WorldWideScience

Sample records for circumcision female

  1. The International Student: Female Circumcision Issues.

    Science.gov (United States)

    Bengston, Barbara; Baldwin, Cynthia

    1993-01-01

    Describes the process and practice of female circumcision, the impact it may have on circumcised female international college students, and some counseling strategies for the college counselor who works with this population. Explains variety of reasons for performing female circumcision, different types of female circumcisions, and psychological…

  2. Bodily integrity and male and female circumcision.

    NARCIS (Netherlands)

    Dekkers, W.J.M.; Hoffer, C.; Wils, J.-P.

    2005-01-01

    This paper explores the ambiguous notion of bodily integrity, focusing on male and female circumcision. In the empirical part of the study we describe and analyse the various meanings that are given to the notion of bodily integrity by people in their daily lives. In the philosophical part we distin

  3. Circumcision

    Science.gov (United States)

    ... and discomfort. previous continue Caring for a Circumcised Penis Following circumcision, it is important to keep the ... easily treated. previous continue Caring for an Uncircumcised Penis As with a penis that's circumcised, an uncircumcised ...

  4. Circumcision

    Directory of Open Access Journals (Sweden)

    Puri Poonam

    2010-01-01

    Full Text Available Circumcision is one of the oldest and the most controversial surgical procedures performed worldwide and is almost universal among Muslim and Jewish men. Most medical institutions in various countries agree that although there may be health benefits, there is no medical justification for routine circumcision in neonates or children. It should be performed only for established medical reasons and should not be universally recommended. There are modern techniques that provide safer, simpler, quicker, and cheaper alternatives to the traditional means of circumcision with good functional and cosmetic results. Female genital mutilation (FGM includes procedure that alters or injures female genital organs for nonmedical reasons. Various degrees of FGM are prevalent, the most mutilating one being infibulation. There are numerous gynecologic and obstetrical complications with infibulation. FGM also plays a significant role in facilitating the transmission of HIV infection through numerous mechanisms. Health care providers have an important role to play in the eradication of this practice. Increased professional and public awareness about such a practice is required.

  5. Circumcision

    Science.gov (United States)

    Circumcision is a surgical procedure to remove the foreskin, the skin that covers the tip of the ... AAP), there are medical benefits and risks to circumcision. Possible benefits include a lower risk of urinary ...

  6. Australian midwives' perspectives on managing obstetric care of women living with female genital circumcision/mutilation.

    Science.gov (United States)

    Ogunsiji, Olayide

    2016-10-01

    Female genital mutilation (FGM) or female circumcision is a global health issue with increasing international migration of affected women and girls to countries unfamiliar with the practice. Western health care providers are unfamiliar with FGM, and managing obstetric care presents challenges to midwives who are in the forefront of care provision for the women. The participants in this Heideggerian qualitative interpretive study elucidated the strategies they used in overcoming the particular physical, emotional, and gynecological health issues with which mutilated women present. Ongoing emphases on women-centered, culturally competent maternity care are germane to optimal maternity care of circumcised women.

  7. Exploration of pathways related to the decline in female circumcision in Egypt

    OpenAIRE

    Modrek, Sepideh; Liu, Jenny X

    2013-01-01

    Abstract Background There has been a large decline in female genital circumcision (FGC) in Egypt in recent decades. Understanding how this change has occurred so rapidly has been an area of particular interest to policymakers and public health officials alike who seek to further discourage the practice elsewhere. Methods We document the trends in this decline in the newest cohorts of young girls and explore th...

  8. Female genital mutilation and male circumcision: toward an autonomy-based ethical framework

    OpenAIRE

    Earp, Brian

    2015-01-01

    Brian D Earp Department of History and Philosophy of Science, University of Cambridge, Cambridge, UK Abstract: The non-therapeutic alteration of children’s genitals is typically discussed in two separate ethical discourses: one for girls, in which such alteration is conventionally referred to as “female genital mutilation” (or FGM), and one for boys, in which it is conventionally referred to as “male circumcision.” The former is typically reg...

  9. Why are current efforts to eliminate female circumcision in Ethiopia misplaced?

    Science.gov (United States)

    Boyden, Jo

    2012-01-01

    This paper discusses the eradication challenges of female circumcision in Ethiopia. It argues that despite an overall decline in the practice nationally, eradication efforts have caused significant quandaries for girls and their families. The most common justification by far for its continuance is that circumcision confirms a girl's social place by proving her readiness for marriage and adulthood and thereby ensures her protection against material want. Hence, intervention has often resulted in the transformation, rather than the elimination, of the practice, the exchange of one type of risk for another, or even increased risk to girls. In discussing policy, the paper argues that there has been a misapplication of the risk concept in the promotion of change in Ethiopia. It calls for risk definitions and interventions that are more holistic, correspond more closely with children's social realities and take into account the phenomenological dimensions of experience. PMID:23030606

  10. Excision of an epidermal inclusion cyst: Correction of a long-term complication of female genital circumcision.

    Science.gov (United States)

    Dun, Erica C; Ackerman, Christina; Cutler, Abigail; Lakhi, Nisha A

    2016-06-01

    Epidermal inclusion cysts are a late complication of female genital circumcision, which is a practice that affects 125 million women primarily from Africa and the Middle East. A 30-year-old woman, gravida 4, para 1, presented to our clinic with an 8-year history of a slowly enlarging periclitoral mass. The patient had undergone female genital circumcision at the age of 5 years. We describe and video-illustrate the surgical technique of excising the 8-cm epidermal inclusion cyst. Using this technique, the entire cyst was resected intact, excess vulvar skin removed, and defect repaired. Postoperatively, she had minimal pain, no dyspareunia, and good cosmesis. Restoration of anatomy for this late complication of female genital circumcision is achievable with knowledge of anatomy, adherence to basic surgical principles that include tension-free closure, and close postoperative follow up. PMID:27001220

  11. To mutilate in the name of Jehovah or Allah: legitimization of male and female circumcision.

    Science.gov (United States)

    Abu-Sahlieh, S A

    1994-01-01

    Female circumcison is practised in Sudan, Somalia, Egypt and a few other Arab and Muslim countries. It has triggered a passionate public debate in the West. This debate has found somewhat of an echo in the Arab and Muslim world, but some Muslim religious circles such as Al-Azhar (Egypt), the most important Islamic centre in the world, try to justify it on the basis of sunnah (that is, to conform with the tradition of the prophet Mohammed). Male circumcision is practised by all Muslims and Jews and also by some Christians in Egypt, in the United States and Canada). For different reasons, the debate on this topic is still taboo in Western and in Arab and Muslim countries. The object of this study is to define the role of Islamic law and Muslim religious leaders in female and male circumcision. On purpose, it avoids any use of the word 'Islam', and concentrates on the written sources of Islamic law and the opinions of contemporary Arab authors, mostly of Egyptian origin. Juridical logic cannot acknowledge the distinction between female and male circumcision, both being the mutilation of healthy organs which is damaging to the physical integrity of the child, whatever the underlying religious motivations. Furthermore, both practices violate the Koran: 'Our Lord, You did not create all this in vain' (3:191), and '[He] perfected everything He created' (32:7). In our opinion, a god who demands that his believers be mutilated and branded on their genitals the same as cattle, is a god of questionable ethics. To mutilate children, boys or girls, under the pretext that it is for their own good, shows the influence of cynicism and fanaticism. PMID:7731348

  12. African women struggling against female circumcision and sexual violence.

    Science.gov (United States)

    Tell, K

    1999-04-01

    In France, Mariatou Koita, a woman born of Malian parents, endured female genital mutilation as a child at the hands of another Malian immigrant. When the mutilator returned years later to perform genital mutilation on Koita's younger sister, Koita took action that resulted in the first case of female genital mutilation tried in France upon the complaint of a victim. The mutilator was sentenced to 8 years in jail for mutilating 48 young girls in the period 1983-94, and 23 mothers and 3 fathers received prison or suspended prison sentences. Women are struggling against another form of sexual violence in South Africa, where Johannesburg is gaining the reputation as the "rape capital" of the world. Surveys by a nongovernmental organization (NGO) have revealed that a third of 4000 women interviewed were raped in the past year and that 25% of the boys in a sample of 1500 school children considered gang rape a recreational activity. In response, the NGO is creating recommendations to address the problem in schools and to raise the role model profile of men who oppose sexual violence. Also, in Wynberg, Western Cape, a special Sexual Offenses Court has been created to mitigate some of the difficulties rape victims have encountered with the legal system. Global studies indicate that most victims of sexual assaults are adolescent girls. PMID:12349047

  13. African women struggling against female circumcision and sexual violence.

    Science.gov (United States)

    Tell, K

    1999-04-01

    In France, Mariatou Koita, a woman born of Malian parents, endured female genital mutilation as a child at the hands of another Malian immigrant. When the mutilator returned years later to perform genital mutilation on Koita's younger sister, Koita took action that resulted in the first case of female genital mutilation tried in France upon the complaint of a victim. The mutilator was sentenced to 8 years in jail for mutilating 48 young girls in the period 1983-94, and 23 mothers and 3 fathers received prison or suspended prison sentences. Women are struggling against another form of sexual violence in South Africa, where Johannesburg is gaining the reputation as the "rape capital" of the world. Surveys by a nongovernmental organization (NGO) have revealed that a third of 4000 women interviewed were raped in the past year and that 25% of the boys in a sample of 1500 school children considered gang rape a recreational activity. In response, the NGO is creating recommendations to address the problem in schools and to raise the role model profile of men who oppose sexual violence. Also, in Wynberg, Western Cape, a special Sexual Offenses Court has been created to mitigate some of the difficulties rape victims have encountered with the legal system. Global studies indicate that most victims of sexual assaults are adolescent girls.

  14. When female circumcision comes to the West: Attitudes toward the practice among Somali Immigrants in Oslo

    Directory of Open Access Journals (Sweden)

    Gele Abdi A

    2012-08-01

    Full Text Available Abstract Background Female circumcision (FC has lifelong adverse social and health consequences for women, and its abolition will not only enhance the health of children and women, but also promote gender equality. Like many other Western countries, Norway hosts a large proportion of immigrants from FC-practicing countries, though primarily from Somalia, which is the country with the highest prevalence of FC in the world. A behavioral change by the practicing communities has the best chance to successfully and sustainably eliminate this practice. However, FC prevention programs require a behavioral surveillance that monitors the process of change, with this being the first quantitative study since the major migration of the Somali community to Norway began in 1991 to investigate whether or not Somali immigrants’ attitudes toward the practice has improved in favor of its abandonment. Methods A cross-sectional study using a respondent-driven sampling (RDS was conducted in Oslo from April to June of 2011. A sample of 214 persons was interviewed, using structured questionnaires. Results The results show that 70% of Somalis in Oslo support the discontinuation of all forms of FC compared to 30% who support its continuation, with the latter group more likely to be people who lived in Norway ≤ 4 years. Of the 10 girls who came to Norway at the age of ≤ 7 years, only one was circumcised, though whether the circumcision occurred before or after the girl’s arrival in Norway remains unclear. The perception that FC is required by religion was the sole factor to be significantly associated with an ongoing support of FC. Conclusion The study reveals that Somalis in Oslo demonstrate a trend to abandon this practice over time. Nevertheless, the 30% of the people who still support its continuation, and who are primarily newly arrived immigrants, require a targeted intervention that is implemented in the early phase of the immigrants’ arrival.

  15. Attitudes toward female circumcision among Somali immigrants in Oslo: a qualitative study

    Directory of Open Access Journals (Sweden)

    Gele AA

    2012-01-01

    Full Text Available Abdi A Gele1,2, Bernadette Kumar3, Karin Harsløf Hjelde3, Johanne Sundby21The Department of Social Science, Oslo University College, 2Section for International Health, Department of General Practice and Community Medicine, University of Oslo, 3Norwegian Center for Minority Health Research, Oslo, NorwayAbstract: Due to its negative impact on public health, female circumcision (FC has gained increased attention from international communities and the Norwegian public in recent decades. In 1995, the Norwegian government outlawed the practice and simultaneously developed a package of measures aimed at preventing and ultimately eradicating FC in Norway. Like many other Western countries, immigrants of Somali descent constitute the largest immigrant group in Norway from countries with FC traditions. Although this immigrant group is often perceived as a cultural society that supports FC generally as a practice, there appears to be a lack of studies that explore the impact of acculturation and the Western social context on Somali immigrants’ attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Oslo, Norway to the practice of FC. Findings from this qualitative study indicate that Somalis in Oslo have, to a large extent, changed their attitude toward the practice. This was proven by the presence in Oslo of a large number of Somali parents who left their daughters uncut as well as Somali girls, boys, men, and women who attribute being uncircumcised a high status. This study adds to the knowledge of the process of abandonment of FC among immigrants in the Western countries. The study highlights the success that has been achieved in improving attitudes toward the practice of the Somali community in Oslo, Norway, as well as emerging challenges that need to be addressed further.Keywords: female circumcision, attitude, behavior, immigrants, Somalis

  16. What Do People Actually Learn from Public Health Campaigns? Incorrect Inferences About Male Circumcision and Female HIV Infection Risk Among Men and Women in Malawi.

    Science.gov (United States)

    Maughan-Brown, Brendan; Godlonton, Susan; Thornton, Rebecca; Venkataramani, Atheendar S

    2015-07-01

    Qualitative studies and polling data from sub-Saharan Africa indicate that many individuals may mistakenly believe that male circumcision directly protects women from contracting HIV. This study examines whether individuals who learn that male circumcision reduces female-to-male HIV transmission also erroneously infer a reduction in direct male-to-female transmission risk (i.e. from an HIV-positive man to an uninfected woman). We used data on Malawian men (n = 917) randomized to receive information about voluntary medical male circumcision (VMMC) and HIV risk in 2008 and a random sample of their wives (n = 418). We found that 72 % of men and 82 % of women who believed that male circumcision reduces HIV risk for men also believed that it reduces HIV risk for women. Regression analyses indicated that men randomly assigned to receive information about the protective benefits of circumcision were more likely to adopt the erroneous beliefs, and that the underlying mechanism was the formation of the belief that male circumcision reduces HIV risk for men. The results suggest the need for VMMC campaigns to make explicit that male circumcision does not directly protect women from HIV-infection.

  17. Neonatal circumcision.

    Science.gov (United States)

    Lerman, S E; Liao, J C

    2001-12-01

    The merits of neonatal circumcision continue to be debated hotly. Some argue that circumcision is a "uniquely American medical enigma." Most of the world's male population remains uncircumcised; however, most boys born in the United States continue to undergo neonatal circumcision. Review of existing literature supports that most children who are uncircumcised do well from a medical standpoint and, thus, the question of whether US health care practitioners are subjecting neonates to an unnecessary surgical procedure remains. The medical benefits of circumcision are multiple, but most are small. The clearest medical benefit of circumcision is the relative reduction in the risk for a UTI, especially in early infancy. Although this risk [figure: see text] is real, the absolute numbers are small (risk ranges from 1 in 100 to 1 in 1000), and one investigator has estimated that it may take approximately 80 neonatal circumcisions to prevent one UTI. In the case of a patient with known urologic abnormalities that predispose to UTI, neonatal circumcision has a clearer role in terms of medical benefit to the patient. Most of the other medical benefits of circumcision probably can be realized without circumcision as long as access to clean water and proper penile hygiene are achieved. Proper penile hygiene should all but eliminate the risk for foreskin-related medical problems that will require circumcision. Moreover, proper hygiene and access to clean water has been shown to reduce the rate of development of squamous cell carcinoma of the penis in the uncircumcised population. Proper techniques on the care of the foreskin are illustrated in the American Academy of Pediatrics pamphlet titled "How to care for the uncircumcised penis." Regarding the relationship between STDs and circumcision, patient education and the practice of low-risk sexual behavior make a far greater impact than does routine circumcision in hopes of reducing the spread of HIV and other STDs. Nevertheless

  18. Libertarianism and Circumcision

    Directory of Open Access Journals (Sweden)

    Patrick Testa

    2014-06-01

    Full Text Available Despite the millenniums-old tradition in Abrahamic circles of removing the foreskin of a penis at birth, the involuntary and aggressive practice of circumcision must not be made an exception to the natural, negative right to self-ownership—a birthright which should prevent a parent from physically harming a child from the moment of birth going forward. This paper will present a natural rights argument against the practice of male child circumcision, while also looking into some of the potential physical and psychological consequences of the practice. It will compare the practice with that of female circumcision, which is banned in developed nations but still practiced in the third world, as well as other forms of aggressive action, some once-prevalent, while disputing arguments made for parental ownership of the child, religious expression, cultural tradition, cleanliness, cosmetics, and conformity.

  19. Associations between Male Anogenital Human Papillomavirus Infection and Circumcision by Anatomic Site Sampled and Lifetime Number of Female Sex Partners

    Science.gov (United States)

    Nielson, Carrie M.; Schiaffino, Melody K.; Dunne, Eileen F.; Salemi, Jason L.; Giuliano, Anna R.

    2016-01-01

    Background Male circumcision may lower men’s risk of human papillomavirus (HPV) infection and reduce transmission to sex partners. Reported associations between circumcision and HPV infection in men have been inconsistent. Methods Four hundred sixty-three men in 2 US cities were tested at 6 anogenital sites and in semen for 37 types of HPV. Men were eligible if they reported sex with a woman within the past year, no history of genital warts or penile or anal cancer, and no current diagnosis of a sexually transmitted infection. Participants completed a self-administered questionnaire. Circumcision status was assessed by the study clinician. Logistic regression was used to examine associations between circumcision and HPV detection at each site and in semen, with adjustment for potential confounders. Results Seventy-four men (16.0%) were uncircumcised. Adjusted odds ratios (AORs) for any HPV genotype and circumcision were 0.53 (95% confidence interval [CI], 0.28–0.99) for any anatomic site/specimen, 0.17 (95% CI, 0.05–0.56) for the urethra, 0.44 (95% CI, 0.23–0.82) for the glans/corona, and 0.53 (95% CI, 0.28–0.99) for the penile shaft. AORs were Circumcision may be protective against HPV infection of the urethra, glans/corona, and penile shaft. PMID:19086813

  20. Attitudes toward Female Circumcision among Men and Women in Two Districts in Somalia: Is It Time to Rethink Our Eradication Strategy in Somalia?

    Directory of Open Access Journals (Sweden)

    Abdi A. Gele

    2013-01-01

    Full Text Available Somalia has the highest global prevalence (98% of female circumcision (FC, and, despite a long history of abandonment efforts, it is not clear as to whether or not these programmes have changed people’s positive attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Hargeisa and Galkayo districts to the practice of FC. Methods. A purposive sampling of 24 Somalis, including activists and practitioners, men and women, was conducted in Somalia. Unstructured interviews were employed to explore the participants' knowledge of FC, their attitudes toward the continuation/discontinuation of the practice, and the type they want to continue or not to continue. Result. The findings of this qualitative study indicate that there is a strong resistance towards the abandonment of the practice in Somalia. The support for the continuation of Sunna circumcision is widespread, while there is a quite large rejection of Pharaonic circumcision. Conclusion. Therefore, since the “zero tolerance policy” has failed to change people’s support for the continuation of the practice in Somalia, programmes that promote the pinch of the clitoral skin and verbal alteration of status, with the goal of leading to total abandonment of FC, should be considered for the Somali context.

  1. Attitudes toward Female Circumcision among Men and Women in Two Districts in Somalia: Is It Time to Rethink Our Eradication Strategy in Somalia?

    Science.gov (United States)

    Gele, Abdi A; Bø, Bente P; Sundby, Johanne

    2013-01-01

    Somalia has the highest global prevalence (98%) of female circumcision (FC), and, despite a long history of abandonment efforts, it is not clear as to whether or not these programmes have changed people's positive attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Hargeisa and Galkayo districts to the practice of FC. Methods. A purposive sampling of 24 Somalis, including activists and practitioners, men and women, was conducted in Somalia. Unstructured interviews were employed to explore the participants' knowledge of FC, their attitudes toward the continuation/discontinuation of the practice, and the type they want to continue or not to continue. Result. The findings of this qualitative study indicate that there is a strong resistance towards the abandonment of the practice in Somalia. The support for the continuation of Sunna circumcision is widespread, while there is a quite large rejection of Pharaonic circumcision. Conclusion. Therefore, since the "zero tolerance policy" has failed to change people's support for the continuation of the practice in Somalia, programmes that promote the pinch of the clitoral skin and verbal alteration of status, with the goal of leading to total abandonment of FC, should be considered for the Somali context.

  2. A Complication of Female Circumcision: Vaginal Stenosis and Total Incontinence Due to Urethral Intercourse

    Directory of Open Access Journals (Sweden)

    Deniz Arslan

    2015-06-01

    Full Text Available Female genital mutilation (FGM is a horrible procedure which may have detrimental physical and pyschological effects on women and mostly performed in the Middle East and African regions. FGM has four different types described in various regions. Total urinary incontinence due to type 3 FGM is described in a 21-year-old female in the present article.

  3. A Complication of Female Circumcision: Vaginal Stenosis and Total Incontinence Due to Urethral Intercourse

    OpenAIRE

    Deniz Arslan; Ozan Bozkurt; Özer Birge; Ömer Demir

    2015-01-01

    Female genital mutilation (FGM) is a horrible procedure which may have detrimental physical and pyschological effects on women and mostly performed in the Middle East and African regions. FGM has four different types described in various regions. Total urinary incontinence due to type 3 FGM is described in a 21-year-old female in the present article.

  4. Urinary tract infection following ritual Jewish circumcision.

    Science.gov (United States)

    Goldman, M; Barr, J; Bistritzer, T; Aladjem, M

    1996-11-01

    Circumcision seems to reduce the overall incidence of urinary tract infections (UTI), although a few studies have suggested that ritual circumcision may be a predisposing factor for UTI within the first 2 weeks following the procedure. The aim of this study was to investigate a possible causal relationship between ritual circumcision and UTI. The study comprised 82 infants with UTI, 55 females and 27 males under the age of 1 year. All males were circumcised on the eighth day of life. The median age of infection was 0.75 and 7.0 months for males and females, respectively. Fifty-two percent (14/27) of UTI episodes were diagnosed within the 2 weeks following circumcision. A significantly lower incidence in Escherichia coli-induced UTI was observed in males compared to females, 67% and 93%, respectively. Similarly, the incidence of E. coli-induced UTI was also significantly lower in males presenting within 2 weeks following circumcision (57%) compared to infants presenting prior or more than 2 weeks following the procedure (92%). Positive blood cultures of an identical microorganism were observed in 6/27 males compared to 2/55 females. The incidence of urinary tract malformations and their severity were similar in both sexes. We conclude that the high incidence of UTI following a ritual Jewish circumcision, as well as the relatively high preponderance of bacteria other than E. coli, may suggest a causal relationship between circumcision and UTI.

  5. Is female circumcision evolving or dissolving in Norway? A qualitative study on attitudes toward the practice among young Somalis in the Oslo area

    Science.gov (United States)

    Gele, Abdi A; Sagbakken, Mette; Kumar, Bernadette

    2015-01-01

    Female genital mutilation or female circumcision (FC) is increasingly visible on the global health and development agenda – both as a matter of social justice and equality for women and as a research priority. Norway is one of the global nations hosting a large number of immigrants from FC-practicing countries, the majority from Somalia. To help counteract this practice, Norway has adopted a multifaceted policy approach that employs one of the toughest measures against FC in the world. However, little is known about the impact of Norway’s approach on the attitudes toward the practice among traditional FC-practicing communities in Norway. Against this background, this qualitative study explores the attitudes toward FC among young Somalis between the ages of 16 to 22 living in the Oslo and Akershus regions of Norway. Findings indicate that young Somalis in the Oslo area have, to a large extent, changed their attitude toward the practice. This was shown by the participants’ support and sympathy toward criminalization of FC in Norway, which they believed was an important step toward saving young girls from the harmful consequences of FC. Most of the uncircumcised girls see their uncircumcised status as being normal, whereas they see circumcised girls as survivors of violence and injustice. Moreover, the fact that male participants prefer a marriage to uncircumcised girls is a strong condition for change, since if uncut girls are seen as marriageable then parents are unlikely to want to circumcise them. As newly arrived immigrants continue to have positive attitudes toward the practice, knowledge of FC should be integrated into introduction program classes that immigrants attend shortly after their residence permit is granted. This study adds to the knowledge of the process of the abandonment of FC among immigrants in Western countries. PMID:26648760

  6. [Medical and legal aspects of genital mutilation and circumcision part I: female genital mutilation (FGM)].

    Science.gov (United States)

    Dettmeyer, Reinhard; Laux, Johannes; Friedl, Hannah; Zedler, Barbara; Bratzke, Hansjürgen; Parzeller, Markus

    2011-01-01

    Female genital mutilation (FGM) is considered to be against the law and against morality not only in Western countries, although a woman of age and able to consent may sometimes think differently. The procedure may have serious physical and emotional consequences for the girl or woman. Nevertheless there are attempts to justify the procedure with medical and hygienic pseudoarguments, ideology, freedom of religion, cultural identity and social adequacy. Outside the Western world, some people claim that religion and culture alone justify the practice. In Germany, parents can lose the right to determine the residence of their daughter, if she is faced with the risk of genital mutilation in order to prevent that the child or girl is taken to her home country. Genital mutilation as a gender-specific threat is recognized as a reason to grant asylum or prevent deportation. Proposals to make genital mutilation a separate punishable offence are presently discussed by the legislator. PMID:21404547

  7. Male circumcision: An overview

    Directory of Open Access Journals (Sweden)

    Bhattacharjee Prosanta

    2008-01-01

    Full Text Available Circumcision is one of the common operations performed worldwide, for various reasons. Controversy exists as to whether circumcision is an operation. This literature review discusses the indications of circumcision, benefits and complications of circumcision, and alternatives to circumcision. Relevant articles on the benefits, complications, indications and alternative to circumcision from 1964 to 2005 were reviewed, from National Library of Medicine′s Pubmed database. Additional articles were obtained from the reference lists of key articles and recent reviews.

  8. Is female circumcision evolving or dissolving in Norway? A qualitative study on attitudes toward the practice among young Somalis in the Oslo area

    Directory of Open Access Journals (Sweden)

    Gele AA

    2015-11-01

    Full Text Available Abdi A Gele,1,2 Mette Sagbakken,1,2 Bernadette Kumar2 1Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway; 2Norwegian Centre for Minority Health Research, Oslo, Norway Abstract: Female genital mutilation or female circumcision (FC is increasingly visible on the global health and development agenda – both as a matter of social justice and equality for women and as a research priority. Norway is one of the global nations hosting a large number of immigrants from FC-practicing countries, the majority from Somalia. To help counteract this practice, Norway has adopted a multifaceted policy approach that employs one of the toughest measures against FC in the world. However, little is known about the impact of Norway’s approach on the attitudes toward the practice among traditional FC-practicing communities in Norway. Against this background, this qualitative study explores the attitudes toward FC among young Somalis between the ages of 16 to 22 living in the Oslo and Akershus regions of Norway. Findings indicate that young Somalis in the Oslo area have, to a large extent, changed their attitude toward the practice. This was shown by the participants’ support and sympathy toward criminalization of FC in Norway, which they believed was an important step toward saving young girls from the harmful consequences of FC. Most of the uncircumcised girls see their uncircumcised status as being normal, whereas they see circumcised girls as survivors of violence and injustice. Moreover, the fact that male participants prefer a marriage to uncircumcised girls is a strong condition for change, since if uncut girls are seen as marriageable then parents are unlikely to want to circumcise them. As newly arrived immigrants continue to have positive attitudes toward the practice, knowledge of FC should be integrated into introduction program classes that immigrants attend shortly after their residence

  9. Attitudes toward and perceived psychosocial impact of female circumcision as practiced among the Bedouin-Arabs of the Negev.

    Science.gov (United States)

    al-Krenawi, A; Wiesel-Lev, R

    1999-01-01

    The present pilot study examines attitudes toward and the perceived psychosocial impact of circumcision as practiced among the Bedouin-Arabs of the Negev, Israel. A convenience sample of 24 women participated in the study: 12 who had experienced the ritual, and 12 who had not, but who had witnessed or been told about the practice of the ritual on women in their extended families. Two research instruments were used: a structured questionnaire, and a semi-structured open-ended interview. Data showed differences in subject responses depending on the research tools. The structured questionnaire revealed that women who had experienced the circumcision gave legitimization and cognitive rationalization to it. In contrast, the semi-structured interview revealed that these same subjects reported insult: traumatization, direct negative influences, and narcissistic insult, and described emotional difficulties during the research interviews. The findings indicated that they had difficulties in mother-daughter relationships and trust. Implications of the ritual on the continuity of polygamy and marital/sexual problems are discussed.

  10. Circumcision: pros and cons.

    Science.gov (United States)

    Burgu, Berk; Aydogdu, Ozgu; Tangal, Semih; Soygur, Tarkan

    2010-01-01

    Circumcision is possibly the most frequently performed elective surgical procedure in men. It can simply be described as the excision of the preputium. There have been several studies about the association between circumcision and urinary tract infections (UTI). Many studies have demonstrated that the frequency of UTI increase in uncircumcised males, especially in the first year of life. This review discusses the embryology of the preputium, epidemiology, indications, complications and benefits of circumcision, as well as operation and anesthesiology techniques. It especially examines the association between UTI and circumcision and the importance of circumcision in congenital urinary system anomalies. In addition, this review examines the associations between circumcision and sexually transmitted diseases, including HIV, and the protective role of circumcision on penile cancer.

  11. Benefits and risks of circumcision.

    OpenAIRE

    Warner, E.; Strashin, E.

    1981-01-01

    Circumcisions are performed either prophylactically in the neonatal period or therapeutically at a later age. About 10% of males not circumcised at birth will eventually require circumcision. The present neonatal circumcision rate is about 80% in the United States and 40% in Canada. The single most important determinant of whether a newborn male will be circumcised is the attitude of the attending physician. The literature was reviewed to determine the proven benefits of circumcision and to c...

  12. Circumcision and Muslim Women’s Identity in Indonesia

    Directory of Open Access Journals (Sweden)

    Lanny Octavia

    2015-03-01

    Full Text Available In Indonesia, female circumcision is generally perceived as a traditional heritage that must be respected and preserved, as well as a religious injunction that must be followed and implemented. Despite there being a lack of religious arguments, the practice has been deemed as a medium to Islamize a girl and as a strong marker of a girl’s Islamic identity. On the other hand, female circumcision is also associated with local tradition. The practice is intended to purify and preserve a girl’s honor. This reflects a patriarchal ideology that emphasizes the importance of protecting female chastity. This paper unfolds the complicated nature of female circumcision in Indonesia, and examines whether it serves as an expression of religious belief, as a preservation of local tradition or as a violation of human rights.Copyright (c 2014 by SDI. All right reserved.DOI: 10.15408/sdi.v21i3.1217

  13. Circumcision revision in male children

    Directory of Open Access Journals (Sweden)

    Mohammed A. Al-Ghazo

    2006-08-01

    Full Text Available OBJECTIVE: To determine indications for circumcision revision and to identify the specialty of the person who performed unsatisfactory primary circumcision. MATERIALS AND METHODS: The authors reviewed medical records of 52 cases that underwent circumcision revision over a 6-year period (1998 to 2004. Sleeve surgical technique was used for revision in patients with redundant foreskin or concealed penis, penoplasty for partial or complete degloving of the penis and meatotomy for external meatal stenosis. The mean age of children was 32 months (range 6 months to 9 years. RESULTS: Most of unsatisfactory primary circumcisions (86.7% were performed by laymen. All patients who underwent circumcision revision had good to excellent cosmetic results. CONCLUSION: Primary circumcision performed by laymen carry a high complication rate and serious complications may occur. A period of training and direct supervision by physicians is required before allowing laymen to perform circumcision independently.

  14. Circumcision and 'uncircumcision'.

    Science.gov (United States)

    Schneider, T

    1976-03-27

    The origin of circumcision is shrouded in antiquity. Mummies, 6 000 years old, have been reported to show evidence of circumcision but the first definite account appears in Genesis, chapter 17. Many nations practise it as a rite, the time of its performance varying from soon after birth to early manhood. Antiochus Epiphanes prohibited it in Palestine and the introduction of Greek gymnasia where nudity was the practice, led to many seeking to become uncircumcised. Celsus has described such an operation which appears to have been successful. In Rome under Hadrian and in 16th century Spain a heavy funnel-shaped copper tube fitting was used as another method of restoring the prepuce. The debate concerning the value of circumcision has continued up until the present day. PMID:775659

  15. [Ethics and ritual circumcision].

    Science.gov (United States)

    Castagnola, C; Faix, A

    2014-12-01

    Circumcision dates back to ancient times, nowadays, this ritual is practiced mainly in the context of Jewish and Muslim religions. The purpose of this article is to give urologists elements of reflection on the act according to the ethical principles of autonomy, beneficence, non-maleficence and justice. According to a Kantian vision, priority should be given to the respect and wishes of the individuals. In contrast, for the utilitarian theory, circumcision can be justified by a contribution to the happiness of the majority of community members at the expense of a given few. In the event of a request for ritual circumcision, urologists find themselves in the middle, uncomfortable for some, questioning the ethics of its meaning. The main pitfall for the surgeon remains in respecting the child's autonomy. PMID:25199723

  16. Complications of Circumcision

    Directory of Open Access Journals (Sweden)

    Aaron J. Krill

    2011-01-01

    Full Text Available In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.

  17. Behavior change pathways to voluntary medical male circumcision: narrative interviews with circumcision clients in Zambia.

    Directory of Open Access Journals (Sweden)

    Jessica E Price

    Full Text Available As an HIV prevention strategy, the scale-up of voluntary medical male circumcision (VMMC is underway in 14 countries in Africa. For prevention impact, these countries must perform millions of circumcisions in adolescent and adult men before 2015. Although acceptability of VMMC in the region is well documented and service delivery efforts have proven successful, countries remain behind in meeting circumcision targets. A better understanding of men's VMMC-seeking behaviors and experiences is needed to improve communication and interventions to accelerate uptake. To this end, we conducted semi-structured interviews with 40 clients waiting for surgical circumcision at clinics in Zambia. Based on Stages of Change behavioral theory, men were asked to recount how they learned about adult circumcision, why they decided it was right for them, what they feared most, how they overcame their fears, and the steps they took to make it to the clinic that day. Thematic analysis across all cases allowed us to identify key behavior change triggers while within-case analysis elucidated variants of one predominant behavior change pattern. Major stages included: awareness and critical belief adjustment, norming pressures and personalization of advantages, a period of fear management and finally VMMC-seeking. Qualitative comparative analysis of ever-married and never-married men revealed important similarities and differences between the two groups. Unprompted, 17 of the men described one to four failed prior attempts to become circumcised. Experienced more frequently by older men, failed VMMC attempts were often due to service-side barriers. Findings highlight intervention opportunities to increase VMMC uptake. Reaching uncircumcised men via close male friends and female sex partners and tailoring messages to stage-specific concerns and needs would help accelerate men's movement through the behavior change process. Expanding service access is also needed to meet

  18. Sociodemographic Predictors of Genital Mutilation (Circumcision of the Girl Child in Nigeria: A Population-Based Study

    Directory of Open Access Journals (Sweden)

    Donatus Ignatius Chidiebere Osuorah

    2015-07-01

    Full Text Available Objectives: Female circumcision is regarded as mutilation of the external genitalia of women and the girl child. It is entrenched in the cultures of many communities in developing countries particularly in Africa. It has long been recognized internationally as a violation of the right of the woman and the girl child. Material and methods: This study tried to determine the socio-demographic factors that predict circumcision of the girl child. Multivariate logistic regression was used to determine predictors of girl child circumcision. Results: The overall prevalence of the girl child circumcision in Nigeria is 23.9%. When stratified by region, the prevalence was 36.8%, 15.6% and 9.1% in the North-west, North-central and North-east region respectively and 30.8%, 22.8% and 8.0% in the South-west, South-east and South-south region respectively. Within states, the prevalence of female circumcision ranged from 0% in Katsina to 57.9% in Jigawa state. Prevalence was almost twice among Muslim households than other religions. Majority (91.8% of the girl child circumcision was done before the first birthday (0-11 months and 84.6% was performed by a traditional circumciser. Type I (44.1% and II (47.9% were the commonest type of genital mutilation performed. In the final regression model, only mothers opinion about female circumcision, whether she was circumcised and region of residence significantly determined the likelihood of a girl child been circumcised. Conclusions: Appropriate and targeted education of mothers and circumcisers focusing on the undesirable effect of female circumcision will significantly reduce the practice of female genital mutilation across Nigeria.

  19. Bloodless, sutureless circumcision

    Directory of Open Access Journals (Sweden)

    Nisar A Bhat

    2013-01-01

    Full Text Available Background: W e present our experience of sutureless and bloodless elective circumcision in neonates and infants with Gomco clamp. Patients and Methods: From March 2008 to May 2011, 200 babies with age ranging from 2 weeks to 7 months underwent Gomco circumcision. All patients were given chlorohydrate 50 mg/kg, paracetamol suppository 15 mg/kg, and local anesthesia. Procedure was done in minor operation theatre (OT and babies were observed for 1 h in recovery room before discharging them home. Results: Two of our patients (1% required immediate suturing on table after Gomco clamp was removed, five patients (2.5% were shifted back from the recovery room to minor OT for suture repair and eight patients (4% required reinforcement of primary dressing to control the minor ooze. There was no other complication. Cosmesis was to the satisfaction of the surgeon as well as the parents. Conclusion: Gomco clamp is a bloodless, sutureless, simple, and safe method of circumcision in newborns and infants. It is cost-effective and can be performed under local anesthesia and sedation with excellent cosmetic results.

