:  Deviation angle measurement according to Kelami. Line 1, transverse line to the base of the penis; line 2, vertical line to line 1 and gives the normal axis; line 3, transverse line at the coronal area of the penis; line 4, vertical line to line 3 and gives the deviation axis; line 5, parallel to line 1 at the junction of lines 2 and 4, the deviation angle is within 90° between lines 2 and 5

Below:  Results of depression level measured by the Beck Depression Inventory questionnaire

Study population consisted of 107 patients with congenital penile deviation (CPD) referred for surgical management. Patients were evaluated with not only clinical assessment, but also by four questionnaires measuring various aspects of quality of life. They were: Short-Form Medical Outcomes, Sexual Quality of Life Questionnaire for Man, Beck Depression Inventory, and International Index of Erectile Function.

Quality of life measurements showed deep decrease in the general quality of life, sexual performance, depression scale, as well as in physical and mental health in men with CPD. All these parameters were restored to normal after the successful surgical treatment with any method.

CPD deeply decreases the quality of life of the affected men in many aspects. Surgical treatment is able to repair the anatomical deformity and as well as significantly restore the patients' psychosocial well-being.

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