A qualitative, phenomenological design was used for the study, and in-depth interviews were used to collect data (Villa et al. 2018). The study was conducted at the Engineers Battalion in Kasungu in the Central Region of Malawi. This battalion is one of the major units in the country and is situated in the southern part of the district, 15 km from Kasungu town along the M1 road, and 3 km west of the M1 road. The battalion, which opened in 2012, comprises soldiers specialised in different fields, such as civil engineering.

The total population of soldiers at the Engineers Battalion was 850, irrespective of being circumcised or not. The sample size of eight participants was determined by data saturation, which was the stage at which additional interviews were no longer yielding new information (Mwita 2022; Saunders et al. 2018). Purposive sampling was used, meaning participants were selected from those who had undergone the procedure within the previous year and were able to provide consent. The researcher purposively selected these participants because they possessed rich information on issues surrounding circumcision.

A semi-structured interview guide, developed through an in-depth literature review, was used (Creswell & Creswell 2017). The method of data collection was face-to-face. During interviews, probing and clarification techniques were employed to encourage participants to provide detailed descriptions. Follow-up questions were asked to obtain further elaboration. Audio recording equipment was used to capture the participants’ responses accurately and in their own words. A register was used to capture the names of soldiers who were circumcised, and a room was used during interviews. A minimum of 60 min was required for each participant. Participants who declined audio recording were excluded from the study.

The data collection process occurred in November 2023. Participants were recruited from the Engineers Battalion. The clearance certificate from the Mzuzu Research Ethics Committee was used to negotiate permission to conduct the study at the Engineers Battalion, and the approval letter was presented as support for this request. A register was used to identify participants. Data were collected in English, as all the participants had at least attained the Malawi School Certificate of Education (MSCE) and were able to understand and comprehend the information without the need for translation into Chichewa. On the day of data collection, each participant was invited to the interview room. The purpose of the study was explained, and everyone was given an opportunity to ask questions or seek clarifications about the study and their participation. This was followed by the administration of the socio-demographic questionnaire and the interview guide, which included probes and follow-up questions.

For immediate psychological experiences (within 24 h after the procedure), participants were asked to describe their initial experiences and feelings following circumcision, including any discomfort, pain, concerns or complications during the immediate post-circumcision period. For the short-term psychological experiences (from 24 h to 7 days), participants were asked to describe the healing process following circumcision and identify any challenges or discomforts faced during this period. For the long-term psychological experiences (8 days to 1 year), participants were asked to describe how they adapted to the longer-term effects of circumcision, how their perceptions or feelings about the procedure changed over time, and whether any negative effects persisted in the long term.

Trustworthiness in qualitative research ensures the rigour and credibility of a study’s findings, encompassing credibility, dependability, confirmability and transferability (Shenton 2004). Credibility was ensured through prolonged engagement, as the researcher spent time with the participants during data collection. Additionally, credibility was strengthened through frequent debriefing sessions between the researcher and the supervisor on the data collected. Moreover, peer debriefing, through discussions of the results with other academic peers, was conducted. Negative case analysis was enhanced by incorporating literature that contrasted the study’s findings in the discussion section. A detailed research process and the methods used to collect data were provided to enhance dependability.

An audit trail, describing the research steps taken from the start of the study to the reporting of findings, was maintained, and a record of the research history was kept by the researcher. Regarding confirmability, the interpretations and findings were derived directly from the data, with detailed conclusions and justifications. The researcher was careful not to allow prior knowledge of the area to cloud their judgment during data collection, analysis and report writing. Finally, transferability was addressed by providing a detailed, context-rich description of the study setting, allowing future researchers to assess the applicability of the findings to different contexts. These measures collectively enhanced the trustworthiness of the study, ensuring its quality and reliability.