  20. Ischemic glans penis after circumcision

    Institute of Scientific and Technical Information of China (English)

    Yuan-ShengTzeng; Shou-HungTang; EnMeng; Teng-FuLin; Guang-HuanSun

    2004-01-01

    A 33-year-old male receiving dorsal penile nerve block (DPNB) for circumcision exhibited a postoperative ischemic change over the glans penis. The event occurred nearly 24 hours after the procedure. The patient was treated with intravenous pentoxifyllin and hyperbaric oxygenation. Total reverse of the ischemia was observed. The complications associated with circumcision and DPNB were reviewed and discussed.

  1. The Cost of Medicaid Savings: The Potential Detrimental Public Health Impact of Neonatal Circumcision Defunding

    Directory of Open Access Journals (Sweden)

    Annie L. Andrews

    2012-01-01

    Full Text Available Objective. To project the increased incidence of HIV and subsequent costs resulting from the expected decreased rate of circumcision due to Medicaid defunding in one southeastern state. Methods. Using 2009 South Carolina (SC Medicaid birth cohort (n=29,316, we calculated expected heterosexually acquired HIV cases at current circumcision rates. To calculate age/race/gender specific HIV incidence rates, we used 2009 South Carolina Department of Health and Environmental Control reported gender and race specific HIV cases, CDC reported age distribution of HIV cases, and 2009 S.C. population data. Accounting for current circumcision rates, we calculated the change in incidence of heterosexually acquired HIV assuming circumcision provides 60% protection against HIV transmission to males and 46% protection against male to female transmission. Published lifetime cost of HIV was used to calculate the cost of additional HIV cases. Results. Assuming Medicaid circumcision rates decrease from current nationally reported levels to zero secondary to defunding, we project an additional 55 male cases of HIV and 47 female cases of HIV among this birth cohort. The total cost discounted to time of infection of these additional HIV cases is $20,924,400 for male cases and $17,711,400 for female cases. The cost to circumcise males in this birth cohort at currently reported rates is $4,856,000. Conclusions. For every year of decreased circumcision rates due to Medicaid defunding, we project over 100 additional HIV cases and $30,000,000 in net medical costs.

  2. [Circumcision: history, religion and law].

    Science.gov (United States)

    Totaro, Angelo; Volpe, Andrea; Racioppi, Marco; Pinto, Francesco; Sacco, Emilio; Bassi, Pier Francesco

    2011-01-01

    The aim of this article is to describe the circumcision procedure during history, its therapeutic and preventive goals, with focus on bioethical, economic and law issues. The origins of this practice are lost in antiquity. It was performed since 3000 BC by the Egyptians for hygienic and religious reasons. Moreover, male circumcision is a religious commandment in Judaism and Islam, and it is customary in some Oriental Orthodox and other Christian churches of Africa. Nowadays, circumcision is performed as a routine procedure by the Jews and the Muslims for religious reasons. The world prevalence of men with circumcision is 12.5-33%, especially in USA, Canada, Islamic people and Africa; in Europe the prevalence rate is low (in Great Britain it is 1.5%). Currently, male circumcision is being highly debated because of ethical, law and scientific issues and the different roles of this procedure: therapeutic, prophylactic (but there is no universal consensus) and ritualistic role. Nowadays, in Italy there is a strong debate about the consensus for this practice and its indications. The Italian law does not allow performing ritualistic circumcision, as a free of charge procedure in public hospitals, at the government's expenses, because the Italian law must protect different religious cultures, in name of the laity of the State. Thus, national bioethical committee (CNB) has established that ritualistic circumcision may only be performed on a paying basis in public hospitals. As a protective practice, circumcision has decreased in the entire world because of the improvement of hygienical conditions and, above all, the lack of unanimous consent on the real usefulness of protective circumcision, even if several studies have recently demonstrated the protecting role of male circumcision against HIV infection. PMID:21452153

  3. Circumcision Is Unethical and Unlawful.

    Science.gov (United States)

    Svoboda, J Steven; Adler, Peter W; Van Howe, Robert S

    2016-06-01

    The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision-the removal of this structure-is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.Circumcision is usually performed for religious, cultural and personal reasons. Early claims about its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.Circumcision violates the cardinal principles of medical ethics, to respect autonomy (self-determination), to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics' position, also risk liability for misleading parents about circumcision. PMID:27338602

  4. Circumcision of male children for reduction of future risk for HIV: acceptability among HIV serodiscordant couples in Kampala, Uganda.

    Directory of Open Access Journals (Sweden)

    Kenneth K Mugwanya

    Full Text Available INTRODUCTION: The ultimate success of medical male circumcision for HIV prevention may depend on targeting male infants and children as well as adults, in order to maximally reduce new HIV infections into the future. METHODS: We conducted a cross-sectional study among heterosexual HIV serodiscordant couples (a population at high risk for HIV transmission attending a research clinic in Kampala, Uganda on perceptions and attitudes about medical circumcision for male children for HIV prevention. Correlates of willingness to circumcise male children were assessed using generalized estimating equations methods. RESULTS: 318 HIV serodiscordant couples were interviewed, 51.3% in which the female partner was HIV uninfected. Most couples were married and cohabiting, and almost 50% had at least one uncircumcised male child of ≤18 years of age. Overall, 90.2% of male partners and 94.6% of female partners expressed interest in medical circumcision for their male children for reduction of future risk for HIV infection, including 79.9% of men and 87.6% of women who had an uncircumcised male child. Among both men and women, those who were knowledgeable that circumcision reduces men's risk for HIV (adjusted prevalence ratio [APR] 1.34 and 1.14 and those who had discussed the HIV prevention effects of medical circumcision with their partner (APR 1.08 and 1.07 were significantly (p≤0.05 more likely to be interested in male child circumcision for HIV prevention. Among men, those who were circumcised (APR 1.09, p = 0.004 and those who were HIV seropositive (APR 1.09, p = 0.03 were also more likely to be interested in child circumcision for HIV prevention. CONCLUSIONS: A high proportion of men and women in Ugandan heterosexual HIV serodiscordant partnerships were willing to have their male children circumcised for eventual HIV prevention benefits. Engaging both parents may increase interest in medical male circumcision for HIV prevention.

  5. A 'snip' in time: what is the best age to circumcise?

    Directory of Open Access Journals (Sweden)

    Morris Brian J

    2012-02-01

    Full Text Available Abstract Background Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves. Discussion We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring, reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used. Summary Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.

  6. Cultural change after migration: Circumcision of girls in Western migrant communities.

    Science.gov (United States)

    Johnsdotter, Sara; Essén, Birgitta

    2016-04-01

    This paper reviews the current knowledge on cultural change after migration in the practice of female circumcision, also named genital cutting or mutilation. Explorative studies show trends of radical change of this practice, especially the most extensive form of its kind (type III or the 'Pharaonic' type). The widespread interpretation that Islam would require circumcision of girls is questioned when, for example, Somalis meet other Muslim migrants, such as Arab Muslims, who do not circumcise their daughters. The few criminal court cases for circumcision of girls that have taken place in Western countries corroborate the conclusion that substantial change in the practice has occurred among migrants. In this literature review, an absence of reports is identified from healthcare providers who have witnessed circumcision after migration. Concurrently, a substantial knowledge exists on how to take care of already circumcised women and girls, and there is a system of recommendations in place regarding best practices for prevention. There is a great potential for healthcare providers to encourage this development towards general abandonment of circumcision of girls. The challenge for the future is how to incorporate culturally sensitive efforts of prevention on the one hand, and the examination of suspicious cases of illegal circumcision on the other. We recommend using--in a cautious way--the existing routines for identifying child abuse in general. Experiences from African contexts show that failure to generate significant change of the harmful practices/tradition may be due to the lack of multidisciplinary collaboration in different sectors of the society. In Western societies, the tendency toward abandonment of the practice could be reinforced by professionals who work toward better inclusion of men and women originally from countries where circumcision is practised. PMID:26644059

  7. The encounters that rupture the myth: contradictions in midwives' descriptions and explanations of circumcised women immigrants' sexuality.

    Science.gov (United States)

    Leval, Amy; Widmark, Catarina; Tishelman, Carol; Maina Ahlberg, Beth

    2004-09-01

    The purpose of the study was to analyze how Swedish midwives (n = 26) discuss sexuality in circumcised African women patients. In focus groups and interviews, discussions concentrated on care provided to circumcised women, training received for this care, and midwives' perceptions of female circumcision. An analytic expansion was performed for discussions pertaining to sexuality and gender roles. Results from the analysis show the following: (1) ethnocentric projections of sexuality; (2) a knowledge paradox regarding circumcision and sexuality; (3) the view of the powerless circumcised women; and (4) the fact that maternity wards function as meeting places between gender and culture where the encounters with men allow masculine hegemonic norms to be ruptured. We conclude that an increased understanding of cultural epistemology is needed to ensure quality care. The encounters that take place in obstetrical care situations can provide a space where gender and culture as prescribed norms can be questioned. PMID:15371079

  8. Seduções e traições de gênero no Islã: a rainha de Sabá e o corpo feminino circuncidado Gender treasons and seductions in Islam: the queen of Sheba and the circumcised female body

    Directory of Open Access Journals (Sweden)

    Mariane Venchi

    2008-06-01

    Full Text Available Este artigo analisa narrativas árabe-islâmicas que tratam de noções de corporalidade e suas conexões com a prática da circuncisão feminina, mostrando que a relação existente entre circuncisão, sexualidade e poder está posta em um cenário que envolve não apenas um idioma religioso de conversão de quem está dentro (crente e fora (descrente e em estados de "poluição", assim como a conversão simbólica entre masculino/feminino subjacente à construção da "comunidade muçulmana" ou califado.This article analises Arab-Muslim narratives dealing with concepts of embodiment in the practice of female circumcision, pointing out that the conection among circumcision, sexuality and power takes place in a setting which involves a religious language of conversion among insiders (believers, outsiders (non-believers and those in state of "pollution" as well as the simbolic conversion between male/female identities subjacent to the idea of "Islamic community" or caliphate.

  9. Decline in male circumcision in South Korea

    Directory of Open Access Journals (Sweden)

    Kim DaiSik

    2012-12-01

    Full Text Available Abstract Background To investigate the changing circumcision rate in South Korea in the last decade and to propose underlying causes for this change, in the context of the present fluctuating world-wide trends in circumcision. Methods From 2009 to 2011, 3,296 South Korean males (or their parents aged 0–64 years were asked about their circumcision status, their age at circumcision, and their information level regarding circumcision. We employed non-probability sampling considering the sensitive questions on the study theme. Results Currently the age-standardized circumcision rate for South Korean males aged 14–29 is found to be 75.8%. In an earlier study performed in 2002, the rate for the same age group was 86.3%. Of particular interest, males aged 14–16 show a circumcision rate of 56.4%, while the same age group 10 years ago displayed a much higher percentage, at 88.4%. In addition, the extraordinarily high circumcision rate of 95.2% found 10 years ago for the 17–19 age group is now reduced to 74.4%. Interestingly, of the circumcised males, the percentage circumcised in the last decade was only 25.2%; i.e., the majority of the currently circumcised males had undergone the operation prior to 2002, indicating that the actual change in the last decade is far greater. Consistent with this conjecture, the 2002 survey showed that the majority of circumcised males (75.7% had undergone the operation in the decade prior to that point. Focusing on the flagship age group of 14–16, this drop suggests that, considering the population structure of Korean males, approximately one million fewer circumcision operations have been performed in the last decade relative to the case of non-decline. This decline is strongly correlated with the information available through internet, newspapers, lectures, books, and television: within the circumcised population, both the patients and their parents had less prior knowledge regarding circumcision, other than

  10. Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy.

    Science.gov (United States)

    Morris, Brian J; Krieger, John N; Klausner, Jeffrey D

    2016-08-01

    We evaluate recent claims opposing infant male circumcision, a procedure now supported by the evidence-based policy of the American Academy of Pediatrics. We find those criticisms depend on speculative claims about the foreskin and obfuscation of the strong scientific evidence supporting pediatric policy development. An argument that circumcision should be delayed to allow a boy to make up his own mind as an adult fails to appreciate the psychological, scheduling and financial burdens later circumcision entails, so reducing the likelihood that it will occur. In contrast, early infant circumcision is convenient, safer, quicker, lower risk, healing is faster, cosmetic outcome is routinely good and the lifetime benefits accrue immediately. Benefits include reduction in urinary tract infections, inflammatory skin conditions, foreskin problems, and, when older, substantial protection against sexually transmitted infections and genital cancers in the male and his female sexual partners. Some authorities regard the failure to offer parents early infant circumcision as unethical, just as it would be unethical to fail to encourage the vaccination of children. In conclusion, the criticisms of evidence-based infant male circumcision policy are seriously flawed and should be dismissed as unhelpful to evidence-based development and implementation of pediatric policy intended to improve public health and individual wellbeing. PMID:27610340

  11. Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy.

    Science.gov (United States)

    Morris, Brian J; Krieger, John N; Klausner, Jeffrey D

    2016-08-01

    We evaluate recent claims opposing infant male circumcision, a procedure now supported by the evidence-based policy of the American Academy of Pediatrics. We find those criticisms depend on speculative claims about the foreskin and obfuscation of the strong scientific evidence supporting pediatric policy development. An argument that circumcision should be delayed to allow a boy to make up his own mind as an adult fails to appreciate the psychological, scheduling and financial burdens later circumcision entails, so reducing the likelihood that it will occur. In contrast, early infant circumcision is convenient, safer, quicker, lower risk, healing is faster, cosmetic outcome is routinely good and the lifetime benefits accrue immediately. Benefits include reduction in urinary tract infections, inflammatory skin conditions, foreskin problems, and, when older, substantial protection against sexually transmitted infections and genital cancers in the male and his female sexual partners. Some authorities regard the failure to offer parents early infant circumcision as unethical, just as it would be unethical to fail to encourage the vaccination of children. In conclusion, the criticisms of evidence-based infant male circumcision policy are seriously flawed and should be dismissed as unhelpful to evidence-based development and implementation of pediatric policy intended to improve public health and individual wellbeing.

  12. Non-therapeutic infant male circumcision

    Science.gov (United States)

    Alkhenizan, Abdullah; Elabd, Kossay

    2016-01-01

    Objectives: To review the evidence of the benefits and harms of infant male circumcision, and the legal and ethical perspectives of infant male circumcision. Methods: We conducted a systematic search of the literature using PubMed, EMBASE, and the Cochrane library up to June 2015. We searched the medical law literature using the Westlaw and Lexis Library law literature resources up to June 2015. Results: Male circumcision significantly reduced the risk of urinary tract infections by 87%. It also significantly reduced transmission of human immunodeficiency virus among circumcised men by 70%. Childhood and adolescent circumcision is associated with a 66% reduction in the risk of penile cancer. Circumcision was associated with 43% reduction of human papilloma virus infection, and 58% reduction in the risk of cervical cancer among women with circumcised partners compared with women with uncircumcised partners. Male infant circumcision reduced the risk of foreskin inflammation by 68%. Conclusion: Infant male circumcision should continue to be allowed all over the world, as long as it is approved by both parents, and performed in facilities that can provide appropriate sterilization, wound care, and anesthesia. Under these conditions, the benefits of infant male circumcision outweigh the rare and generally minor potential harms of the procedure. PMID:27570848

  13. Circumcision: Perspective in a Nigerian teaching hospital

    Directory of Open Access Journals (Sweden)

    L O Abdur-Rahman

    2013-01-01

    Full Text Available Background: The practice and pattern of male infants circumcised is influenced by culture, religion and socio-economic classification. The debate about the benefits and risks of circumcision has made a hospital-based practice the most acceptable. Objective: The objective of this study is to evaluate the ages, indications, co-morbidity, types and methods of circumcision, usage and mode of anaesthesia and outcome of male circumcision at a tertiary health centre in Nigeria. Materials and Methods: A retrospective review of male circumcision in a paediatric surgery unit was done from January 2002 to December 2007. The data was analysed using SPSS software version 15. Results: There were 438 boys with age ranged between 6 days and 10 years (median 28 days, mean 53.6 days standard deviation 74.2. Neonatal circumcision (<29 days was 201 (46% and 318 (72.6% of the children were circumcised by the 3 rd month of live. Religion or tradition were the major indicators in 384 (87.7% patients while phimosis 38 (8.7%, paraphimosis 4 (1%, redundant post circumcision skin 10 (2.3% and defective prepuce in 2 (0.5% were other indications. Plastibel™ (PD was used in 214 (48.9%, classical circumcision 194 (44.2%, guillotine technique (GT and Gomco™ 10 (2.3% cases each while 10 (2.3% had a refashioning/re-excision post previous circumcision. There was an increase in use of PD, drop in the use of GT; and increase in the number of circumcision done over the years. Only 39.7% had anaesthesia administered and complication rate was 6.7%. Conclusion: Neonatal circumcision was highest in the hospital-based circumcision practice, which allowed the expected ideals in the use of devices in a tertiary health centre. However, the low rate of anaesthetic use is unacceptable.

  14. Prepuce: Phimosis, Paraphimosis, and Circumcision

    Directory of Open Access Journals (Sweden)

    Yutaro Hayashi

    2011-01-01

    Full Text Available Phimosis is a condition in which the prepuce cannot be retracted over the glans penis. Actually, physiologic phimosis is common in male patients up to 3 years of age, but often extends into older age groups. Balanoposthitisis a common inflammation occurring in 4–11% of uncircumcised boys. Circumcision is generally undertaken for three reasons: first, as an item of religious practice, typically neonatally although occasionally transpubertally, as a rite of passage; second, as a prophylactic measure against future ailments for the reduction in the risk of penile cancer, urinary tract infection, and sexually transmitted infection; and third, for immediate medical indication. Balanitisxeroticaobliterans is an infiltrative skin condition that causes a pathological phimosis and has been considered to be the only absolute indication for circumcision. Various kinds of effective alternatives to circumcision have been described, including manual retraction therapy, topical steroid therapy, and several variations of preputioplasty. All of these treatments have the ability to retract the foreskin as their goal and do not involve the removal of the entire foreskin. Paraphimosis is a condition in which the foreskin is left retracted. When manipulation is not effective, a dorsal slit should be done, which is usually followed by circumcision.

  15. Complications of Circumcision: Report of Four Cases

    OpenAIRE

    S Delshad

    1997-01-01

    Circumcision is a common surgical procedure in the world. It seems to prevent phimosis, urinary tract infection, transsexual diseases, adhesion between foreskin and glans, and the possibility of penis and uterus cervical cancer. In addition to Jews and Muslims, who practice circumcision as a religious ritual, a remarkable percentage of Christians also take advantage of the prophylactic effect of the procedure. The complications of circumcision are not numerous but some may be serious. In this...

  16. Doctors Told to Guard Against Female Circumcision

    Institute of Scientific and Technical Information of China (English)

    白青山

    2001-01-01

    在非洲和中东的许多国家有一种令人毛骨悚然的“文化”:女性阴部的切除,最严重的称之为infibulation(为防止性交而封锁阴部),即使这些人离开故土,来到英国,他们仍然保留这种文化。英国的医生因此也就多了一件事情:protect girls from ethnic minorities(少数民族)against genital mutilation(生殖器的切割)

  17. Circumcision in Baby Boys (Beyond the Basics)

    Science.gov (United States)

    ... in male infants less than one year old. Studies consistently report that uncircumcised male infants are at higher risk of UTI compared with circumcised male infants. UTIs in infants can result in kidney infection requiring ... suggest that circumcision helps decrease the risk of ...

  18. The effect of circumcision on the frequency of urinary tract infection, growth and nutrition status in infants with antenatal hydronephrosis.

    Science.gov (United States)

    Kose, Engin; Yavascan, Onder; Turan, Ozlem; Kangin, Murat; Bal, Alkan; Alparslan, Caner; Sirin Kose, Seda; Kuyum, Pinar; Aksu, Nejat

    2013-01-01

    The objective of this study was to determine the effect of circumcision on the frequency of urinary tract infection (UTI), growth development, and the nutrition status in infants with antenatal hydronephrosis (AH). The data were collected prospectively between 1998 and 2010. Infants with a fetal pelvis diameter of >5 mm identified with antenatal ultrasound were followed-up. Body height and weight were expressed as HZ scores (observed height - median height/standard deviation) and WZ scores (observed weight - median weight/Standard deviation). The nutritional status was evaluated and the body weight was transformed to a weight-for-height index (WHI = weight/median weight for the height age × 100). The HZ and WZ scores or WHI were calculated for each patient at the first and last visits. The chi-square and Student's t tests were used for statistical analysis. A p value circumcised. The mean monitoring time was 45±24.9 months and the mean age of circumcision was 14 ± 16.06 months. The pre-circumcision UTI frequency (2.97 ± 1.14/y) was significantly higher than post-circumcision period (0.25 ± 0.67/y) (p circumcision UTI frequency (2.97 ± 1.14/y) was significantly higher than the UTI frequency observed in female cases (0.85 ± 0.91/y) and in the overall study group (0.73 ± 0.79/y) (p circumcised subjects (0.18 ± 1.01) was statistically higher than uncircumcised subjects (-0.26 ± 0.92) (p circumcised males (0.13 ± 1.24) with VUR was higher than the uncircumcised patients (0.03 ± 0.55) (p > 0.05). In obstructive uropathy groups, the HZ of the circumcised males (-0.13 ± 0.54) was also found to be higher than uncircumcised males (-0.49 ± 0.66) (p circumcised males, no statistically significant effect of circumcision on the nutrition status was detected. In conclusion, postnatal early circumcision of infants with AH seems to prevent frequent UTIs and nutritional disturbances enabling

  19. Factors influencing Chinese male's willingness to undergo circumcision: a cross-sectional study in western China.

    Directory of Open Access Journals (Sweden)

    Xiaobo Yang

    Full Text Available BACKGROUND: Male circumcision (MC has been shown to reduce the risk of female to male transmission of HIV. The goal of this survey was to explore the acceptability of MC among the Chinese and to identify factors associated with circumcision preference. METHODS: A cross-sectional survey was conducted between September 2009 and December 2010. We interviewed 2,219 male community participants, from three high HIV prevalence provinces in western China. A structured questionnaire was used to collect data on MC knowledge, willingness to accept MC, reasons to accept or refuse MC, and sexual behaviors and health. For those who refused MC, a health education intervention providing information on the benefits of circumcision was conducted. We used multiple logistic regression models to identify factors associated with the acceptability of MC. RESULTS: Of the respondents (n = 2,219, 44.6% (989/2,219 reported they would accept MC for the following reasons: promotion of female partners' hygiene (60.3%, redundant foreskin (59.4%, prevention of penile cancer (50.2%, enhanced sexual pleasure (41.4%, and protection against HIV and STDs (34.2%. The multivariable logistic regression showed that five factors were associated with MC willingness: long foreskin (OR = 15.98, residing in Xinjiang province (OR = 3.69, being younger than 25 (OR = 1.60, knowing hazards of redundant foreskin (OR = 1.78, and having a friend who underwent circumcision (OR = 1.36. CONCLUSION: The acceptability of male circumcision was high among the general population in China. Our study elucidates the factors associated with circumcision preference and suggests that more health education campaigns about positive health effects are necessary to increase the MC rate in China.

  20. "What do You Mean I've Got to Wait for Six Weeks?!" Understanding the Sexual Behaviour of Men and Their Female Partners after Voluntary Medical Male Circumcision in the Western Cape.

    Directory of Open Access Journals (Sweden)

    Yoesrie Toefy

    Full Text Available Several studies have shown that voluntary male medical circumcision (VMMC reduces the incidence of the Type-1 human immunodeficiency virus (HIV in heterosexual men by up to 60%. However, there is an increased risk of transmission of STIs, including HIV, in the immediate post-operative period after receiving VMMC. This study is to understand sexual practices of couples in the post-operative period in a Coloured population in the Western Cape Province of South Africa.Coloured Males who had undergone VMMC in the previous six months in the Cape Town area and their partners participated in eight single-gender focus group discussions. The groups explored why the men decided to undergo VMMC, what kind of counselling they received, and how they experienced the 6-week post-operative period, including sexually.The primary motivation to VMMC uptake included religious injunction and hygiene reasons and protection against sexually transmitted infections not necessarily HIV. There was some exploration of alternative sexual practices. During the period immediately post operation the respondents spoke of pain and fear of any sexual arousal, but towards the end of the six week period, sexual desire returned. Both men and women felt that sex was important to maintain the relationship. Gaps were identified in the pre- and post-MC procedure counselling.There is a real risk that men in this population may begin sex before complete healing has occurred. VMMC counselling to encourage men to stay sexually safe in the wound-healing period, needs to take into account the real-life factors of the circumcised men. It is essential from a public health, and gender perspective that effective counselling strategies for the VMMC post-operative period, and the longer term, are developed and tested.

  1. Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa

    Directory of Open Access Journals (Sweden)

    Moses Stephen

    2007-03-01

    Full Text Available Abstract Background Recent clinical trials in Africa, in combination with several observational epidemiological studies, have provided evidence that male circumcision can reduce HIV female-to-male transmission risk by 60% or more. However, the public health impact of large-scale male circumcision programs for HIV prevention is unclear. Methods Two mathematical models were examined to explore this issue: a random mixing model and a compartmental model that distinguishes risk groups associated with sex work. In the compartmental model, two scenarios were developed, one calculating HIV transmission and prevalence in a context similar to the country of Botswana, and one similar to Nyanza Province, in western Kenya. Results In both models, male circumcision programs resulted in large and sustained declines in HIV prevalence over time among both men and women. Men benefited somewhat more than women, but prevalence among women was also reduced substantially. With 80% male circumcision uptake, the reductions in prevalence ranged from 45% to 67% in the two "countries", and with 50% uptake, from 25% to 41%. It would take over a decade for the intervention to reach its full effect. Conclusion Large-scale uptake of male circumcision services in African countries with high HIV prevalence, and where male circumcision is not now routinely practised, could lead to substantial reductions in HIV transmission and prevalence over time among both men and women.

  2. Determinants of circumcision and willingness to be circumcised by Rwandan men, 2010

    Directory of Open Access Journals (Sweden)

    Gasasira Rwego A

    2012-02-01

    Full Text Available Abstract Background Male Circumcision (MC has been recommended as one of the preventive measures against sexual HIV transmission by the World Health Organization (WHO. Rwanda has adopted MC as recommended but the country is a non-traditionally circumcising society. The objective was to explore knowledge and perception of Rwandan men on Male Circumcision (MC and to determine the factors associated with the willingness to be circumcised and to circumcise their sons. Methods This cross sectional study was conducted in 29 districts of Rwanda between January and March 2010. Data were collected using a structured questionnaire among men aged 15-59 years. The rate of MC was measured and its perception from respondents, and then the factors associated with the willingness to go for MC were analysed using multiple logistic regressions. Results A total of 1098 men were interviewed. Among respondents 17% (95% CI 14-19% reported being circumcised. About three-quarter (72% could define MC, but 37% of adolescent could not. Half of the participants were willing to get circumcised and 79% of men would accept circumcision for their sons. The main motivators for MC were its benefits in HIV/STI prevention (69% and improving hygiene (49%. Being too old was the main reason (32% reported by men reluctant to undergo MC and younger men were afraid of pain in particular those less than 19 years old (42%. The willingness to circumcise was significantly associated with younger age, living in the Eastern Province, marital status, and the knowledge of the preventive role of circumcision. Conclusions Adolescents and young adults were more willing to be circumcised. It is critical to ensure the availability of pain free services in order to satisfy the increasing demand for the scale up of MC in Rwanda.

  3. Notes from the Field: Tetanus Cases After Voluntary Medical Male Circumcision for HIV Prevention--Eastern and Southern Africa, 2012-2015.

    Science.gov (United States)

    Grund, Jonathan M; Toledo, Carlos; Davis, Stephanie M; Ridzon, Renee; Moturi, Edna; Scobie, Heather; Naouri, Boubker; Reed, Jason B; Njeuhmeli, Emmanuel; Thomas, Anne G; Benson, Francis Ndwiga; Sirengo, Martin W; Muyenzi, Leon Ngeruka; Lija, Gissenge J I; Rogers, John H; Mwanasalli, Salli; Odoyo-June, Elijah; Wamai, Nafuna; Kabuye, Geoffrey; Zulu, James Exnobert; Aceng, Jane Ruth; Bock, Naomi

    2016-01-22

    Voluntary medical male circumcision (VMMC) decreases the risk for female-to-male HIV transmission by approximately 60%, and the President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the scale-up of VMMC for adolescent and adult males in countries with high prevalence of human immunodeficiency virus (HIV) and low coverage of male circumcision. As of September 2015, PEPFAR has supported approximately 8.9 million VMMCs.

  4. Comparison of post circumcision complications and wound

    International Nuclear Information System (INIS)

    The objective of this study is to compare the frequency of post circumcision complications like bleeding and infection along with wound healing in infants by conventional open method and the bone-cutter method. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital and Military Hospital Rawalpindi, from March 2009 to March 2010. Patients and Methods: A total of 400 patients were included in the study that underwent circumcision. Patients were randomly allotted to either group A in whom the circumcision was done with conventional open technique (n = 200) or to group B, in whom circumcision was done with bone-cutter (n = 200). Patients were followed up in the surgical OPD after 5 days for assessment and earlier in case of any complication. Outcomes were measured by absence or presence of infection, post operative bleeding and cosmetic acceptance by the parents. Results: Comparison between the two groups showed that the bleeding rate was 8% in group A and 7% in group B (p = 0.704). Infection rate was 6% in group A and 5% in group B (p = 0.661). Delayed wound healing was seen in 4% of circumcisions in group A as opposed to 2% in group B ( p = 0.241). Conclusion: Complication is a part of any surgical procedure. So is the case with circumcision however no significant difference was found between the two procedures in terms of bleeding, infection, trauma to the glans and the cosmetic outcome. (author)

  5. Adult male circumcision with a circular stapler versus conventional circumcision: A prospective randomized clinical trial.

    Science.gov (United States)

    Jin, X D; Lu, J J; Liu, W H; Zhou, J; Yu, R K; Yu, B; Zhang, X J; Shen, B H

    2015-06-01

    Male circumcision is the most frequently performed procedure by urologists. Safety and efficacy of the circumcision procedure requires continual improvement. In the present study, we investigated the safety and efficacy of a new male circumcision technique involving the use of a circular stapler. In total, 879 consecutive adult male patients were randomly divided into 2 groups: 441 underwent stapler circumcision, and 438 underwent conventional circumcision. The operative time, pain score, blood loss volume, healing time, treatment costs, and postoperative complications were compared between the two groups. The operative time and blood loss volume were significantly lower in the stapler group than in the conventional group (6.8 ± 3.1 vs 24.2 ± 3.2 min and 1.8 ± 1.8 vs 9.4 ± 1.5 mL, respectively; Pcircumcision required removal of residual staple nails. Overall, the present study has shown that stapler circumcision is a time-efficient and safe male circumcision technique, although it requires further improvement.

  6. Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa

    NARCIS (Netherlands)

    N.J.D. Nagelkerke (Nico); S. Moses (Stephen); S.J. de Vlas (Sake); R.C. Bailey (Robert)

    2007-01-01

    textabstractBackground: Recent clinical trials in Africa, in combination with several observational epidemiological studies, have provided evidence that male circumcision can reduce HIV female-to-male transmission risk by 60% or more. However, the public health impact of large-scale male circumcisio

  7. Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark

    DEFF Research Database (Denmark)

    Frisch, Morten; Lindholm, Morten; Grønbæk, Morten

    2011-01-01

    One-third of the world's men are circumcised, but little is known about possible sexual consequences of male circumcision. In Denmark (~5% circumcised), we examined associations of male circumcision with a range of sexual measures in both sexes.......One-third of the world's men are circumcised, but little is known about possible sexual consequences of male circumcision. In Denmark (~5% circumcised), we examined associations of male circumcision with a range of sexual measures in both sexes....

  8. Achieving the HIV prevention impact of voluntary medical male circumcision: lessons and challenges for managing programs.

    Science.gov (United States)

    Sgaier, Sema K; Reed, Jason B; Thomas, Anne; Njeuhmeli, Emmanuel

    2014-05-01

    Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009-2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection "Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up." The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform.

  9. Ketamine-propofol sedation in circumcision

    Directory of Open Access Journals (Sweden)

    Handan Gulec

    2015-10-01

    Full Text Available ABSTRACTBACKGROUND AND OBJECTIVE: To compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation.METHODS: 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05 mg/kg + ketamine 3 mg/kg + atropine 0.02 mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II.RESULTS: In the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p > 0.050. Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20th min, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p < 0.050.CONCLUSION: Propofol-ketamine (Ketofol provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.

  10. Experience of Using Amniotic Membrane After Circumcision

    International Nuclear Information System (INIS)

    It is compulsory, for boys to undergone circumcision before getting adult in Moslem region. It can be done by General Surgeon, General Practitioner, Nurse, Midwife or Quack. The place to carry out the circumcision can be inside or outside hospital. The utmost problems are injections, point for secondary wound covering and delay of using underpants. To overcome those problem amniotic membranes can be used as wound covering, based on : they are soft, easy to shape wound surface, satisfactory adhesive properties, good elasticity and sufficient, transparency which allows wound control without redressing of the wound. From January until December 1999, 165 boys at an age between 6-10 years, which have been carried out circumcision, were evaluated. Radiation sterilized lyophilized amniotic membranes were used in this work as wound covering Result show that amniotic membrane gave a good result in wound healing. All the patients observed, showed early mobilization as well as early using underpants. There is no different result between circumcision which had been done either inside or out hospital, carried out by surgeon or non-surgeon

  11. Paediatric male circumcision and penile hygiene: a Japanese mothers' view.

    Science.gov (United States)

    Castro-Vázquez, Genaro

    2013-01-01

    This paper analyses the views of 20 Japanese mothers concerning paediatric male circumcision and penile hygiene. In Japan, routine male circumcision has never been implemented for newborns and children, and adult males are mostly circumcised at aesthetic clinics. However, media reports indicate a trend of Japanese mothers willing to have their sons circumcised. In discussing penile hygiene and male circumcision, the construct of a 'sexual script' becomes relevant to understanding how linguistic and gender barriers made references to male genitalia and penile hygiene largely appear as 'vulgar' and 'unfeminine' in daily life conversations. Peers were often identified as the main source of information and only mothers who have struggled with their children's penile infections have learnt about male genital hygiene, a domain of knowledge largely transmitted by men. Male circumcision becomes a double-edged sword that could help prevent penile infections but also an embarrassing conversational topic that could elicit discrimination because most Japanese children are uncircumcised. PMID:24152018

  12. Parental Decision Making in Male Circumcision

    OpenAIRE

    Sardi, Lauren; Livingston, Kathy

    2015-01-01

    Abstract Purpose: To study which healthcare professionals (HCPs) firstasked parents about their decision regarding circumcision; whether parents felt they were given enough information by their HCP; and what reasons parents cited for their decision. Study Design and Methods: Bilingual questionnaires were administered to parents and expecting parents of boys (N = 60). Close-ended survey responses were analyzed through factor analysis to ascertain what types of beliefs parents used in their dec...

  13. Female genital mutilation : Conditions of decline

    NARCIS (Netherlands)

    Caldwell, JC; Orubuloye, IO; Caldwell, P

    2000-01-01

    Female genital mutilation (or female circumcision) has been experienced by over 100 million women in sub-Saharan Africa and the Nile valley Efforts to suppress the practice were made in the earlier decades of the present century, especially by missionaries in Kenya in the 1920s and early 1930s. Succ

  14. [Long-term benefit of male circumcision to the reduction of urinary tract infections and genitourinary cancers in China].

    Science.gov (United States)

    Zhao, Fu-jun; Li, Philip S; Lü, Nian-qing; Lee, Richard; Peng, Yi-feng; Cheng, Feng; Li, Zheng; Xu, Hao-qin; Barone, Mark; Goldstein, Marc; Xia, Shu-jia

    2014-11-01

    Increasingly accumulated results from randomized controlled trials and other clinical studies have demonstrated that male circumcision reduces the risks of acquisition and transmission of HIV, HPV, HSV-2, and other sexually transmitted infections, and thus has a potential role in preventing cervical cancer, penile cancer and prostate cancer. The prevalence of male circumcision in China is currently less than 5%. The clinical evaluation studies and randomized controlled trials of the Shang Ring device showed excellent safety profiles, extremely high acceptability, and satisfaction among the participants and service providers in Africa and China. Given the recent recommendations by the World Health Organization and the Joint United Nations Program on HIV/AIDS (UNAIDS), voluntary medical male circumcision should be promoted in China at the national level as an important alternative intervention to reduce reproductive tract infections and prevent both males and females from reproductive tract cancers. More emphasis is required on the studies of the long-term health benefits of male circumcision in uro-andrology.

  15. Circumcision: The Good, the Bad and American Values

    Science.gov (United States)

    Buie, Mary E.

    2005-01-01

    National statistics estimate that 1.2 million newborn males are circumcised annually in the United States (70% to 80%). Such values as sanctity, equity, fraternity, paternity and liberty affect circumcision rates in America. The value of sanctity allows freedom of religious beliefs and traditions that often overcome medical impetus in…

  16. Acceptability of neonatal circumcision by pregnant women in KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Rogerio Phili

    2015-02-01

    Full Text Available Background: Studies on voluntary medical male circumcision (VMMC have provided convincing evidence on its efficacy to provide partial protection against female-to-male HIV transmission in circumcised men. The World Health Organization and UNAIDS subsequently formulated recommendations for VMMC implementation that included implementation of neonatal medical male circumcision (NMMC to all infants up to two months old. Knowledge regarding the acceptability of NMMC by pregnant women who are candidates for granting of consents for NMMC procedures or its ideal placement within health programmes is low.Objectives: We sought to establish NMMC acceptability by pregnant women and the feasibility of its integration within Maternal, Child and Women’s Health (MCWH programmes to inform implementation guidelines.Method: Nurses and counsellors at two public health facilities were trained to provide NMMC counselling and offer NMMC to 1778 pregnant women presenting for antenatal care services. Univariate and bivariate analyses were performed on data collected on NMMC acceptance and refusals. Thematic analysis was also performed on qualitative reasons for refusals.Results: Acceptability of NMMC by women was high (82.9%. Refusals resulted from the need for consultations with partners and/or family members prior to consenting (41.3%, fear of the procedure (23.8%, cultural reasons (15.9% and no reasons given (15.3%.Conclusion: The acceptability of NMMC by pregnant women and its integration with MCWH services was feasible. However socio-cultural factors, including the need for further consultation prior to consenting for NMMC procedures and preference of traditional circumcision by some women, need to be addressed in order to increase uptakes.

