The Effects of Medical Male Circumcision on Female Partners’ Sexual and Reproductive Health

Abstract

Abstract  Purpose of Review Voluntary medical male circumcision (VMMC) reduces the risk of HIV acquisition by 60% among heterosexual men, provides protection against certain sexually transmitted infections (STI), and leads to penile microbiome composition changes associated with reduced risk of HIV infection. Intuitively, the benefits of VMMC for female sex partners in relation to STI are likely and have been evaluated. The purpose of this review is to examine emerging findings of broader sexual and reproductive health (SRH) benefits of VMMC for female sex partners. Recent Findings Systematic reviews find strong evidence for beneficial effects of VMMC on female sex partners risk of HPV, cervical dysplasia, cervical cancer, and with likely protection against trichomoniasis and certain genital ulcerative infections. Few studies assess the direct impact of VMMC on the vaginal microbiome (VMB), though several studies demonstrate reductions in BV, which is mediated by the VMB. Studies are lacking regarding male circumcision status and outcomes associated with non-optimal VMB, such as female infertility and adverse pregnancy outcomes. VMMC has positive effects on women’s perceptions of sexual function and satisfaction, and perceptions of disease risk and hygiene, without evidence of risk compensation. Summary VMMC has consistent association with a broad range of women’s SRH outcomes, highlighting the biological and non-biological interdependencies within sexual relationships, and need for couples-level approaches to optimize SRH for men and women. The paucity of information on VMMC and influence on VMB is a barrier to optimizing VMB-associated SRH outcomes in female partners.