64. DOES CIRCUMCISION MAKE A DIFFERENCE TO THE SEXUAL EXPERIENCE OF GAY MEN? FINDINGS FROM THE HEALTH IN MEN (HIM) COHORT

Abstract

The relevance of circumcision in preventing HIV male-to-male sex transmission is poorly understood, in particular because any potential effect could be obscured by sexual practice as a mediating or confounding factor.

Using data from the Health in Men (HIM) cohort of 1426 HIV-negative homosexually active men in Sydney, we compared the sexual practices and sexual experiences of circumcised and uncircumcised men.

Overall 66% of men (n = 939) in the cohort were circumcised. After adjusting for age and ethnicity, we found no difference between circumcised and uncircumcised men in anal sexual practices, difficulty using condoms, or sexual difficulties (e.g. loss of libido). Among the circumcised men, we compared those circumcised at infancy (n = 854) with those circumcised after infancy (n = 81). The majority cited phimosis (i.e., an inability to fully retract the foreskin) and parents' decision as the main reasons for circumcision after infancy. After adjusting for age and ethnicity, men circumcised after infancy were more likely to practise receptive anal sex (88% vs 75%, p < 0.05) and to experience erection difficulties (52% vs 47%, p < 0.05); but less likely to practise insertive anal sex (79% vs 87%, p < 0.05) and to experience premature ejaculation (15% vs 23%, p < 0.05) than those circumcised at infancy.

Our data suggest that overall circumcision status does not affect HIV-negative gay men's anal sexual practices, experience of condom use or likelihood of sexual difficulties. However, there is some suggestion of differences between circumcised men depending on the age at circumcision.