  17. Effects of Adult Male Circumcision on Premature Ejaculation: Results from a Prospective Study in China

    OpenAIRE

    Jingjing Gao; Chuan Xu; Jingjing Zhang; Chaozhao Liang; Puyu Su; Zhen Peng; Kai Shi; Dongdong Tang; Pan Gao; Zhaoxiang Lu; Jishuang Liu; Lei Xia; Jiajia Yang; Zongyao Hao; Jun Zhou

    2015-01-01

    The purpose of this study is to investigate the effects of adult male circumcision on premature ejaculation (PE). Therefore, between December 2009 and March 2014, a total of 575 circumcised men and 623 uncircumcised men (control group) were evaluated. Detailed evaluations (including circumcision and control groups) on PE were conducted before circumcision and at the 3-, 6-, 9-, and 12-month follow-up visits after circumcision. Self-estimated intravaginal ejaculatory latency time (IELT), Patie...

  18. Perceptions and knowledge of voluntary medical male circumcision for HIV prevention in traditionally non-circumcising communities in South Africa.

    Science.gov (United States)

    Hoffman, Jacob Robin; Arendse, Kirsten D; Larbi, Carl; Johnson, Naomi; Vivian, Lauraine M H

    2015-01-01

    Voluntary medical male circumcision (VMMC) has been recommended for the prevention of HIV transmission, particularly in sub-Saharan Africa. Uptake of the campaign has been relatively poor, particularly in traditionally non-circumcising regions. This study evaluates the knowledge, attitudes and practices of medical male circumcision (MC) of 104 community members exposed to promotional campaigns for VMMC for five years. Results show that 93% of participants have heard of circumcision and 72% have heard of some health benefit from the practice. However, detailed knowledge of the relationship with HIV infection is lacking: 12.2% mistakenly believed you could not get HIV after being circumcised, while 75.5% believe that a circumcised man is still susceptible and another 12.2% do not know of any relationship between HIV and MC. There are significant barriers to the uptake of the practice, including misperceptions and fear of complications commonly attributed to traditional, non-medical circumcision. However, 88.8% of participants believe circumcision is an acceptable practice, and community-specific promotional campaigns may increase uptake of the service.

  19. Epidemiology of complications of male circumcision in Ibadan, Nigeria

    Directory of Open Access Journals (Sweden)

    Ikuerowo Odunayo S

    2006-08-01

    Full Text Available Abstract Background The number of infants managed for neonatal circumcision injuries in our unit has been on the increase over the past 16 years. In our search for the sources and reasons for these injuries, we were unable to identify any previous studies of circumcision injuries from our environment. We therefore decided to carry out this study in order to shed some light on this growing problem. Methods The patients were made up of 370 consecutive consented children attending our infant welfare clinic for immunization over a period of 3 months. Information on their demographic data, their age at circumcision, where, why and who circumcised them was obtained from their mothers. They were clinically examined for the presence and type of complications of circumcision. Results Our circumcision rate was 87%. Neonatal circumcision had been performed in 270 (83.9% of the children. Two hundred and fifty nine (80.7% were performed in hospitals. The operation was done by nurses in 180 (55.9%, doctors in 113 (35.1% and by the traditional circumcisionist in 29 (9% of the children. Complications of circumcision occurred in 65 [20.2%] of the children. Of those who sustained these complications, 35 (53.8% had redundant foreskin, 16 (24.6% sustained excessive loss of foreskin, 11 (16.9% had skin bridges, 2 (3.1% sustained amputation of the glans penis and 1 (1.5% had a buried penis. One of the two children who had amputation of the glans also had severe hemorrhage and was transfused. Even though the complications tended to be more likely with nurses than with doctors or traditional circumcisionists, this did not reach statistical significance (p = 0.051. Conclusion We have a very high rate of complications of circumcision of 20.2%. We suggest that training workshops should be organized to adequately retrain all practitioners of circumcision on the safe methods available.

  20. Newborn Male Circumcision with Parental Consent, as Stated in the AAP Circumcision Policy Statement, Is Both Legal and Ethical.

    Science.gov (United States)

    Brady, Michael T

    2016-06-01

    Newborn male circumcision is a minor surgical procedure that has generated significant controversy. Accumulating evidence supports significant health benefits, most notably reductions in urinary tract infections, acquisition of HIV and a number of other sexually transmitted infections, penile cancer, phimosis, paraphimosis, balanitis and lichen sclerosis. While circumcision, like any surgical procedure, has risks for complications, they occur in less than 1 in 500 infants circumcised and most are minor and require minimal intervention. The CDC and the American Academy of Pediatrics (AAP) believe that health benefits of circumcision outweigh the risks. For this reason, the AAP believes that parents should be allowed to make the decision concerning circumcision of their male infants after receiving non-biased information on health risks and health benefits. PMID:27338601

  1. Newborn Male Circumcision with Parental Consent, as Stated in the AAP Circumcision Policy Statement, Is Both Legal and Ethical.

    Science.gov (United States)

    Brady, Michael T

    2016-06-01

    Newborn male circumcision is a minor surgical procedure that has generated significant controversy. Accumulating evidence supports significant health benefits, most notably reductions in urinary tract infections, acquisition of HIV and a number of other sexually transmitted infections, penile cancer, phimosis, paraphimosis, balanitis and lichen sclerosis. While circumcision, like any surgical procedure, has risks for complications, they occur in less than 1 in 500 infants circumcised and most are minor and require minimal intervention. The CDC and the American Academy of Pediatrics (AAP) believe that health benefits of circumcision outweigh the risks. For this reason, the AAP believes that parents should be allowed to make the decision concerning circumcision of their male infants after receiving non-biased information on health risks and health benefits.

  2. Surgical reimplantation of penile glans amputation in children during circumcision

    Directory of Open Access Journals (Sweden)

    Bouassida Khaireddine

    2014-01-01

    Full Text Available Circumcision is one of the oldest and most commonly performed surgical procedures. Unfortunately, various complications may occur during circumcision, ranging from trivial to tragic such as penile amputation which is a serious complication and a challenging injury to treat. We describe two cases of non-microsurgical successful reattachment of a distal penile glans which were amputated during circumcision. In the first case, a 5-year-old child underwent circumcision by an urologist under local anesthesia. In the second one, a 3-year-old child underwent circumcision by a general practitioner who used to make circumcision. In this article, the literature is reviewed; results and potential complications of this surgery are also discussed. Glans sensation was present, early morning erection was maintained, and there was an erectile response during penile manipulation in both cases. Although circumcision is not technically difficult, it should be taken seriously. The use of microsurgical reattachment is not always possible, especially in pediatric cases; it also requires special equipment and training.

  3. Does circumcision alter the periurethral uropathogenic bacterial flora

    Directory of Open Access Journals (Sweden)

    Mushtaq Ahmad Laway

    2012-01-01

    Full Text Available Background: The aim of this study was to assess the pattern of periurethral bacterial flora in uncircumcised boys and to evaluate the effect of circumcision on alteration of periurethral uropathogenic bacterial flora. Materials and Methods: Pattern of periurethral bacterial flora before and after circumcision was studied prospectively in 124 boys. The results were analysed to compare change in bacterial colonisation before and after circumcision. Results: The age range was 6 weeks to 96 months. Most (94.3% of the boys had religious indication and 5.7% had medical indication for circumcision. E. coli, Proteus and Klebsiella were most common periurethral bacterial flora in uncircumcised subjects. Coagulase-negative staphylococcus and Staphylococcus aureus was most common periurethral bacterial flora in circumcised subjects. In 66.1% of circumcised subjects, no bacteria were grown from periurethral region. Conclusion: We conclude that presence of prepuce is associated with great quantity of periurethral bacteria, greater likelihood of the presence of high concentration of uropathogens and high incidence of urinary tract infection (UTI. This study provides circumstantial evidence supporting the idea that early circumcision may be beneficial for prevention of UTI.

  4. Knowledge, attitudes and perceptions of pharmacy and nursing students towards male circumcision and HIV in a KwaZulu-Natal University, South Africa

    Directory of Open Access Journals (Sweden)

    Panjasaram V. Naidoo

    2012-07-01

    Full Text Available Background: Male circumcision is currently being promoted in South Africa as a HumanImmunodeficiency Virus (HIV prevention method. Effective implementation requires thathealthcare providers should believe in the procedure’s efficacy and should possess a positiveattitude. A study was undertaken amongst pharmacy and nursing students with differentobjectives.Objectives: To ascertain students’ knowledge, attitudes and perceptions regarding malecircumcision and (HIV prevention.Method: A descriptive cross-sectional study using anonymous questionnaires was undertakenamongst 4th year pharmacy and nursing students studying at a university in KwaZulu-Natal,after obtaining their consent. Data were captured and analysed using SPSS version 15.Results: A response rate of 83.18% and a mean knowledge score of 66.43% with relativelypositive attitudes (62.7 were obtained; 85.4% of the respondents felt that promoting malecircumcision is appropriate, with all Muslim students (n < 11 supporting the promotion ofmale circumcision. Even though all Muslim students supported male circumcision, only 3students were willing to perform the procedure if adequately trained (p < 0.03. The majorityof the female students were unwilling to perform the procedure (p < 0.005. A third of therespondents indicated that male circumcision would both undermine existing protectivebehaviours and strategies as well as increase riskier sexual behaviour. Over 54% of therespondents believed that the South African Health System would be able to cope with themassive male circumcision drive. The majority of the respondents favoured the procedure tobe done at birth. Pain was cited as the most important reason for not wanting to be circumcised.Conclusion: Pharmacy and nursing students have a moderate knowledge of male circumcisionand HIV prevention with relatively positive attitudes. The majority felt that promoting malecircumcision is appropriate and should be encouraged.

  5. "If You Are Not Circumcised, I Cannot Say Yes": The Role of Women in Promoting the Uptake of Voluntary Medical Male Circumcision in Tanzania.

    Directory of Open Access Journals (Sweden)

    Haika Osaki

    Full Text Available Voluntary Medical Male Circumcision (VMMC for HIV prevention in Tanzania was introduced by the Ministry of Health and Social Welfare in 2010 as part of the national HIV prevention strategy. A qualitative study was conducted prior to a cluster randomized trial which tested effective strategies to increase VMMC up take among men aged ≥20 years. During the formative qualitative study, we conducted in-depth interviews with circumcised males (n = 14, uncircumcised males (n = 16, and participatory group discussions (n = 20 with men and women aged 20-49 years in Njombe and Tabora regions of Tanzania. Participants reported that mothers and female partners have an important influence on men's decisions to seek VMMC both directly by denying sex, and indirectly through discussion, advice and providing information on VMMC to uncircumcised partners and sons. Our findings suggest that in Tanzania and potentially other settings, an expanded role for women in VMMC communication strategies could increase adult male uptake of VMMC services.

  6. Should Male Circumcision be Advocated for Genital Cancer Prevention?

    OpenAIRE

    Morris, Brian J.; Mindel, Adrian; Tobian, Aaron AR; Hankins, Catherine A.; Ronald H Gray; Bailey, Robert C.; Bosch, Xavier; Wodak, Alex D

    2012-01-01

    The recent policy statement by the Cancer Council of Australia on infant circumcision and cancer prevention and the announcement that the quadrivalent human papillomavirus (HPV) vaccine will be made available for boys in Australia prompted us to provide an assessment of genital cancer prevention. While HPV vaccination of boys should help reduce anal cancer in homosexual men and cervical cancer in women, it will have little or no impact on penile or prostate cancer. Male circumcision can reduc...

  7. How do you circumcise a nation? The Rwandan case study

    OpenAIRE

    Mutabazi, Vincent; Forrest, Jamie I; Ford, Nathan; Mills, Edward J

    2014-01-01

    Voluntary medical male circumcision has been conclusively demonstrated to reduce the lifetime risk of male acquisition of HIV. The strategy has been adopted as a component of a comprehensive strategy towards achieving an AIDS-free generation. A number of countries in which prevalence of HIV is high and circumcision is low have been identified as a priority, where innovative approaches to scale-up are currently being explored. Rwanda, as one of the priority countries, has faced a number of cha...

  8. Paediatric sutureless circumcision-an alternative to the standard technique.

    LENUS (Irish Health Repository)

    2012-01-31

    INTRODUCTION: Circumcision is one of the most commonly performed surgical procedures in male children. A range of surgical techniques exist for this commonly performed procedure. The aim of this study is to assess the safety, functional outcome and cosmetic appearance of a sutureless circumcision technique. METHODS: Over a 9-year period, 502 consecutive primary sutureless circumcisions were performed by a single surgeon. All 502 cases were entered prospectively into a database including all relevant clinical details and a review was performed. The technique used to perform the sutureless circumcision is a modification of the standard sleeve technique with the use of a bipolar diathermy and the application of 2-octyl cyanoacrylate (2-OCA) to approximate the tissue edges. RESULTS: All boys in this study were pre-pubescent and the ages ranged from 6 months to 12 years (mean age 3.5 years). All patients had this procedure performed as a day case and under general anaesthetic. Complications included: haemorrhage (2.2%), haematoma (1.4%), wound infection (4%), allergic reaction (0.2%) and wound dehiscence (0.8%). Only 9 (1.8%) parents or patients were dissatisfied with the cosmetic appearance. CONCLUSION: The use of 2-OCA as a tissue adhesive for sutureless circumcisions is an alternative to the standard suture technique. The use of this tissue adhesive, 2-OCA, results in comparable complication rates to the standard circumcision technique and results in excellent post-operative cosmetic satisfaction.

  9. Traditional Male Circumcision In A Rural Community In Kedah, Malaysia

    Directory of Open Access Journals (Sweden)

    Rashid A K

    2009-12-01

    Full Text Available Background: Circumcision though not mentioned inthe Quran is believed to be a compulsory practiceamong the Muslims. In Malaysia, although there areseveral methods of circumcision available andtraditional circumcision is still popular.Methods: A cross-sectional survey was carried out in asmall fishing village of Kedah to study the methods ofcircumcision available to the villagers. This wasfollowed with an in-depth interview conducted with‘Tok Mudim’, a practitioner of traditional method ofcircumcision.Results: Forty three of the eligible 71 subjectsparticipated in the study giving the response rate as60.5%. The most common age for circumcision was9 years old. Despite private clinics being the mostcommon place of circumcisions, there was an increasingnumber of boys going to the ‘Tok Mudim’ forcircumcision. A Mass Circumcision Ceremony istraditionally practiced. The ‘Tok Mudim’ described theprocedure in detail and was of the opinion that thereason traditional method is still popular was because ofthe fear of injections and impotency among the parents.Most common complication faced by the ‘Tok Mudim’was bleeding and infection.Discussion and Conclusion: Till the community shiftsentirely to using modern medicine, there is a need tointegrate traditional practitioners into the system.Training the ‘Tok Mudim’ to use modern instrumentsand aseptic techniques should be considered.

  10. Influence of circumcision technique on frequency of urinary tract infections in neonates.

    Science.gov (United States)

    Harel, Liora; Straussbergr, Rachel; Jackson, Shlomo; Amir, Jacob; Tiqwa, Petah

    2002-09-01

    An increase in urinary tract infection (UTI) during the first weeks after traditional Jewish circumcision has been reported. Circumcision can be performed by a nonmedical person (mohel) or by a physician, with the main difference being in hemostasis techniques. We assessed the effect of circumcision procedure on development of UTI in neonates. Circumcision performed by a mohel was associated with higher incidence of UTI compared with that by physicians. Hemostasis technique and shaft wrapping are postulated risk factors.

  11. Circumcision for the prevention of significant bacteriuria in boys.

    Science.gov (United States)

    Nayir, A

    2001-12-01

    The aim of this study was to determine whether circumcision affects significant bacteriuria in boys. During a 60-month prospective study, 100 boys with microbiologically confirmed symptomatic urinary tract infection (UTI) were evaluated. Twelve patients with abnormal ultrasonography findings were excluded from the study. Eighteen of the boys had not been circumcised due to parental choice. The remaining 70 boys with normal renal ultrasonography were randomly allocated into two groups. In the first group 35 boys ranging in age from 6 months to 10 years (mean 33.2+/-30.9 months) were observed for 6 months and urinary cultures were taken monthly. When they had a positive urine culture (with or without any symptoms), they received antibiotic treatment. After 6 months they were circumcised and then observed for another 6-month period. Group 2 comprised 35 boys aged from 3 months to 9 years (mean 29.1+/-36.7 months). They were circumcised immediately after the first UTI and were followed for 6 months. Urine samples were obtained by the bag technique in infants and by the mid-stream technique in older patients. In the uncircumcised group, the rate of significant bacteriuria per patient did not change in two 6-month follow-up periods (3.46+/-0.91 and 3.33+/-0.97 episodes). In group 1, the rate of positive urine cultures dropped from 3.57+/-1.11 to 0.14+/-0.35 episodes after circumcision (Pcircumcision. Among the uncircumcised patients, symptomatic UTI was observed in 6 cases (3 cases in the first period of group 1, 1 case in the first and 2 cases in the second period of the uncircumcised group), whereas after circumcision no patient had symptomatic UTI. The mean age at circumcision was 42.7+/-28.4 months. No complication due to circumcision occurred in any patient. UTI may also occur in boys after the 1st year of life. The present study indicated that circumcision in boys decreases the rate of positive urine cultures. Therefore circumcision could be considered as a part of

  12. The Effect of Health Education Program for Caregivers on Circumcision Outcome in Neonates and Infants

    Science.gov (United States)

    Gafer, Youser abd Elsalam; Nafee, Houda Mohammed; Pal, Kamlish

    2015-01-01

    Circumcision is a surgical excision of the foreskin to the level of the coronal sulcus which may perform in the neonatal period or in later life. Circumcision has many medical benefits such as minimizing urinary tract infection, reduces the incidence of balanitis and enhances of penile hygiene, prevents of penile cancer. However, Circumcision may…

  13. AB221. Effects of adult male circumcision on premature ejaculation: results from a prospective study in China

    OpenAIRE

    Gao, Jingjing; Xu, Chuan; Zhang, Xiansheng

    2016-01-01

    Objective The purpose of this study is to investigate the effects of adult male circumcision on premature ejaculation (PE). Methods Therefore, between December 2009 and March 2014, a total of 575 circumcised men and 623 uncircumcised men (control group) were evaluated. Detailed evaluations (including circumcision and control groups) on PE were conducted before circumcision and at the 3-, 6-, 9-, and 12-month follow-up visits after circumcision. Self-estimated intravaginal ejaculatory latency ...

  14. [Ethical Evaluation of Non-Therapeutic Male Circumcision].

    Science.gov (United States)

    İzgi, M Cumhur

    2015-01-01

    Elective circumcision for nonmedical reasons is a surgical approach which is historically long standing and accepted as the most performed procedure. The necessity of the procedure is usually for religious and traditional reasons alongside some medical ground related benefits to enable its social acceptability. The discussion of the subject from the aspect of ethics becomes necessary as there is no consensus about the benefits or harmfulness of nonmedical circumcision. Fundamental ethical discussions about circumcision, which contradicts legal acceptance criteria of any medical application, are related to the basic concepts of the existence of an individual such as sovereignty, the loss of bodily integrity, and privacy. The recent legal processes and the fact that the European Council and the American Academy of Pediatrics have put the issue on their agenda have increased the necessity of these ethical evaluations. The responsibility of consideration and evaluation of ethical permission of every circumcision procedure, besides discussing the necessity of circumcision for improvement and protection of health rests on the shoulders of the physicians because the dignity and intellectual identity of the profession require so. PMID:26364175

  15. [Ethical Evaluation of Non-Therapeutic Male Circumcision].

    Science.gov (United States)

    İzgi, M Cumhur

    2015-01-01

    Elective circumcision for nonmedical reasons is a surgical approach which is historically long standing and accepted as the most performed procedure. The necessity of the procedure is usually for religious and traditional reasons alongside some medical ground related benefits to enable its social acceptability. The discussion of the subject from the aspect of ethics becomes necessary as there is no consensus about the benefits or harmfulness of nonmedical circumcision. Fundamental ethical discussions about circumcision, which contradicts legal acceptance criteria of any medical application, are related to the basic concepts of the existence of an individual such as sovereignty, the loss of bodily integrity, and privacy. The recent legal processes and the fact that the European Council and the American Academy of Pediatrics have put the issue on their agenda have increased the necessity of these ethical evaluations. The responsibility of consideration and evaluation of ethical permission of every circumcision procedure, besides discussing the necessity of circumcision for improvement and protection of health rests on the shoulders of the physicians because the dignity and intellectual identity of the profession require so.

  16. Voluntary medical male circumcision: a cross-sectional study comparing circumcision self-report and physical examination findings in Lesotho.

    Directory of Open Access Journals (Sweden)

    Anne Goldzier Thomas

    Full Text Available BACKGROUND: Overwhelming evidence, including three clinical trials, shows that male circumcision (MC reduces the risk of HIV infection among men. However, data from recent Lesotho Demographic and Health Surveys do not demonstrate MC to be protective against HIV. These contradictory findings could partially be due to inaccurate self-reported MC status used to estimate MC prevalence. This study describes MC characteristics among men applying for Lesotho Defence Force recruitment and seeks to assess MC self-reported accuracy through comparison with physical-examination-based data. METHODS AND FINDINGS: During Lesotho Defence Force applicant screening in 2009, 241 (77% of 312 men, aged 18-25 y, consented to a self-administered demographic and MC characteristic survey and physician-performed genital examination. The extent of foreskin removal was graded on a scale of 1 (no evidence of MC to 4 (complete MC. MC was self-reported by 27% (n = 64/239 of participants. Of the 64 men self-reporting being circumcised, physical exam showed that 23% had no evidence of circumcision, 27% had partial circumcision, and 50% had complete circumcision. Of the MCs reportedly performed by a medical provider, 3% were Grade 1 and 73% were Grade 4. Of the MCs reportedly performed by traditional circumcisers, 41% were Grade 1, while 28% were Grade 4. Among participants self-reporting being circumcised, the odds of MC status misclassification were seven times higher among those reportedly circumcised by initiation school personnel (odds ratio = 7.22; 95% CI = 2.29-22.75. CONCLUSIONS: Approximately 27% of participants self-reported being circumcised. However, only 50% of these men had complete MC as determined by a physical exam. Given this low MC self-report accuracy, countries scaling up voluntary medical MC (VMMC should obtain physical-exam-based MC data to guide service delivery and cost estimates. HIV prevention messages promoting VMMC should provide

  17. Female genital mutilation : a hidden epidemic (statement from the European Academy of Paediatrics)

    NARCIS (Netherlands)

    Sauer, Pieter J. J.; Neubauer, David

    2014-01-01

    Female genital mutilation or female circumcision is frequently performed worldwide. It is estimated by the World Health Organisation that worldwide, 100-140 million girls and women currently have to live with the consequences of female genital mutilation. The article argues that the tradition is one

  18. Complications of Circumcision in Childhood and Preventive Strategies

    Directory of Open Access Journals (Sweden)

    Akgun Oral

    2011-10-01

    Full Text Available Circumcision is the most common surgical procedure applied worldwide. Besides the medical necessities, it is also common due to religious and cultural reasons. The frequent performance of this surgical procedure increases the importance of the management of the complications arising during/after the operation. In our country performing this procedure under the improper conditions especially by non-medical persons or inexperienced operators increases the likelihood of complications, which sometimes causes non-recoverable tissue and organ loss. The persons performing this surgical procedure must be well acquainted with the complications which may arise during/after a circumcision procedure. For this reason, the possible complications regarding a circumcision procedure should be classified. Within this context, the required suggestions are presented in this article to reduce the complications to a minimal level. [TAF Prev Med Bull 2011; 10(5.000: 605-610

  19. Towards a solution concerning female genital mutilation? An approach from within according to Islamic legal opinions

    Directory of Open Access Journals (Sweden)

    Jens Kutscher

    2011-01-01

    Full Text Available Female circumcision is a tradition that is widespread and not restricted to predominantly Muslim countries. It is prevalent among all religious groups in many parts of Africa and Western Asia, whether they are Coptic Christians, Ethiopian Jews, or Arab Muslims. Female genital cutting or—more to the point—female genital mutilation (FGM, generally referred to as circumcision, occurs in at least five different forms. Circumcision is essentially a powerful bodily sign of the human—male and female—covenant with God. In the Quran it is reaffirmed in sura al-Nahl and quoted as example in the fatwas endorsing circumcision. It seems to be true that men are hardly involved in the actual decision in favour of female genital cutting. A man should not interfere in the decision of women to be circumcised. It is practiced and transmitted among women and midwives. Only sometimes is a (male or female physician involved. On the basis of Islamic normativity, mirrored in fatwas, this paper aims to examine a very ambivalent approach concerning female genital mutilation.

  20. Barriers and motivators to voluntary medical male circumcision uptake among different age groups of men in Zimbabwe: results from a mixed methods study.

    Directory of Open Access Journals (Sweden)

    Karin Hatzold

    Full Text Available BACKGROUND: We conducted quantitative and qualitative studies to explore barriers and motivating factors to VMMC for HIV prevention, and to assess utilization of existing VMMC communication channels. METHODS AND FINDINGS: A population-based survey was conducted with 2350 respondents aged 15-49. Analysis consisted of descriptive statistics and bivariate analysis between circumcision and selected demographics. Logistic regression was used to determine predictors of male circumcision uptake compared to intention to circumcise. Focus group discussions (FGDs were held with men purposively selected to represent a range of ethnicities. 68% and 53% of female/male respondents, respectively, had heard about VMMC for HIV prevention, mostly through the radio (71%. Among male respondents, 11.3% reported being circumcised and 49% reported willingness to undergo VMMC. Factors which men reported motivated them to undergo VMMC included HIV/STI prevention (44%, improved hygiene (26%, enhanced sexual performance (6% and cervical cancer prevention for partner (6%. Factors that deterred men from undergoing VMMC included fear of pain (40%, not believing that they were at risk of HIV (18%, lack of partner support (6%. Additionally, there were differences in motivators and barriers by age. FGDs suggested additional barriers including fear of HIV testing, partner refusal, reluctance to abstain from sex and myths and misconceptions. CONCLUSIONS: VMMC demand-creation messages need to be specifically tailored for different ages and should emphasize non-HIV prevention benefits, such as improved hygiene and sexual appeal, and need to address men's fear of pain. Promoting VMMC among women is crucial as they appear to have considerable influence over men's decision to get circumcised.

  1. Perceptions of HIV and Safe Male Circumcision in High HIV Prevalence Fishing Communities on Lake Victoria, Uganda.

    Directory of Open Access Journals (Sweden)

    Paul E Nevin

    Full Text Available In 2010, the Uganda Ministry of Health introduced its Safe Male Circumcision (SMC strategy for HIV prevention with the goal of providing 4.2 million voluntary medical male circumcisions by 2015. Fishing communities, where HIV prevalence is approximately 3-5 times higher than the national average, have been identified as a key population needing targeted HIV prevention services by the National HIV Prevention Strategy. This study aimed to understand perceptions of HIV and identify potential barriers and facilitators to SMC in fishing communities along Lake Victoria.We conducted 8 focus group discussions, stratified by sex and age, with 67 purposefully sampled participants in 4 communities in Kalangala District, Uganda.There was universal knowledge of the availability of SMC services, but males reported high uptake in the community while females indicated that it is low. Improved hygiene, disease prevention, and improved sexual performance and desirability were reported facilitators. Barriers included a perceived increase in SMC recipients' physiological libido, post-surgical abstinence, lost income during convalescence, and lengthier recovery due to occupational hazards. Both males and females reported concerns about spousal fidelity during post-SMC abstinence. Reported misconceptions and community-held cultural beliefs include fear that foreskins are sold after their removal, the belief that a SMC recipient's first sexual partner after the procedure should not be his spouse, and the belief that vaginal fluids aid circumcision wound healing.Previous outreach efforts have effectively reached these remote communities, where availability and health benefits of SMC are widely understood. However, community-specific intervention strategies are needed to address the barriers identified in this study. We recommend the development of targeted counseling, outreach, and communication strategies to address barriers, misconceptions, and community-held beliefs

  2. Effects of adult male circumcision on premature ejaculation: results from a prospective study in China.

    Science.gov (United States)

    Gao, Jingjing; Xu, Chuan; Zhang, Jingjing; Liang, Chaozhao; Su, Puyu; Peng, Zhen; Shi, Kai; Tang, Dongdong; Gao, Pan; Lu, Zhaoxiang; Liu, Jishuang; Xia, Lei; Yang, Jiajia; Hao, Zongyao; Zhou, Jun; Zhang, Xiansheng

    2015-01-01

    The purpose of this study is to investigate the effects of adult male circumcision on premature ejaculation (PE). Therefore, between December 2009 and March 2014, a total of 575 circumcised men and 623 uncircumcised men (control group) were evaluated. Detailed evaluations (including circumcision and control groups) on PE were conducted before circumcision and at the 3-, 6-, 9-, and 12-month follow-up visits after circumcision. Self-estimated intravaginal ejaculatory latency time (IELT), Patient-Reported Outcome measures, and 5-item version of the International Index of Erectile Function were used to measure the ejaculatory and erectile function for all subjects. The results showed that, during the one-year follow-up, men after circumcision experienced higher IELT and better scores of control over ejaculation, satisfaction with sexual intercourse, and severity of PE than men before circumcision (P circumcised men reported significantly improved IELT, control over ejaculation, and satisfaction with sexual intercourse (P circumcision might have positive effects on IELT, ejaculatory control, sexual satisfaction, and PE severity. In addition, circumcision was significantly associated with the development of PE.

  3. Effects of Adult Male Circumcision on Premature Ejaculation: Results from a Prospective Study in China

    Directory of Open Access Journals (Sweden)

    Jingjing Gao

    2015-01-01

    Full Text Available The purpose of this study is to investigate the effects of adult male circumcision on premature ejaculation (PE. Therefore, between December 2009 and March 2014, a total of 575 circumcised men and 623 uncircumcised men (control group were evaluated. Detailed evaluations (including circumcision and control groups on PE were conducted before circumcision and at the 3-, 6-, 9-, and 12-month follow-up visits after circumcision. Self-estimated intravaginal ejaculatory latency time (IELT, Patient-Reported Outcome measures, and 5-item version of the International Index of Erectile Function were used to measure the ejaculatory and erectile function for all subjects. The results showed that, during the one-year follow-up, men after circumcision experienced higher IELT and better scores of control over ejaculation, satisfaction with sexual intercourse, and severity of PE than men before circumcision (P<0.001 for all. Similarly, when compared with the control group, the circumcised men reported significantly improved IELT, control over ejaculation, and satisfaction with sexual intercourse (P<0.001 for all. These findings suggested that circumcision might have positive effects on IELT, ejaculatory control, sexual satisfaction, and PE severity. In addition, circumcision was significantly associated with the development of PE.

  4. Male circumcision in the general population of Kisumu, Kenya: beliefs about protection, risk behaviors, HIV, and STIs.

    Directory of Open Access Journals (Sweden)

    Matthew Westercamp

    Full Text Available Using a population-based survey we examined the behaviors, beliefs, and HIV/HSV-2 serostatus of men and women in the traditionally non-circumcising community of Kisumu, Kenya prior to establishment of voluntary medical male circumcision services. A total of 749 men and 906 women participated. Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with understanding that circumcised men are less likely to become infected with HIV.

  5. Low frequency of male circumcision and unwillingness to be circumcised among MSM in Buenos Aires, Argentina: association with sexually transmitted infections

    Directory of Open Access Journals (Sweden)

    María A Pando

    2013-06-01

    Full Text Available Objective: The aims of this study were to investigate the frequency of male circumcision among men who have sex with men (MSM in Buenos Aires, Argentina; the association between circumcision and sexually transmitted infections (STIs; and, among those uncircumcised, the willingness to be circumcised. Methods: A cross-sectional study was conducted among 500 MSM recruited through the respondent-driven sampling (RDS technique. Participants underwent a consent process, responded to a Web-based survey that included questions on demographic information, sexual behaviour, and circumcision and provided biological samples. HIV, hepatitis B virus (HBV, hepatitis C virus (HCV, Treponema pallidum, and human papiloma virus (HPV diagnoses were performed using standard methodologies. For all analyses, data were weighted based on participants’ network size. Results: Only 64 (13% of the 500 MSM in our study reported being circumcised. Among uncircumcised men (n=418, 302 (70.4% said that they would not be willing to get circumcised even if the procedure could reduce the risk of HIV infection. When considering all participants, circumcision status was not significantly associated with HIV, HBV, HCV, T. pallidum or HPV infections. However, when we restricted the sample to men who do not practice receptive anal intercourse (RAI and compared circumcised to uncircumcised men, the former (N=33 had no cases of HIV infection, while 34 of 231 (14.8% uncircumcised men were HIV positive (p=0.020. Regarding HPV, uncircumcised men had a significantly larger number of different HPV types compared with circumcised men (mean 1.83 vs. 1.09, p<0.001 and a higher frequency of high-risk-HPV genotypes (47.6% vs. 12.5%, p=0.012. Conclusions: Consistent with international evidence, male circumcision appears to have a partial protective effect among MSM. The efficacy of circumcision in reducing risk of HIV infection among MSM appears to be correlated with sexual practices. Given the

  6. "When I was circumcised I was taught certain things": risk compensation and protective sexual behavior among circumcised men in Kisumu, Kenya.

    Directory of Open Access Journals (Sweden)

    Thomas H Riess

    Full Text Available BACKGROUND: Male circumcision has been shown to reduce the transmission of HIV from women to men through vaginal sex by approximately 60%. There is concern that men may engage in risk compensation after becoming circumcised, diminishing the benefits of male circumcision. METHODS AND FINDINGS: We conducted qualitative interviews with 30 sexually active circumcised men in Kisumu, Kenya from March to November 2008. Most respondents reported no behavior change or increasing protective sexual behaviors including increasing condom use and reducing the number of sexual partners. A minority of men reported engaging in higher risk behaviors either not using condoms or increasing the number of sex partners. Circumcised respondents described being able to perform more rounds of sex, easier condom use, and fewer cuts on the penis during sex. CONCLUSIONS: Results illustrate that information about MC's protection against HIV has disseminated into the larger community and MC accompanied by counseling and HIV testing can foster positive behavior change and maintain sexual behavior.

  7. Risk factors for HIV infection among circumcised men in Uganda: a case-control study

    Directory of Open Access Journals (Sweden)

    Michael Ediau

    2015-01-01

    Full Text Available Introduction: Male circumcision (MC reduces the risk of HIV infection. However, the risk reduction effect of MC can be modified by type of circumcision (medical, traditional and religious and sexual risk behaviours post-circumcision. Understanding the risk behaviours associated with HIV infection among circumcised men (regardless of form of circumcision is critical to the design of comprehensive risk reduction interventions. This study assessed risk factors for HIV infection among men circumcised through various circumcision approaches. Methods: This was a case-control study which enrolled 155 cases (HIV-infected and 155 controls (HIV-uninfected, all of whom were men aged 18–35 years presenting at the AIDS Information Center for HIV testing and care. The outcome variable was HIV sero-status. Using SPSS version 17, multivariable logistic regression was performed to identify factors independently associated with HIV infection. Results: Overall, 83.9% among cases and 56.8% among controls were traditionally circumcised; 7.7% of cases and 21.3% of controls were religiously circumcised while 8.4% of cases and 21.9% of controls were medically circumcised. A higher proportion of cases than controls reported resuming sexual intercourse before complete wound healing (36.9% vs. 14.1%; p18 years (AOR: 5.0, CI: 2.4–10.2; resuming sexual intercourse before wound healing (AOR: 3.4, CI: 1.6–7.3; inconsistent use of condoms (AOR: 2.7, CI: 1.5–5.1; and having sexual intercourse under the influence of peers (AOR: 2.9, CI: 1.5–5.5. Men who had religious circumcision were less likely to have HIV infection (AOR: 0.4, 95% CI: 0.2–0.9 than the traditionally circumcised but there was no statistically significant difference between those who were traditionally circumcised and those who were medically circumcised (AOR: 0.40, 95% CI: 0.1–1.1. Conclusions: Being circumcised at adulthood, resumption of sexual intercourse before wound healing, inconsistent

  8. Towards a gender perspective in qualitative research on voluntary medical male circumcision in east and southern Africa.

    Science.gov (United States)

    Martínez Pérez, Guillermo; Triviño Durán, Laura; Gasch, Angel; Desmond, Nicole

    2015-01-01

    The World Health Organization endorsed voluntary medical male circumcision (VMMC) in 2007 as an effective method to provide partial protection against heterosexual female-to-male transmission of HIV in regions with high rates of such transmission, and where uptake of VMMC is low. Qualitative research conducted in east and southern Africa has focused on assessing acceptability, barriers to uptake of VMMC and the likelihood of VMMC increasing men's adoption of risky sexual behaviours. Less researched, however, have been the perceptions of women and sexual minorities towards VMMC, even though they are more vulnerable to HIV/AIDS transmission than are heterosexual men. The purpose of this paper is to identify core areas in which a gendered perspective in qualitative research might improve the understanding and framing of VMMC in east and southern Africa. Issues explored in this analysis are risk compensation, the post-circumcision appearance of the penis, inclusion of men who have sex with men as study respondents and the antagonistic relation between VMMC and female genital cutting. If biomedical and social science researchers explore these issues in future qualitative inquiry utilising a gendered perspective, a more thorough understanding of VMMC can be achieved, which could ultimately inform policy and implementation. PMID:25727455

  9. Coping with Aversive Stimulation in the Neonatal Period: Quiet Sleep and Plasma Cortisol Levels during Recovery from Circumcision.

