The Journal of Urology
Volume 184, Issue 1 , Pages 203-209, July 2010

Circumcision and Reduced Risk of Self-Reported Penile Coital Injuries: Results From a Randomized Controlled Trial in Kisumu, Kenya

  • Supriya D. Mehta

      Affiliations

    • Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois
    • Corresponding Author InformationCorrespondence: 1603 W. Taylor St., M/C 923, Chicago, Illinois 60622 (telephone: 312-413-7485; FAX: 312-996-0064)
    • ,
  • John N. Krieger

      Affiliations

    • Department of Urology, University of Washington, Seattle, Washington
    • ,
  • Kawango Agot

      Affiliations

    • UNIM Project, Kisumu, Kenya
    • ,
  • Stephen Moses

      Affiliations

    • Departments of Medical Microbiology, Community Health Sciences and Medicine, University of Manitoba, Winnipeg, Canada
    • Recipient of a Canadian Institutes of Health Research Investigator Award.
    • ,
  • Jeckoniah O. Ndinya-Achola

      Affiliations

    • Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
    • ,
  • Corette Parker

      Affiliations

    • RTI International, Research Triangle Park, North Carolina
    • ,
  • Robert C. Bailey

      Affiliations

    • Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois

Received 27 October 2009 published online 17 May 2010.

Purpose

Injuries to the penis during intercourse represent a hypothesized mechanism by which uncircumcised men are at increased risk for HIV. There are no published, systematically collected data regarding mild penile coital trauma to our knowledge. We identified risks of self-reported penile coital injuries in men 18 to 24 years old in a randomized trial of circumcision to prevent HIV in Kisumu, Kenya.

Materials and Methods

Each participant underwent standardized interview, medical history and physical examination at baseline, and 6, 12, 18 and 24 months after enrollment. Self-reported penile coital injuries were assessed at each visit, and were defined as penis feels sore during sex, penis gets scratches, cuts or abrasions during sex, and skin of the penis bleeds after sex. Generalized estimating equation analysis estimated odds ratios for penile coital injuries.

Results

From February 2002 to September 2005, 2,784 participants were randomized. At baseline 1,775 (64.4%) men reported any coital injury including 1,313 (47.6%) soreness, 1,328 (48.2%) scratches, abrasions or cuts and 461 (16.7%) bleeding. On multivariable analysis coital injury risk was lower for circumcised than for uncircumcised men with soreness (OR 0.71, 95% CI 0.64–0.80), scratches/abrasions/cuts (OR 0.52, 95% CI 0.46–0.59), bleeding (OR 0.62, 95% CI 0.51–0.75) and any coital injury (OR 0.61, 95% CI 0.54–0.68). Other significant risks included increasing age, multiple recent sex partners, HSV-2 seropositivity and genital ulcers (p <0.05). Condom use, cleaning the penis soon after intercourse and being married/cohabiting were protective (p <0.05, each).

Conclusions

Self-reported penile coital injuries were common in these healthy young men. Circumcised men were at lower risk for coital injuries. Verifying penile coital injuries, the mechanism of acquisition and the association with HIV risk is needed.

Key Words: circumcision, male, HIV, wounds and injuries, penis, coitus

Abbreviations and Acronyms: HSV-2, herpes simplex virus type 2, STI, sexually transmitted infection

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 Study received institutional review board approval.

 Supported by Grant AI50440 from the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, and by Grant HCT 44180 from the Canadian Institutes of Health Research. The sponsors reviewed and commented on the study design, and monitored the study management and analyses. The sponsors had no role in the final analyses, interpretation of the data, or in the preparation, review or approval of the manuscript.

PII: S0022-5347(10)02988-5

doi:10.1016/j.juro.2010.03.015

The Journal of Urology
Volume 184, Issue 1 , Pages 203-209, July 2010

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