To achieve trustworthy and insightful findings, thematic analysis (Braun & Clarke 2020) was used to analyse the collected qualitative data. Data were transcribed from the audio recordings and organised according to the specific objectives of the study. The researcher familiarised herself with the data by listening to the audio and reading and re-reading the transcripts. Thereafter, the researcher began identifying meaningful texts with similar characteristics, thus developing initial codes (Braun & Clarke 2020). The researcher identified the code name and indicated the portion of the text associated with it. Codes were reviewed and sorted, and those that exhibited similarities were clustered to reflect a coherent and meaningful pattern in the data. A set of themes matching the coded data was then developed. After the initial development of themes, the researcher refined the set of themes derived from the coded data (Braun & Clarke 2020). Any inadequacies within the coded data were addressed, and themes were revised accordingly. The refined themes were defined and named to give the reader a clear sense of their meaning.

An application for full ethical approval was made to the Mzuzu University and the Faculty of Health Science Research Committee and ethics consent was received on 30 October 2024. The ethics approval number is FOHS/STJOG/24/001. Thereafter, site approval was sought to interview the soldiers (MDFHS/A/145). Participants’ rights were protected throughout the study. They were informed of their freedom to withdraw at any time without any penalty, thereby upholding the ethical principles of autonomy and self-determination. All interviews with participants who provided written consent were conducted in a private room, thus ensuring the principle of privacy. Participants were assured that their personal details and interview data would remain confidential. Data were stored in a password-protected computer to enhance confidentiality. Informed consent and participant authorisation were obtained prior to data collection.

The socio-demographics of the eight participants are shown in Table 1. Eight soldiers were interviewed until data saturation was reached. Five soldiers were aged between 22 and 25 years, while three were aged between 30 and 35 years. Two soldiers were married, and six were not married. Seven were Christians, and one was a Muslim. In terms of education, seven soldiers had the Malawi School Certificate of Education, while one had a Bachelor’s degree in Environmental Health. Regarding ethnicity, one participant was Ngoni, while seven were Chewa.

In this section, the researcher began the write-up of the report (Braun & Clarke 2020) in a concise, coherent, logical and non-repetitive manner, quoting the verbatim which best described the identified themes. Three major themes and six sub-themes emerged from the study. The three major themes were immediate, short-term and long-term psychological experiences (See Table 2). These are described as follows:

The demographic characteristics of the participants provide essential context for understanding the psychological experiences of soldiers who underwent VMMC. This diverse age distribution highlights a mix of early-career and mid-career military personnel, which may influence their psychological responses to VMMC differently because of varying life experiences and responsibilities, as age appears to play a significant role in shaping perceptions and motivations. Patel et al. (2018) conducted a study across South Africa, Tanzania and Zimbabwe, finding that younger adolescents (aged 10–14) were more likely to seek VMMC because of external advice, such as suggestions from parents or school officials.

In contrast, older adolescents (aged 15–19) were more motivated by personal health benefits, including protection against HIV and other sexually transmitted infections. In addition, younger adolescents exhibited less awareness of the partial protection VMMC offers against HIV compared to their older counterparts (Patel et al. 2018). These findings suggest that age-related differences in motivations and understanding of VMMC could influence the psychological responses of individuals undergoing the procedure. Younger individuals may require more targeted education and counselling to address their specific concerns and informational needs, while older individuals might benefit from discussions that reinforce their health-related motivations. This multifaceted approach could help address the diverse psychological experiences associated with VMMC across different age groups.

Marital status could play a role in shaping psychological experiences, particularly in how participants perceive the effect of VMMC on intimate relationships. Married participants may focus more on the procedure’s implications for their spouses, while unmarried participants might view it from an individual health or social perspective. The predominance of Christianity as a religious belief may influence participants’ attitudes towards VMMC, especially in how they interpret its cultural, spiritual or health-related significance. The variation in participants’ educational backgrounds suggests differing levels of health literacy, which could impact their understanding of and psychological adjustment to the procedure. The tribal identities of Chewa and Ngoni may also have cultural implications for participants’ perceptions of VMMC. Circumcision practices and attitudes towards the procedure can vary across ethnic groups in Malawi, and this was consistent with the findings of Mphepo et al. (2023).