    Science.gov (United States)

    Gunnar, Megan R.; And Others

    1985-01-01

    Determines the time course of circulating cortisol following circumcision in 80 healthy newborns and investigates whether changes in behavioral state following circumcision in anyway paralleled the adrenocortical time course. Adrenocortical and behavioral data indicated that subjects were able to cope with circumcision trauma. Cortisol levels…

  10. Cost-effectiveness of newborn circumcision in reducing lifetime HIV risk among U.S. males.

    Directory of Open Access Journals (Sweden)

    Stephanie L Sansom

    Full Text Available BACKGROUND: HIV incidence was substantially lower among circumcised versus uncircumcised heterosexual African men in three clinical trials. Based on those findings, we modeled the potential effect of newborn male circumcision on a U.S. male's lifetime risk of HIV, including associated costs and quality-adjusted life-years saved. METHODOLOGY/PRINCIPAL FINDINGS: Given published estimates of U.S. males' lifetime HIV risk, we calculated the fraction of lifetime risk attributable to heterosexual behavior from 2005-2006 HIV surveillance data. We assumed 60% efficacy of circumcision in reducing heterosexually-acquired HIV over a lifetime, and varied efficacy in sensitivity analyses. We calculated differences in lifetime HIV risk, expected HIV treatment costs and quality-adjusted life years (QALYs among circumcised versus uncircumcised males. The main outcome measure was cost per HIV-related QALY saved. Circumcision reduced the lifetime HIV risk among all males by 15.7% in the base case analysis, ranging from 7.9% for white males to 20.9% for black males. Newborn circumcision was a cost-saving HIV prevention intervention for all, black and Hispanic males. The net cost of newborn circumcision per QALY saved was $87,792 for white males. Results were most sensitive to the discount rate, and circumcision efficacy and cost. CONCLUSIONS/SIGNIFICANCE: Newborn circumcision resulted in lower expected HIV-related treatment costs and a slight increase in QALYs. It reduced the 1.87% lifetime risk of HIV among all males by about 16%. The effect varied substantially by race and ethnicity. Racial and ethnic groups who could benefit the most from circumcision may have least access to it due to insurance coverage and state Medicaid policies, and these financial barriers should be addressed. More data on the long-term protective effect of circumcision on heterosexual males as well as on its efficacy in preventing HIV among MSM would be useful.

  11. Male circumcision: care practices and attitudes in a Muslim community of western Nepal

    Directory of Open Access Journals (Sweden)

    Mohan Paudel

    2011-03-01

    Full Text Available

    Abstract:
    Background: Male circumcision is a removal of the foreskin of the glans penis. There are medical, ritual and religious reasons for male circumcision. The purpose of this study is to explore the current practices, perceptions, future recommendations and health seeking behavior during and after performing male circumcision in a Muslim community of western Nepal. Method: A total of 64 households were sampled by a simple random sampling method. Information was collected using semi-structured questionnaires and focus group discussions. Result: Circumcision was practiced among all Muslim households and the main reason was religious rite and ritual. It was the traditional circumciser, locally known as hazam, who circumcised all male children in the community. Interestingly, in only 5 % of the household children had been circumcised using modern medicines. The rest of the households, i.e. 95%, relied on traditional healing systems, the use of local herbs and homemade ointments (mainly the suspension of ghee and ash.A Non-sterilized knife was the main surgical instrument used during circumcision. The wound healing after circumcision was much longer, even up to 90 days or more. Conclusions: Circumcision is a practice that is still largely carried out outside the domain of the formal health care system in this community. It demands a design of service delivery models from health policy makers in the Ministry of Health, thus bringing circumcision within formal health care systems in those communities. It deserves an urgent attention to provide safe, culturally acceptable and sustainable services from health institutions.

  12. Modeling the population-level effects of male circumcision as an HIV-preventive measure: a gendered perspective.

    Directory of Open Access Journals (Sweden)

    Jonathan Dushoff

    Full Text Available BACKGROUND: Evidence from biological, epidemiological, and controlled intervention studies has demonstrated that male circumcision (MC protects males from HIV infection, and MC is now advocated as a public-health intervention against HIV. MC provides direct protection only to men, but is expected to provide indirect protection to women at risk of acquiring HIV from heterosexual transmission. How such indirect protection interacts with the possibility that MC campaigns will lead to behavior changes, however, is not yet well understood. Our objective here is to investigate the link between individual-level effects of MC campaigns and long-term population-level outcomes resulting from disease dynamics, looking at both genders separately, over a broad range of parameters. METHODS AND FINDINGS: We use simple mathematical models of heterosexual transmission to investigate the potential effects of a circumcision scale-up, combined with possible associated behavioral disinhibition. We examine patterns in expected long-term prevalence using a simple equilibrium model based on transmission factors, and validate our results with ODE-based simulations, focusing on the link between effects on females and those on males.We find that the long-term population-level effects on females and males are not strongly linked: there are many possible ways in which an intervention which reduces prevalence in males might nonetheless increase prevalence in females. CONCLUSIONS: Since an intervention that reduces long-term male prevalence could nonetheless increase long-term female prevalence, MC campaigns should explicitly consider both the short-term and long-term effects of MC interventions on females. Our findings strongly underline the importance of pairing MC programs with education, support programs and HIV testing and counseling, together with other prevention measures.

  13. Circumcision using CO2 laser: report of 860 cases

    Science.gov (United States)

    Chen, Wen B.; Chen, Zi-Fu; Zhan, Tian-qi; Gao, Xiang-Xun; Huang, Chao

    1993-03-01

    Eight-hundred-sixty cases of circumcision using CO2 laser are reported. The age of patients ranged from 9 - 65 years, with a mean age of 23.8 years. The technique was simple and can be quickly accomplished by a single operator. After local anesthesia the glans penis was protected by a protector. Then, circumcision was performed with a CO2 laser -- HeNe laser combined machine. There was an HeNe laser aiming system in this machine thus the surgeon had a three-dimensional visible indicator of the incision. The focusing CO2 laser beam was used for cutting the prepuce during the operation. There was almost no operative bleeding. All the patients needed no antibiotic postoperatively. Complications were minimal and satisfactory results were achieved.

  14. Traumatic neuroma of the penis after circumcision--Case report.

    Science.gov (United States)

    Cardoso, Thaís Abrão; dos Santos, Karen Regina; Franzotti, Aline Martinez; Avelar, Juliana Centofanti Dentello; Tebcherani, Antonio José; Pegas, José Roberto Pereira

    2015-01-01

    Traumatic neuromas are tumors resulting from hyperplasia of axons and nerve sheath cells after section or injury to the nervous tissue. We present a case of this tumor, confirmed by anatomopathological examination, in a male patient with history of circumcision. Knowledge of this entity is very important in achieving the differential diagnosis with other lesions that affect the genital area such as condyloma acuminata, bowenoid papulosis, lichen nitidus, sebaceous gland hyperplasia, achrochordon and pearly penile papules. PMID:26131873

  15. Traumatic neuroma of the penis after circumcision - Case report*

    Science.gov (United States)

    Cardoso, Thaís Abrão; dos Santos, Karen Regina; Franzotti, Aline Martinez; Avelar, Juliana Centofanti Dentello; Tebcherani, Antonio José; Pegas, José Roberto Pereira

    2015-01-01

    Traumatic neuromas are tumors resulting from hyperplasia of axons and nerve sheath cells after section or injury to the nervous tissue1. We present a case of this tumor, confirmed by anatomopathological examination, in a male patient with history of circumcision. Knowledge of this entity is very important in achieving the differential diagnosis with other lesions that affect the genital area such as condyloma acuminata, bowenoid papulosis, lichen nitidus, sebaceous gland hyperplasia, achrochordon and pearly penile papules. PMID:26131873

  16. : Male circumcision as HIV prevention between controversies and scientific investigation

    OpenAIRE

    Harrous-Paicheler, Genevieve

    2010-01-01

    The randomised controlled trial (RCT) is considered the scientific foundation of medical practice in evidence based medicine. Therefore, the evidence it brings should put an end to controversies. But this was not the case if we look at the demonstration of the protective role of male circumcision (MC) against HIV/AIDS infection. Although based on a series of epidemiological investigations, culminating in RCTs, the benefits of MC are a controversial subject in the medical and scientific commun...

  17. Disposable circumcision suture device:clinical effect and patient satisfaction

    Institute of Scientific and Technical Information of China (English)

    BoDong Lv; ShiGeng Zhang; XuanWen Zhu; Jie Zhang; Gang Chen; MinFu Chen; HongLiang Shen; ZaiJun Pei; ZhaoDian Chen

    2014-01-01

    In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the beneifts of a new disposable circumcision suture device (DCSD). A total of 942 patients were equally divided into three groups (conventional circumcision, Shang ring and disposable suture device group). Patients in the DCSD group were anesthetized with compound 5%lidocaine cream, the others with a 2%lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were signiifcantly lower in the Shang ring and suture device groups compared to the conventional group (P<0.001). Intra-operative pain was less in the suture device group compared with the other two groups (P<0.001);whereas post-operative pain was higher in the conventional group compared to the other two groups (P<0.001). Patients in the suture device (80.57%) and Shang ring (73.57%) groups were more satisifed with penile appearances compared with the conventional circumcision group (20.06%, P<0.05). Patients in suture device group also healed markedly faster than the conventional group (P<0.01). The overall satisfaction rate was better in the suture device group (78.66%) compared with the conventional (47.13%) and Shang ring (50.00%) groups (P<0.05). The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.

  18. Female genital mutilation: perspectives, risks, and complications.

    Science.gov (United States)

    Morris, R I

    1999-03-01

    Female genital mutilation, traditionally known as female circumcision, is a surgically unnecessary modification of the female genitalia, practiced in nations in Africa, the Arab Peninsula, among some communities in Asia, and among immigrants and refugees from these areas who have settled in other areas. The practice is known across socio-economic classes and among many different ethnic and cultural groups, including Christians, Muslims, Jews, and followers of indigenous African religions. As people from these areas immigrate to North America, health care professionals need to understand the important aspects of this growing problem, including management of complications, cultural attitudes, and sensitivities. PMID:10373987

  19. Can circumcision prevent recurrent urinary tract infections in hospitalized infants?

    Science.gov (United States)

    Cason, D L; Carter, B S; Bhatia, J

    2000-12-01

    Urinary tract infection (UTI) is an uncommon but concerning condition for hospitalized premature infants. A retrospective chart review of all male infants admitted to the neonatal intensive care unit (NICU) from June 1996 through March 1999 was conducted at the Medical College of Georgia--a large academic medical center with a tertiary Level III NICU--to investigate the frequency and potential prevention of recurrent UTI in hospitalized infants. The effect of circumcision on recurrence of UTI was also investigated. There were 38 infants with 53 UTIs among 744 male infants admitted during the study period (5.1%). Infants were divided into two groups: A1 UTI and A2 UTI. In groups A1 and A2, 57% of the first UTIs were due to Candida or E. coli, the remaining were due to other gram-negative organisms and Staphylococcus species. Mean gestational age (GA) in groups A1 and A2 were similar (29 +/- 2 weeks, and 29 +/- 4 weeks); however, mean GA of infants with Candida UTI was 27 +/- 2 weeks, and for bacterial UTI, 30 +/- 3 weeks (pUTI once a circumcision was performed. Premature uncircumcised males had an increased risk for UTI (Odds Ratio=11.1, 95% CI, 3.3-28.9, pCircumcision appears beneficial in reducing the risk for recurrent UTI in these infants.

  20. Student Teachers' Perception on Integration of Traditional Circumcision Education into the School Curriculum

    Science.gov (United States)

    Seloana, S. M.

    2011-01-01

    The purpose of this article is to report on the research findings of the views of student-teachers on the integration of some aspects of a traditional circumcision curriculum into higher education. The main question is: Could a traditional circumcision curriculum be integrated into the higher education curriculum? Seventy five participants were…

  1. Need for Physician Education on the Benefits and Risks of Male Circumcision in the United States

    Science.gov (United States)

    Carbery, Baevin; Zhu, Julia; Gust, Deborah A.; Chen, Robert T.; Kretsinger, Katrina; Kilmarx, Peter H.

    2012-01-01

    Physicians may be called upon to counsel male patients or parents of newborn males regarding their decision to circumcise their newborn sons. The purpose of the present study was to describe physicians who do not understand the benefits and risks associated with male circumcision well enough to counsel parents of newborn male infants and adult…

  2. High Flow Priapism in a Pediatric Patient after Circumcision with Dorsal Penile Nerve Block

    Science.gov (United States)

    Fantony, Joseph J.; Routh, Jonathan C.

    2016-01-01

    We report the first documented case of high flow priapism after circumcision with dorsal penile nerve block. A 7-year-old male who had undergone circumcision three years before presented to our institution with a 3-year history of persistent nonpainful erections. Workup revealed a high flow priapism and, after discussion of the management options, the patient's family elected continued observation. PMID:27648333

  3. Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection.

    Science.gov (United States)

    To, T; Agha, M; Dick, P T; Feldman, W

    1998-12-01

    A prospective population-based cohort study assessed the association between male circumcision and subsequent urinary tract infection (UTI) in children born in Ontario, Canada, in a 12-month period in 1993-94. Of the 69,100 eligible infants, 30,105 (43.6%) were circumcised in the first month of life. 29,217 uncircumcised boys were matched to circumcised boys by date of birth and followed for 24-36 months. Information on UTIs was extracted from the Canadian Institute for Health Information computerized database on hospital discharges. There were 83 UTI cases in the circumcised cohort (1.88/1000 person-years of observation) and 247 in the uncircumcised group (7.02/1000 person-years) (p 0.0001). The relative risk of UTI in uncircumcised compared to circumcised boys was 4.5 (95% CI, 2.4-8.4) in the first month of life and 3.7 (95% CI, 2.8-4.9) in the year after the procedure. Calculation of the attributable risk indicated 195 circumcisions would be necessary to prevent one admission for UTI in the first year of life. Previous studies have recorded UTI rates 10-20 times higher in uncircumcised than circumcised boys. These findings support the hypothesis that circumcision protects boys from UTI, but the magnitude of this effect may be less than previously estimated.

  4. Cultural bias in the AAP's 2012 Technical Report and Policy Statement on male circumcision

    NARCIS (Netherlands)

    Frisch, M.; Aigrain, Y.; Barauskas, V.; Bjarnason, R.; Boddy, S.A.; Czauderna, P.; Gier, R.P.E. de; Jong, T.P. de; Fasching, G.; Fetter, W.; Gahr, M.; Graugaard, C.; Greisen, G.; Gunnarsdottir, A.; Hartmann, W.; Havranek, P.; Hitchcock, R.; Huddart, S.; Janson, S.; Jaszczak, P.; Kupferschmid, C.; Lahdes-Vasama, T.; Lindahl, H.; Macdonald, N.; Markestad, T.; Martson, M.; Nordhov, S.M.; Palve, H.; Petersons, A.; Quinn, F.; Qvist, N.; Rosmundsson, T.; Saxen, H.; Soder, O.; Stehr, M.; Loewenich, V.C. von; Wallander, J.; Wijnen, R.

    2013-01-01

    The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large numbe

  5. Histological Correlates of Penile Sexual Sensation: Does Circumcision Make a Difference?

    Directory of Open Access Journals (Sweden)

    Guy Cox, MA, DPhil

    2015-06-01

    Conclusion: Based on histological findings and correlates of sexual function, loss of the prepuce by circumcision would appear to have no adverse effect on sexual pleasure. Our evaluation supports overall findings from physiological measurements and survey data. Cox G, Krieger JN, and Morris BJ. Histological correlates of penile sexual sensation: Does circumcision make a difference? Sex Med 2015;3:76–85.

  6. Circumcision with Glubran® 2 in children: experience of Italian Center

    Science.gov (United States)

    Cerchia, Elisa; Molinaro, Francesco; Bulotta, Anna Lavinia; Ferrara, Francesco; Bindi, Edoardo; Messina, Mario

    2016-01-01

    Background Circumcision is one of the most common surgical procedures in the world. Despite it is known its wide prevalence for religious and medical reasons in children, it remains a controversial practice in paediatric age. To date, there is no described the gold standard technique to circumcise paediatric patients. We started to use glue for circumcision about 2 years ago. We designed this prospective study with the aim to compare two surgical techniques, which were used in our hospital to perform circumcision in children. The implication for practice was the understanding if there were differences between these approaches related to patient’s and parents benefits to manage this condition and benefits for surgeon and hospital in term of saving money and time. Methods This is a randomized, single-blind one-center study. It was conducted at the Department of Paediatric Surgery of Siena. Data were collected between March 2011 and December 2012. Study’s population involved all patients who required circumcision. Two randomizes groups: group one which involved patients who underwent circumcision using sutures and group two, which involved patients who underwent circumcision using surgical glue (Glubran® 2). Two exclusion criteria were used: the redo-circumcision and the allergy or hyper-sensibility to cyanoacrylate (main component of glue). Results We report 99 patients who underwent circumcision with Glubran® 2 in comparison with a group of children circumcised with sutures (vycril rapide). We measured three outcomes (operating time, postoperative pain and assessment of cosmetic), which, even if not all statistically significant, allowed us to draw any conclusions about the use of glue in circumcision. Conclusions Traditional circumcision is performed using a standard sleeve technique with sutures for the approximation of the skin edges. However, since some years a tissue adhesive as N-butyl-2-cyanoacrylate (NBCA) (Glubran® 2) is used in many centers to

  7. Modified one-cut circumcision technique by clamp: reports of 2000 cases

    Institute of Scientific and Technical Information of China (English)

    LI Gang; WANG Yan; LIU Li; ZHANG Xu; LI Qian; FU Wei-jun; HONG Bao-fa; LUO Jin; XU Fu-qiang; CAO Lei; KANG Yi-sheng; DONG Xin

    2010-01-01

    @@ In the western countries, circumcision has been performed for a long time. However, because of religious and cultural differences, circumcision was rare in China before the 20th century. As a result, penile cancer, accounting for 17% of all cancers, was more common.1 With the introduction of western medicine in the 1920s, especially after the establishment of urology as a separate department, gradually more circumcisions were carried out. The incidence of penile cancer was also reduced to 0.34/100 000, which was similar to Western developed countries.1 Recently, in China, circumcision has become one of the most basic operations in urological surgery. More people have realized the efficacy of circumcision in preventing acquisition and transmission of sexually transmitted infections.2,3

  8. Voluntary medical male circumcision: strategies for meeting the human resource needs of scale-up in southern and eastern Africa.

    Directory of Open Access Journals (Sweden)

    Kelly Curran

    2011-11-01

    Full Text Available Voluntary medical male circumcision (VMMC reduces female-to-male HIV transmission by approximately 60%; modeling suggests that scaling up VMMC to 80% of men 15- to 49-years-old within five years would avert over 3.3 million new HIV infections in 14 high priority countries/regions in southern and eastern Africa by 2025 and would require 20.33 million circumcisions. However, the shortage of health professionals in these countries must be addressed to reach these proposed coverage levels. To identify human resource approaches that are being used to improve VMMC volume and efficiency, we looked at previous literature and conducted a program review. We identified surgical efficiencies, non-surgical efficiencies, task shifting, task sharing, temporary redeployment of public sector staff during VMMC campaign periods, expansion of the health workforce through recruitment of unemployed, recently retired, newly graduating, or on-leave health care workers, and the use of volunteer medical staff from other countries as approaches that address human resource constraints. Case studies from Kenya, Tanzania, and Swaziland illustrate several innovative responses to human resource challenges. Although the shortage of skilled personnel remains a major challenge to the rapid scale-up of VMMC in the 14 African priority countries/regions, health programs throughout the region may be able to replicate or adapt these approaches to scale up VMMC for public health impact.

  9. Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa.

    Directory of Open Access Journals (Sweden)

    Timothy B Hallett

    Full Text Available BACKGROUND: Three randomised controlled trials have clearly shown that circumcision of adult men reduces the chance that they acquire HIV infection. However, the potential impact of circumcision programmes--either alone or in combination with other established approaches--is not known and no further field trials are planned. We have used a mathematical model, parameterised using existing trial findings, to understand and predict the impact of circumcision programmes at the population level. FINDINGS: Our results indicate that circumcision will lead to reductions in incidence for women and uncircumcised men, as well as those circumcised, but that even the most effective intervention is unlikely to completely stem the spread of the virus. Without additional interventions, HIV incidence could eventually be reduced by 25-35%, depending on the level of coverage achieved and whether onward transmission from circumcised men is also reduced. However, circumcision interventions can act synergistically with other types of prevention programmes, and if efforts to change behaviour are increased in parallel with the scale-up of circumcision services, then dramatic reductions in HIV incidence could be achieved. In the long-term, this could lead to reduced AIDS deaths and less need for anti-retroviral therapy. Any increases in risk behaviours following circumcision, i.e. 'risk compensation', could offset some of the potential benefit of the intervention, especially for women, but only very large increases would lead to more infections overall. CONCLUSIONS: Circumcision will not be the silver bullet to prevent HIV transmission, but interventions could help to substantially protect men and women from infection, especially in combination with other approaches.

  10. Impact of psychological disorders after female genital mutilation among Kurdish girls in Northern Iraq

    Directory of Open Access Journals (Sweden)

    Jan Ilhan Kizilhan

    2011-06-01

    Full Text Available Background and Objectives: This study investigated the mental health status of young girls after genital mutilation in Northern Iraq. Although experts assume that circumcised girls are more prone to psychiatric illnesses than non-circumcised girls, little research has been conducted to confirm this claim. For the purpose of this study, it was assumed that female genital mutilation is connected with a high rate of posttraumatic stress disorders (PTSD. Methods: The psychological impact of female genital mutilation was assessed in Northern Iraq with 79 circumcised Kurdish girls who were between 8 and 14 years of age. Thirty uncircumcised girls from the above area and thirty-one uncircumcised girls from other areas of Iraq served as comparison subjects. A psychological interview and further questionnaires were used to assess traumatization and psychiatric illnesses. Results: The circumcised girls showed a significantly higher prevalence of PTSD (44.3%, depression disorder (33.6%, anxiety disorder (45.6% and somatic disturbance (36.7% than the uncircumcised girls. We could not find any significant differences between the two control groups. Conclusions: Within the circumcised group, a mental health problem can be diagnosed that may constitute the first evidence for the severe psychological consequences of juvenile girls´ genital mutilation.

  11. Criminal enforcement in the area of female genital mutilation in France, England and the Netherlands: a comparative law perspective

    NARCIS (Netherlands)

    Kool, Renée; Wahedi, S.

    2014-01-01

    The criminal justice system in Western countries is ever more frequently facing the question of how to deal with immigrants’ cultural practices, such as honour killings, blood revenges and female circumcision, better known as ‘Female Genital Mutilation’, that are considered to be in violation of hum

  12. Female genital mutilation.

    Science.gov (United States)

    Ladjali, M; Rattray, T W; Walder, R J

    1993-08-21

    Female genital mutilation, also misleadingly known as female circumcision, is usually performed on girls ranging in from 1 week to puberty. Immediate physical complications include severe pain, shock, infection, bleeding, acute urinary infection, tetanus, and death. Longterm problems include chronic pain, difficulties with micturition and menstruation, pelvic infection leading to infertility, and prolonged and obstructed labor during childbirth. An estimated 80 million girls and women have undergone female genital mutilation. In Britain alone an estimated 10,000 girls are currently at risk. Religious, cultural, medical, and moral grounds rationalize the custom which is practiced primarily in sub-Saharan Africa, the Arab world, Malaysia, Indonesia, and among migrant populations in Western countries. According to WHO it is correlated with poverty, illiteracy, and the low status of women. Women who escape mutilation are not sought in marriage. WHO, the UN Population Fund, the UN Children's Fund, the International Planned Parenthood Federation, and the UN Convention on the Rights of the Child have issued declarations on the eradication of female genital mutilation. In Britain, local authorities have intervened to prevent parents from mutilating their daughters. In 1984, the Inter-African Committee Against Harmful Traditional Practices Affecting Women and Children was established to work toward eliminating female genital mutilation and other damaging customs. National committees in 26 African countries coordinate projects run by local people using theater, dance, music, and storytelling for communication. In Australia, Canada, Europe, and the US women have organized to prevent the practice among vulnerable migrants and refugees. PMID:8400925

  13. Limits of Enlightenment and the Law - On the Legality of Ritual Male Circumcision in Europe today

    Directory of Open Access Journals (Sweden)

    Mark Swatek-Evenstein

    2013-07-01

    Full Text Available The legality of ritual circumcision of male infants is a subject not regularly discussed under European or international Human Rights Law, let alone national law. In Germany, this changed dramatically in 2012, when a regional court declared ritual circumcision of a male infant illegal, even if performed at the parents' request and according to current medical standards. After a fierce public discussion, the German parliament voted towards the end of the year in favour of a bill that explicitly permits male infant circumcision. The discussion on whether this new law is in line with European human rights law and international law is expected to continue. This paper takes no position on whether infant male circumcision should be legal and takes no position on the medical questions attached to the subject. It argues for the legality of infant male circumcision in Western democracies like Germany for historic reasons: Jewish emancipation in the 18th and 19th century throughout Europe meant an incorporation of Jewish laws and customs into the legal fabric of European countries. Taking into account the relatively wide acceptance of the practice of infant male circumcision in communities worldwide, the paper suggests that arguments from international human rights law make simple equations difficult to sustain. Gender and children's rights-based approaches may be utilized to develop a deeper sensibility for the issues related to circumcision, but must not obscure the fact that minority rights sometimes rightfully allow a minority to do things the majority does not understand.

  14. Limits of Enlightenment and the Law - On the Legality of Ritual Male Circumcision in Europe today

    Directory of Open Access Journals (Sweden)

    Mark Swatek-Evenstein

    2013-07-01

    Full Text Available The legality of ritual circumcision of male infants is a subject not regularly discussed under European or international Human Rights Law, let alone national law. In Germany, this changed dramatically in 2012, when a regional court declared ritual circumcision of a male infant illegal, even if performed at the parents' request and according to current medical standards. After a fierce public discussion, the German parliament voted towards the end of the year in favour of a bill that explicitly permits male infant circumcision. The discussion on whether this new law is in line with European human rights law and international law is expected to continue. This paper takes no position on whether infant male circumcision should be legal and takes no position on the medical questions attached to the subject. It argues for the legality of infant male circumcision in Western democracies like Germany for historic reasons: Jewish emancipation in the 18 and 19 century throughout Europe meant an incorporation of Jewish laws and customs into the legal fabric of European countries. Taking into account the relatively wide acceptance of the practice of infant male circumcision in communities worldwide, the paper suggests that arguments from international human rights law make simple equations difficult to sustain. Gender and children's rights-based approaches may be utilized to develop a deeper sensibility for the issues related to circumcision, but must not obscure the fact that minority rights sometimes rightfully allow a minority to do things the majority does not understand.

  15. Circumcision: is the risk of urinary tract infection really the pivotal issue?

    Science.gov (United States)

    Chessare, J B

    1992-02-01

    Recent information regarding the increased risk of urinary tract infections in the first year of life for uncircumcised boys has created confusion regarding the appropriate guidance to be given to parents confronting the circumcision issue. A decision model was built that addressed the question of whether or not to circumcise a newborn male considering the probability of a non-circumcised boy having a UTI in the first year of life (0.041), the probability of a circumcised boy having a UTI in the first year of life (0.002), and the likelihood of renal scarring from a UTI (0.075). After considering the morbidity associated with the procedure, all possible outcomes were ranked from worst to best (circumcised-renal pathology to uncircumcised-no infection) and given a value on a 0 to 1 scale. For the set of values assigned to the outcomes, the choice of no circumcision yielded the highest expected utility. For the set of assigned utilities, sensitivity analysis showed that unless the probability of a UTI in the first year of life for an uncircumcised male was greater than or equal to 0.29, then non-circumcision was still the preferred choice. The decision was most sensitive to the degree of aversion to the morbidity associated with the procedure (pain, bleeding, inflammation).

  16. The When and How of male circumcision and the risk of HIV: a retrosepctive cross-sectional analysis of two HIV surveys from Guiné-Bissau

    DEFF Research Database (Denmark)

    Sodemann, Morten

    2016-01-01

    Introduction: Male circumcision (MC) reduces the risk of HIV, and this risk reduction may be modified by socio-cultural factors such as the timing and method (medical and traditional) of circumcision. Understanding regional variations in circumcision practices and their relationship to HIV...... risk and circumcision status, timing, method of circumcision, and socio-demographic factors. Results: MC was protective against HIV infection in both cohorts, with adjusted odds ratios (AORs) of 0.28 (95% CI 0.12-0.66) and 0.30 (95% CI 0.09-0.93), respectively. We observed that post-pubertal (≥13 years......) circumcision provided the highest level of HIV risk reduction in both cohorts compared to non-circumcised. However, the difference between pre-pubertal (≤12 years) and post-pubertal (≥13 years) circumcision was not significant in the multivariate analysis. Seventy-six percent (678/888) of circumcised males...

  17. The when and how of male circumcision and the risk of HIV: a retrospective cross-sectional analysis of two HIV surveys from Guinea-Bissau

    DEFF Research Database (Denmark)

    Rasmussen, Dlama; Wejse, Christian; Larsen, Olav Ditlevsen;

    2016-01-01

    Introduction: Male circumcision (MC) reduces the risk of HIV, and this risk reduction may be modified by socio-cultural factors such as the timing and method (medical and traditional) of circumcision. Understanding regional variations in circumcision practices and their relationship to HIV...... risk and circumcision status, timing, method of circumcision, and socio-demographic factors. Results: MC was protective against HIV infection in both cohorts, with adjusted odds ratios (AORs) of 0.28 (95% CI 0.12-0.66) and 0.30 (95% CI 0.09-0.93), respectively. We observed that post-pubertal (≥13 years......) circumcision provided the highest level of HIV risk reduction in both cohorts compared to non-circumcised. However, the difference between pre-pubertal (≤12 years) and post-pubertal (≥13 years) circumcision was not significant in the multivariate analysis. Seventy-six percent (678/888) of circumcised males...

  18. Adult bipolar diathermy circumcision and related procedures in adults – a safe and efficient technique

    Directory of Open Access Journals (Sweden)

    Nalavenkata S

    2014-06-01

    Full Text Available Sunny Nalavenkata, Matthew Winter, Rachel Kour, Nam-Wee Kour, Paul RuljancichDepartment of Urology, Eastern Health, Box Hill Hospital, Box Hill, VIC, AustraliaObjectives: To present our novel technique and step-by-step approach to bipolar diathermy circumcision and related procedures in adult males.Methods: We reviewed our technique of bipolar circumcision and related procedures in 54 cases over a 22-month period at our day procedure center. Bipolar diathermy cutting and hemostasis was performed using bipolar forceps with a Valleylab machine set at 15. Sleeve circumcision was used. A dorsal slit was made, followed by frenulum release and ventral slit, and was completed with bilateral circumferential cutting. Frenuloplasties released the frenulum. Preputioplasties used multiple 2–3 mm longitudinal cuts to release the constriction, with frenulum left intact. All wounds were closed with interrupted 4/0 Vicryl Rapide™.Results: A total of 54 nonemergency bipolar circumcision procedures were carried out from November 2010–August 2012 (42 circumcisions, eight frenuloplasties, and four preputioplasties. Patients were aged 18–72 years (mean, 34 years. There was minimal to no intraoperative bleeding in all cases, allowing for precise dissection. All patients were requested to attend outpatient reviews; three frenuloplasty and two circumcision patients failed to return. Of the remaining 49, mean interval to review was 49 days, with a range of 9–121 days. Two circumcision patients reported mild bleeding with nocturnal erections within a week postoperatively, but they did not require medical attention. Two others presented to family practitioners with possible wound infections which resolved with oral antibiotics. All 49 patients had well-healed wounds.Conclusion: The bipolar diathermy technique is a simple procedure, easily taught, and reproducible. It is associated with minimal bleeding, is safe and efficient, uses routine operating equipment and

  19. Male Circumcision and STI Acquisition in Britain: Evidence from a National Probability Sample Survey.

    Directory of Open Access Journals (Sweden)

    Virginia Homfray

    Full Text Available It is well-established that male circumcision reduces acquisition of HIV, herpes simplex virus 2, chancroid, and syphilis. However, the effect on the acquisition of non-ulcerative sexually transmitted infections (STIs remains unclear. We examined the relationship between circumcision and biological measures of three STIs: human papillomavirus (HPV, Chlamydia trachomatis and Mycoplasma genitalium.A probability sample survey of 15,162 men and women aged 16-74 years (including 4,060 men aged 16-44 years was carried out in Britain between 2010 and 2012. Participants completed a computer-assisted personal interview, including a computer-assisted self-interview, which asked about experience of STI diagnoses, and circumcision. Additionally, 1,850 urine samples from sexually-experienced men aged 16-44 years were collected and tested for STIs. Multivariable logistic regression was used to calculate adjusted odds ratios (AOR to quantify associations between circumcision and i self-reporting any STI diagnosis and ii presence of STIs in urine, in men aged 16-44 years, adjusting for key socio-demographic and sexual behavioural factors.The prevalence of circumcision in sexually-experienced men aged 16-44 years was 17.4% (95%CI 16.0-19.0. There was no association between circumcision and reporting any previous STI diagnoses, and specifically previous chlamydia or genital warts. However, circumcised men were less likely to have any HPV type (AOR 0.26, 95% confidence interval (CI 0.13-0.50 including high-risk HPV types (HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and/or 68 (AOR 0.14, 95% CI 0.05-0.40 detected in urine.Circumcised men had reduced odds of HPV detection in urine. These findings have implications for improving the precision of models of STI transmission in populations with different circumcision prevalence and in designing interventions to reduce STI acquisition.

  20. Ischemia of the glans penis following circumcision: case report and revision of the literature.

    Science.gov (United States)

    Pepe, Pietro; Pietropaolo, Francesco; Candiano, Giuseppe; Pennisi, Michele

    2015-03-01

    Ischemic complications of the glans penis are rare and commonly result from trauma, inadvertent administration of vasoconstrictive solutions, diabetes mellitus, circumcision and vasculitis; we refer about a young man with severe ischemia of the glans penis following circumcision. The patient had undergone circumcision 5 days before in a surgery department under local anesthesia (1% mepivacaine hydrochloride). The patient noticed a brownish color and edema of the glans penis at 24 h after he opened the wound dressing, but arrived to our hospital only 5 days after circumcision because these findings had progressed. Physical examination revealed the black color or necrotic appearance of the glans penis, and edema on the dorsal penile skin. The patient underwent antibiotic, antiplatatelet, corticosteroid and iperbaric therapy achieving a complete restitutio ad integrum.

  1. Ischemia of the glans penis following circumcision: case report and revision of the literature

    Directory of Open Access Journals (Sweden)

    Pietro Pepe

    2015-03-01

    Full Text Available Ischemic complications of the glans penis are rare and commonly result from trauma, inadvertent administration of vasoconstrictive solutions, diabetes mellitus, circumcision and vasculitis; we refer about a young man with severe ischemia of the glans penis following circumcision. The patient had undergone circumcision 5 days before in a surgery department under local anesthesia (1% mepivacaine hydrochloride. The patient noticed a brownish color and edema of the glans penis at 24 h after he opened the wound dressing, but arrived to our hospital only 5 days after circumcision because these findings had progressed. Physical examination revealed the black color or necrotic appearance of the glans penis, and edema on the dorsal penile skin. The patient underwent antibiotic, antiplatatelet, corticosteroid and iperbaric therapy achieving a complete restitutio ad integrum.

  2. Cultural bias in the AAP's 2012 Technical Report and Policy Statement on male circumcision

    DEFF Research Database (Denmark)

    Frisch, Morten; Aigrain, Yves; Barauskas, Vidmantas;

    2013-01-01

    The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large...... number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision...... associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against...

  3. Complication rate after circumcision in a paediatric surgical setting should not be neglected

    DEFF Research Database (Denmark)

    Thorup, Jørgen; Thorup, Sebastian Cortes; Ifaoui, Inge Botker Rasmussen

    2013-01-01

    As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated our results from a paediatric surgical department.......As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated our results from a paediatric surgical department....

  4. Removal of foreskin remnants in circumcised adults for treatment of premature ejaculation

    OpenAIRE

    Mohammad Reza Namavar; Boroomand Robati

    2011-01-01

    Background and Aim : Premature ejaculation (PE) is the most prevalent sexual dysfunction in every country. There are many types of treatment, but the main limitation of medical treatment for premature ejaculation is recurrence after withdrawal of medicine. The prepuce is a specific erogenous zone that contains a rich and complex network of nerves. Circumcision radically desensitizes the penis, but incomplete circumcision may cause premature ejaculation. We evaluate the effect of removal of fo...

  5. The Strong Protective Effect of Circumcision against Cancer of the Penis

    OpenAIRE

    Morris, Brian J.; Gray, Ronald H.; Xavier Castellsague; F. Xavier Bosch; Halperin, Daniel T.; Waskett, Jake H; Hankins, Catherine A.

    2011-01-01

    Male circumcision protects against cancer of the penis, the invasive form of which is a devastating disease confined almost exclusively to uncircumcised men. Major etiological factors are phimosis, balanitis, and high-risk types of human papillomavirus (HPV), which are more prevalent in the glans penis and coronal sulcus covered by the foreskin, as well as on the penile shaft, of uncircumcised men. Circumcised men clear HPV infections more quickly. Phimosis (a constricted foreskin opening imp...

