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

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. 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. 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.

男性自愿医疗包皮环切术（VMMC）可使异性恋男性感染艾滋病毒的风险降低60%，对某些性传播感染（STI）具有防护作用，并导致阴茎微生物组构成发生变化，从而降低感染艾滋病毒的风险。直观地说，VMMC对女性性伴侣在性传播感染方面的益处是有可能的，并且已经得到了评估。本综述的目的是研究VMMC对女性性伴侣在更广泛的性健康和生殖健康（SRH）方面所产生益处的新发现。 系统综述发现，有强有力的证据表明VMMC对女性性伴侣感染人乳头瘤病毒（HPV）、宫颈发育不良、宫颈癌的风险具有有益影响，并且可能对滴虫病和某些生殖器溃疡性感染具有防护作用。很少有研究评估VMMC对阴道微生物组（VMB）的直接影响，尽管有几项研究表明细菌性阴道炎（BV）有所减少，而BV是由VMB介导的。关于男性包皮环切状况以及与非理想VMB相关的结果（如女性不孕和不良妊娠结局）的研究还很缺乏。VMMC对女性性功能和满意度的认知以及对疾病风险和卫生的认知有积极影响，且没有风险补偿的证据。 VMMC与女性广泛的性健康和生殖健康结果始终相关，这凸显了性关系中生物和非生物的相互依存关系，以及需要采取夫妻层面的方法来优化男性和女性的性健康和生殖健康。关于VMMC及其对VMB影响的信息匮乏，是优化女性伴侣中与VMB相关的性健康和生殖健康结果的一个障碍。