Circumcision is a cultural and medical practice that has been widely debated for its health benefits (Freedman, 2016; Earp & Darby, 2019). This section examines the perceptions of male students at university of Botswana on circumcision. The section presents the reasons for undergoing the procedure and their attitudes towards it. It also explores how circumcision has influenced their sexual experiences.
4.1.1 Reasons for circumcision
Participants provided various reasons for undergoing circumcision. The participants narrated varying reasons for undergoing circumcision. The primary reasons were; circumcision reduces the risk of contracting HIV and other STIs and for hygiene purposes. Other reasons were; influence from healthcare campaigns and pressure from society and family. One participant stated:
“Safe male circumcision can reduce HIV and AIDS by 60%.”
Others shared this opinion:
“…circumcision reduced the risk of getting infected by HIV by 60%.”
“I circumcised because I learned that circumcision reduces the risk of sexual transmitted infections by 60%.”
“We were encouraged to get circumcised and they also showed us proof why we need to get circumcised. As they said, it would prevent the infection with 60%. We have a 60% chance of avoiding the spread of HIV.”
“I heard this thing that circumcision reduces a 60% chance of getting HIV when you have unprotected sex.”
Other participants circumcised because of the broader health benefits associated with circumcision. One participant noted:
“Circumcision reduces the chances of contacting STDs.”
Another stated:
“I did circumcision because from my perspective it is an important public health intervention that can help reduce the risk of HIV infection and other sexually transmitted infections. It can also help reduce the risk of penile cancer, and urinary tract infections, and it has no negative impact on sexual functions or pleasure.”
The participants also noted the effect of circumcision on hygiene. When asked, the reason why they circumcised:
“For hygiene purposes.”
“Because circumcision is said to be reducing the chances of contracting HIV and keeps the manhood hygienic.”
Several participants highlighted the influence of health campaigns in their decision to undergo circumcision. One participant shared:
“I circumcised because there was a campaign by the Ministry of Health encouraging people to circumcise, so I decided to do it.”
This was supported by another:
“I circumcised because I saw a flyer about circumcision, and I became interested.”
Healthcare professionals also influenced the decision to circumcise:
“The nurses said it reduced chances of HIV infections. Through the campaign.”
Some participants underwent circumcision due to parental decisions made during their childhood:
“I did circumcision when I was doing Standard 6, by that time I didn’t know what I was doing. Our parents are the ones who made that decision for us, like forcing us, saying we should go do it for our own benefit and I think by that time we were too small and not understanding a lot of things.”
“As I said, it was around 7 years, so it’s been a long time.”
In another case, the decision was influenced by a partner:
“There was pressure from my partner to do it.”
4.1.2 Attitudes towards circumcision
Participants expressed varying attitudes towards circumcision. This was assessed by asking participants whether they would recommend circumcision to others. Most participants were in favor of recommending circumcision to others.
A significant number of participants had positive attitude towards circumcision. For instance, one participant noted:
“Yes, I would recommend it to anyone else. Reason number one being that it reduces HIV and AIDS by 60%, the infection by 60%, right? And again, it is painless. It’s not that deep and it’s easy. And it took me two weeks to heal”.
Similarly, several other participants supported this sentiment:
“I would recommend it because like I said it reduces the risk of contracting HIV by 60% and for hygiene purposes”.
“Of course, yes, because like I said it’s beneficial in that it reduces the risk of HIV transmission to a male and it is hygienic to a male”.
“Because it reduces chance of getting HIV virus by 60%”.
“Yes, I would because of the benefit of 60% reduction in the risk of contracting HIV infection and other STIs”.
Others would recommend circumcision because of the dual benefits of reducing HIV risk and keeping the genital area clean:
“I would recommend it. Because I learned that it reduces the chances of contracting STI by 60% and also makes it easy to keep the area around the glans penis clean”.
Health campaigns also influenced the attitude towards circumcision:
“Yes, I would recommend it. I saw on the pamphlet that it is said that it reduces the chances of contracting HIV and STI by 60%”.
Attitude towards circumcision was also influenced by the desire to protect family and friends:
“Yes, I will recommend circumcision to my friends and my younger brothers. I would recommend circumcision to them in order to get protected against HIV and sexually transmitted infections”.