  6. Readiness of health facilities to deliver safe male circumcision services in Tanzania: a descriptive study

    Directory of Open Access Journals (Sweden)

    Frank Felix Mosha

    2013-03-01

    Full Text Available Assessing the readiness of health facilities to deliver safe male circumcision services is more important in sub-Saharan Africa because of the inadequacy state of health facilities in many ways. The World Health Organization recommends that only facilities equipped with available trained staff, capable to perform at least minor surgery, able to offer minimum MC package and appropriate equipment for resuscitation, and compliant with requirements for sterilization and infection control should be allowed to deliver safe circumcision services. A cross-sectional study using quantitative data collection technique was conducted to assess the readiness of the health facilities to deliver safe circumcision services in selected districts of Tanzania. All hospitals, health centres and 30% of all dispensaries in these districts were selected to participate in the study. Face-toface questionnaires were administered to the heads of the health facilities and to health practitioners. Overall, 49/69 (59% of the facilities visited provided circumcision services and only 46/203 (24% of the health practitioners performed circumcision procedures. These were mainly assistant medical officers and clinical officers. The vast majority – 190/203 (95% – of the health practitioners require additional training prior to providing circumcision services. Most facilities – 63/69 (91% – had all basic supplies (gloves, basin, chlorine and waste disposal necessary for infection prevention, 44/69 (65% provided condoms, HIV counselling and testing, and sexuallytransmitted infections services, while 62/69 (90% had the capability to perform at least minor surgery. However, only 25/69 (36% and 15/69 (22% of the facilities had functioning sterilization equipment and appropriate resuscitation equipment, respectively. There is readiness for roll out of circumcision services; however, more practitioners need to be trained on circumcision procedures, demand forecasting

  7. Safe male circumcision in Botswana: Tension between traditional practices and biomedical marketing

    OpenAIRE

    Katisi, Masego; Daniel, Marguerite

    2015-01-01

    Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circum...

  8. Somatosensory evoked potentials assess the efficacy of circumcision for premature ejaculation.

    Science.gov (United States)

    Xia, J-D; Jiang, H-S; Zhu, L-L; Zhang, Z; Chen, H; Dai, Y-T

    2016-07-01

    To assess the efficacy and mechanism of circumcision in the treatment of premature ejaculation (PE) with redundant prepuce, we enrolled a total of 81 PE patients who received circumcision. The patients' ejaculatory ability and sexual performances were evaluated before and after circumcision by using questionnaires (Intravaginal ejaculation latency time (IELT), Chinese Index of PE with 5 questions (CIPE-5) and International Index of Erectile function- 5 (IIEF-5)). Furthermore, somatosensory evoked potentials (SEPs) including dorsal nerve (DNSEP) and glans penis (GPSEP) of the patients were also measured. The mean IELTs of preoperation and post operation were 1.10±0.55 and 2.48±2.03 min, respectively (P<0.001). In addition, the geometric mean IELT after operation was 2.16 min, compared with the baseline 1.07 min before the operation, the fold increase of the IELT was 2.02. Compared with the uncircumcised status, scores of CIPE-5 showed a significant increase after circumcision (P<0.001). The mean latencies (and amplitudes) of GPSEP and DNSEP were 38.1±4.0 ms (3.0±1.9 uV) and 40.5±3.4 ms (2.8±1.6 uV) before circumcision, respectively; and 42.8±3.3 ms (2.8±1.6 uV) and 40.5±4.1 ms (2.4±1.2 uV) in the follow-up end point after circumcision. Only the latencies of GPSEP showed significant prolongation before and after circumcision (P<0.001). The ejaculation time improvement after circumcision is so small, and equal to placebo response, therefore it could not be interpreted as a therapeutic method in men with PE. PMID:27193064

  9. Somatosensory evoked potentials assess the efficacy of circumcision for premature ejaculation.

    Science.gov (United States)

    Xia, J-D; Jiang, H-S; Zhu, L-L; Zhang, Z; Chen, H; Dai, Y-T

    2016-07-01

    To assess the efficacy and mechanism of circumcision in the treatment of premature ejaculation (PE) with redundant prepuce, we enrolled a total of 81 PE patients who received circumcision. The patients' ejaculatory ability and sexual performances were evaluated before and after circumcision by using questionnaires (Intravaginal ejaculation latency time (IELT), Chinese Index of PE with 5 questions (CIPE-5) and International Index of Erectile function- 5 (IIEF-5)). Furthermore, somatosensory evoked potentials (SEPs) including dorsal nerve (DNSEP) and glans penis (GPSEP) of the patients were also measured. The mean IELTs of preoperation and post operation were 1.10±0.55 and 2.48±2.03 min, respectively (PIELT after operation was 2.16 min, compared with the baseline 1.07 min before the operation, the fold increase of the IELT was 2.02. Compared with the uncircumcised status, scores of CIPE-5 showed a significant increase after circumcision (P<0.001). The mean latencies (and amplitudes) of GPSEP and DNSEP were 38.1±4.0 ms (3.0±1.9 uV) and 40.5±3.4 ms (2.8±1.6 uV) before circumcision, respectively; and 42.8±3.3 ms (2.8±1.6 uV) and 40.5±4.1 ms (2.4±1.2 uV) in the follow-up end point after circumcision. Only the latencies of GPSEP showed significant prolongation before and after circumcision (P<0.001). The ejaculation time improvement after circumcision is so small, and equal to placebo response, therefore it could not be interpreted as a therapeutic method in men with PE.

  10. Infant male circumcision and the autonomy of the child: two ethical questions.

    Science.gov (United States)

    McMath, Akim

    2015-08-01

    Routine neonatal circumcision--the non-therapeutic circumcision of infant males--has generated considerable ethical controversy. In this article, I suggest that much of the disagreement results from conflicting ideas about the autonomy of the child. I examine two questions about autonomy. First, I ask whether we should be realists or idealists about the future autonomous choices of the child-that is, whether we should account for the fact that the child may not make the best choices in future, or whether we should assume that his future choices will reflect his best interests. Second, I ask whether the child has a right to autonomy with respect to circumcision, an interest in autonomy or neither--that is, whether respect for autonomy overrides considerations of interests, whether it counts as one interest among many or whether it counts for nothing. In response to the first question, I argue that we should be idealists when evaluating the child's own interests, but realists when evaluating public health justifications for circumcision. In response to the second question, I argue that the child has an interest in deciding whether or not to be circumcised, insofar as the decision is more likely to reflect his actual interests and his own values. Finally, I show how these findings may help to resolve some particular disputes over the ethics of infant male circumcision.

  11. The Strong Protective Effect of Circumcision against Cancer of the Penis

    Directory of Open Access Journals (Sweden)

    Brian J. Morris

    2011-01-01

    Full Text Available Male circumcision protects against cancer of the penis, the invasive form of which is a devastating disease confined almost exclusively to uncircumcised men. Major etiological factors are phimosis, balanitis, and high-risk types of human papillomavirus (HPV, which are more prevalent in the glans penis and coronal sulcus covered by the foreskin, as well as on the penile shaft, of uncircumcised men. Circumcised men clear HPV infections more quickly. Phimosis (a constricted foreskin opening impeding the passage of urine is confined to uncircumcised men, in whom balanitis (affecting 10% is more common than in circumcised men. Each is strongly associated with risk of penile cancer. These findings have led to calls for promotion of male circumcision, especially in infancy, to help reduce the global burden of penile cancer. Even more relevant globally is protection from cervical cancer, which is 10-times more common, being much higher in women with uncircumcised male partners. Male circumcision also provides indirect protection against various other infections in women, along with direct protection for men from a number of genital tract infections, including HIV. Given that adverse consequences of medical male circumcision, especially when performed in infancy, are rare, this simple prophylactic procedure should be promoted.

  12. Innovative Methods of Male Circumcision for HIV Prevention-Getting the Right Evidence.

    Science.gov (United States)

    Samuelson, Julia; Hargreave, Timothy; Ridzon, Renee; Farley, Tim

    2016-06-01

    World Health Organization recommends that countries with hyperendemic and generalized HIV epidemics implement voluntary medical male circumcision programs for HIV prevention. Innovative methods of male circumcision including devices have the potential to simplify the procedure, reduce time and cost, increase client acceptability, enhance safety, and expand the numbers of providers who may perform circumcision. We describe work led by World Health Organization and supported by global partners to define a pathway for the evaluation of efficacy and safety of male circumcision devices, to set priority criteria, and to establish a process to guide the use of devices in publicly funded voluntary medical male circumcision programs for HIV prevention. A device classification scheme, an expert Technical Advisory Group on Innovations in Male Circumcision, and a formal prequalification program have also guided considerations on safe use of devices. A rigorous approach was deemed appropriate given the intervention is for use among healthy men for public health purposes. The pathway and processes led to coordinated research, better standardization in research outcomes, and guidance that informed the research, introduction and implementation phases. The lessons learnt from this case study can inform evaluation and use of future public health innovations. PMID:27331591

  13. Neonatal circumcision in severe haemophilia: a survey of paediatric haematologists at United States Hemophilia Treatment Centers.

    Science.gov (United States)

    Kearney, S; Sharathkumar, A; Rodriguez, V; Chitlur, M; Valentino, L; Boggio, L; Gill, J

    2015-01-01

    Neonatal circumcision in patients with severe haemophilia has not been well studied. We performed a survey of paediatric haematologists from Hemophilia Treatment Centers (HTC) across the United States to better understand the attitudes toward and management of neonatal circumcision in haemophilia patients. Response rate to our survey was 40% (n = 64/159). Thirty-eight percent of respondents (n = 24) said that they would allow this procedure in the newborn period but in many cases this was against medical advice. The most reported concern regarding neonatal circumcision in haemophilia patients was the risk of development of an inhibitor (n = 25; 39%) followed by the concern for bleeding (n = 22; 34%) and issues related to vascular access in the neonate (n = 11; 17%). All respondents recommended at least one preprocedure dose of factor replacement. Twenty-two percent (n = 14) of respondents did not use more than one dose of factor replacement but 32% (n = 21) used 1-2 postoperative doses. The remainder of paediatric haematologists surveyed recommended between 3-5 (16%; n = 10) and 6-10 (3%, n = 2) additional days postoperatively. There was wide variation in both techniques of circumcision as well as adjuvant haemostatic agents used. Only 22% of respondents said that they had an established protocol for management of circumcision in the newborn haemophilia patient. These survey results highlight the need for evidence-based guidelines regarding the optimal management of circumcision in neonates with severe haemophilia.

  14. Innovative Methods of Male Circumcision for HIV Prevention-Getting the Right Evidence.

    Science.gov (United States)

    Samuelson, Julia; Hargreave, Timothy; Ridzon, Renee; Farley, Tim

    2016-06-01

    World Health Organization recommends that countries with hyperendemic and generalized HIV epidemics implement voluntary medical male circumcision programs for HIV prevention. Innovative methods of male circumcision including devices have the potential to simplify the procedure, reduce time and cost, increase client acceptability, enhance safety, and expand the numbers of providers who may perform circumcision. We describe work led by World Health Organization and supported by global partners to define a pathway for the evaluation of efficacy and safety of male circumcision devices, to set priority criteria, and to establish a process to guide the use of devices in publicly funded voluntary medical male circumcision programs for HIV prevention. A device classification scheme, an expert Technical Advisory Group on Innovations in Male Circumcision, and a formal prequalification program have also guided considerations on safe use of devices. A rigorous approach was deemed appropriate given the intervention is for use among healthy men for public health purposes. The pathway and processes led to coordinated research, better standardization in research outcomes, and guidance that informed the research, introduction and implementation phases. The lessons learnt from this case study can inform evaluation and use of future public health innovations.

  15. [Clinical studies of shang ring male circumcision in China and Africa].

    Science.gov (United States)

    Cheng, Feng; Lü, Nian-Qing; Xu, Hao-Qin; Barone, Mark A; Lee, Richard; Goldstein, Marc; Li, Philip S

    2014-04-01

    HIV/STIs remain a major global public health problem. One of the global strategies for the prevention and control of HIV/STIs is to interrupt their transmission, which requires the public health methods based on scientific evidence and cost-effectiveness. The scale-up of male circumcision services in the priority countries of the HIV-prevention project in sub-Saharan Africa has been hampered by the scarcity of trained providers and relative technical difficulty of male circumcision techniques recommended by WHO and UNAIDS. Shang Ring is an innovative and disposable device for male circumcision, which has been safely used for over 600 000 males in China since 2006. Clinical studies of more than 3 000 cases of Shang Ring circumcision in China, Kenya, Zambia, and Uganda have demonstrated its safety, effectiveness, acceptability and ease of use. The most obvious advantages of Shang Ring include short procedure time (3-6 min), excellent postoperative cosmesis, low rate of complications, high acceptance by clients and providers, ease of use, and standardization for reliable performance. As an innovative technique, Shang Ring has a great potential for facilitating the safe and effective scale-up of circumcision services. This article comprehensively reviews the clinical studies of Shang Ring male circumcision in China and Africa.

  16. AB221. Effects of adult male circumcision on premature ejaculation: results from a prospective study in China

    Science.gov (United States)

    Gao, Jingjing; Xu, Chuan; Zhang, Xiansheng

    2016-01-01

    Objective The purpose of this study is to investigate the effects of adult male circumcision on premature ejaculation (PE). Methods Therefore, between December 2009 and March 2014, a total of 575 circumcised men and 623 uncircumcised men (control group) were evaluated. Detailed evaluations (including circumcision and control groups) on PE were conducted before circumcision and at the 3-, 6-, 9-, and 12-month follow-up visits after circumcision. Self-estimated intravaginal ejaculatory latency time (IELT), patient-reported outcome measures, and 5-item version of the International Index of Erectile Function were used to measure the ejaculatory and erectile function for all subjects. Results The results showed that, during the 1 year follow-up, men after circumcision experienced higher IELT and better scores of control over ejaculation, satisfaction with sexual intercourse, and severity of PE than men before circumcision (Pejaculation, and satisfaction with sexual intercourse (P<0.001 for all). These findings suggested that circumcision might have positive effects on IELT, ejaculatory control, sexual satisfaction, and PE severity. Conclusions In addition, circumcision was significantly associated with the development of PE.

  17. 'If you are circumcised, you are the best': understandings and perceptions of voluntary medical male circumcision among men from KwaZulu-Natal, South Africa.

    Science.gov (United States)

    Humphries, Hilton; van Rooyen, Heidi; Knight, Lucia; Barnabas, Ruanne; Celum, Connie

    2015-01-01

    While the uptake of voluntary medical male circumcision (VMMC) is increasing, South Africa has only attained 20% of its target to circumcise 80% of adult men by 2015. Understanding the factors influencing uptake is essential to meeting these targets. This qualitative study reports on findings from focus-group discussions with men in rural KwaZulu-Natal, South Africa, about what factors influence their perceptions of VMMC. The study found that VMMC is linked to perceptions of masculinity and male gender identity including sexual health, sexual performance and pleasure, possible risk compensation and self-identity. Findings highlight the need to understand how these perceptions of sexual health and performance affect men's decisions to undergo circumcision and the implications for uptake of VMMC. The study also highlights the need for individualised and contextualised information and counselling that can identify, understand and address the perceptions men have of VMMC, and the impacts they believe it will have on them. PMID:25567140

  18. Male circumcision as strategy for HIV prevention and sexually transmitted diseases: the potential role of traditional birth attendants in neonatal male circumcision

    Directory of Open Access Journals (Sweden)

    Catia Dini

    2010-12-01

    Full Text Available In developing countries, it would be advisable to give priority to human immunodeficiency virus (HIV prevention strategies, because of the high mortality caused by the rapid spread of the pandemic. Furthermore, HIV prevention could contribute to the mitigation of tuberculosis (TB propagation, which is tightly correlated to acquired immune deficiency syndrome (AIDS. As demonstrated, male circumcision (MC confers protection against HIV and sexually transmitted diseases (STD. The suggested strategy considers the neonatal MC advantageous, since it is safer, feasible, culturally more acceptable and less costly than adult MC. This approach is based on the assumption that, if newborn males are circumcised, within the next 15-20 years the sexually active population will be almost entirely circumcised and, consequently, the HIV transmission will be reduced. The employment of retrained traditional birth attendants is considered in order to implement the MC after the child birth and to facilitate its acceptance in those contexts where it is not traditionally performed.

  19. 'It brought joy in my home as in the area of my wife.' How recently circumcised adult men ascribe value to and make sense of male circumcision

    DEFF Research Database (Denmark)

    Lundsby, Katrine; Dræbel, Tania; Wolf Meyrowitsch, Dan

    2012-01-01

    The present study used a phenomenological approach to explore the everyday-life experiences of male circumcision (MC) and to learn how recently circumcised men ascribe value to and make sense of MC. Thirteen recently circumcised Zambian men were identified through the snowball technique...... and interviewed using a semi-structured interviewer's guide. Findings indicate that the post-operational experience of adult MC smoothly fits into the everyday-life experience of the men interviewed and is perceived and experienced as a broader social health issue, which largely transcends both the personal HIV...... that in addition to emphasising the HIV protective effect of MC, MC promotion should also highlight the social, sexual and romantic values perceived and experienced by the interviewees of this study; (3) the analysis reveals potentially harmful misconceptions about the health benefits of MC, demonstrating...

  20. Modeling Costs and Impacts of Introducing Early Infant Male Circumcision for Long-Term Sustainability of the Voluntary Medical Male Circumcision Program

    Science.gov (United States)

    Stegman, Peter; Kripke, Katharine; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Hatzold, Karin; Christensen, Alice; Stover, John

    2016-01-01

    Voluntary medical male circumcision (VMMC) has been shown to be an effective prevention strategy against HIV infection in males [1–3]. Since 2007, the President’s Emergency Plan for AIDS Relief (PEPFAR) has supported VMMC programs in 14 priority countries in Africa. Today several of these countries are preparing to transition their VMMC programs from a scale-up and expansion phase to a maintenance phase. As they do so, they must consider the best approaches to sustain high levels of male circumcision in the population. The two alternatives under consideration are circumcising adolescents 10–14 years old over the long term or integrating early infant male circumcision (EIMC) into maternal and child health programs. The paper presents an analysis, using the Decision Makers Program Planning Tool, Version 2.0 (DMPPT 2.0), of the estimated cost and impact of introducing EIMC into existing VMMC programs in several countries in eastern and southern Africa. Limited cost data exist for the implementation of EIMC, but preliminary studies, such as the one detailed in Mangenah, et al. [4–5], suggest that the cost of EIMC may be less than that of adolescent and adult male circumcision. If this is the case, then adding EIMC to the VMMC program will increase the number of circumcisions that need to be performed but will not increase the total cost of the program over the long term. In addition, we found that a delayed or slow start-up of EIMC would not substantially reduce the impact of adding it to the program or increase cumulative long-term costs, which should make introduction of EIMC more feasible and attractive to countries contemplating such a program innovation. PMID:27410233

  1. Modeling Costs and Impacts of Introducing Early Infant Male Circumcision for Long-Term Sustainability of the Voluntary Medical Male Circumcision Program.

    Science.gov (United States)

    Njeuhmeli, Emmanuel; Stegman, Peter; Kripke, Katharine; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Hatzold, Karin; Christensen, Alice; Stover, John

    2016-01-01

    Voluntary medical male circumcision (VMMC) has been shown to be an effective prevention strategy against HIV infection in males [1-3]. Since 2007, the President's Emergency Plan for AIDS Relief (PEPFAR) has supported VMMC programs in 14 priority countries in Africa. Today several of these countries are preparing to transition their VMMC programs from a scale-up and expansion phase to a maintenance phase. As they do so, they must consider the best approaches to sustain high levels of male circumcision in the population. The two alternatives under consideration are circumcising adolescents 10-14 years old over the long term or integrating early infant male circumcision (EIMC) into maternal and child health programs. The paper presents an analysis, using the Decision Makers Program Planning Tool, Version 2.0 (DMPPT 2.0), of the estimated cost and impact of introducing EIMC into existing VMMC programs in several countries in eastern and southern Africa. Limited cost data exist for the implementation of EIMC, but preliminary studies, such as the one detailed in Mangenah, et al. [4-5], suggest that the cost of EIMC may be less than that of adolescent and adult male circumcision. If this is the case, then adding EIMC to the VMMC program will increase the number of circumcisions that need to be performed but will not increase the total cost of the program over the long term. In addition, we found that a delayed or slow start-up of EIMC would not substantially reduce the impact of adding it to the program or increase cumulative long-term costs, which should make introduction of EIMC more feasible and attractive to countries contemplating such a program innovation.

  2. Acceptability of early infant male circumcision among chinese parents: strategy implications of HIV prevention for china

    Directory of Open Access Journals (Sweden)

    Pan Lianjun

    2012-09-01

    Full Text Available Abstract Background Recent evidence has confirmed that circumcision can be performed as a preventive strategy for HIV and early infant male circumcision (EIMC is regarded to be safer than circumcision in adulthood; however, limited data are available in the literature about EIMC in China. Therefore, the present study was designed to determine the willingness and attitudes of Chinese parents on newborn male circumcision so as to provide data for exploring the feasibility of implementing EIMC as an HIV prevention strategy in China. Methods Simple random sampling was used to draw participants from parents who had a newborn son delivered at Nanjing Maternity and Child Health Care Hospital, which is affiliated to Nanjing Medical University, between March and December 2010. A questionnaire was used to determine general medical knowledge or information about circumcision, attitudes about EIMC, and level of decision-making on circumcision for the newborn son. Results Data derived from 558 responses were analyzed and the ratio of respondents was 56.3% for fathers and 43.6% for mothers. Of the respondents, 34.4% agreed to circumcise their newborn son, and the level of agreement was 3.25 ± 1.17 (range, 1–5 with “1” being “reluctantly agree” and “5” being “very strongly agree”. The major reason for EIMC was for health (44.8%, followed by doctor’s advice (31.2%. The major reason not to agree to EIMC was concern about pain (50.5%, followed by the risk of the procedure (23.5%. Conclusion The willingness and acceptability of EIMC in China is low and the parents of newborn sons are usually not very affirmative when making a decision on such a procedure, suggesting that significant effort will be needed if EIMC is to be implemented as an HIV prevention strategy for China.

  3. Sex is never the same: Men's perspectives on refusing circumcision from an in-depth qualitative study in Kwaluseni, Swaziland

    NARCIS (Netherlands)

    A. Adams; E. Moyer

    2015-01-01

    Faced with an HIV prevalence of 31% among 18- to 49-year-olds, Swaziland developed a male circumcision policy in 2009, following compelling scientific evidence from three randomised controlled trials. Utilising United States Agency for International Development funds, the state set out to circumcise

  4. Behandeling van fimosis zonder circumcisie en reconstructie van het preputium na circumcisie. [Treatment of phimosis without circumcision and reconstruction of the prepuce following circumcision

    NARCIS (Netherlands)

    Nicolai, J.P.; Meek, M.F.

    2005-01-01

    : Phimosis of the prepuce can be treated without performing a circumcision. The most common and most effective treatment option is the local application ofcorticosteroid ointment. Should this be insufficiently effective, then the constricted ring can be interrupted with two Z-plasties, which is suff

  5. 儿童包皮环切术739例治疗体会%Experience of 739 cases of circumcision with disposable circumcision stapler in children

    Institute of Scientific and Technical Information of China (English)

    颜志刚; 王容; 肖波; 封雷; 周智; 谢珍

    2012-01-01

    Objective To observe the effect of the disposable circumcision stapler in circumcising children with either phimosis or redundant prepuce and investigate its superiority over the similar devices available. Methods A total of 739 children with phimosis as redundant prepuce underwent circumcision with the disposable circumcision stapler. The clinical data ware assessed concerning the duration of the procedure, incidence of past-operation complications, time of recovery and appearance of the penis. Results The operation time was (5. 2±1. 3)min. and the complication included infection in 9 (1. 22%), bleeding in 5 (0. 68%),edema in 27 (3. 65%) of the cases. The time for complete wound healing after circumcision was 19. 90 ±5. 33 days. Conclusion Child circumcision with the disposable circumcision stapler has advantages of short operation time, slight pain, law sate of complication and high satisfaction and acceptance of the patients.%目的 观察一次性包皮环切吻合器行儿童包皮环切术的临床运用效果,探讨应用一次性包皮环切吻合器行儿童包皮环切术的优越性.方法 应用一次性包皮环切吻合器对739例包皮过长及包茎儿童行包皮环切术,对手术时间、术后并发症、术后恢复时间和外观情况进行观察.结果 手术时间(5.2±1.3)分钟,主要并发症为术后感染9例(1.22%)、出血5例(0.68%)和水肿27例(3.65%).术后包皮创口完全愈合时间为(19.90±5.33)天.结论 应用一次性包皮环切吻合器行儿童包皮环切术具有手术时间短、术中疼痛轻、术后并发症少、外观满意度高、受术者易于接受等优点,值得在临床推广应用.

  6. Longer-Term Follow-Up of Kenyan Men Circumcised Using the ShangRing Device.

    Directory of Open Access Journals (Sweden)

    Paul J Feldblum

    Full Text Available To ascertain clinical sequelae, client satisfaction and sexual behavior 2+ years after male circumcision using the ShangRing device.We enrolled 199 men from the Kenya sites (Homa Bay district participating in a 2012 study of the ShangRing device used in routine male circumcision services (N = 552. We enrolled men who had had the ShangRing placed successfully, and over-sampled men who had had an adverse event and/or were HIV-positive during the field study. In the present study, each participant was examined and interviewed by a study clinician, and penile photographs were taken to document longer-term cosmetic results and any abnormal findings.194 men were included in the analysis. The mean and median times between circumcision and the longer-term follow-up visit in this study were 31.8 and 32 months, respectively. Four men (2.1% had signs/symptoms of a sexually transmitted infection (STI. Virtually all (99.5% of the men were very satisfied with the appearance of their circumcised penis, and all would recommend a ShangRing circumcision to friends or family members. The most prevalent reported advantage of the circumcision was the ease of bathing and enhanced cleanliness of the penis (75.8%. 94.3% of the men did not cite a single negative feature of their circumcision. 87.5% of men reported more sexual pleasure post-MC, the most common reason being more prolonged intercourse. The majority of men (52.6% reported one sexual partner post-MC, but more than a quarter of the men (28.1% reported an increased number of partners post-MC. Less than half of the men (44.3% reported using condoms half of the time or more, but the great majority of condom users stated that condom use was much easier post-MC, and 76.9% of users said they used condoms more after circumcision than before.This study supports the safety and acceptability of ShangRing male circumcision during 2-3 years of follow-up. It should allay worries that the ShangRing procedure could lead to

  7. Safe male circumcision in Botswana: tension between traditional practices and biomedical marketing.

    Science.gov (United States)

    Katisi, Masego; Daniel, Marguerite

    2015-01-01

    Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance.

  8. Combination of Circumcision and Microwave in Treatment of Genital Warts in Uncircumcised Patients

    Institute of Scientific and Technical Information of China (English)

    樊翌明; 马泽粦; 吴志华; 李顺凡; 陈秋霞

    2003-01-01

    Objective: To investigate the efficacy of combina-tion of circumcision and microwave on genital warts in uncircumcised men.Methods: A randomized, prospective study of 109 uncircumcised adult men with genital warts was con-ducted in a STD clinic in Zhanjiang, Guangdong. One group (n=54) received microwave therapy only, while the other group (n=55) was taken the combination of circumcision and microwave therapy. The recurrences were observed at the end of months 3, 6 and 12, and operative complications were also recorded.Results: There were no significant differences in the mean age and duration of the disease between two groups (P>0.05). No serious operative complications were documented. The recurrence rate in circumci-sion plus microwave group was markedly lower than that in microwave group (12.7% vs 29.6%, PO.05).Conclusion: Circumcision can be safely performed under local anesthesia in an outpatient setting. Com-bination of circumcision and microwave can produce excellent effect as well as less tissue damage,therefore, it may be ideal for uncircumcised patients with extensive condvlomas.

  9. Urosepsis and postrenal acute renal failure in a neonate following circumcision with Plastibell device

    Science.gov (United States)

    McQueen, Derrick; Sykes, Joseph; Phatak, Tej; Malik, Farhaan; Raghava, Preethi S.

    2015-01-01

    Plastibell is one of the three most common devices used for neonatal circumcision in the United States, with a complication rate as low as 1.8%. The Plastibell circumcision device is commonly used under local anesthesia for religious circumcision in male neonates, because of cosmetic reasons and ease of use. Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine. Furthermore, the foreskin of neonates is highly vascularized, and hence, hemorrhage and infection are possible when the skin is cut. Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention. We report a case of fulminant urosepsis, acute renal failure, and pyelonephritis in a 4-day-old male neonate secondary to impaction of a Plastibell circumcision device. Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications. Pediatricians and Emergency Department physicians should be cognizant of the complications from Plastibell circumcision device in order to institute appropriate and timely management in neonates. PMID:25932038

  10. Exposé of fallacious claims that male circumcision will increase HIV infections in Africa

    Directory of Open Access Journals (Sweden)

    Brian J. Morris

    2011-09-01

    Full Text Available Despite over two decades of extensive research showing that male circumcision protects against heterosexual acquisition of HIV in men, and that includes findings from large randomized controlled trials leading to acceptance by the WHO/UNAIDS and the Cochrane Committee, opponents of circumcision continue to generate specious arguments to the contrary. In a recent issue of the Journal of Public Health in Africa, Van Howe and Storms claim that male circumcision will increase HIV infections in Africa. Here we review the statements they use in support of their thesis and show that there is no scientific basis to such an assertion. We also evaluate the statistics used and show that when these data are properly analyzed the results lead to a contrary conclusion affirming the major role of male circumcision in protecting against HIV infection in Africa. Researchers, policy makers and the wider community should rely on balanced scholarship when assessing scientific evidence. We trust that our assessment may help refute the claims by Van Howe and Storms, and provide reassurance on the importance of circumcision for HIV prevention.

  11. Male circumcision for HIV prevention in India: emerging viewpoints and practices of health care providers.

    Science.gov (United States)

    Sinha, Anju; Chandhiok, Nomita; Sahay, Seema; Deb, Sibnath; Bharat, Shalini; Gupta, Abhilasha; Bhatt, Sripad; Kanthe, Vidisha; Kumar, Bijesh; Joglekar, Neelam; Paranjape, Ramesh; Mehendale, Sanjay

    2015-01-01

    A compelling case for promoting male circumcision (MC) as an intervention for reducing the risk of heterosexually acquired HIV infection was made by dissemination of the results of three studies in Africa. The WHO/UNAIDS recommendation for MC for countries like India, where the epidemic in concentrated in high-risk groups, advocates MC for specific population groups such as men at higher risk for HIV acquisition. A multicentre qualitative study was conducted in four geographically distinct districts (Belgaum, Kolkata, Meerut and Mumbai) in India during June 2009 to June 2011. Two categories of health care providers: Registered Healthcare Providers (RHCPs) and traditional circumcisers were interviewed by trained research staff who had received master's level education using interview guides with probes and open-ended questions. Respondents were selected using purposive sampling. A comparative analysis of the perspectives of the RHCP vs. traditional circumcisers is presented. Representatives of both categories of providers expressed the need for Indian data on MC. Providers feared that promoting circumcision might jeopardize/undermine the progress already made in the field of condom promotion. Reservation was expressed regarding its adoption by Hindus. Behavioural disinhibition was perceived as an important limitation. A contrast in the practice of circumcision was apparent between the traditional and the trained providers. MC should be mentioned as a part of comprehensive HIV prevention services in India that includes HIV counselling and testing, condom distribution and diagnosis and treatment of sexually transmitted infections. It should become an issue of informed personal choice rather than ethnic identity.

  12. Triggering the decision to undergo medical male circumcision: a qualitative study of adult men in Botswana.

    Science.gov (United States)

    Wirth, Kathleen E; Semo, Bazghina-Werq; Ntsuape, Conrad; Ramabu, Nankie M; Otlhomile, Boyce; Plank, Rebeca M; Barnhart, Scott; Ledikwe, Jenny H

    2016-08-01

    In 2007, the World Health Organization endorsed voluntary medical male circumcision (VMMC) as part of comprehensive HIV-prevention strategies. A major challenge facing VMMC programs in sub-Saharan Africa remains demand creation; there is urgent need for data on key elements needed to trigger the decision among eligible men to seek VMMC. Using qualitative methods, we sought to better understand the circumcision decision-making process in Botswana related to VMMC. From July to November 2013, we conducted 27 focus group discussions in four purposively selected communities in Botswana with men (stratified by circumcision status and age), women (stratified by age) and community leaders. All discussions were facilitated by a trained same-sex interviewer, audio recorded, transcribed and translated to English, and analyzed for key themes using an inductive content analytic approach. Improved hygiene was frequently cited as a major benefit of circumcision and many participants believed that cleanliness was directly responsible for the protective effect of VMMC on HIV infection. While protection against HIV was frequently noted as a benefit of VMMC, the data indicate that increased sexual pleasure and perceived attractiveness, not fear of HIV infection, was an underlying reason why men sought VMMC. Data from this qualitative study suggest that more immediate benefits of VMMC, such as improved hygiene and sexual pleasure, play a larger role in the circumcision decision compared with protection from potential HIV infection. These findings have immediate implications for targeted demand creation and mobilization activities for increasing uptake of VMMC among adult men in Botswana.

  13. HIV prevention: Making male circumcision the 'right' tool for the job.

    Science.gov (United States)

    Bell, Kirsten

    2015-01-01

    In recent years, HIV/AIDS programming has been transformed by an ostensibly 'new' procedure: male circumcision. This article examines the rise of male circumcision as the 'right' HIV prevention tool. Treating this controversial topic as a 'matter of concern' rather than a 'matter of fact', I examine the reasons why male circumcision came to be seen as a partial solution to the problem of HIV transmission in the twenty-first century and to what effect. Grounded in a close reading of the primary literature, I suggest that the embrace of male circumcision in HIV prevention must be understood in relation to three factors: (1) the rise of evidence-based medicine as the dominant paradigm for conceptualising medical knowledge, (2) the fraught politics of HIV/AIDS research and funding, which made the possibility of a biomedical intervention attractive and (3) underlying assumptions about the nature of African 'culture' and 'sexuality'. I conclude by stressing the need to expand the parameters of the debate beyond the current polarised landscape, which presents us with a problematic either/or scenario regarding the efficacy of male circumcision.

  14. Safe male circumcision in Botswana: tension between traditional practices and biomedical marketing.

    Science.gov (United States)

    Katisi, Masego; Daniel, Marguerite

    2015-01-01

    Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance. PMID:25866013

  15. Willingness of men who have sex with men (MSM in the United States to be circumcised as adults to reduce the risk of HIV infection.

    Directory of Open Access Journals (Sweden)

    Elin B Begley

    Full Text Available BACKGROUND: Circumcision reduces HIV acquisition among heterosexual men in Africa, but it is unclear if circumcision may reduce HIV acquisition among men who have sex with men (MSM in the United States, or whether MSM would be willing to be circumcised if recommended. METHODS: We interviewed presumed-HIV negative MSM at gay pride events in 2006. We asked uncircumcised respondents about willingness to be circumcised if it were proven to reduce risk of HIV among MSM and perceived barriers to circumcision. Multivariate logistic regression was used to identify covariates associated with willingness to be circumcised. RESULTS: Of 780 MSM, 133 (17% were uncircumcised. Of these, 71 (53% were willing to be circumcised. Willingness was associated with black race (exact odds ratio [OR]: 3.4, 95% confidence interval [CI]: 1.3-9.8, non-injection drug use (OR: 6.1, 95% CI: 1.8-23.7 and perceived reduced risk of penile cancer (OR: 4.7, 95% CI: 2.0-11.9. The most commonly endorsed concerns about circumcision were post-surgical pain and wound infection. CONCLUSIONS: Over half of uncircumcised MSM, especially black MSM, expressed willingness to be circumcised. Perceived risks and benefits of circumcision should be a part of educational materials if circumcision is recommended for MSM in the United States.

  16. Efficient and equitable HIV prevention: A case study of male circumcision in South Africa

    Directory of Open Access Journals (Sweden)

    Verguet Stéphane

    2013-01-01

    Full Text Available Abstract Background We determine efficient, equitable and mixed efficient-equitable allocations of a male circumcision (MC intervention reducing female to male HIV transmission in South Africa (SA, as a case study of an efficiency-equity framework for resource allocation in HIV prevention. Methods We present a mathematical model developed with epidemiological and cost data from the nine provinces of SA. The hypothetical one-year-long MC intervention with a budget of US$ 10 million targeted adult men 15–49 years of age in SA. The intervention was evaluated according to two criteria: an efficiency criterion, which focused on maximizing the number of HIV infections averted by the intervention, and an equity criterion (defined geographically, which focused on maximizing the chance that each male adult individual had access to the intervention regardless of his province. Results A purely efficient intervention would prevent 4,008 HIV infections over a year. In the meantime, a purely equitable intervention would avert 3,198 infections, which represents a 20% reduction in infection outcome as compared to the purely efficient scenario. A half efficient-half equitable scenario would prevent 3,749 infections, that is, a 6% reduction in infection outcome as compared to the purely efficient scenario. Conclusions This paper provides a framework for resource allocation in the health sector which incorporates a simple equity metric in addition to efficiency. In the specific context of SA with a MC intervention for the prevention of HIV, incorporation of geographical equity only slightly reduces the overall efficiency of the intervention.

  17. Women's Perceptions and Misperceptions of Male Circumcision: A Mixed Methods Study in Zambia.

    Science.gov (United States)

    Haberland, Nicole A; Kelly, Christine A; Mulenga, Drosin M; Mensch, Barbara S; Hewett, Paul C

    2016-01-01

    Women's perceptions of male circumcision (MC) have implications for behavioral risk compensation, demand, and the impact of MC programs on women's health. This mixed methods study combines data from the first two rounds of a longitudinal study (n = 934) and in-depth interviews with a subsample of respondents (n = 45) between rounds. Most women correctly reported that MC reduces men's risk of HIV (64% R1, 82% R2). However, 30% of women at R1, and significantly more (41%) at R2, incorrectly believed MC is fully protective for men against HIV. Women also greatly overestimated the protection MC offers against STIs. The proportion of women who believed MC reduces a woman's HIV risk if she has sex with a man who is circumcised increased significantly (50% to 70%). Qualitative data elaborate women's misperception regarding MC. Programs should address women's informational needs and continue to emphasize that condoms remain critical, regardless of male partner's circumcision status.