The findings from this study not only reflect several psychological experiences observed in prior research but also highlight aspects unique to the military context of the sample. The immediate psychological responses, including anxiety, pain and vulnerability, are consistent with Uberoi et al. (2021) and Yang et al. (2014), who noted that individuals often experience a heightened sense of anxiety and discomfort before and after VMMC. The high anxiety levels observed in this study align with Yang et al.’s (2014) findings, which indicate that psychological factors can amplify pain perception. Yang et al. (2014) noted that anxiety could amplify the perception of pain, suggesting that the soldiers’ emotional responses may have influenced their physical experiences. Given soldiers’ rigorous physical training and social expectations of resilience, they may experience amplified anxiety and stress before circumcision, as they are accustomed to a physically demanding and high-stakes environment. Moreover, Josephine, Grace and Kabunga (2023) indicated that anxiety was a reason for the low uptake of VMMC, thus suggesting the need for adequate psychological preparation, including pre-procedure counselling and emotional support to address specific military-related anxiety triggers.

Participants reported heightened emotional reactions following the circumcision, including fear and relief. These reactions are primarily linked to uncertainties about the procedure’s success and concerns about potential complications, such as infection or prolonged pain. Soldiers often expressed heightened sensitivity to these risks because of their need to maintain physical performance and fulfil demanding military roles. These findings align with Uberoi et al. (2021) and Yang et al. (2014), who observed similar heightened levels of anxiety and emotional distress before and immediately after VMMC. This is particularly relevant in a military context, where high-stakes environments and expectations of resilience may exacerbate emotional responses. Furthermore, the sense of relief expressed by participants after completing the procedure suggests a psychological release from the anticipation of pain or complications. This dual experience of anxiety and relief highlights the complex emotional landscape soldiers navigate during the immediate recovery period.

Participants consistently reported pain and discomfort as significant physical reactions immediately after the procedure. This physical discomfort often led to feelings of vulnerability and a perceived loss of control, as soldiers were temporarily unable to perform their routine tasks or engage in physical activities critical to their roles. These experiences are consistent with the findings of Mehmetoğlu (2023), who reported that physical discomfort is a common immediate reaction to circumcision, often accompanied by emotional distress. Soldiers’ heightened sense of vulnerability is notable, as it contrasts with their usual perception of physical strength and endurance, which is integral to their identity and roles. This perceived vulnerability could be further amplified in military settings, where soldiers are expected to maintain physical readiness at all times. Bossio, Pukall and Steele (2017) suggested that the psychological impact of temporary physical limitations may be more pronounced in individuals with high physical demands, such as soldiers, compared to civilians. The combination of emotional and physical challenges during this period underscores the need for comprehensive pre-procedure and post-procedure counselling. Such counselling could help soldiers anticipate and manage both emotional responses (e.g. anxiety) and physical reactions (e.g. pain), thereby promoting a smoother recovery process.

Short-term psychological experiences also highlighted concerns about body image and masculinity, echoing findings from Agha (2024) and Bossio et al. (2017). These studies observed that men, particularly soldiers, may struggle with altered self-perceptions and concerns about physical appearance following circumcision, which could impact their confidence and social interactions. Soldiers in this study similarly reported feelings of self-consciousness and social withdrawal, aligning with the observations of Agha (2024). Notably, the social dynamics in a military setting, where physical performance and appearance are highly valued, may exacerbate concerns around body image and masculinity, underscoring the value of incorporating body image counselling into post-circumcision support.

In the short term, many soldiers experienced frustration and emotional distress as a result of the physical limitations imposed by the healing process. These restrictions affected their ability to fully participate in military training and duties, leading to feelings of inadequacy and a temporary loss of their physical identity as soldiers. Participants described this adjustment as mentally taxing, as they struggled to reconcile their usual physical capabilities with their temporary limitations. These findings align with Agha (2024) and Szivak and Kraemer (2015), who noted that men in military contexts, where physical readiness is not only a requirement but also a measure of identity and pride, are likely to experience intensified challenges. Soldiers accustomed to rigorous training routines may experience greater psychological strain when faced with temporary physical restrictions (Tornero-Aguilera et al. 2024). Additionally, the frustration expressed by participants highlights the need for clear communication about the expected healing timeline and reassurance about their ability to regain full functionality. Thus, short-term counselling sessions focusing on coping strategies during recovery could address this frustration and provide emotional support.

