Posted on August 24, 2009.
Guest blogger: Pierre Brouard, Deputy Director, Centre for the Study of Aids, University of Pretoria, South Africa
So what headlines have grabbed you lately about male circumcision in South Africa? These caught my eye:
“The death toll in the Eastern Cape’s winter circumcision season has risen to 31”
“Circumcision ’scam’ probed”
“Two on run after initiate dies”
As alarming and distressing as these headlines are – and the sad, desperate and greedy subtexts embedded in them – they don’t say much about the other big debate that is raging across southern Africa: the value of male circumcision to prevent HIV acquisition in heterosexual men, and what’s in it for women.
Well what’s in it for women is the topic du jour: Since observational studies had reported an association between male circumcision and reduced risk of HIV infection in female sexual partners, researchers in Uganda conducted an unblinded, randomised control trial to investigate this (Lancet July 2009) by circumcising some HIV positive men and not others. They found that circumcision did not reduce the risk of transmission to their female partners. So no luck there.
But what’s really getting gender activists of all genders to rise up from their sofas and comment on websites and chat rooms is the matter of sexual pleasure, and more specifically, the sexual pleasure of women.
What is sexual pleasure?
Now as a gay man I have to confess this is a topic that I have no personal experience of, but I am as interested in the notion of pleasure for my sisters of any sexual orientation as I am in mine.
I believe sexual pleasure should be a human right advanced to all, though for some of us this may be a progressive realisation of rights as we work through all the baggage of our socialisation!
I’m raising this issue because one of the many studies emerging as a companion to the now famous three circumcision trials, which showed the partial protective efficacy of male circumcision, suggests that “women whose male sexual partners were circumcised report an improvement in their sex life.”
Nearly 40% said sex was more satisfying afterward. About 57% reported no change in sexual satisfaction, and only 3% said sex was less satisfying after their partner was circumcised.
Top reasons cited by women for their better sex life: improved hygiene, longer time for their partner to achieve orgasm, and their partner wanting more frequent sex, said Godfrey Kigozi at the Fifth International AIDS Society Conference on Pathogenesis, Treatment and Prevention of HIV in Cape Town recently.
Firstly, if you look at the data above, while 40% did say the sex was more satisfying, the majority in fact said there was either no change or it was less satisfying. Is the headline summary of the research accurate? Why do we need to spin this data?
Fluid and enigmatic
But really what’s vexed me, and others, is this notion of pleasure and how we define it. Those of us who come from a “social” as opposed to “biomedical” or “public health” paradigm would argue that sexuality is fluid, it changes over our lifetimes, it may be context or relationship dependent, it is informed not only by our gender but our class and orientation.
So “pleasure” in a sexual encounter may be shaped by mood, the time of life, the way a woman is relating to her partner that day, whether she was exhausted from chores, her beliefs about female agency in a sexual encounter, whether she was menstruating or in menopause, whether foreplay had occurred.
Pleasure, surely, is variable, contextual, dynamic, changing, unpredictable. Even enigmatic sometimes: a woman may have a good orgasm but still feel angry with her husband or partner. She may never have had an orgasm but feel happy that he does. She may secretly masturbate after he falls asleep and feel fantastic after that.
A biomedical or public health perspective, I would argue, reduces men and women and their practice to simple categories and distinct binaries: gay vs straight; masculine vs feminine; satisfied vs unsatisfied; safe vs dangerous.
This is necessary if you want a simplified view of the world and if you want “proof” that most women will be happy to have their male partners circumcised.
Who needs long and complicated qualitative research when a checklist with a choice of three options tells us all we need to know to placate those pesky social scientists with their doubts and ifs, buts and maybes? But how do you capture the nuances of satisfaction in a questionnaire?
You don’t. I think pleasure is much more complicated than that – and we need better and more interesting research to tease it out (as it were). What do you think?