Safety and satisfaction of voluntary medical male circumcision among men who have sex with men in China

Abstract

PURPOSE: To investigate the safety and satisfaction of circumcision among men who have sex with men (MSM), as voluntary male medical circumcision (VMMC) may be an innovative and acceptable tool for HIV prevention among this population in the future. METHODS: Participants who voluntarily underwent VMMC between August 2020 and April 2022 were recruited from eight cities in China. Weekly online follow-up assessments were conducted for six consecutive weeks postoperatively to evaluate safety, and satisfaction was assessed at 6 and 12 months. Between-group comparisons were performed using Mann-Whitney U, chi-squared or Fisher's exact tests, as appropriate. For satisfaction outcomes, effect sizes were quantified using Cramér's V with 95% bootstrap confidence intervals. Repeated ordinal adverse event (AE) levels were analyzed using a cumulative link mixed model with random intercept, adjusting for age, lifetime male anal intercourse partners and follow-up time. Multivariable logistic regression identified factors associated with early resumption of sex. Time to complete wound healing was compared using Kaplan-Meier analysis with the log-rank test. RESULTS: A total of 118 MSM underwent circumcision, with 59 using a disposable circumcision suture device and 59 receiving conventional circumcision. Postoperative AEs were predominantly mild. Moderate-to-severe events were rare, limited to edema (15.3%) and exudation (5.9%), and decreased to 0.0% by Week 3. No significant differences in overall AE level were observed between groups in adjusted analyses (OR 0.86, 95% CI: 0.29-2.57; P = 0.786). By Week 6, 93.2% reported complete wound healing, with no between-group difference (P = 0.379). During the abstinence period, 61% resumed sex early, with most (88.9%) occurring after Week 4. Multivariable regression identified no significant predictors. A total of 115 participants completed the satisfaction assessment. Overall satisfaction was high at 6 months and 12 months (median scores 8 and 9), with appearance satisfaction being the lowest among all dimensions (62.7%). Effect sizes for between-group satisfaction differences were uniformly small (Cramér's V 0.07-0.27). CONCLUSIONS: VMMC showed favorable safety and satisfaction among MSM. However, two key issues cannot be overlooked, including frequent early resumption of sex during abstinence periods and consistently low appearance satisfaction. Future VMMC programs should strengthen integrated guidance throughout the care pathway, with particular emphasis on preoperative communication regarding aesthetic expectations and postoperative reinforcement of abstinence adherence, to maximize health benefits.