Feelings of self-consciousness were another prominent theme in the short-term psychological experiences of soldiers. Participants reported heightened awareness of their healing process, with some expressing embarrassment or fear of judgment from their peers. This self-consciousness often led to social withdrawal and avoidance of discussions about their condition, as soldiers sought to shield themselves from potential stigma or discomfort. These findings echo Bossio et al. (2017) and Ngalande et al. (2006), who observed that concerns about body image and masculinity are prevalent in men recovering from circumcision. In a military environment, where physical strength and appearance are closely tied to conceptions of masculinity, these feelings of self-consciousness can be particularly significant. The fear of judgment reported by participants may stem from the perception that discussing personal health matters, especially those related to circumcision, could be seen as a sign of weakness. This aligns with previous research indicating that social dynamics in male-dominated environments often discourage open discussions about vulnerability or health concerns. To mitigate these experiences, it is essential to incorporate body image counselling and peer support into post-circumcision care programmes. Normalising discussions about the recovery process and creating a safe environment for soldiers to share their experiences can reduce feelings of isolation and foster a sense of camaraderie.

In the long term, participants in this study experienced a composite of positive self-perceptions and enduring discomfort, which differs from the findings of Aydoğdu, Azizoğlu & Okur. (2022) and Aydogmus et al. (2016). Aydoğdu et al. (2022) observed that some soldiers experienced enduring changes in body image and self-esteem, and Aydogmus et al. (2016) found that long-term psychological adjustment was generally positive when adequate social support was provided. Soldiers who perceived the procedure positively often cited improved health and cleanliness, similar to the positive long-term outcomes noted by Kigozi et al. (2008) regarding sexual satisfaction and body confidence. For others, however, ongoing sensitivity and self-consciousness indicate that not all soldiers experience a complete psychological adjustment, highlighting the need for extended post-procedure psychological and social support to ensure long-term well-being.

Over time, many participants reported a positive shift in their self-perception, often associating VMMC with improved health, cleanliness and personal hygiene. These changes contributed to an increased sense of pride and self-confidence, as participants viewed the procedure as a proactive step towards better overall health. These findings align with Kigozi et al. (2008), who found that men often associate circumcision with increased cleanliness, sexual satisfaction and improved body confidence. For soldiers, the association between circumcision and personal health is particularly meaningful, as their roles often demand peak physical performance and well-being. The transformative effect of VMMC on self-perception suggests that, for many, the procedure serves as a milestone in personal development, fostering a more positive relationship with their bodies. However, this shift is not universal, as some participants reported lingering challenges related to self-image and confidence.

While many participants experienced positive changes, a subset reported enduring physical and emotional effects that continued to shape their experiences months after the procedure. These effects included ongoing sensitivity, heightened self-consciousness in intimate settings, and concerns about the procedure’s long-term implications. These findings diverge slightly from the observations of Aydogmus et al. (2016). While Aydogmus et al. (2016) found that most men reported positive psychological adjustment when adequate social support was provided, the participants in this study highlighted enduring emotional challenges, suggesting the need for more sustained post-procedure support. The military context may amplify these experiences, as soldiers must navigate unique pressures related to physical readiness, intimate relationships and social dynamics within their units. For those who reported enhanced sexual satisfaction and relationship improvement, the procedure was seen as a contributor to personal and relational well-being, consistent with findings from Kigozi et al. (2008). However, for others, the ongoing self-consciousness underscores the variability in long-term psychological adjustment.

There was a chance of information bias, as participants might have provided inaccurate information. This was mitigated by probing with additional questions. Recall bias was possible, as participants were asked to remember their circumcision experience. To mitigate recall bias, only participants circumcised within the past 2 years were selected. Researcher bias was also expected, since the researchers had prior knowledge of the concepts under study. However, the researchers employed reflexivity and engaged a diverse research team to maintain transparency during data collection and analysis.

Immediate and short-term psychological support should include pre-procedure counselling to address anxiety, pain management and recovery expectations. Educational workshops are also recommended to prepare soldiers for the psychological and physical experiences associated with VMMC. Moreover, future studies should investigate the long-term psychological and physical effects of VMMC on larger military populations to better understand how soldiers’ experiences evolve. Lastly, policies should be developed to allow soldiers to perform lighter duties or non-physical tasks during the recovery period.