Sex Transm Infect doi:10.1136/sextrans-2011-050294
  • Epidemiology
  • Original article

Inter-rater reliability of self-reported response on foreskin status in questionnaire among Japanese adult men

  1. Ohyama Takaaki3
  1. 1Field Epidemiology Training Program, National Institute of Infectious Diseases, Tokyo, Japan
  2. 2Department of Epidemiology, National Institute of Public Health, Saitama, Japan
  3. 3Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
  4. 4Iizuka Clinic, Kanagawa, Japan
  5. 5Miyamotocho Chuo Clinic, Kanagawa, Japan
  6. 6Department of Urology, Yamato City Hospital, Kanagawa, Japan
  1. Correspondence to Dr Takuya Yamagishi, Gakuen 4-7-1, Musashimurayama, Tokyo 208-0011, Japan; tack-8{at}
  1. Contributors TY, HI, HN, YY and OT were involved in the design of the study, statistical analysis and interpretation of the results. NI, YO, UK and HM were involved in the physical examination and gathering the questionnaires. HI, HN, YY and OT revised the manuscript before submission.

  • Accepted 22 April 2012
  • Published Online First 24 May 2012


Objectives To determine whether foreskin status is a measurable marker for evaluating the effect of the foreskin on sexually transmitted infections.

Methods Inter-rater comparison of the responses on foreskin status and circumcision in a self-report questionnaire with the findings of a physical examination by an experienced well-trained urologist was performed for patients who visited a healthcare facility in Kanagawa, Japan. Foreskin status was defined using a five-point graphical scale based on the degree to which the foreskin covers the foreskin and the glans penis in a non-erectile condition: type 1, a fully exposed glans penis; types 2–4, the glans penis partly covered by the foreskin and type 5, phimosis. Linear weighted κ and per cent agreement were used to evaluate the reliability of responses.

Results Among 188 participants who were evaluated about their foreskin status, linear weighted κ and per cent agreement were 0.74% and 68.4%, respectively. Linear weighted κ improved from 0.74 to 0.80 when the number of categories was changed to three. All the self-reported responses on circumcision were in agreement with the findings of the physical examination. Seventeen participants (9.0%) had been circumcised, and among them, three (17.6%) had approximately one-half of their glans penis covered by the foreskin. In 90 among the 171 uncircumcised participants (52.6%), the foreskin did not cover the glans penis.

Conclusions The self-reported response on foreskin status in this questionnaire has sufficient reliability to replace physical examination, and this questionnaire can facilitate further studies about the effect of foreskin on sexually transmitted infections.


  • All authors, external and internal, had full access to all of the data in the study and can take responsibility for the integrity of that data and the accuracy of the data analysis.

  • Funding This study was partially funded by the National Institute of Public Health, Japan, for Master's research program.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethics committee of the National Institute of Public Health, Japan.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Free sample

This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of STI.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Navigate This Article