“I would recommend safe male circumcision to my classmates, my peers, my friends, or any family member or even my roommate. Because as you already know the benefit of it, that’s the benefit. It’s that it reduces the risk of HIV infection, reduces the risk of tract infections, reduces the risk of penile cancer and you have no negative impact on sexual functions”.
“I would recommend safe male circumcision to my peers because it reduces 60% chances of getting HIV when you’ve had unprotected sex”.
The hygiene benefit was another recurring theme among participants. One participant stated:
“I would because it is hygienic to the manhood, and also because of the benefit of reducing chances of contacting STI”.
“Yes, I would recommend my peers to be circumcised. Well, I feel as if, if you are circumcised, your penis will be cleaner because, due to the foreskin. You know, in terms of the dirt and everything. It cleans out; there are fewer chances of having dirt around your penis area”.
Some participants highlighted the safety aspect and benefits of the procedure:
“It’s a very safe procedure and very beneficial. It can help you with your performance in sexual intercourse and also so as you can be safer.”
Some participants expressed reservations about recommending circumcision. Their views were influenced by factors such as, circumcision is a personal choice and lack of information:
“Me? To be honest? Not really. I think it’s a personal choice.”
Another participant said:
“Nope. I don’t think it’s my place. I lost sensation on my penis, and I don’t think I have enough information.”
4.1.3 Impact of Circumcision on Sexual Pleasure
Participants’ perceptions indicate that male circumcision has an influence on sexuality. They expressed mixed perceptions on effect of circumcision on sexual pleasure.
When asked whether circumcised and uncircumcised men experience the same sexual pleasure, majority of participants reported a decrease in sensitivity and overall sexual pleasure following circumcision. One participant said:
“… I don’t think they do experience the same pleasure because when I still had my foreskin the head was sensitive to touch, nowadays it’s not sensitive so I believe that if you are sensitive sex will be amazing. So, I believe those guys who are not circumcised they are having it all.”
Several participants added:
“Uncircumcised men have high pleasure than circumcised men because before circumcising the sensitivity of the glans penis is very high and after circumcision this sensitivity reduces and therefore the pleasure of sex.”
“I would say from my experience circumcision does reduce pleasure, because before doing the procedure the glans penis was more sensitive, so it created more pleasure when engaging in sexual intercourse. But after circumcision the sensitivity was reduced, so this also led me to not use condom consistently as it further reduces the pleasure”.
“I think uncircumcised men experience more pleasurable sex because their glans penis is very sensitive while the circumcised experience less pleasure because their glans penis has lost a significant level of sensitivity after the procedure”.
Other participants shared their personal experience:
“With me there’s a difference because before circumcision I would cum quickly because the sensation was high and ever since I did the procedure I take long to cum because the sensation around the head of the penis has reduced.”
“That one, I think it’s the sexual pleasure, it’s slightly different. I can really recall, but there’s a slight difference. Because right now the foreskin is less sensitive because the foreskin is no longer there, which is different than way back you know. Sometimes it could react to fluids and stuff like that. But since I have been circumcised, I haven’t experienced any of those”.
Similarly, another participant highlighted link between circumcision and consistent condom use:
“I would say circumcision by itself reduces the sensitivity of the penis and this reduces the pleasure of sexual intercourse so putting a condom on the already less sensitive penis significantly reduces the pleasure, so this led me to inconsistently use condoms”.
Some participants had a more neutral stance. They acknowledged a difference in sensation without definitively stating whether one experience was superior to the other. For example
“No, I don’t think circumcised men and uncircumcised men experienced the same sexual pleasure. I think there might be a difference and this is mostly influenced by conversations with my friends who are not circumcised. I don’t think one is better, just different, you know”.
Some participants believed that circumcision did not adversely affect or even improved their sexual experiences. One participant said:
“Because when one is circumcised, they sometimes get disturbed by the foreskin during sex intercourse, but those that have circumcised, they don’t get that experience. I think they enjoy. They enjoy sex more compared to uncircumcised. I think you get me. They enjoy such sex compared to uncircumcised ones.”
