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

Abstract

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 no research on these dynamics among men who have received a circumcision 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 6-12 months post-circumcision (N = 293) and in-depth interviews with a sub-sample 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 (OR = 1.70, 95% CI: 1.25-2.32), feeling more potent erections post-circumcision (OR = 2.25, 95% CI: 1.26-4.03), and reporting increased ability to satisfy their partner post-circumcision (OR = 2.30, 95% CI: 1.11-4.77). 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.

Exploring drivers for safe male circumcision: Experiences with health education and understanding of partial HIV protection among newly circumcised men in Wakiso, Uganda

“…Such influence through beliefs about sexual performance has also been reported in many studies in WHO priority SMC countries [30, 28, 21, 36, 29, 37–39] and elsewhere [40]. Perception of partner preference for circumcised men has also been reported in other places [34, 24, 41, 26, 40, 42]. These widespread perceptions are also most likely influenced by the SMC social marketing campaigns.…”

Masculinity and HIV: Dimensions of Masculine Norms that Contribute to Men’s HIV-Related Sexual Behaviors

“…Being unable or unwilling to perform sexually with a woman could make a man suspect of belonging to the ‘other’ type of sexualities (e.g. homosexual, asexual) that would preclude him from achieving the dominant ideal (67, 86, 87). This may encourage men in some settings to have a higher number of female sexual partners since research in various cultural contexts has shown that men who abstain from sex or refuse sex with a particular women are subject to teasing that challenges their masculine status (79, 81, 88–90).…”

Prevalence and Predictors of Uncircumcised, Kenyan Men’s Desire for Circumcision for Their Infant Sons

“…But some measures of sexual pleasure may increase after circumcision, as recently shown in sub-Saharan Africa and the Dominican Republic. The effect is likely because sexual pleasure is a multifaceted construct with biological, psychological, and cultural contributions (26, 27). These results suggest that adult men’s attitudes towards IMC are likely to be shaped by their beliefs about what circumcision does to sexual pleasure.…”