Circumcision and reduced risk of self-reported penile coital injuries: results from a randomized controlled trial in Kisumu, Kenya

Purpose: Injuries to the penis during intercourse represent one hypothesized mechanism by which uncircumcised men are at increased risk for HIV. There are no published, systematically collected data regarding mild penile coital trauma. We identified risks for self-reported penile coital injuries in men aged 18-24 in our 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: penis feels sore during sex; penis gets scratches, cuts or abrasions during sex; skin of the penis bleeds after sex. Generalized estimating equation analysis estimated odds ratios (OR) for penile coital injuries. Results: February 2002-September 2005, 2,784 participants were randomized. At baseline, 1,775 (64.4%) men reported any coital injury: 1,313 (47.6%) soreness; 1,328 (48.2%) scratches, abrasions, or cuts; 461 (16.7%) bleeding. In multivariable analysis, coital injury risk was lower for circumcised than uncircumcised men: 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], any coital injury [OR=0.61, 95% CI 0.54-0.68]. Other significant risks (p<0.05) included: increasing age, multiple recent sex partners, HSV-2 seropositivity, and genital ulcers. 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, mechanism of acquisition, and association with HIV risk is needed.