Another participant expressed a unique perspective. He noted that cleanliness could enhance sexual enjoyment:
“No, I don’t think circumcised men and uncircumcised men experienced the same sexual pleasure. I believe that circumcised ones enjoy sex more than the uncircumcised men. Because from the discussions we usually have as boys, other boys who are uncircumcised are always complaining that their partners don’t like doing oral sex because they feel like they are dirty. This foreskin traps some germs and dirt, so it is really difficult to enjoy sex without foreplay. And as we all know that foreplay is very important when you come to sexual intercourse and oral sex is the best foreplay someone can give.”
4.2 Condom use post-circumcision
The findings revealed a spectrum of attitudes towards condom use post-circumcision. There were several recurring themes: consistent condom use, the perception of reduced necessity for condoms due to circumcision and the influence of external factors such as education and personal beliefs.
4.2.1 Consistent condom use
Despite the perceived protective benefits of circumcision, many participants maintained a strong commitment to condom use. The participants were asked how they would describe their attitude towards condom use after circumcision. One participant said:
“It’s just okay and it has not changed, I still use condoms when I engage in sexual activities”.
Another participant echoed this sentiment:
“I think it’s just fine; I still consider it important to condomise and I do it almost all the time”.
Similarly, another participant mentioned:
“I think my attitude towards condom use is fine, I don’t feel any significant difference when I’m using it and when I’m not using it, so I continue to use it almost all the time”.
Some participants reported a more mixed approach to condom use. This was often influenced by trust in their partners and personal circumstances. One participant explained:
“I use it like 50-50, sometimes I use it and sometimes I don’t, it just depends on my current partner”.
This participant further elaborated:
“For me, I think it’s not because of the knowledge about circumcision but rather my trust for my partner. Sometimes I don’t use condoms because we trust each other; we know each other’s HIV status. Sometimes we don’t use condoms to prevent unplanned pregnancies”
Another participant shared a similar experience:
“Well yes, because sex without a condom is nice, so when one hears of the possibility of not using it and getting away with it, we take chances. With that said, I would say yes, sometimes I don’t use it”.
There were also participants who reported an increased commitment to condom use after gaining more knowledge about its importance. One participant noted:
“It has changed. At first, after circumcision, I didn’t rate it. But after hearing more about its importance, I really believe in its correct use all the time”.
Some participants continued using condoms for reasons beyond circumcision. These are, safety, to avoid contracting sexually transmitted diseases and family planning. One participant said:
“I still trust condoms more. It hasn’t really been impacted”.
This indicates that, the participant trusts the safety provided by condoms. Another added:
“My attitude is still the same. I really don’t want to have children, and the best way to prevent that is by using condoms. So NO, condoms all the way”.
Similarly, another participant emphasized:
“I’m afraid of contracting diseases, so I still use it”.
Not all participants had a positive view of condom use. One participant expressed discomfort:
“I don’t like it. It makes things worse for me”.
4.2.2 Impact of circumcision on condom use
Several participants highlighted that their commitment to using condoms. The participants were asked whether the knowledge about the benefits of circumcision impacted their condom use. Some participants acknowledged that circumcision does not offer complete protection against sexually transmitted infections and pregnancy. One participant said:
“It was just my decision because I’ve been taught that when you use a condom, you prevent pregnancy, you prevent the infection of HIV and AIDS and other STDs”.
Another participant shared:
“My decision to have protected sex is because I don’t want to get HIV and AIDS or other STDs. It is not related to circumcision messages”.
Some participants stated their awareness on limitations of circumcision. For instance:
“I’m aware that circumcision only reduces the risk and there is still a chance of being infected. Safe circumcision doesn’t protect you 100%, so there is need for extra protection”.
Another participant noted:
“No, circumcision has its benefits but it doesn’t protect against everything”.
Several participants reported a tendency to use condoms less frequently post-circumcision due to changes in sexual sensitivity. One participant explained:
“I would say yes, because since the sensitivity has reduced, sometimes, I just want to do without the condom to have that maximum feeling, just to experiment”.
Another participant mentioned:
“Well sort of because since the sensation of the head of the penis has reduced, I feel condom makes it worse. So sometimes I don’t use it”.