  18. Early infant male circumcision for human immunodeficiency virus prevention: knowledge and attitudes of women attending a rural hospital in Swaziland, Southern Africa.

    Science.gov (United States)

    Jarrett, Prudence; Kliner, Merav; Walley, John

    2014-01-01

    Swaziland has the highest prevalence of human immunodeficiency virus (HIV) in the world at 26% of the adult population. Medical male circumcision (MMC) has been shown to reduce the risk of acquiring HIV from heterosexual sex by up to 60% and the Government of Swaziland has been promoting adult male circumcision. Infant circumcision commenced in 2013 so it is important to understand the knowledge and views of women as potential mothers, around infant circumcision for medical purposes to inform the development of the service. This study interviewed 14 women of reproductive age attending the outpatient department of Good Shepherd Mission Hospital (GSMH), a rural district hospital, on their knowledge of and attitudes to early infant male circumcision (EIMC). Participants were highly knowledgeable about the health benefits of medical circumcision, although knowledge of the comparative risks and benefits of EIMC to adult circumcision was poor. All participants would have a son circumcised; the preferred age varied from early infancy to adolescence. Complications and pain were the main barriers whilst religious and cultural reasons were mentioned both for and against circumcision. A variety of family members are important in the decision to circumcise a young boy. Acceptability of medical circumcision was high in this study, but concerns about safety, pain, autonomy and cultural factors reduce the acceptability of infant circumcision more specifically. It will be important to provide accurate, culturally sensitive information about infant circumcision to mothers, fathers and grandparents using existing hospital and community services provided at GSMH and throughout Swaziland. Where possible services for MMC should be available to males of all ages so that families and young men may choose the most favourable age for circumcision.

  19. Complications of traditional circumcision amongst young Xhosa males seen at St Lucy’s Hospital, Tsolo, Eastern Cape, South Africa

    Directory of Open Access Journals (Sweden)

    Ugochukwu Anike

    2013-01-01

    Full Text Available Background: Traditional circumcision of males is common amongst many societies in sub-Saharan Africa. Circumcision amongst the Xhosa people of South Africa represents a rite of passage to manhood. Traditional male circumcision has an increased risk for complications that include sepsis, genitalmutilation, gangrenous penis, excessive bleeding, dehydration, renal failure and death. The aim of this study was to describe the complications of traditional circumcisions amongst Xhosa men as seen at St. Lucy’s Hospital in the Eastern Cape Province.Method: A cross-sectional descriptive quantitative study was conducted in 2008. Records of 105 malesadmitted to St. Lucy’s Hospital with complications following traditional circumcision were reviewed. Data collected included age, education level, race, reasons for circumcision, complications, the period of circumcision, duration of hospital stay and the outcomes. Descriptive data analysis was performed using statistical software SPSS 17.0.Results: The ages ranged from 15–35 years with 68 (64.8% between 15–19 years. 83 (79% had a secondarylevel of education, 16 (15.2% primary, 5 (4.8% tertiary and 1% had no education. 60 (57% werecircumcised as initiation to manhood, 21 (20.0% due to peer pressure, 20 (19.0% for cultural reasons, and 1(1.0% was forced. The complications were sepsis (59 [56.2%], genital mutilation (28 [26.7%], dehydration(12 [11.4%] and amputation of genitalia (6 [5.7%].Fifty-nine (56.2% patients were circumcised in winter.79 (75.2% were circumcised in the forest, and 25 (23.8% in initiation centres. Fifty-eight (55.2% werecircumcised by traditionalists, and 47 (44.8% by tribal elders (initiators. Hospital stays ranged from 8 to28 days. 66% were healed and discharged, and 29 (27.6% were referred to higher centres of care.Conclusion: Genital sepsis was the most common complication of traditional male circumcision.Complications were related to the circumciser, advanced age of the patient

  20. Prospective investigation of penile length with newborn male circumcision and second to fourth digit ratio

    Science.gov (United States)

    Park, Jong Kwan; Doo, A. Ram; Kim, Joo Heung; Park, Hyung Sub; Do, Jung Mo; Choi, Hwang; Park, Seung Chol; Kim, Myung Ki; Jeong, Young Beom; Kim, Hyung Jim; Kim, Young Gon; Shin, Yu Seob

    2016-01-01

    Introduction: We prospectively investigated the relationship between newborn male circumcision (NMC) and second to fourth digit ratio with penile length. Methods: As participants for our study, we identified already circumcised young patients who visited our hospital for urological treatment. The age at which the circumcision had been done was assessed. The patients’ height and weight were measured. Second to fourth digit ratio was calculated by measuring the second and fourth digit lengths. The flaccid and erectile penile lengths were measured from the base of the penis to the tip of the glans in standing position. Results: A total of 248 patients were included in our study. In univariate analysis, height, second to fourth digit ratio, flaccid penile length, and age of circumcision were associated with erectile penile length. Among these variables, second to fourth digit ratio, flaccid penile length, and age of circumcision were significant predictive factors for erectile penile length in multivariate analysis. The subjects were divided into two groups, including 72 patients in the NMC group and 176 patients in the non-NMC group. No significant difference was found in height, weight, and second to fourth digit ratio between both groups. However, flaccid (p<0.001) and erectile (p=0.001) penile lengths were shorter in the NMC group than in the non-NMC group. Conclusions: Despite the small number of subjects, this study shows that NMC was associated with shorter penile length. Second to fourth digit ratio, flaccid penile length, and age of circumcision were also significant predictive factors for erectile penile length. Further multicentre studies with larger number of subjects and biochemical analyses are needed for potential clinical applicability. PMID:27695583

  1. Histopathological examination of the prepuce after circumcision: Is it a waste of resources?

    Directory of Open Access Journals (Sweden)

    Hussein Naji

    2013-01-01

    Full Text Available Background: The aim of this article is to evaluate the histopathological findings of foreskin after circumcision for medical indications and to find out if analyzing the biopsy is a waste of resources. Material and Methods: This retrospective analysis was carried out of the medical records and histopathological findings of 112 boys who underwent circumcision from June 2002 to June 2005. The study group consisted of 52 boys that were circumcised for medical indications, while the control group consisted of 60 boys who underwent circumcision for religious belief. Results: The mean (range age of children in the study group was six (2-12 years. 36 boys had phimosis, 15 had recurrent balanoposthitis and one had paraphimosis as an indication for circumcision. Balanitis xerotica obliterans (BXO was diagnosed in eight out of 52 biopsies (15%. In five of the eight BXO, the histopathological examination revealed focal lichenoid infiltrate which was considered as early form of BXO. There was no suspicion of BXO in the physical examination of those five patients. Chronic inflammation was reported in seven patients, while minor changes in the form of minimal inflammation and oedema were found in another 15 patients. The rest of the biopsies (22 patients showed normal preputial pathology. The histopathological examinations of the control group revealed chronic inflammation in three patients and acute inflammation with cellular oedema in another three patients. Conclusions: There is a place for routine biopsy after circumcision for medical indications. The clinical examination failed to suspect 5 of the 8 cases of BXO that were diagnosed by histopathology.

  2. Acceptability of early infant male circumcision as an HIV prevention intervention in Zimbabwe: a qualitative perspective.

    Directory of Open Access Journals (Sweden)

    Webster Mavhu

    Full Text Available BACKGROUND: Early infant male circumcision (EIMC is simpler, safer and more cost-effective than adult circumcision. In sub-Saharan Africa, there are concerns about acceptability of EIMC which could affect uptake. In 2009 a quantitative survey of 2,746 rural Zimbabweans (aged 18-44 indicated that 60% of women and 58% of men would be willing to have their newborn son circumcised. Willingness was associated with knowledge of HIV and male circumcision. This qualitative study was conducted to better understand this issue. METHODS: In 2010, 24 group discussions were held across Zimbabwe with participants from seven ethnic groups. Additionally, key informant interviews were held with private paediatricians who offer EIMC (n = 2 plus one traditional leader. Discussions were audio-recorded, transcribed, translated into English (where necessary, coded using NVivo 8 and analysed using grounded theory principles. RESULTS: Knowledge of the procedure was poor. Despite this, acceptability of EIMC was high among parents from most ethnic groups. Discussions suggested that fathers would make the ultimate decision regarding EIMC although mothers and extended family can have (often covert influence. Participants' concerns centred on: safety, motive behind free service provision plus handling and disposal of the discarded foreskin. Older men from the dominant traditionally circumcising population strongly opposed EIMC, arguing that it separates circumcision from adolescent initiation, as well as allowing women (mothers to nurse the wound, considered taboo. CONCLUSIONS: EIMC is likely to be an acceptable HIV prevention intervention for most populations in Zimbabwe, if barriers to uptake are appropriately addressed and fathers are specifically targeted by the programme.

  3. Early Infant Male Circumcision in Cameroon and Senegal: Demand, Service Provision, and Cultural Context

    Science.gov (United States)

    Kenu, Ernest; Sint, Tin Tin; Kamenga, Claude; Ekpini, Rene

    2016-01-01

    ABSTRACT Background: Male circumcision is almost universal in North and West Africa, and practiced for various reasons. Yet there is little documentation on service delivery, clinical procedures, policies, and programmatic strategies. The United Nations Children’s Fund (UNICEF) commissioned country program reviews in 2014 to shed light on the delivery of male circumcision services for infants in Cameroon and Senegal. Methods: We conducted a policy desk review, key informant interviews, and focus group discussions at health centers and in communities. Between December 2014 and January 2015, we conducted 21 key informant interviews (13 with regional and district officers, 5 with national officers, and 3 with UNICEF officials) and 36 focus group discussions (6 with men, 6 with women, 12 with adolescent boys, and 12 with service providers). Some of the men and women were parents of the adolescents who participated in the focus group discussions. In the French-speaking areas, the focus group discussions were conducted in French through an accredited translator, audio recorded, and transcribed into English. Results: All of the facilities we visited in Cameroon and Senegal offer medical male circumcision, with 10 out of 12 performing early infant male circumcision (EIMC) routinely. Neither country has policies, guidelines, or strategies for EIMC. The procedure is done mainly by untrained service providers, with some providers using modern circumcision devices. There are no key messages on EIMC for families; the increasing demand for EIMC is led by the community. Conclusion: Despite the absence of national policies and strategies, EIMC is routinely offered at all levels of the health care system in Cameroon and Senegal, mainly by untrained service providers. Improving circumcision services will require guidelines for EIMC and improvements in training, equipment, supply chains, recordkeeping, and demand creation. PMID:27413080

  4. Factors contributing to the low uptake of medical male circumcision in Mutare Rural District, Zimbabwe

    Directory of Open Access Journals (Sweden)

    Irene O. Chiringa

    2016-03-01

    Full Text Available Background: Medical male circumcision (MMC has become a significant dimension of HIV prevention interventions, after the results of three randomised controlled trials in Uganda, South Africa and Kenya demonstrated that circumcision has a protective effect against contracting HIV of up to 60%. Following recommendations by the World Health Organization, Zimbabwe in 2009 adopted voluntary MMC as an additional HIV prevention strategy to the existing ABC behaviour change model.Purpose: The purpose of this study is thus to investigate the factors contributing to the low uptake of MMC.Methods: The study was a quantitative cross-sectional survey conducted in Mutare rural district, Zimbabwe. Questionnaires with open- and closed-ended questions were administered to the eligible respondents. The target population were male participants aged 15–29 who met the inclusion criteria. The households were systematically selected with a sample size of 234. Statistical Package for the Social Sciences was used to analyse the data.Results: Socioculturally, circumcised men are viewed as worthless (37%, shameful (30% and are tainted as promiscuous (20%, psychological factors reported were infection and delayed healing (39%, being ashamed and dehumanised (58%, stigmatised and discriminated (40.2% and fear of having an erection during treatment period (89.7% whilst socio-economic factors were not having time, as it will take their time from work (58% and complications may arise leading to spending money on treatment (84%.Conclusion: Knowledge deficits regarding male medical circumcision lead to low uptake, education on male medical circumcision and its benefits. Comprehensive sexual health education should target men and dispel negative attitudes related to the use of health services.Keywords: Factors, Low uptake, Medical Male Circumcision (MMC

  5. What nurses need to know about female genital mutilation.

    Science.gov (United States)

    Momoh, Comfort; Olufade, Olamide; Redman-Pinard, Patrice

    Female genital mutilation, also known as female circumcision (FGM/C) is a deep-rooted practice in some countries that needs to be addressed if the health needs of women and girls are to be met. FGM/C has no medical or health benefits. This article will discuss the different types of FGM/C, the law and legal implications and urological complications. Urology nurses need to be aware of what their medical roles and legal responsibilities are so that they are able to sensitively and holistically care for girls and women living with or at risk of FGM/C.

  6. What nurses need to know about female genital mutilation.

    Science.gov (United States)

    Momoh, Comfort; Olufade, Olamide; Redman-Pinard, Patrice

    Female genital mutilation, also known as female circumcision (FGM/C) is a deep-rooted practice in some countries that needs to be addressed if the health needs of women and girls are to be met. FGM/C has no medical or health benefits. This article will discuss the different types of FGM/C, the law and legal implications and urological complications. Urology nurses need to be aware of what their medical roles and legal responsibilities are so that they are able to sensitively and holistically care for girls and women living with or at risk of FGM/C. PMID:27172505

  7. Voluntary medical male circumcision in resource-constrained settings.

    Science.gov (United States)

    Tobian, Aaron A R; Adamu, Tigistu; Reed, Jason B; Kiggundu, Valerian; Yazdi, Youseph; Njeuhmeli, Emmanuel

    2015-12-01

    Throughout East and Southern Africa, the WHO recommends voluntary medical male circumcision (VMMC) to reduce heterosexual HIV acquisition. Evidence has informed policy and the implementation of VMMC programmes in these countries. VMMC has been incorporated into the HIV prevention portfolio and more than 9 million VMMCs have been performed. Conventional surgical procedures consist of forceps-guided, dorsal slit or sleeve resection techniques. Devices are also becoming available that might help to accelerate the scale-up of adult VMMC. The ideal device should make VMMC easier, safer, faster, sutureless, inexpensive, less painful, require less infrastructure, be more acceptable to patients and should not require follow-up visits. Elastic collar compression devices cause vascular obstruction and necrosis of foreskin tissue and do not require sutures or injectable anaesthesia. Collar clamp devices compress the proximal part of the foreskin to reach haemostasis; the distal foreskin is removed, but the device remains and therefore no sutures are required. Newer techniques and designs, such as tissue adhesives and a circular cutter with stapled anastomosis, are improvements, but none of these methods have achieved all desirable characteristics. Further research, design and development are needed to address this gap to enable the expansion of the already successful VMMC programmes for HIV prevention.

  8. Circumcision of the Female Intellect: 19th Century Women Who Opposed Scholarly Education

    Science.gov (United States)

    Holmes, Marbeth

    2009-01-01

    In 19th century America, some women decried the opportunity for scholarly education as rebellion against religion and predicted a grim decline in the quality of life, home, and hearth for American families and for American culture and politics. In particular, women who opposed scholarly education argued that God had not created men and women…

  9. Routine (non-religious) neonatal circumcision and bodily integrity: a transatlantic dialogue.

    NARCIS (Netherlands)

    Dekkers, W.J.M.

    2009-01-01

    In the current debate about the pros and cons of routine (non-religious) neonatal circumcision (RNC), the emphasis is on medical justifications for the practice. Questions of human rights also are widely discussed. However, even if the alleged medical benefits of RNC were to outweigh the harms and r

  10. Transfer of the Kenyan Kikuyu Male Circumcision Ritual to Future Generations Living in the United States

    Science.gov (United States)

    Mbito, Michael N.; Malia, Julia A.

    2009-01-01

    This phenomenological research report from analysis of interviews with 18 participants focuses on the theme of transferring an age-old initiation-into-manhood circumcision ritual to future generations of Kenyan Kikuyu who are living in the US. We identified three subthemes and found a strong indication that, while personally meaningful to the…

  11. Universelle kramper og respirationsstop som komplikation i forbindelse med lokalanalgesi ved circumcision

    DEFF Research Database (Denmark)

    Heiberg, Ida Louise; Nebrich, Lars; Pedersen, Pernille

    2015-01-01

    We present two cases in which two boys of four weeks and four and a half months, respectively, experienced seizures and respiratory insufficiency as complications to the local anaesthesia administered for ritual circumcision. They both needed intubation and anticonvulsive therapy and acquired...

  12. Penile injury due to blunt trauma after circumcision in a male child: A case report

    Directory of Open Access Journals (Sweden)

    Hulya Ozturk

    2014-08-01

    Full Text Available Injury in the case presented here is different from the cause of penile trauma. Our case has been exposed to blunt trauma after circumcision. Type developments of the penile trauma, treatment, and precautions have been discussed with the literature.

  13. Do the benefits of male circumcision outweigh the risks? A critique of the proposed CDC guidelines

    Directory of Open Access Journals (Sweden)

    Brian D. Earp

    2015-03-01

    Full Text Available The Centers for Disease Control and Prevention (CDC have announced a set of provisional guidelines concerning male circumcision, in which they suggest that the benefits of the surgery outweigh the risks. In this perspective article, I highlight a few of the key scientific and ethical issues worth considering in interpreting the new CDC recommendations.

  14. Traditional male circumcision in Uganda: a qualitative focus group discussion analysis.

    Directory of Open Access Journals (Sweden)

    Amir Sabet Sarvestani

    Full Text Available BACKGROUND: The growing body of evidence attesting to the effectiveness of clinical male circumcision in the prevention of HIV/AIDS transmission is prompting the majority of sub-Saharan African governments to move towards the adoption of voluntary medical male circumcision (VMMC. Even though it is recommended to consider collaboration with traditional male circumcision (TMC providers when planning for VMMC, there is limited knowledge available about the TMC landscape and traditional beliefs. METHODOLOGY AND MAIN FINDINGS: During 2010-11 over 25 focus group discussions (FGDs were held with clan leaders, traditional cutters, and their assistants to understand the practice of TMC in four ethnic groups in Uganda. Cultural significance and cost were among the primary reasons cited for preferring TMC over VMMC. Ethnic groups in western Uganda circumcised boys at younger ages and encountered lower rates of TMC related adverse events compared to ethnic groups in eastern Uganda. Cutting styles and post-cut care also differed among the four groups. The use of a single razor blade per candidate instead of the traditional knife was identified as an important and recent change. Participants in the focus groups expressed interest in learning about methods to reduce adverse events. CONCLUSION: This work reaffirmed the strong cultural significance of TMC within Ugandan ethnic groups. Outcomes suggest that there is an opportunity to evaluate the involvement of local communities that still perform TMC in the national VMMC roll-out plan by devising safer, more effective procedures through innovative approaches.

  15. Mathieu repair of distal and midshaft hypospadias: risks and benefits of foreskin reconstruction versus circumcision

    Directory of Open Access Journals (Sweden)

    Moslemi MK

    2011-06-01

    Full Text Available Mohammad Kazem Moslemi1, Mohammad Ali Sadighi Gilani2, Hossein Shahrokh31Department of Urology, Kamkar Hospital, School of Medicine, Qom, University of Medical Science, Qom, Iran; 2Department of Urology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; 3Department of Urology, Hasheminejad Kidney Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, IranBackground: The purpose of this study was to compare the risks and benefits of Mathieu repair of hypospadias with or without circumcision in consecutive operated cases.Methods: Eighty-six children with midshaft or distal hypospadias were randomly divided into two groups and underwent circumcision (Group A or preputial reconstruction (Group B during hypospadias repair. Postoperative complications, outcomes, and parental satisfaction were assessed for circumcised and uncircumcised patients. All patients with midshaft or distal hypospadias with or without minimal chordee were included.Results: No statistically significant differences in urethral complications were found between the two groups. Meatal stenosis occurred in one case in Group A and one case in Group B. Fistulae occurred in five cases in Group A and six cases in Group B. Urethral dehiscence occurred in no case in either group. No case of phimosis was seen in Group B. After a mean follow-up of 6 months, all parents of Group A cases stated that they were satisfied with the circumcision for religious and/or social reasons, but no parents of Group B cases were satisfied with preputioplasty (P ≤ 0.05. No case of hypospadias repair failure was seen in our operated cases. Finally, no cases in Group B required redo hypospadias surgery.Conclusion: Mathieu repair with synchronous circumcision is feasible in all patients with distal or midshaft hypospadias with or without minimal chordee, and should be considered in accordance with surgeon preference. In the case of prepuce

  16. Triggering the decision to undergo medical male circumcision: a qualitative study of adult men in Botswana.

    Science.gov (United States)

    Wirth, Kathleen E; Semo, Bazghina-Werq; Ntsuape, Conrad; Ramabu, Nankie M; Otlhomile, Boyce; Plank, Rebeca M; Barnhart, Scott; Ledikwe, Jenny H

    2016-08-01

    In 2007, the World Health Organization endorsed voluntary medical male circumcision (VMMC) as part of comprehensive HIV-prevention strategies. A major challenge facing VMMC programs in sub-Saharan Africa remains demand creation; there is urgent need for data on key elements needed to trigger the decision among eligible men to seek VMMC. Using qualitative methods, we sought to better understand the circumcision decision-making process in Botswana related to VMMC. From July to November 2013, we conducted 27 focus group discussions in four purposively selected communities in Botswana with men (stratified by circumcision status and age), women (stratified by age) and community leaders. All discussions were facilitated by a trained same-sex interviewer, audio recorded, transcribed and translated to English, and analyzed for key themes using an inductive content analytic approach. Improved hygiene was frequently cited as a major benefit of circumcision and many participants believed that cleanliness was directly responsible for the protective effect of VMMC on HIV infection. While protection against HIV was frequently noted as a benefit of VMMC, the data indicate that increased sexual pleasure and perceived attractiveness, not fear of HIV infection, was an underlying reason why men sought VMMC. Data from this qualitative study suggest that more immediate benefits of VMMC, such as improved hygiene and sexual pleasure, play a larger role in the circumcision decision compared with protection from potential HIV infection. These findings have immediate implications for targeted demand creation and mobilization activities for increasing uptake of VMMC among adult men in Botswana. PMID:26754167

  17. The ultrasonic harmonic scalpel for circumcision:experimental evaluation using dogs

    Institute of Scientific and Technical Information of China (English)

    Mou Peng; Zhe Meng; Zhong-Hua Yang; Xing-Huan Wang

    2013-01-01

    Male circumcision is one of the most commonly performed operations worldwide,and many novel techniques have been developed for better postoperative outcomes.The purpose of this study was to explore the feasibility of applying the ultracision harmonic scalpel (UHS) for circumcision by using dogs.Sixteen adult male dogs were divided into two groups:the UHS group and the control group.The dogs were circumcised with either the UHS or a conventional scalpel.The UHS circumcision procedure and the effects were imaged 1 week after surgery.The two groups were compared with respect to the operative time and volume of blood loss.Postoperative complications,including oedema,infection,bleeding of the incision and wound dehiscence,were recorded for both groups.The mean operative time for the UHS group was only 5.1 min compared with the 35.5 min of the conventional group.The mean blood loss was less than 2 ml for the UHS group and 15 ml for the conventional group.There was only one case of mild oedema in the UHS group,but the postoperative complications in the conventional group included two cases of mild oedema,one infection of the incision and one case of bleeding of the incision.In conclusion,circumcision using UHS is a novel technique to treat patients with phimosis and excessive foreskin,and this method has a short operative time,less blood loss and fewer complications than the conventional scalpel method.This small animal study provides a basis for embarking on a larger-scale clinical trial of the UHS.

  18. Modeling the Impact of Uganda's Safe Male Circumcision Program: Implications for Age and Regional Targeting.

    Directory of Open Access Journals (Sweden)

    Katharine Kripke

    Full Text Available Uganda aims to provide safe male circumcision (SMC to 80% of men ages 15-49 by 2016. To date, only 2 million men have received SMC of the 4.2 million men required. In response to age and regional trends in SMC uptake, the country sought to re-examine its targets with respect to age and subnational region, to assess the program's progress, and to refine the implementation approach.The Decision Makers' Program Planning Tool, Version 2.0 (DMPPT 2.0, was used in conjunction with incidence projections from the Spectrum/AIDS Impact Module (AIM to conduct this analysis. Population, births, deaths, and HIV incidence and prevalence were used to populate the model. Baseline male circumcision prevalence was derived from the 2011 AIDS Indicator Survey. Uganda can achieve the most immediate impact on HIV incidence by circumcising men ages 20-34. This group will also require the fewest circumcisions for each HIV infection averted. Focusing on men ages 10-19 will offer the greatest impact over a 15-year period, while focusing on men ages 15-34 offers the most cost-effective strategy over the same period. A regional analysis showed little variation in cost-effectiveness of scaling up SMC across eight regions. Scale-up is cost-saving in all regions. There is geographic variability in program progress, highlighting two regions with low baseline rates of circumcision where additional efforts will be needed.Focusing SMC efforts on specific age groups and regions may help to accelerate Uganda's SMC program progress. Policy makers in Uganda have already used model outputs in planning efforts, proposing males ages 10-34 as a priority group for SMC in the 2014 application to the Global Fund's new funding model. As scale-up continues, the country should also consider a greater effort to expand SMC in regions with low MC prevalence.

  19. Factors associated with the acceptability of male circumcision among men in Jamaica.

    Directory of Open Access Journals (Sweden)

    Melonie M Walcott

    Full Text Available OBJECTIVES: To determine the prevalence of male circumcision (MC among men in the western region of Jamaica, and to identify factors associated with acceptability of MC for self, infants (<1 year and older sons (1-17 years. METHODS: A cross-sectional, interviewer-administered questionnaire survey of 549 men aged 19-54 years was conducted in the western region of Jamaica. The survey included questions about the acceptance of MC for self, infants, and sons before and after an information session about the benefits of MC in preventing HIV/STI transmission. Logistic regression models were used to identify factors that were associated with acceptability of MC. Adjusted odds ratios (AOR and 95% confidence intervals (CI were calculated from the models. RESULTS: Fourteen percent of the men reported that they were circumcised. In the multivariable model, which adjusted for age, education, religion and income, there were increased odds of accepting MC for infants/sons among uncircumcised men who accepted MC for self (AOR=8.1; 95% CI = 4.1-15.9, believed they would experience more pleasure during sex if circumcised (AOR=4.0; 95% CI = 2.0-8.2, and reported having no concerns regarding MC (AOR=3.0; 95% CI = 1.8-4.8. Similarly, uncircumcised men who reported no concerns about MC or who believed that they would experience more pleasure during sex if circumcised were more likely to accept MC for self. CONCLUSION: Providing men with information about MC increased acceptance of MC for self, infants (<17 years and sons (1-17 years. Since targeted education on the benefits of male circumcision for prevention of HIV/STI can be effective in increasing acceptability of MC, health professionals should be trained, and willing to discuss MC with men in healthcare facilities and in the community.

  20. A rose by any other name? Rethinking the similarities and differences between male and female genital cutting.

    Science.gov (United States)

    Darby, Robert; Svoboda, J Steven

    2007-09-01

    In this article, we offer a critical examination of the tendency to segregate discussion of surgical alterations to the male and female genitals into separate compartments--the first known as circumcision, the second as genital mutilation. We argue that this fundamental problem of definition underlies the considerable controversy surrounding these procedures when carried out on minors, and that it hinders objective discussion of the alleged benefits, harms, and risks. We explore the variable effects of male and female genital surgeries, and we propose a scale of damage for male circumcision to complement the World Health Organization's categorization of female genital mutilation. The origins of the double standard identified are placed in historical perspective, and in a brief conclusion we make a plea for greater gender neutrality in the approach to this contentious issue. PMID:17937251

  1. Comparison of Postoperative Analgesic Efficacy of Penile Block, Caudal Block and Intravenous Paracetamol for Circumcision: A prospective Randomized Study

    OpenAIRE

    Ahmet Hakan Haliloglu; Mehmet Ilker Gokce; Semih Tangal; Mehmet Salih Boga; Hakan Tapar; Ebru Aladag

    2013-01-01

    Purpose To evaluate the postoperative analgesic efficacy of penile block, caudal block and intravenous paracetamol administration following circumcision. Materials and Methods In this prospective randomized study a total of 159 patients underwent circumcision under general anesthesia at urology clinic of Ufuk University Faculty of Medicine and Sorgun State Hospital between May 2012 and September 2012. The patients were randomized to three groups to receive penile block (Group 1), caudal blo...

  2. Reach and cost-effectiveness of the PrePex device for safe male circumcision in Uganda.

    Directory of Open Access Journals (Sweden)

    Kevin Duffy

    Full Text Available INTRODUCTION: Modelling, supported by the USAID Health Policy Initiative and UNAIDS, performed in 2011, indicated that Uganda would need to perform 4.2 million medical male circumcisions (MMCs to reach 80% prevalence. Since 2010 Uganda has completed 380,000 circumcisions, and has set a national target of 1 million for 2013. OBJECTIVE: To evaluate the relative reach and cost-effectiveness of PrePex compared to the current surgical SMC method and to determine the effect that this might have in helping to achieve the Uganda national SMC targets. METHODS: A cross-sectional descriptive cost-analysis study conducted at International Hospital Kampala over ten weeks from August to October 2012. Data collected during the performance of 625 circumcisions using PrePex was compared to data previously collected from 10,000 circumcisions using a surgical circumcision method at the same site. Ethical approval was obtained. RESULTS: The moderate adverse events (AE ratio when using the PrePex device was 2% and no severe adverse events were encountered, which is comparable to the surgical method, thus the AE rate has no effect on the reach or cost-effectiveness of PrePex. The unit cost to perform one circumcision using PrePex is $30.55, 35% ($7.90 higher than the current surgical method, but the PrePex method improves operator efficiency by 60%, meaning that a team can perform 24 completed circumcisions compared to 15 by the surgical method. The cost-effectiveness of PrePex, comparing the cost of performing circumcisions to the future cost savings of potentially averted HIV infections, is just 2% less than the current surgical method, at a device cost price of $20. CONCLUSION: PrePex is a viable SMC tool for scale-up with unrivalled potential for superior reach, however national targets can only be met with effective demand creation and availability of trained human resource.

  3. Attitudes, perceptions and potential uptake of male circumcision among older men in Turkana County, Kenya using qualitative methods.

    Directory of Open Access Journals (Sweden)

    Kate Macintyre

    Full Text Available BACKGROUND: In many communities, older men (i.e., over 25 years of age have not come forward for Voluntary Medical Male Circumcision (VMMC services. Reasons for low demand among this group of men are not well understood, and may vary across geographic and cultural contexts. This paper examines the facilitators and barriers to VMMC demand in Turkana County, Kenya, with a focus on older men. This is one of the regions targeted by the VMMC program in Kenya because the Turkana ethnic group does not traditionally circumcise, and the rates of HIV and STD transmission are high. METHODS AND FINDINGS: Twenty focus group discussions and 69 in-depth interviews were conducted with circumcised and uncircumcised men and their partners to elicit their attitudes and perceptions toward male circumcision. The interviews were conducted in urban, peri-urban, and rural communities across Turkana. Our results show that barriers to circumcision include stigma associated with VMMC, the perception of low risk for HIV for older men and their "protection by marriage," cultural norms, and a lack of health infrastructure. Facilitators include stigma against not being circumcised (since circumcision is associated with modernity, protection against disease including HIV, and cleanliness. It was also noted that older men should adopt the practice to serve as role models to younger men. CONCLUSIONS: Both men and women were generally supportive of VMMC, but overcoming barriers with appropriate communication messages and high quality services will be challenging. The justification of circumcision being a biomedical procedure for protection against HIV will be the most important message for any communication strategy.

  4. The when and how of male circumcision and the risk of HIV: a retrospective cross-sectional analysis of two HIV surveys from Guinea-Bissau

    OpenAIRE

    Rasmussen, Dlama Nggida; Wejse, Christian; Larsen, Olav; da Silva, Zacarias; Aaby, Peter; Sodemann, Morten

    2016-01-01

    Introduction Male circumcision (MC) reduces the risk of HIV, and this risk reduction may be modified by socio-cultural factors such as the timing and method (medical and traditional) of circumcision. Understanding regional variations in circumcision practices and their relationship to HIV is crucial and can increase insight into the HIV epidemic in Africa. Methods We used data from two retrospective HIV surveys conducted in Guinea-Bissau from 1993 to 1996 (1996 cohort) and from 2004 to 2007 (...

  5. To circ or not to circ: clinical and pharmacoeconomic outcomes of a prospective trial of topical steroid versus primary circumcision

    Directory of Open Access Journals (Sweden)

    Yuri D. Nobre

    2010-02-01

    Full Text Available PURPOSE: To compare the efficacy and costs of circumcision versus topical treatment using a prospective pharmacoeconomic protocol. MATERIALS AND METHODS: We treated 59 patients (3-10 years of age randomized into two groups: 29 underwent an 8-week course of topical treatment with 0.2% betamethasone-hyaluronidase cream twice a day; and 30 underwent circumcision. Topical treatment success was defined as complete exposure of the glans. In cases of treatment failure, circumcision was performed and its cost imputed to that of the initial treatment. The pharmacoeconomic aspects were defined according to the Brazilian National Public Health System database and the Brazilian Community Pharmacies Index. RESULTS: The two groups were statistically similar for all clinical parameters evaluated. Topical treatment resulted in complete exposure of the glans in 52% of the patients. Topical treatment was associated with preputial pain and hyperemia. However, treatment suspension was unnecessary. Minor complications were observed in 16.6% of the surgical group patients. The mean cost per patient was US$ 53.70 and US$ 125.20, respectively, for topical steroid treatment (including the costs related to treatment failure and circumcision. The total costs were US$ 2,825.32 and US$ 3,885.73 for topical treatment and circumcision, respectively. CONCLUSIONS: Topical treatment of phimosis can reduce costs by 27.3% in comparison with circumcision. Therefore, topical treatment of phimosis should be considered prior to the decision to perform surgery.

  6. Ability and willingness to pay for voluntary medical male circumcision: a cross-sectional survey in Kisumu County, Kenya.

    Science.gov (United States)

    Wandei, Stephen; Nangami, Mabel; Egesa, Omar

    2016-01-01

    Voluntary medical male circumcision is one of the most effective measures in preventing male acquisition of HIV during heterosexual intercourse. In Kenya, the voluntary medical male circumcision programme was launched in the year 2008 as part of a comprehensive national HIV prevention strategy. With the global challenge of funding HIV intervention programs, the sustainability of the programme beyond the donor periods need to be assessed. The purpose of this study was to determine the household ability and willingness to pay for voluntary medical male circumcision as an alternative method of funding the programme. The findings show that 62.2% of the households were "able" to pay for medical circumcision. However, 60.4% of them were not "willing" to pay for the service regardless of the cost. The findings indicate that ability to pay is not a significant predictor of willingness to pay for voluntary medical male circumcision within Kisumu County. Knowledge on the role of medical circumcision is a more important factor in determining willingness to pay for the service.

  7. Informing the scaling up of voluntary medical male circumcision efforts through the use of theory of reasoned action: survey findings among uncircumcised young men in Swaziland.

    Science.gov (United States)

    Gurman, Tilly A; Dhillon, Preeti; Greene, Jessica L; Makadzange, Panganai; Khumlao, Philisiwe; Shekhar, Navendu

    2015-04-01

    Assessing predictors of intention to circumcise can help to identify effective strategies for increasing uptake of voluntary medical male circumcision (VMMC). Grounded in the theory of reasoned action (TRA), the current study of uncircumcised males ages 13-29 in Swaziland (N = 1,257) employed multivariate logistic regression to determine predictors of VMMC intention. The strongest predictors were strongly disagreeing/disagreeing that sex was more painful for a circumcised man (odds ratio [OR] = 4.37; p = theory to explore young men's intention to circumcise and can help inform interventions aimed at increasing uptake of VMMC.

  8. Comparative Study on the Effects of Shang Ring Circumcision,Sleeve Circumcision and Improved Circumcision in Treatment of Adults and Children%商环包皮环切术、袖套包皮环切术和改良包皮环切术在成人与儿童中的疗效对比

    Institute of Scientific and Technical Information of China (English)

    谈健; 何永辉; 崔飞伦; 宁松毅

    2015-01-01

    文章选取包皮过长或包茎患者266例,根据患者入院时间随机分为商环组(85例)、袖套组(103例)和改良组(78例),比较手术时间、失血量、疼痛评分、愈合时间、外观满意率、治疗费用和术后并发症等。对比分析商环包皮环切术、袖套包皮环切术和改良包皮环切术在成人与儿童中的手术疗效和手术并发症。得出结论:儿童包皮过长或包茎患者更适合选用商环包皮环切术;袖套包皮环切术更适合用于成人包皮过长或包茎患者。%This paper took 266 adults and children patients,with excess foreskin or phimosis were treated with Shang ring circumcision,sleeve circumcision or improved circumcision. Surgical duration,blood loss,pain score, wound healing time,satisfaction with the penile appearance,treatment cost and postoperative were recorded and analyzed. To evaluate the effects of Shang ring circumcision ,sleeve circumcision and improved circumcision on treating the excess foreskin and phimosis of adults and children. Come to conclusion:For treatment of children with excess foreskin and phimosis,Shang ring circumcision might be the better method. For treatment of adults with excess foreskin and phimosis,sleeve circumcision might be the better method.