Some participants expressed that their condom use varied based on trust and relationship dynamics rather than circumcision. One participant said:
“Condom use is important, but again I feel as if it depends on two individuals. Because, you know, people could date for the longest time… and always doing checkups for things like STIs. So, it all depends”.
One participant had a different view. He attributed his lack of condom use to benefits of circumcision:
“I think so because knowing that there’s less chance of contracting HIV and other STDs, I sometimes take chances not using condoms when engaging in sexual intercourse”.
Some participants noted that health education played a significant role in reinforcing the importance of condom use post-circumcision. One participant mentioned:
“It did. But thanks to health talks, I was able to understand the benefits of condoms”.
Another participant stated:
“Yes, it has affected because right now I know the importance of protected sex, and I know the risks of unprotected sex”.
4.3 Influence on condom use
A variety of factors played a significant role in influence of condom use among participants. These factors include; education, family, peers, and personal experiences. Participants expressed that formal education and health workshops influenced their condom use. These educational sessions often took place in school settings or through organized health talks. One participant stated:
“I think maybe education. I got it at school when we talked about condom use, about the importance of having protected sex. So, yeah, I think that’s what influenced me to use condoms after circumcision”.
Another participant shared a similar experience:
“I learnt it from the hospital, during one of the visits there was a health talk which was held in the morning and there were teaching about it. I was also taught before I did circumcision”.
Family members, particularly parents and other close relatives, also played a major role in encouraging condom use. One participant mentioned:
“My mother was the one who encouraged me to do circumcision and encouraged afterwards on the use of condoms”.
Another participant noted:
“… it was my uncle, he tried to teach me, though he was indirect in his messages. He would just emphasize that I should be careful to use condoms so that I don’t impregnate girls since I’m still young”.
Other participants learned about condom use from peers and friends. For instance:
“My friends and family always encourage me”.
Participants often encountered messages about safe sex practices through various media channels:
“The teachings about condom use are everywhere these days, I think from different sources; school and the media”.
Several participants highlighted that, personal experiences and curiosity played a role in their initial encounters with condom use. For example:
“It was out of curiosity, you know as a boy you steal a condom, go to the back of the house and try it on, so yeah no one introduced me, I just taught myself; sometimes looking at YouTube”.
Another participant mentioned:
“The first time I had sex”.
Several participants mentioned health professionals and organized workshops as important sources of information and motivation for using condoms. One participant said:
“I think through learning. Health professionals came to our schools and they told us about safe methods of contraception. And they told us all these, including the condom use”.
Another participant shared:
“Okay, when I started engaging in sexual activities, I had unprotected sex. Then, nearly a year later, I attended a health education workshop, that was conducted in my home village. That’s where we were taught properties of condom, the importances of using your condom and the risks of having unprotected sex. That’s when I realised the importance of using a condom. Since then, I’ve been using it until right now”.
Some participants indicated that their decision to use condoms was a personal one:
“No one, it was a personal decision”.
4.4 Preferred contraception method
The participants expressed a strong preference for condoms as a method of contraception. The reasons cited for this preference include their dual functionality, ease of use, availability, and lack of side effects. One participant said:
“Condom because it is a dual method of contraception as it protects against contracting HIV and other STIs and prevents unwanted pregnancies”.
Another participant noted:
“I would say condom. Because I think it protects us 99% from being infected with STI or HIV and also from pregnancy”.
Some participants mentioned the ease of use and widespread availability of condoms as key factors in their preference:
“Because it is easy to use and easily available”.
Similarly, another participant mentioned:
“I prefer condom since it’s the simplest and easiest method of family planning, I mean”.
The participants chose condoms for its lack of side effects:
“It doesn’t have side effects like other methods”.
Participants also expressed effectiveness of condoms in reducing the risks associated with sexual activity. One participant said:
“Condoms because they reduce the higher risk of having unwanted pregnancies and also reduce the risk of sexually transmitted diseases”.
Some participants preferred the contraceptive pill:
“The pill. It helps very much. I’m too young for a baby”.
Another participant expressed a preference for their partner to use the pill:
“I prefer my partner be on the pill”.