  9. Rural female adolescence: Indian scenario.

    Science.gov (United States)

    Kumari, R

    1995-01-01

    This article describes the life conditions of female adolescents in India and issues such as health, discrimination in nutrition and literacy, child labor, early marriage, juvenile delinquency, and violence against girls in rural areas of India. Data are obtained from interview samples conducted among 12 villages in north India. Female adolescents suffer from a variety of poverty-ridden village life conditions: caste oppression, lack of facilities, malnutrition, educational backwardness, early marriage, domestic burden, and gender neglect. Girls carry a heavy work burden. Adolescence in rural areas is marked by the onset of puberty and the thrust into adulthood. Girls have no independent authority to control their sexuality or reproduction. Girls are expected to get married and produce children. Control of female sexuality is shifted from the father to the husband. There is a strong push to marry girls soon after menstruation, due to the burden of imposing strict restrictions on female sexuality, the desire to reduce the burden of financial support, and the need to ensure social security for daughters. Girls may not go out alone or stay outside after dark. Many rural parents fear that education and freedom would ruin their daughter. Girls develop a low self-image. Rural villages have poor sanitation, toilet facilities, and drainage systems. Girls are ignorant of health and sex education and lack access to education. The neglect of female children includes malnutrition, sex bias, and early marriage. In 1981, almost 4 out of every 100 girls had to work. 5.527 million girls 5-14 years old were child laborers. Girls are veiled, footbound, circumcised, and burnt by dowry hungry in-laws. Female delinquents are subjected to sexual harassment and sometime to sexual abuse while in custody. Cows are treated better in rural India than women. Gender disparity is caused by the perpetuation of patriarchal masculine values. PMID:12158005

  10. Rural female adolescence: Indian scenario.

    Science.gov (United States)

    Kumari, R

    1995-01-01

    This article describes the life conditions of female adolescents in India and issues such as health, discrimination in nutrition and literacy, child labor, early marriage, juvenile delinquency, and violence against girls in rural areas of India. Data are obtained from interview samples conducted among 12 villages in north India. Female adolescents suffer from a variety of poverty-ridden village life conditions: caste oppression, lack of facilities, malnutrition, educational backwardness, early marriage, domestic burden, and gender neglect. Girls carry a heavy work burden. Adolescence in rural areas is marked by the onset of puberty and the thrust into adulthood. Girls have no independent authority to control their sexuality or reproduction. Girls are expected to get married and produce children. Control of female sexuality is shifted from the father to the husband. There is a strong push to marry girls soon after menstruation, due to the burden of imposing strict restrictions on female sexuality, the desire to reduce the burden of financial support, and the need to ensure social security for daughters. Girls may not go out alone or stay outside after dark. Many rural parents fear that education and freedom would ruin their daughter. Girls develop a low self-image. Rural villages have poor sanitation, toilet facilities, and drainage systems. Girls are ignorant of health and sex education and lack access to education. The neglect of female children includes malnutrition, sex bias, and early marriage. In 1981, almost 4 out of every 100 girls had to work. 5.527 million girls 5-14 years old were child laborers. Girls are veiled, footbound, circumcised, and burnt by dowry hungry in-laws. Female delinquents are subjected to sexual harassment and sometime to sexual abuse while in custody. Cows are treated better in rural India than women. Gender disparity is caused by the perpetuation of patriarchal masculine values.

  11. Men in Papua New Guinea accurately report their circumcision status.

    Directory of Open Access Journals (Sweden)

    Parana Hewage Mangalasiri Jayathunge

    Full Text Available Male circumcision (MC is a well-established component of HIV prevention in countries with high HIV prevalence and heterosexually driven epidemics. Delivery and monitoring of MC programs are reliant on good quality MC data. Such data are often generated through self-reported MC status surveys. This study examined self-reported MC status in comparison with genital photographs from men in Papua New Guinea (PNG.This retrospective non-interventional study collated self-reported MC status data from the 'acceptability and feasibility of MC' study at 4 sites in PNG during 2010-2011. Participants reported their MC status based on an 8-category photographic classification covering the range of foreskin cutting practices in PNG. Genital photographs of 222 participants from this study were independently classified by 2 investigators. The 8-category photographic classification was simplified into a 3 category classification of 'no cut', 'straight cut' and 'round cut' before comparing for agreement between self-reporting and investigator assessment using Cohen's Kappa measure.Using the 3-category classification, there was 90.6% (201/222 agreement between self-assessment and investigator classification (κ value 0.805. Of the discordant 9.4% (21/222, 3.6% (8/222 self-classified as having a cut foreskin (5 straight cut; 3 round cut while investigators classified as having no cut; 4.1% (9/222 self-classified as having no cut while investigators classified them as having had a cut (6 straight cut; 3 round cut and 1.8% (4/222 self-classified as having a round cut while investigators classified as having a straight cut. Given the great variety of foreskin cutting practices and appearances, feasible explanations are suggested for two-thirds (13/21 of these discordant results.This study demonstrates a high level of agreement between self-reporting and investigator assessment of MC status in PNG and suggests self-reporting of MC status to be highly reliable among men

  12. Voluntary medical male circumcision: logistics, commodities, and waste management requirements for scale-up of services.

    Directory of Open Access Journals (Sweden)

    Dianna Edgil

    2011-11-01

    Full Text Available BACKGROUND: The global HIV prevention community is implementing voluntary medical male circumcision (VMMC programs across eastern and southern Africa, with a goal of reaching 80% coverage in adult males by 2015. Successful implementation will depend on the accessibility of commodities essential for VMMC programming and the appropriate allocation of resources to support the VMMC supply chain. For this, the United States President's Emergency Plan for AIDS Relief, in collaboration with the World Health Organization and the Joint United Nations Programme on HIV/AIDS, has developed a standard list of commodities for VMMC programs. METHODS AND FINDINGS: This list of commodities was used to inform program planning for a 1-y program to circumcise 152,000 adult men in Swaziland. During this process, additional key commodities were identified, expanding the standard list to include commodities for waste management, HIV counseling and testing, and the treatment of sexually transmitted infections. The approximate costs for the procurement of commodities, management of a supply chain, and waste disposal, were determined for the VMMC program in Swaziland using current market prices of goods and services. Previous costing studies of VMMC programs did not capture supply chain costs, nor the full range of commodities needed for VMMC program implementation or waste management. Our calculations indicate that depending upon the volume of services provided, supply chain and waste management, including commodities and associated labor, contribute between US$58.92 and US$73.57 to the cost of performing one adult male circumcision in Swaziland. CONCLUSIONS: Experience with the VMMC program in Swaziland indicates that supply chain and waste management add approximately US$60 per circumcision, nearly doubling the total per procedure cost estimated previously; these additional costs are used to inform the estimate of per procedure costs modeled by Njeuhmeli et al. in

  13. An Overview of Female Genital Mutilation in Nigeria

    OpenAIRE

    Okeke, TC; Anyaehie, USB; Ezenyeaku, CCK

    2012-01-01

    Nigeria, due to its large population, has the highest absolute number of female genital mutilation (FGM) worldwide, accounting for about one-quarter of the estimated 115–130 million circumcised women in the world. The objective of this review is to ascertain the current status of FGM in Nigeria. Pertinent literature on FGM retrieved from internet services [Google search on FGM in Nigeria, www.online Nigeria, PubMed of the national library of medicine www.medconsumer. Info/tropics/fgm.htm, Bio...

  14. Male circumcision, alcohol use and unprotected sex among patrons of bars and taverns in rural areas of North-West province, South Africa.

    Science.gov (United States)

    Nkosi, Sebenzile; Sikweyiya, Yandisa; Kekwaletswe, Connie T; Morojele, Neo K

    2015-01-01

    Strong research evidence has shown that medical male circumcision significantly reduces heterosexual HIV acquisition among men. However, its effectiveness is enhanced by behavioural factors such as condom use. Currently, little is known of unprotected sex associated with male circumcision (MC) among alcohol-drinking tavern-going men, or whether engagement in unprotected sex may differ between men who have been traditionally circumcised and those who have been medically circumcised. The study sought to determine the relative importance of alcohol consumption and MC as correlates of unprotected sex and to compare the risk of engaging in unprotected sex between traditionally circumcised and medically circumcised tavern-going men from two rural villages in North-West province, South Africa. Data from 314 adult men (≥18 years) were analysed. The men were recruited from four bars/taverns using systematic sampling. They responded to questions regarding their demographic characteristics, alcohol consumption, circumcision status and method (where applicable), and engagement in unprotected sex. Descriptive analyses and bivariate and multivariate logistic regression analyses were conducted. Age, education, relationship status, alcohol consumption and traditional male circumcision (TMC) were independently and significantly associated with unprotected sex. Specifically, probable alcohol dependence and traditional circumcision were independent risk factors for engaging in unprotected sex among tavern-going men. Traditionally circumcised men had a higher risk of engaging in unprotected sex than medically circumcised men. Interventions aimed at reducing alcohol consumption, encouraging protective behaviour among men who have undergone TMC, and increasing condom use are needed in bar/tavern settings. HIV prevention education must be urgently incorporated into TMC programmes.

  15. [The use of preputial skin as cutaneous graft after circumcision. Report of 30 clinical cases].

    Science.gov (United States)

    Chlihi, A; Benbrahim, A; Diouri, M; Terrab, S; Bahechar, N; Boukind, E H

    2002-06-01

    Through a study of 30 clinical cases, collected at the service center of plastic surgery and burns in Averroes University hospital at Casablanca, the authors underline the interest of using preputial skin as full-thickness skin graft for the treatment of burns and their sequelaes in non-circumcised boys, whose age ranged from one to four years. At this age, they are more exposed to domestic accidents. The preputial skin graft gives the advantage of the absence of scare prejudice at the donor site each time the circumcision is possible; and provides a skin of good elastic quality avoiding secondary retraction with a very favorable rate of graft intake. Although the application of this technique for other affections is possible, but remains limited by the hyperpigmentation of the graft.

  16. Circumcision of male infants and children as a public health measure in developed countries

    DEFF Research Database (Denmark)

    Frisch, Morten; Earp, Brian D

    2016-01-01

    in contrast to the more recent 2015 policy from the Canadian Paediatric Society as well as prior policies (still in force) from medical associations in Europe and Australasia - the CDC suggested that the benefits of the surgery outweigh the risks. In this article, we provide a brief scientific and...... conceptual analysis of the CDC's assessment of benefit versus risk, and argue that it deserves a closer look. Although we set aside the burgeoning bioethical debate surrounding the moral permissibility of performing non-therapeutic circumcisions on healthy minors, we argue that, from a scientific and medical...... perspective, current evidence suggests that such circumcision is not an appropriate public health measure for developed countries such as the United States....

  17. Correlates of male circumcision in Eastern and Southern African countries: establishing a baseline prior to VMMC Scale-up.

    Directory of Open Access Journals (Sweden)

    Khai Hoan Tram

    Full Text Available BACKGROUND: Despite the importance of male circumcision (MC prevalence to HIV prevention efforts in Eastern and Southern Africa, there has been no systematic analysis on the correlates of male circumcision. This analysis identifies correlates of MC in 12 countries in the region with available data. METHODS: Data from the male questionnaire of DHS surveys collected between 2006-2011 in Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe were analyzed. The dependent variable was self-reported male circumcision status. Independent variables included age, education, wealth quintile, place of residence, ethnicity, religion and region. Bivariate and multivariate analyses were conducted separately for each country. RESULTS: MC prevalence ranged from 8.2 percent in Swaziland to 92.2 percent in Ethiopia. Bivariate analyses showed a consistent positive association between age (being older and male circumcision. Education, wealth quintile, and place of residence were either not significantly related or differed in the direction of the relationship by country. Multivariate logistic regression showed three variables consistently associated with MC status: age (being older, religion (being Muslim and ethnicity. DISCUSSION: These data were collected prior to the scale-up of voluntary medical male circumcision (VMMC programs in 11 of the 12 countries. As the VMMC scale-up intensifies in countries across Eastern and Southern Africa, the correlates of VMMC are likely to change, with (younger age and education emerging as key correlates of VMMC performed in medical settings. The centuries-long tradition among Muslims to circumcise should continue to favor MC among this group. Non-circumcising ethnicities may become more open to MC if promoted as a health practice for decreasing HIV risk.

  18. Awareness and predictors of female genital mutilation/cutting among young health advocates

    Directory of Open Access Journals (Sweden)

    Abolfotouh SM

    2015-02-01

    Full Text Available Sherif M Abolfotouh,1,2 Ahmed Z Ebrahim,1,3 Mostafa A Abolfotouh4 On Behalf of IFMSA-Egypt 1IFMSA-Egypt, Alexandria, Egypt; 2Oulu University Hospital, Oulu, Finland; 3Alexandria Faculty of Medicine, Alexandria, Egypt; 4King Abdullah International Medical Research Center (KAIMRC, King Saud bin-Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Abstract: The act of female genital mutilation/cutting (FGM/C is considered internationally as a violent act against girls and women and a violation of their human rights. This study sought to assess the awareness and predictors of FGM/C in young Egyptian health advocates. A cross-sectional study of 600 medical students from a total of 2,500 members of the International Federation of Medical Students’ Associations (IFMSA-Egypt, across all Egyptian medical schools, was conducted using a previously validated online Google survey. The overall prevalence of circumcision was 14.7/100 female students, with a significantly higher prevalence in students from rural areas (25% than in non-rural areas (10.8%, P=0.001, and in those residing in Upper (southern Egypt (20.6% than in Lower (northern Egypt (8.7%, P=0.003. The students’ mean percentage score for knowledge about the negative health consequences of FGM/C was 53.50±29.07, reflecting a modest level of knowledge; only 30.5% had a good level of knowledge. The mean percentage score for the overall attitude toward discontinuation of the practice of FGM/C was 76.29±17.93, reflecting a neutral attitude; 58.7% had a favorable attitude/norms toward discontinuation of the practice. Of circumcised students, approximately one-half (46.8% were unwilling to have their daughters circumcised, and 60% reported no harm from being circumcised. After controlling for confounders, a negative attitude toward FGM/C was significantly (P<0.001 in all cases associated with male sex, residency in Upper Egypt, rural origin, previous circumcision, and the preclinical

  19. Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic.

    OpenAIRE

    Cook, L. S.; Koutsky, L A; Holmes, K. K.

    1993-01-01

    INTRODUCTION--A recent study comparing heterosexual men with and without confirmed sexually transmitted diseases (STDs) in an urban STD clinic showed that uncircumcised men were less likely than circumcised men to have genital warts detectable by clinical examination (adjusted odds ratio 0.7, 95% confidence interval 0.4, 0.9). Based on these initial findings we hypothesised that the appearance and anatomic distribution of genital warts, and possibly treatment response, may be different for ci...

  20. Factors Associated with Knowledge of and Willingness for Adult Male Circumcision in Changsha, China.

    Directory of Open Access Journals (Sweden)

    Mingqiang Zeng

    Full Text Available Male circumcision (MC has been shown to reduce the risk of male genital diseases. MC is not commonly practiced among Chinese males and little is known about the factors associated with their knowledge of and willingness for MC. This study was to explore the knowledge regarding the foreskin among Chinese males and to identify factors associated with their willingness to undergo circumcision.A total of 237 patients with redundant prepuce/phimosis were interviewed through face-to-face interviews. The items on the questionnaire included: demographics, an objective scale assessing knowledge about the foreskin, willingness to have MC, the attitudes of sexual partners and doctors toward redundant prepuce/phimosis, and the approaches that patients used to acquire knowledge regarding the prepuce. Univariate analysis and multiple logistic regression analysis were performed to identify factors that are associated with willingness to be circumcised (WTC.A total of 212 patients completed the interview. Multivariable logistic regression showed that three factors were significantly associated with WTC: being married (OR = 0.43, perceiving redundant prepuce/phimosis as a disease (OR = 1.93, and if a patient's partner supported MC (OR = 1.39. 58% (n = 122 had received information about the foreskin from another party: 18% (n = 37 from school, 8% (n = 17 from family, 17% (n = 36 from friends, 27% (n = 57 from health care providers. About 4% (n = 8 believed that their partners disliked their redundant prepuce/phimosis. 20% (n = 42 had received doctors' advice to undergo circumcision.Knowledge about the foreskin was low among Chinese males. Our study elucidates the factors associated with WTC and suggests that more education of the population about the foreskin can help improve the recognition of a correctible abnormality and help patients assess the potential role of MC in their health.

  1. A critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries

    OpenAIRE

    Morris, Brian J.; Bailey, Robert C.; Klausner, Jeffrey D.; Leibowitz, Arleen; Wamai, Richard G; Waskett, Jake H.; Banerjee, Joya; Halperin, Daniel T.; Zoloth, Laurie; Helen A. Weiss; Hankins, Catherine A.

    2012-01-01

    A potential impediment to evidence-based policy development on medical male circumcision (MC) for HIV prevention in all countries worldwide is the uncritical acceptance by some of arguments used by opponents of this procedure. Here we evaluate recent opinion-pieces of 13 individuals opposed to MC. We find that these statements misrepresent good studies, selectively cite references, some containing fallacious information, and draw erroneous conclusions. In marked contrast, the scientific evide...

  2. What is the efficacy of circumcision in boys with complex urinary tract abnormalities?

    Science.gov (United States)

    Bader, Mohammed; McCarthy, Liam

    2013-12-01

    The risk of urinary tract infection (UTI) in normal boys is 1%. This risk is significantly increased in boys with congenital abnormalities of the urinary tract, which includes such abnormalities as vesico-ureteric reflux, obstructive megaureter (VUJO) and posterior urethral valves. UTI in these boys can lead to urosepsis, a potentially life-threatening complication, and in the longer term renal scarring complicating pyelonephritis can lead to chronic renal impairment or even end-stage renal disease. Circumcision has been shown in normal boys to reduce the risk of UTI by 90%, and potentially could be a simple intervention to reduce the risk of urosepsis and renal scarring. In order to make this decision a clinician really needs to have the answers to two questions: 1) What is the risk of UTI in this particular boy? 2) What is the evidence of efficacy of circumcision in this particular condition? This article reviews what evidence exists to make a calculation of the risk/benefit ratio for circumcision in boys with abnormalities of the urinary tract.

  3. Initial commitment to pre-exposure prophylaxis and circumcision for HIV prevention amongst Indian truck drivers.

    Directory of Open Access Journals (Sweden)

    John A Schneider

    Full Text Available Studies of HIV prevention interventions such as pre-exposure prophylaxis (PREP and circumcision in India are limited. The present study sought to investigate Indian truck-drivers initial commitment to PREP and circumcision utilizing the AIDS Risk Reduction Model. Ninety truck-drivers completed an in-depth qualitative interview and provided a blood sample for HIV and HSV-2 testing. Truck-drivers exhibited low levels of initial commitment towards PREP and even lower for circumcision. However, potential leverage points for increasing commitment were realized in fear of infecting family rather than self, self-perceptions of risk, and for PREP focusing on cultural beliefs towards medication and physicians. Cost was a major barrier to both HIV prevention interventions. Despite these barriers, our findings suggest that the ARRM may be useful in identifying several leverage points that may be used by peers, health care providers and public health field workers to enhance initial commitment to novel HIV prevention interventions in India.

  4. The perceptions on male circumcision as a preventive measure against HIV infection and considerations in scaling up of the services: a qualitative study among police officers in Dar es Salaam, Tanzania

    Directory of Open Access Journals (Sweden)

    Tarimo Edith AM

    2012-07-01

    Full Text Available Abstract Background In recent randomized controlled trials, male circumcision has been proven to complement the available biomedical interventions in decreasing HIV transmission from infected women to uninfected men. Consequently, Tanzania is striving to scale-up safe medical male circumcision to reduce HIV transmission. However, there is a need to investigate the perceptions of male circumcision in Tanzania using specific populations. The purpose of the present study was to assess the perceptions of male circumcision in a cohort of police officers that also served as a source of volunteers for a phase I/II HIV vaccine (HIVIS-03 trial in Dar es Salaam, Tanzania. Methods In-depth interviews with 24 men and 10 women were conducted. Content analysis informed by the socio-ecological model was used to analyze the data. Results Informants perceived male circumcision as a health-promoting practice that may prevent HIV transmission and other sexually transmitted infections. They reported male circumcision promotes sexual pleasure, confidence and hygiene or sexual cleanliness. They added that it is a religious ritual and a cultural practice that enhances the recognition of manhood in the community. However, informants were concerned about the cost involved in male circumcision and cleanliness of instruments used in medical and traditional male circumcision. They also expressed confusion about the shame of undergoing circumcision at an advanced age and pain that could emanate after circumcision. The participants advocated for health policies that promote medical male circumcision at childhood, specifically along with the vaccination program. Conclusions The perceived benefit of male circumcision as a preventive strategy to HIV and other sexually transmitted infections is important. However, there is a need to ensure that male circumcision is conducted under hygienic conditions. Integrating male circumcision service in the routine childhood vaccination

  5. The curative effect and complication of circumcision and traditional circumcision for circumcision%商环包皮环切术和传统包皮环切术的疗效和手术并发症

    Institute of Scientific and Technical Information of China (English)

    曾锋; 曾令浩

    2016-01-01

    Objective: To investigate the clinical effect and complications between Shang ring circumcision and traditional circumcision for the treatment of phimosis and redundant prepuce.Methods: According to the order of admission, 376 cases of phimosis and prepuce patients were divided into quotient ring group (n=188) and traditional group (n=188), circumcision was used in the quotient ring group, traditional group used circumcision laser circumcision treatment, compared of perioperative and postoperative complications between the two groups. Results:Quotient ring group operative time (4.3±1.2) min, blood loss (2.0±0.6) mL, intraoperative pain score (1.1±0.7) were significantly lower than traditional group, wound healing time (18.4±4.2) d was significantly higher than the traditional group and the differences were statistically signiifcant (P quotient ring group (86.84%) signiifcantly was higher than than the traditional group (65.79%), the difference was statistically signiifcant (P<0.05). Postoperative IIEF-5, TSS scores of quotient ring group were signiifcantly higher than the traditional group (P<0.05).Conclusion: Quotient ring circumcision more traditional circumcision treatment of phimosis and prepuce has a shorter operative time, less blood loss, postoperative complication rate, recovery effect good advantage.%目的:对比商环包皮环切术和传统包皮环切术治疗包茎及包皮过长的临床效果及并发症差异。方法:根据患者入院顺序将376例包茎及包皮患者分为商环组与传统组各188例,商环组采用商环包皮环切术、传统组采用包皮背部切开激光环切术治疗,比较两组患者的围手术期指标、术后并发症。结果:商环组的手术时间(4.3±1.2) min、术中出血量(2.0±0.6) mL、术中疼痛评分(1.1±0.7)分均显著的低于传统组、创口愈合时间(18.4±4.2) d显著的高于传统组且差异均具有统计学意义(P<0.05)。商环组术后1、12、24 h的疼痛评

  6. Comparison of disposable circumcision suture device with disposable circumcision stapler and conventional%新式包皮环切缝合器临床效果观察

    Institute of Scientific and Technical Information of China (English)

    曹赟杰; 何小舟; 宋广来; 许贤林; 徐仁芳; 王建平; 毛庆岩; 庄乾锋; 周耀军

    2013-01-01

    目的:比较一次性包皮环切缝合器与一次性包皮环切吻合器、传统包皮环切术三种术式的临床疗效。方法将到门诊就诊的包茎和包皮过长患者随机分成三组,采用三种手术方法,一次性包皮环切缝合器49例,一次性包皮环切吻合器46例,传统组61例,在其安全性、术式优越性及疗效等方面进行对比。结果包皮环切缝合器组和环切吻合器组手术时间为(6.2±1.6)min和(6.3±1.7)min,优于传统包皮环切术组(29.2±4.9)min,失血量三组中传统包皮环切术组最多[(1.0±0.2)ml vs.(1.0±0.2)ml vs.(10.9±2.3) ml],差异有统计学意义(P0.05);包皮环切缝合器组和环切吻合器组术后无需换药,切口愈合好,外形美观,患者满意度较高;环切吻合器组拆环疼痛评分高(8.8±1.0),伤口愈合时间最长,包皮环切缝合器组患者疼痛、出血等并发症更低。结论应用一次性包皮环切缝合器进行包皮环切术,手术更为简单、方便与安全,并发症少,效果更为满意,值得在临床中推广应用。%Objective To compare the advantage and disadvantage of disposable circumcision suture device, disposable circumcision stapler and conventional circumcision. Methods From June 2012 to December 2012, according to the wishes of patients,people who were receiving circumcision in our hospital were divided into three groups:disposable circumcision suture device(DCSD group, n=49), disposable circumcision stapler (DCS group, n=46)and conventional circumcision(CC group, n=61). The operation time,pain score, blood loss,wound healing time,rate of postoperative complications, postoperative satisfaction with penile appearance, and treatment cost were compared among the groups. Results DCSD group and DCS group showed significantly shorter operation time[(6.2±1.6) min vs. (6.3±1.7) min vs. (29.2±4.9) min], less blood loss[(1.0±0.2) ml vs. (1.0±0.2) ml

  7. 商环行包皮环切术的临床体会%Clinical Experience of Disposable Circumcision Suture Device on Circumcision

    Institute of Scientific and Technical Information of China (English)

    宋琳; 李亚军

    2014-01-01

    Objective To compare the advantage and disadvantage of disposable circumcision suture device and conventional circumcision. Methods From July 2013 to February 2014, according to the wishes of patients, people who were receiving circumcision in our hospital were divided into two groups: disposable circumcision suture device (DCSD group, n=44) and conventional circumcision (CC group, n=56). The operation time, blood loss, wound healing time, rate of postoperative complications and postoperative satisfaction with penile appearance were compared between the two groups. Results DCSD group showed markly shorter operation time [(6.8±1.8) min vs. (25.4±4.5) min], less blood loss [(1.2±0.5) ml vs.(9.5±1.5) ml], higher rate of postoperative satisfaction with penile appearance (97.7% vs.78.6%), similar to CC group in healing time [(14.9±1.9) d vs. (15.4±2.1) d]. No significant dif erence existed in the rate of postoperative complications among the two groups (6.8% vs7.1%) ( >0.05). Conclusion The DCSD is a innovation on circumcision. circumcision and suture nearly complete in the same time. The DCSD is a good approach (simple and safe) for circumcision with short operation time, few blood loss, and satisfying postoperative appearance of the penile. Not only is the patient satisfied with it, but also it improves the ef iciency of the doctor's work . It is worth at ention and promotion.%目的与传统包皮环切术(CC)相比,一次性包皮环切缝合器(DCSD)在包皮环切术中的疗效观察。方法选择我院2013年7月~2014年2月的82例患者,根据患者的意愿,分别用一次性包皮环切缝合器和传统的方法行包皮环切术。一次性包皮环切缝合器40例,传统方法42例。分别在手术时间,术中失血量,伤口愈合时间,术后并发症及患者对术后阴茎外观的满意度方面进行比较观察。结果与传统的包皮环切术相比,一次性包皮环切缝合器在手术持续时间[DCSD 组(6

  8. Acceptability of medical male circumcision among uncircumcised men in Kenya one year after the launch of the national male circumcision program.

    Directory of Open Access Journals (Sweden)

    Amy Herman-Roloff

    Full Text Available BACKGROUND: Numerous studies have demonstrated that male circumcision (MC reduces the incidence of the Type-1 human immunodeficiency virus (HIV among heterosexual men by at least half. METHODS: One year after the launch of a national Voluntary Medical Male Circumcision program in Kenya, this study conducted 12 focus group discussions among uncircumcised men in Nyanza Province to assess the revealed, non-hypothetical, facilitators and barriers to the uptake of MC. RESULTS: The primary barriers to MC uptake included time away from work; culture and religion; possible adverse events; and the post-surgical abstinence period. The primary facilitators of MC uptake included hygiene; social pressure; protection against HIV and other sexually transmitted infections; and improved sexual performance and satisfaction. CONCLUSIONS: Some activities which might increase MC uptake include dispelling MC misconceptions; increasing involvement of religious leaders, women's groups, and peer mobilizers for MC promotion; and increasing the relevance of MC among men who are already practicing an HIV prevention method.

  9. No-needle, single-visit adult male circumcision with Unicirc: a multi-centre field trial.

    Directory of Open Access Journals (Sweden)

    Peter S Millard

    Full Text Available Voluntary medical male circumcision (VMMC is a priority HIV preventive intervention. Current adult circumcision methods need improvement.Field trial in 3 primary care centres. Minimally invasive VMMC using the Unicirc instrument following topical lidocaine/prilocaine anesthetic. Men were followed up at 1 and 4 weeks.We circumcised 110 healthy volunteers. Two men complained of transient burning pain during circumcision, but none required injectable anaesthesia. Median blood loss was 1ml and median procedure time was 9.0 min. There were 7 (6.3% moderate complications (5 (4.5% post-operative bleeds requiring suture and 2 (1.8% post-operative infections affecting 7 men. No men experienced significant wound dehiscence. 90.4% of men were fully healed at 4 weeks of follow-up and all were highly satisfied.Use of topical anaesthesia obviates the need for injectable anesthetic and makes the Unicirc procedure nearly painless. Unicirc is rapid, easy to learn, heals by primary intention with excellent cosmetic results, obviates the need for a return visit for device removal, and is potentially cheaper and safer than other methods. Use of this method will greatly facilitate scale-up of mass circumcision programs.ClinicalTrials.gov NCT02091726.

  10. Mucosal cuff length to penile length ratio may affect the risk of premature ejaculation in circumcised males.

    Science.gov (United States)

    Yuruk, E; Temiz, M Z; Colakerol, A; Muslumanoglu, A Y

    2016-01-01

    Data regarding the relation between premature ejaculation (PE) and post-circumcision mucosal cuff length are controversial. The aim of this study is to analyze the relation between post-circumcision mucosal cuff length/penile length ratio (MCR) and PE. After exclusion of patients with erectile dysfunction, penile deformity, history of penile surgery and severe lower urinary tract symptoms, 49 circumcised men with PE were included. The control group is constituted of 50 healthy volunteers with normal ejaculatory function. Self-estimated intravaginal ejaculation latency time (IELT) and premature ejaculation profile (PEP) measures of all subjects were recorded, and the MCRs of patients and controls were compared. The mean age of PE patients and controls was 35.82 ± 7.73 (range 23-54) and 38.78 ± 13.42 (range 19-71) years, respectively (P=0.183). Although mucosal cuff length was not associated with either self-estimated IELT (r=-0.185, P=0.067) or PEP (r=-0.098, P=0.336), there was a negative correlation between MCR and self-estimated IELT (r=-0.205, P=0.0001) and PEP measures (r=-0.308, P=0.002). The length of the mucosal cuff after circumcision may have an impact on ejaculatory function. Surgeons should avoid leaving excessive amount of mucosa during circumcision. PMID:26700215

  11. Knowledge, attitude and practice of female genital mutilation among doctors and nurses in Bayelsa state, Niger-Delta of Nigeria

    OpenAIRE

    Oyeyemi A.S; Ibrahim I.A; Ekine A.A

    2013-01-01

    Background: Female genital mutilation (FGM) is a harmful traditional practice that is deeply rooted in Africa. It has been outlawed in Bayelsa state of Nigeria but there is evidence that its performance by traditional circumcisers and health professionals continues. Aim: The study aimed to determine the knowledge, attitude and practice of FGM among doctors and nurses/midwives practising in public secondary and tertiary hospitals in Bayelsa state. Methods: One hundred and ninety seven (197) s...

  12. Scaling Up Early Infant Male Circumcision: Lessons From the Kingdom of Swaziland

    Science.gov (United States)

    Fitzgerald, Laura; Benzerga, Wendy; Mirira, Munamato; Adamu, Tigistu; Shissler, Tracey; Bitchong, Raymond; Malaza, Mandla; Mamba, Makhosini; Mangara, Paul; Curran, Kelly; Khumalo, Thembisile; Mlambo, Phumzile; Njeuhmeli, Emmanuel; Maziya, Vusi

    2016-01-01

    ABSTRACT Background: The government of the Kingdom of Swaziland recognizes that it must urgently scale up HIV prevention interventions, such as voluntary medical male circumcision (VMMC). Swaziland has adopted a 2-phase approach to male circumcision scale-up. The catch-up phase prioritizes VMMC services for adolescents and adults, while the sustainability phase involves the establishment of early infant male circumcision (EIMC). Swaziland does not have a modern-day tradition of circumcision, and the VMMC program has met with client demand challenges. However, since the launch of the EIMC program in 2010, Swaziland now leads the Eastern and Southern Africa region in the scale-up of EIMC. Here we review Swaziland’s program and its successes and challenges. Methods: From February to May 2014, we collected data while preparing Swaziland’s “Male Circumcision Strategic and Operational Plan for HIV Prevention 2014–2018.” We conducted structured stakeholder focus group discussions and in-depth interviews, and we collected EIMC service delivery data from an implementing partner responsible for VMMC and EIMC service delivery. Data were summarized in consolidated narratives. Results: Between 2010 and 2014, trained providers performed more than 5,000 EIMCs in 11 health care facilities in Swaziland, and they reported no moderate or severe adverse events. According to a broad group of EIMC program stakeholders, an EIMC program needs robust support from facility, regional, and national leadership, both within and outside of HIV prevention coordination bodies, to promote institutionalization and ownership. Providers and health care managers in 3 of Swaziland’s 4 regional hospitals suggest that when EIMC is introduced into reproductive, maternal, newborn, and child health platforms, dedicated staff attention can help ensure that EIMC is performed amid competing priorities. Creating informed demand from communities also supports EIMC as a service delivery priority

  13. Male circumcision at different ages in Rwanda: a cost-effectiveness study.

    Directory of Open Access Journals (Sweden)

    Agnes Binagwaho

    2010-01-01

    Full Text Available BACKGROUND: There is strong evidence showing that male circumcision (MC reduces HIV infection and other sexually transmitted infections (STIs. In Rwanda, where adult HIV prevalence is 3%, MC is not a traditional practice. The Rwanda National AIDS Commission modelled cost and effects of MC at different ages to inform policy and programmatic decisions in relation to introducing MC. This study was necessary because the MC debate in Southern Africa has focused primarily on MC for adults. Further, this is the first time, to our knowledge, that a cost-effectiveness study on MC has been carried out in a country where HIV prevalence is below 5%. METHODS AND FINDINGS: A cost-effectiveness model was developed and applied to three hypothetical cohorts in Rwanda: newborns, adolescents, and adult men. Effectiveness was defined as the number of HIV infections averted, and was calculated as the product of the number of people susceptible to HIV infection in the cohort, the HIV incidence rate at different ages, and the protective effect of MC; discounted back to the year of circumcision and summed over the life expectancy of the circumcised person. Direct costs were based on interviews with experienced health care providers to determine inputs involved in the procedure (from consumables to staff time and related prices. Other costs included training, patient counselling, treatment of adverse events, and promotion campaigns, and they were adjusted for the averted lifetime cost of health care (antiretroviral therapy [ART], opportunistic infection [OI], laboratory tests. One-way sensitivity analysis was performed by varying the main inputs of the model, and thresholds were calculated at which each intervention is no longer cost-saving and at which an intervention costs more than one gross domestic product (GDP per capita per life-year gained. RESULTS: Neonatal MC is less expensive than adolescent and adult MC (US$15 instead of US$59 per procedure and is cost

  14. Impact of male circumcision on the HIV epidemic in Papua New Guinea: a country with extensive foreskin cutting practices.

    Directory of Open Access Journals (Sweden)

    Richard T Gray

    Full Text Available The degree to which adult medical male circumcision (MC programs can reduce new HIV infections in a moderate HIV prevalence country like Papua New Guinea (PNG are uncertain especially given the widespread prevalence of longitudinal foreskin cuts among adult males. We estimated the likely impact of a medical MC intervention in PNG using a mathematical model of HIV transmission. The model was age-structured and incorporated separate components for sex, rural/urban, men who have sex with men and female sex workers. Country-specific data of the prevalence of foreskin cuts, sexually transmitted infections, condom usage, and the acceptability of MC were obtained by our group through related studies. If longitudinal foreskin cutting has a protective efficacy of 20% compared to 60% for MC, then providing MC to 20% of uncut males from 2012 would require 376,000 procedures, avert 7,900 HIV infections by 2032, and require 143 MC per averted infection. Targeting uncut urban youths would achieve the most cost effective returns of 54 MC per HIV infection averted. These numbers of MC required to avert an HIV infection change little even with coverage up to 80% of men. The greater the protective efficacy of longitudinal foreskin cuts against HIV acquisition, the less impact MC interventions will have. Dependent on this efficacy, increasing condom use could have a much greater impact with a 10 percentage point increase averting 18,400 infections over this same period. MC programs could be effective in reducing HIV infections in PNG, particularly in high prevalence populations. However the overall impact is highly dependent on the protective efficacy of existing longitudinal foreskin cutting in preventing HIV.

  15. Acceptability of Male Circumcision among College Students in Medical Universities in Western China: A Cross-Sectional Study.

    Directory of Open Access Journals (Sweden)

    Junjun Jiang

    Full Text Available Male circumcision (MC has been shown to reduce the risk of female to male transmission of HIV. The goal of this survey was to explore MC's acceptability and the factors associated with MC among college students in medical universities in western China.A cross-sectional study was carried out in three provinces in western China (Guangxi, Chongqing and Xinjiang to assess the acceptability of MC as well as to discover factors associated with the acceptability among college students in medical universities. A total of 1,790 uncircumcised male students from three medical universities were enrolled in this study. In addition, 150 students who had undergone MC were also enrolled in the survey, and they participated in in-depth interviews.Of all the uncircumcised participants (n = 1,790, 55.2% (n = 988 were willing to accept MC. Among those who accepted MC, 67.3% thought that MC could improve their sexual partners' hygiene, 46.3% believed that HIV and sexually transmitted diseases (STDs could be partially prevented by MC. The multivariable logistic regression indicates that MC's acceptability was associated with three factors: the redundant foreskin (OR = 10.171, 95% CI = 7.629-13.559, knowing the hazard of having a redundant foreskin (OR = 1.597, 95% CI = 1.097-2.323, and enhancing sexual pleasure (OR = 1.628, 95% CI = 1.312-2.021. The in-depth interviews for subjects who had undergone MC showed that the major reason for having MC was the redundant foreskin (87.3%, followed by the benefits and the fewer complications of having MC done. In addition, most of these participants (65.3% said that the MC could enhance sexual satisfaction.MC's acceptance among college students in medical universities is higher than it is among other populations in western China. An implementation of an MC programme among this population is feasible in the future.

  16. Effects of medical male circumcision (MC on plasma HIV viral load in HIV+ HAART naive men; Rakai, Uganda.

    Directory of Open Access Journals (Sweden)

    Godfrey Kigozi

    Full Text Available BACKGROUND: Medical male circumcision (MC of HIV-infected men may increase plasma HIV viral load and place female partners at risk of infection. We assessed the effect of MC on plasma HIV viral load in HIV-infected men in Rakai, Uganda. METHODS: 195 consenting HIV-positive, HAART naïve men aged 12 and above provided blood for plasma HIV viral load testing before surgery and weekly for six weeks and at 2 and 3 months post surgery. Data were also collected on baseline social demographic characteristics and CD4 counts. Change in log10 plasma viral load between baseline and follow-up visits was estimated using paired t tests and multivariate generalized estimating equation (GEE. RESULTS: Of the 195 men, 129 had a CD4 count ≧ 350 and 66 had CD4 <350 cells/mm3. Men with CD4 counts <350 had higher baseline mean log10 plasma viral load than those with CD4 counts ≧ 350 cells/mm3 (4.715 vs 4.217 cps/mL, respectively, p = 0.0005. Compared to baseline, there was no statistically significant increase in post-MC HIV plasma viral loads irrespective of CD4. Multivariate analysis showed that higher baseline log10 plasma viral load was significantly associated with reduction in mean log10 plasma viral load following MC (coef.  = -0.134, p<0.001. CONCLUSION: We observed no increase in plasma HIV viral load following MC in HIV-infected, HAART naïve men.

  17. Impact of male circumcision on the HIV epidemic in Papua New Guinea: a country with extensive foreskin cutting practices.

    Science.gov (United States)

    Gray, Richard T; Vallely, Andrew; Wilson, David P; Kaldor, John; MacLaren, David; Kelly-Hanku, Angela; Siba, Peter; Murray, John M

    2014-01-01

    The degree to which adult medical male circumcision (MC) programs can reduce new HIV infections in a moderate HIV prevalence country like Papua New Guinea (PNG) are uncertain especially given the widespread prevalence of longitudinal foreskin cuts among adult males. We estimated the likely impact of a medical MC intervention in PNG using a mathematical model of HIV transmission. The model was age-structured and incorporated separate components for sex, rural/urban, men who have sex with men and female sex workers. Country-specific data of the prevalence of foreskin cuts, sexually transmitted infections, condom usage, and the acceptability of MC were obtained by our group through related studies. If longitudinal foreskin cutting has a protective efficacy of 20% compared to 60% for MC, then providing MC to 20% of uncut males from 2012 would require 376,000 procedures, avert 7,900 HIV infections by 2032, and require 143 MC per averted infection. Targeting uncut urban youths would achieve the most cost effective returns of 54 MC per HIV infection averted. These numbers of MC required to avert an HIV infection change little even with coverage up to 80% of men. The greater the protective efficacy of longitudinal foreskin cuts against HIV acquisition, the less impact MC interventions will have. Dependent on this efficacy, increasing condom use could have a much greater impact with a 10 percentage point increase averting 18,400 infections over this same period. MC programs could be effective in reducing HIV infections in PNG, particularly in high prevalence populations. However the overall impact is highly dependent on the protective efficacy of existing longitudinal foreskin cutting in preventing HIV.

  18. Voluntary medical male circumcision for HIV prevention in fishing communities in Uganda: the influence of local beliefs and practice.

    Science.gov (United States)

    Mbonye, Martin; Kuteesa, Monica; Seeley, Janet; Levin, Jonathan; Weiss, Helen; Kamali, Anatoli

    2016-09-01

    Local beliefs and practices about voluntary medical male circumcision (VMMC) may influence uptake and effectiveness. Data were gathered through interviews with 40 people from four ethnically mixed fishing communities in Uganda. Some men believed that wound healing could be promoted by contact with vaginal fluids while sex with non-regular partners could chase away spirits - practices which encouraged unsafe sexual practices. Information given by providers stressed that VMMC did not afford complete protection from sexually-transmitted infections, however, a number of male community members held the view that they were fully protected once circumcised. Both men and women said that VMMC was good not just for HIV prevention but also as a way of maintaining hygiene among the men. The implementation of VMMC in high-HIV prevalence settings needs to take account of local beliefs about circumcision, working with local religious/social group leaders, women and peers in the roll-out of the intervention.

  19. Age Targeting of Voluntary Medical Male Circumcision Programs Using the Decision Makers' Program Planning Toolkit (DMPPT 2.0.

    Directory of Open Access Journals (Sweden)

    Katharine Kripke

    Full Text Available Despite considerable efforts to scale up voluntary medical male circumcision (VMMC for HIV prevention in priority countries over the last five years, implementation has faced important challenges. Seeking to enhance the effect of VMMC programs for greatest and most immediate impact, the U. S. President's Plan for AIDS Relief (PEPFAR supported the development and application of a model to inform national planning in five countries from 2013-2014.The Decision Makers' Program Planning Toolkit (DMPPT 2.0 is a simple compartmental model designed to analyze the effects of client age and geography on program impact and cost. The DMPPT 2.0 model was applied in Malawi, South Africa, Swaziland, Tanzania, and Uganda to assess the impact and cost of scaling up age-targeted VMMC coverage. The lowest number of VMMCs per HIV infection averted would be produced by circumcising males ages 20-34 in Malawi, South Africa, Tanzania, and Uganda and males ages 15-34 in Swaziland. The most immediate impact on HIV incidence would be generated by circumcising males ages 20-34 in Malawi, South Africa, Tanzania, and Uganda and males ages 20-29 in Swaziland. The greatest reductions in HIV incidence over a 15-year period would be achieved by strategies focused on males ages 10-19 in Uganda, 15-24 in Malawi and South Africa, 10-24 in Tanzania, and 15-29 in Swaziland. In all countries, the lowest cost per HIV infection averted would be achieved by circumcising males ages 15-34, although in Uganda this cost is the same as that attained by circumcising 15- to 49-year-olds.The efficiency, immediacy of impact, magnitude of impact, and cost-effectiveness of VMMC scale-up are not uniform; there is important variation by age group of the males circumcised and countries should plan accordingly.

  20. Age Targeting of Voluntary Medical Male Circumcision Programs Using the Decision Makers’ Program Planning Toolkit (DMPPT) 2.0

    Science.gov (United States)

    Kripke, Katharine; Opuni, Marjorie; Schnure, Melissa; Sgaier, Sema; Castor, Delivette; Reed, Jason; Stover, John

    2016-01-01

    Background Despite considerable efforts to scale up voluntary medical male circumcision (VMMC) for HIV prevention in priority countries over the last five years, implementation has faced important challenges. Seeking to enhance the effect of VMMC programs for greatest and most immediate impact, the U. S. President’s Plan for AIDS Relief (PEPFAR) supported the development and application of a model to inform national planning in five countries from 2013–2014. Methods and Findings The Decision Makers’ Program Planning Toolkit (DMPPT) 2.0 is a simple compartmental model designed to analyze the effects of client age and geography on program impact and cost. The DMPPT 2.0 model was applied in Malawi, South Africa, Swaziland, Tanzania, and Uganda to assess the impact and cost of scaling up age-targeted VMMC coverage. The lowest number of VMMCs per HIV infection averted would be produced by circumcising males ages 20–34 in Malawi, South Africa, Tanzania, and Uganda and males ages 15–34 in Swaziland. The most immediate impact on HIV incidence would be generated by circumcising males ages 20–34 in Malawi, South Africa, Tanzania, and Uganda and males ages 20–29 in Swaziland. The greatest reductions in HIV incidence over a 15-year period would be achieved by strategies focused on males ages 10–19 in Uganda, 15–24 in Malawi and South Africa, 10–24 in Tanzania, and 15–29 in Swaziland. In all countries, the lowest cost per HIV infection averted would be achieved by circumcising males ages 15–34, although in Uganda this cost is the same as that attained by circumcising 15- to 49-year-olds. Conclusions The efficiency, immediacy of impact, magnitude of impact, and cost-effectiveness of VMMC scale-up are not uniform; there is important variation by age group of the males circumcised and countries should plan accordingly. PMID:27410966

  1. Bringing Early Infant Male Circumcision Information Home to the Family: Demographic Characteristics and Perspectives of Clients in a Pilot Project in Tanzania.

    Science.gov (United States)

    Amuri, Mbaraka; Msemo, Georgina; Plotkin, Marya; Christensen, Alice; Boyee, Dorica; Mahler, Hally; Phafoli, Semakaleng; Njozi, Mustafa; Hellar, Augustino; Mlanga, Erick; Yansaneh, Aisha; Njeuhmeli, Emmanuel; Lija, Jackson

    2016-07-01

    Iringa region of Tanzania has had great success reaching targets for voluntary medical male circumcision (VMMC). Looking to sustain high coverage of male circumcision, the government introduced a pilot project to offer early infant male circumcision (EIMC) in Iringa in 2013. From April 2013 to December 2014, a total of 2,084 male infants were circumcised in 8 health facilities in the region, representing 16.4% of all male infants born in those facilities. Most circumcisions took place 7 days or more after birth. The procedure proved safe, with only 3 mild and 3 moderate adverse events (0.4% overall adverse event rate). Overall, 93% of infants were brought back for a second-day visit and 71% for a seventh-day visit. These percentages varied significantly by urban and rural residence (97.4% urban versus 84.6% rural for day 2 visit; 82.2% urban versus 49.9% rural for day 7 visit). Mothers were more likely than fathers to have received information about EIMC. However, fathers tended to be key decision makers regarding circumcision of their sons. This suggests the importance of addressing fathers with behavioral change communication about EIMC. Successes in scaling up VMMC services in Iringa did not translate into immediate acceptability of EIMC. EIMC programs will require targeted investments in demand creation to expand and thrive in traditionally non-circumcising settings such as Iringa. PMID:27413081

  2. Bringing Early Infant Male Circumcision Information Home to the Family: Demographic Characteristics and Perspectives of Clients in a Pilot Project in Tanzania.

    Science.gov (United States)

    Amuri, Mbaraka; Msemo, Georgina; Plotkin, Marya; Christensen, Alice; Boyee, Dorica; Mahler, Hally; Phafoli, Semakaleng; Njozi, Mustafa; Hellar, Augustino; Mlanga, Erick; Yansaneh, Aisha; Njeuhmeli, Emmanuel; Lija, Jackson

    2016-07-01

    Iringa region of Tanzania has had great success reaching targets for voluntary medical male circumcision (VMMC). Looking to sustain high coverage of male circumcision, the government introduced a pilot project to offer early infant male circumcision (EIMC) in Iringa in 2013. From April 2013 to December 2014, a total of 2,084 male infants were circumcised in 8 health facilities in the region, representing 16.4% of all male infants born in those facilities. Most circumcisions took place 7 days or more after birth. The procedure proved safe, with only 3 mild and 3 moderate adverse events (0.4% overall adverse event rate). Overall, 93% of infants were brought back for a second-day visit and 71% for a seventh-day visit. These percentages varied significantly by urban and rural residence (97.4% urban versus 84.6% rural for day 2 visit; 82.2% urban versus 49.9% rural for day 7 visit). Mothers were more likely than fathers to have received information about EIMC. However, fathers tended to be key decision makers regarding circumcision of their sons. This suggests the importance of addressing fathers with behavioral change communication about EIMC. Successes in scaling up VMMC services in Iringa did not translate into immediate acceptability of EIMC. EIMC programs will require targeted investments in demand creation to expand and thrive in traditionally non-circumcising settings such as Iringa.

  3. Rural Zulu women’s knowledge of and attitudes towards medical male circumcision

    Directory of Open Access Journals (Sweden)

    Joseph N. Ikwegbue

    2015-02-01

    Full Text Available Background: Medical male circumcision (MMC is a key strategy in the South African HIV infection prevention package. Women may have a potentially powerful role in supporting such a strategy. Circumcision is not a traditional part of Zulu society, and Zulu women may have limited knowledge and ambivalent or negative attitudes towards MMC.Aim: This study employs quantitative data to expand insight into rural Zulu women’s knowledge of and attitudes towards MMC, and is important as women could potentially yield a powerful positive or negative influence over the decisions of their partners and sons.Setting: A hospital-based antenatal clinic in rural KwaZulu-Natal.Methods: Participants were 590 pregnant, mostly isiZulu-speaking women. Data on their knowledge of and attitude towards MMC were collected using a questionnaire and were analysed descriptively.Results: The majority of the women supported MMC; however, knowledge of the potential benefits was generally poor. Most would encourage their partners and sons to undergo MMC. The preferred place for the procedure was a hospital.Conclusion: Zulu participants supported MMC and would support their partners and children being circumcised. Knowledge around potential benefits was worryingly poor, and further research into disseminating information is essential. The findings highlight the need for an expanded campaign of health education for women, and innovative means are suggested to enhance information accessibility. Reasons for preferring that MMC be carried out in hospital need to be explored further.

  4. Safety, Feasibility, and Acceptability of the PrePex Device for Adult Male Circumcision in Malawi

    Science.gov (United States)

    Tippett Barr, Beth A.; Kang'ombe, Anderson; Hofstee, Carola; Kilembe, Franklin; Galagan, Sean; Chilongozi, David; Namate, Dorothy; Machaya, Medson; Kabwere, Khuliena; Mwale, Mwawi; Msunguma, Wezi; Reed, Jason; Chimbwandira, Frank

    2016-01-01

    Introduction: Nonsurgical adult male circumcision devices present an alternative to surgery where health resources are limited. This study aimed to assess the safety, feasibility, and acceptability of the PrePex device for adult male circumcision in Malawi. Methods: A prospective single-arm cohort study was conducted at 3 sites (1 urban static, 1 rural static, 1 rural tent) in Malawi. Adverse event (AE) outcomes were stratified to include/exclude pain, and confidence intervals (CIs) were corrected for clinic-level clustering. Results: Among 935 men screened, 131 (14.0%) were not eligible, 13 (1.4%) withdrew before placement, and 791 (84.6%) received the device. Moderate and severe AEs totaled 7.1% including pain [95% CI: 3.4–14.7] and 4.0% excluding pain (95% CI: 2.6 to 6.4). Severe AEs included pain (n = 3), insufficient skin removal (n = 4), and early removal (n = 4). Among early removals, 1 had immediate surgical circumcision, 1 had surgery after 48 hours of observation, 1 declined surgery, and 1 did not return to our site although presented at a nearby clinic. More than half of men (51.9%) reported odor; however, few (2.2%) stated they would not recommend the device to others because of odor. Median levels of reported pain (scale, 1–10) were 2 (interquartile range, 2–4) during application and removal, and 0 (interquartile range, 0–2) at all other time points. Conclusions: Severe AEs were rare and similar to other programs. Immediate provision of surgical services after displacement or early removal proved a challenge. Cases of insufficient skin removal were linked to poor technique, suggesting provider training requires reinforcement and supervision. PMID:27331590

  5. Costs and impacts of scaling up voluntary medical male circumcision in Tanzania.

    Directory of Open Access Journals (Sweden)

    Veena Menon

    Full Text Available BACKGROUND: Given the proven effectiveness of voluntary medical male circumcision (VMMC in preventing the spread of HIV, Tanzania is scaling up VMMC as an HIV prevention strategy. This study will inform policymakers about the potential costs and benefits of scaling up VMMC services in Tanzania. METHODOLOGY: The analysis first assessed the unit costs of delivering VMMC at the facility level in three regions-Iringa, Kagera, and Mbeya-via three currently used VMMC service delivery models (routine, campaign, and mobile/island outreach. Subsequently, using these unit cost data estimates, the study used the Decision Makers' Program Planning Tool (DMPPT to estimate the costs and impact of a scaled-up VMMC program. RESULTS: Increasing VMMC could substantially reduce HIV infection. Scaling up adult VMMC to reach 87.9% coverage by 2015 would avert nearly 23,000 new adult HIV infections through 2015 and an additional 167,500 from 2016 through 2025-at an additional cost of US$253.7 million through 2015 and US$302.3 million from 2016 through 2025. Average cost per HIV infection averted would be US$11,300 during 2010-2015 and US$3,200 during 2010-2025. Scaling up VMMC in Tanzania will yield significant net benefits (benefits of treatment costs averted minus the cost of performing circumcisions in the long run-around US$4,200 in net benefits for each infection averted. CONCLUSION: VMMC could have an immediate impact on HIV transmission, but the full impact on prevalence and deaths will only be apparent in the longer term because VMMC averts infections some years into the future among people who have been circumcised. Given the health and economic benefits of investing in VMMC, the scale-up of services should continue to be a central component of the national HIV prevention strategy in Tanzania.

  6. Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa.

    Directory of Open Access Journals (Sweden)

    Emmanuel Njeuhmeli

    2011-11-01

    Full Text Available BACKGROUND: There is strong evidence showing that voluntary medical male circumcision (VMMC reduces HIV incidence in men. To inform the VMMC policies and goals of 13 priority countries in eastern and southern Africa, we estimate the impact and cost of scaling up adult VMMC using updated, country-specific data. METHODS AND FINDINGS: We use the Decision Makers' Program Planning Tool (DMPPT to model the impact and cost of scaling up adult VMMC in Botswana, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe, and Nyanza Province in Kenya. We use epidemiologic and demographic data from recent household surveys for each country. The cost of VMMC ranges from US$65.85 to US$95.15 per VMMC performed, based on a cost assessment of VMMC services aligned with the World Health Organization's considerations of models for optimizing volume and efficiencies. Results from the DMPPT models suggest that scaling up adult VMMC to reach 80% coverage in the 13 countries by 2015 would entail performing 20.34 million circumcisions between 2011 and 2015 and an additional 8.42 million between 2016 and 2025 (to maintain the 80% coverage. Such a scale-up would result in averting 3.36 million new HIV infections through 2025. In addition, while the model shows that this scale-up would cost a total of US$2 billion between 2011 and 2025, it would result in net savings (due to averted treatment and care costs amounting to US$16.51 billion. CONCLUSIONS: This study suggests that rapid scale-up of VMMC in eastern and southern Africa is warranted based on the likely impact on the region's HIV epidemics and net savings. Scaling up of safe VMMC in eastern and southern Africa will lead to a substantial reduction in HIV infections in the countries and lower health system costs through averted HIV care costs.

  7. A prospective evaluation of plastibell® circumcision in older children

    Directory of Open Access Journals (Sweden)

    Jose Murillo Bastos Netto

    2013-07-01

    Full Text Available Introduction and Objective Circumcision is one of the oldest surgical procedures and one of the most frequently performed worldwide. It can be done by many different techniques. This prospective series presents the results of Plastibell® circumcision in children older than 2 years of age, evaluating surgical duration, immediate and late complications, time for plastic device separation and factors associated with it. Materials and Methods We prospectively analyzed 119 children submitted to Plastic Device Circumcision with Plastibell® by only one surgeon from December 2009 to June 2011. In all cases the surgery was done under general anesthesia associated with dorsal penile nerve block. Before surgery length of the penis and latero-lateral diameter of the glans were measured. Surgical duration, time of Plastibell® separation and use of analgesic medication in the post-operative period were evaluated. Patients were followed on days 15, 45, 90 and 120 after surgery. Results Age at surgery varied from 2 to 12.5 (5.9 ± 2.9 years old. Mean surgical time was 3.7 ± 2.0 minutes (1.9 to 9 minutes. Time for plastic device separation ranged from 6 to 26 days (mean: 16 ± 4.2 days, being 14.8 days for children younger than 5 years of age and 17.4 days for those older than 5 years of age (p < 0.0001. The diameter of the Plastibell® does not interfered in separations time (p = 0,484. Late complications occurred in 32 (26.8% subjects, being the great majority of low clinical significance, especially prepucial adherences, edema of the mucosa and discrete hypertrophy of the scar, all resolving with clinical treatment. One patient still using diaper had meatus stenosis and in one case the Plastibell® device stayed between the glans and the prepuce and needed to be removed manually. conclusions Circumcision using a plastic device is a safe, quick and an easy technique with low complications, that when occur are of low clinical importance and of easy

  8. Policy environment and male circumcision for HIV prevention: Findings from a situation analysis study in Tanzania

    Directory of Open Access Journals (Sweden)

    Mshana Gerry

    2011-06-01

    Full Text Available Abstract Background Male circumcision (MC has been shown to be effective against heterosexual acquisition of HIV infection and is being scaled up as an additional strategy against HIV in several countries of Africa. However, the policy environment (whether to formulate new specific policy on MC or adapts the existing ones; and the role of various stakeholders in the MC scale up process in Tanzania was unclear. We conducted this study as part of a situation analysis to understand the attitudes of policy makers and other key community and health authority decision makers towards MC, policy and regulatory environment, and the readiness of a health system to accommodate scaling up of MC services. Methods We conducted 36 key informants' interviews with a broad range of informants including civil servants, religious leaders, cultural and traditional gatekeepers and other potential informants. Study informants were selected at the national level, regional, district and community levels to represent both traditionally circumcising and non-circumcising communities. Results Study informants had positive attitudes and strong beliefs towards MC. Key informants in traditionally non-circumcising districts were willing to take their sons for medically performed MC. Religious leaders and traditional gatekeepers supported MC as it has been enshrined in their holy scripts and traditional customs respectively. Civil servants highlighted the need for existence of enabling policy and regulatory environment in the form of laws, regulations and guidelines that will ensure voluntary accessibility, acceptability, quality and safety for those in need of MC services. Majority of informants urged the government to make improvements in the health system at all levels to ensure availability of adequate trained personnel, infrastructure, equipment, and supplies for MC scale up, and insisted on the involvement of different MC stakeholders as key components in effective roll

  9. 使用一次性包皮环切缝合器手术后并发症分析及处理%The analysis of complications and prevention treatment circumcision with disposable circumcision suture device

    Institute of Scientific and Technical Information of China (English)

    景治安; 刘彦军; 李纪华; 胡和平

    2014-01-01

    Objective To discuss the cause of the postoperative complications, prevention and treatment measures of circumcision with disposable circumcision suture device, so as to reduce the incidence of postoperative complications, further improve the quality of the circumcision. Methods A total of 111 patients undergoing circumcision with dispos-able circumcision suture device were included. Complications and the satisfaction of the post-operative appearance were evaluated. Results The total rate of postoperative complications was 8.1%(9/111). The complications were infec-tion 1.8%(2/111),bleeding 6.3%(7/111),without wound dehiscence and penile edema. Conclusion Circumcision with disposable circumcision suture device has the advantages of fewer complications, and higher satisfied postoperative ap-pearance of the penile. Most of the complications can be treated with conservative management.%目的:探讨应用一次性包皮环切缝合器包皮环切术后并发症的原因、预防及处理措施,减少术后并发症的发生率,提高包皮环切手术的质量。方法采用一次性包皮环切缝合器对111例包皮过长和包茎的男性患者进行包皮环切术,对术后出现的并发症和术后外观情况进行观察和随访。结果111例患者术后并发症总发生率为8.1%(9/111),其中术后感染1.8%(2/111)、术后出血6.3%(7/111),无伤口裂开和包皮水肿。结论一次性包皮环切缝合器包皮环切术术后并发症少、包皮切口整齐美观,其并发症的出现与使用者的熟练程度有明显关系。

  10. Comparison of Postoperative Analgesic Efficacy of Penile Block, Caudal Block and Intravenous Paracetamol for Circumcision: A prospective Randomized Study

    Directory of Open Access Journals (Sweden)

    Ahmet Hakan Haliloglu

    2013-07-01

    Full Text Available Purpose To evaluate the postoperative analgesic efficacy of penile block, caudal block and intravenous paracetamol administration following circumcision. Materials and Methods In this prospective randomized study a total of 159 patients underwent circumcision under general anesthesia at urology clinic of Ufuk University Faculty of Medicine and Sorgun State Hospital between May 2012 and September 2012. The patients were randomized to three groups to receive penile block (Group 1, caudal block (Group 2 and intravenous paracetamol administration (group 3. Pain measurement of the patients was done via CHEOPS scoring system at 30,60,120 and 180 minutes postoperatively and compared. Statistical tests were performed with a conventional statistics program and statistical significance was set at a p value of < 0.05. Results The mean age of the patients was 5.7 years. Patients in group 1 had significantly lower pain score at 30 minutes compared to other two groups. At 60 minutes groups 1 and 2 had significantly lower score compared to group 3. At 120 and 180 minutes no difference between the groups was observed. No significant major complications were observed in all 3 groups. Conclusion Penile block and caudal block provide similar pain scores and painless postoperative periods after circumcision under general anesthesia. Intravenous paracetamol is insufficient at the early postoperative period. The three procedures were shown to be safe for analgesia following circumcision.

  11. 包皮环切手术的改进%Improvement of circumcision:a review of 656 cases

    Institute of Scientific and Technical Information of China (English)

    刘齐贵; 张文滔; 段娟; 李坤林; 周庆余

    2011-01-01

    目的 研究改进包皮环切手术的麻醉、环剪、缝合、打结等方面的技术及注意事项.方法 回顾性分析我院近10年来采用传统及改进方法行包皮环切手术的两组病人的临床资料.结果 两组病人治愈率均为100%,但改进方法组病人痛苦小、省事省时,病人满意度高.结论 包皮环切术之改进方法切实可行,特别适合于好哭闹的小儿.%Objective To study the effectiveness and announcements of a improved circumcision. Methods The clinical data of 656 patients in two groups respectively undergoing traditional or improved circumcision in recent 10 years have been retrospectively analyzed. Results The cure rates in two groups were all 100%, but the improved circumcision was timesaving and less troublesome,and patients undergoing it had less pain and better satisfactory degree. Conclusion The improved circumcision is reliable and feasible, especially for crying children.

  12. Estimating the resources needed and savings anticipated from roll-out of adult male circumcision in sub-Saharan Africa

    NARCIS (Netherlands)

    B. Auvert (Bertran); E. Marseille (Elliot); E.L. Korenromp (Eline); J. Lloyd-Smith (James); R. Sitta (Remi); D. Taljaard (Dirk); C. Pretorius (Carel); B. Williams (Brian); J.G. Kahn (James)

    2008-01-01

    textabstractBackground: Trials in Africa indicate that medical adult male circumcision (MAMC) reduces the risk of HIV by 60%. MAMC may avert 2 to 8 million HIV infections over 20 years in sub-Saharan Africa and cost less than treating those who would have been infected. This paper estimates the fina

  13. Awareness and predictors of female genital mutilation/cutting among young health advocates.

    Science.gov (United States)

    Abolfotouh, Sherif M; Ebrahim, Ahmed Z; Abolfotouh, Mostafa A

    2015-01-01

    The act of female genital mutilation/cutting (FGM/C) is considered internationally as a violent act against girls and women and a violation of their human rights. This study sought to assess the awareness and predictors of FGM/C in young Egyptian health advocates. A cross-sectional study of 600 medical students from a total of 2,500 members of the International Federation of Medical Students' Associations (IFMSA)-Egypt, across all Egyptian medical schools, was conducted using a previously validated online Google survey. The overall prevalence of circumcision was 14.7/100 female students, with a significantly higher prevalence in students from rural areas (25%) than in non-rural areas (10.8%, P=0.001), and in those residing in Upper (southern) Egypt (20.6%) than in Lower (northern) Egypt (8.7%, P=0.003). The students' mean percentage score for knowledge about the negative health consequences of FGM/C was 53.50±29.07, reflecting a modest level of knowledge; only 30.5% had a good level of knowledge. The mean percentage score for the overall attitude toward discontinuation of the practice of FGM/C was 76.29±17.93, reflecting a neutral attitude; 58.7% had a favorable attitude/norms toward discontinuation of the practice. Of circumcised students, approximately one-half (46.8%) were unwilling to have their daughters circumcised, and 60% reported no harm from being circumcised. After controlling for confounders, a negative attitude toward FGM/C was significantly (P<0.001 in all cases) associated with male sex, residency in Upper Egypt, rural origin, previous circumcision, and the preclinical medical phase of education. The low level of knowledge among even future health professions in our study suggests that communication, rather than passive learning, is needed to convey the potentially negative consequences of FGM/C and to drive a change in attitude toward discontinuation of this harmful practice. PMID:25759602

  14. 包皮手术196例疗效分析%Clinical anaalisis on operation of circumcision

    Institute of Scientific and Technical Information of China (English)

    吴忠良; 钱伟华; 苏志刚; 王心治

    2014-01-01

    Objective:To compare the curative effect of three kinds of circumcision .Methods:196 cases of wrapping was too long , phi-mosis patients into three groups , respectively by classical circumcision , circumcision TaoZa apparatus , circumcision surgery .Results:Classic mature operation , suitable for all kinds of patients , but slightly more postoperative complications , the foreskin edema and edema with lace-up side was relatively rare , and the edge was not beautiful;Circumcision TaoZa operation , less bleeding , incision neatly , ede-ma were less light , but the foreign body sensation;Circumcision surgery , time was short , less bleeding , incision and tidy and beautiful , significant edema was light , time was short .Conclusion:Circumcision surgery should be a good operation method .%目的:总结比较3种包皮环切术的疗效。方法:对196例包皮过长、包茎患者分3组,分别以传统包皮环切术、包皮环切套扎器术、包皮环切器手术。结果:经典手术成熟,适用于各种患者,但术后并发症稍多,包皮水肿且以系带侧水肿较为多见,且边缘不够美观;包皮环切套扎术,出血少,切口整齐,水肿情况稍轻,但异物感明显;包皮环切器术,时间短,出血少,切口整齐美观,水肿情况较前明显轻,且时间短。结论:包皮环切器术是很好的手术方式,但价格昂贵。

  15. Male circumcision for HIV prevention - a cross-sectional study on awareness among young people and adults in rural Uganda

    Directory of Open Access Journals (Sweden)

    Hizaamu Ramadhan NB

    2010-04-01

    Full Text Available Abstract Background Medical male circumcision is now part of a comprehensive approach to HIV prevention. It has been shown that awareness of the protective effect of male circumcision leads to high acceptability towards the introduction of medical male circumcision services within countries. The objective of this survey was to identify factors determining awareness of male circumcision for HIV prevention. Methods We interviewed 452 participants (267 adults >24 years of age; 185 youths 14-24 years living in three rural Ugandan districts in 2008. Using a standardized questionnaire, we assessed socio-demographic parameters, awareness of MC for HIV prevention, general beliefs/attitudes regarding MC and MC status. Determinants for awareness of MC for HIV prevention were examined with multiple logistic regression models. Results Out of all adults, 52.1% were male (mean ± SD age 39.8 ± 11 years, of whom 39.1% reported to be circumcised. Out of all youths, 58.4% were male (18.4 ± 2.5, 35.0% circumcised. Adults were more aware of MC for HIV prevention than youths (87.1% vs. 76.5%; p = 0.004. In adults, awareness was increased with higher educational level compared to no school: primary school (adjusted OR 9.32; 95%CI 1.80-48.11, secondary (5.04; 1.01-25.25, tertiary (9.91; 0.76-129.18, university education (8.03; 0.59-109.95. Younger age and male sex were further significant determinants of increased awareness, but not marital status, religion, district, ethnicity, employment status, and circumcision status. In youths, we found a borderline statistically significant decrease of awareness of MC for HIV prevention with higher educational level, but not with any other socio-demographic factors. Conclusions Particularly Ugandans with low education, youths, and women, playing an important role in decision-making of MC for their partners and sons, should be increasingly targeted by information campaigns about positive health effects of MC.

  16. Cost and Impact of Voluntary Medical Male Circumcision in South Africa: Focusing the Program on Specific Age Groups and Provinces

    Science.gov (United States)

    Kripke, Katharine; Thambinayagam, Ananthy; Pillay, Yogan; Loykissoonlal, Dayanund; Bonnecwe, Collen; Barron, Peter; Kiwango, Eva; Castor, Delivette

    2016-01-01

    Background In 2012, South Africa set a goal of circumcising 4.3 million men ages 15–49 by 2016. By the end of March 2014, 1.9 million men had received voluntary medical male circumcision (VMMC). In an effort to accelerate progress, South Africa undertook a modeling exercise to determine whether circumcising specific client age groups or geographic locations would be particularly impactful or cost-effective. Results will inform South Africa’s efforts to develop a national strategy and operational plan for VMMC. Methods and Findings The study team populated the Decision Makers’ Program Planning Tool, Version 2.0 (DMPPT 2.0) with HIV incidence projections from the Spectrum/AIDS Impact Module (AIM), as well as national and provincial population and HIV prevalence estimates. We derived baseline circumcision rates from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. The model showed that circumcising men ages 20–34 offers the most immediate impact on HIV incidence and requires the fewest circumcisions per HIV infection averted. The greatest impact over a 15-year period is achieved by circumcising men ages 15–24. When the model assumes a unit cost increase with client age, men ages 15–29 emerge as the most cost-effective group. When we assume a constant cost for all ages, the most cost-effective age range is 15–34 years. Geographically, the program is cost saving in all provinces; differences in the VMMC program’s cost-effectiveness across provinces were obscured by uncertainty in HIV incidence projections. Conclusion The VMMC program’s impact and cost-effectiveness vary by age-targeting strategy. A strategy focusing on men ages 15–34 will maximize program benefits. However, because clients older than 25 access VMMC services at low rates, South Africa could consider promoting demand among men ages 25–34, without denying services to those in other age groups. Uncertainty in the provincial estimates makes them

  17. Cost and Impact of Voluntary Medical Male Circumcision in South Africa: Focusing the Program on Specific Age Groups and Provinces.

    Directory of Open Access Journals (Sweden)

    Katharine Kripke

    Full Text Available In 2012, South Africa set a goal of circumcising 4.3 million men ages 15-49 by 2016. By the end of March 2014, 1.9 million men had received voluntary medical male circumcision (VMMC. In an effort to accelerate progress, South Africa undertook a modeling exercise to determine whether circumcising specific client age groups or geographic locations would be particularly impactful or cost-effective. Results will inform South Africa's efforts to develop a national strategy and operational plan for VMMC.The study team populated the Decision Makers' Program Planning Tool, Version 2.0 (DMPPT 2.0 with HIV incidence projections from the Spectrum/AIDS Impact Module (AIM, as well as national and provincial population and HIV prevalence estimates. We derived baseline circumcision rates from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. The model showed that circumcising men ages 20-34 offers the most immediate impact on HIV incidence and requires the fewest circumcisions per HIV infection averted. The greatest impact over a 15-year period is achieved by circumcising men ages 15-24. When the model assumes a unit cost increase with client age, men ages 15-29 emerge as the most cost-effective group. When we assume a constant cost for all ages, the most cost-effective age range is 15-34 years. Geographically, the program is cost saving in all provinces; differences in the VMMC program's cost-effectiveness across provinces were obscured by uncertainty in HIV incidence projections.The VMMC program's impact and cost-effectiveness vary by age-targeting strategy. A strategy focusing on men ages 15-34 will maximize program benefits. However, because clients older than 25 access VMMC services at low rates, South Africa could consider promoting demand among men ages 25-34, without denying services to those in other age groups. Uncertainty in the provincial estimates makes them insufficient to support geographic targeting.

  18. The relevance of castration and circumcision to the origins of psychoanalysis: 1. The medical context.

    Science.gov (United States)

    Bonomi, Carlo

    2009-06-01

    In this paper the author outlines and discusses the origins and the decline of castration and circumcision as a cure for the nervous and psychic disturbances in women and little girls between 1875 and 1905. The author argues that the opposition to this medical practice affected the conception of hysteria, promoting a distinction between sexuality and the genital organs, and the emergence of an enlarged notion of sexuality, during the period from Freud's medical education to the publication of the Three Essays on the Theory of Sexuality. The hypothesis is put forward that Freud came directly in contact with the genital theory of the neurosis at the time of his training on the nervous disturbances in children with the paediatrician, Adolf Baginsky, in Berlin, in March 1886. It is hypothesized that this experience provoked in Freud an abhorrence of circumcision 'as a cure or punishment for masturbation', prompting an inner confrontation which resulted in a radical reorganization of the way of thinking about sexuality. It is also suggested that this contributed to Freud developing a capacity to stay with contradictions, something which would become a central quality of the psychoanalytic attitude. PMID:19580597

  19. Voluntary medical male circumcision for HIV prevention and early resumption of sexual activity: a literature review.

    Science.gov (United States)

    Kamath, Veena; Limaye, Rupali J

    2015-01-01

    A number of programs have focused on scale-up and implementation research regarding voluntary medical male circumcision; however, there is limited research with regard to factors and strategies related to abstinence compliance and the effects of resuming sex during the wound healing period (42-day post-circumcision). We searched the literature for peer-reviewed articles examining early resumption of sex during this period. This review identifies factors that may predispose a client to engage in sex during the 42-day postoperative period, examines how early resumption of sex can inhibit wound healing and increase seroconversion, and reviews strategies that may increase adherence to abstinence during the wound healing period. We found that the most common factor that may predispose a client to engage in sex before the end of the postoperative period is marriage or cohabitation with a sexual partner. With regard to the effect of sex during the postoperative period on wound healing and seroconversion, we found that adverse events incurred were mild, and there was an increased risk of seroconversion. The only strategy studied to increase compliance to abstinence during the postoperative period utilized text messaging, and the trial results indicate that text messaging did not increase abstinence compliance. PMID:25738780

  20. Transient Peripheral Immune Activation follows Elective Sigmoidoscopy or Circumcision in a Cohort Study of MSM at Risk of HIV Infection

    Science.gov (United States)

    Lama, Javier R.; Karuna, Shelly T.; Grant, Shannon P.; Swann, Edith M.; Ganoza, Carmela; Segura, Patricia; Montano, Silvia M.; Lacherre, Martin; De Rosa, Stephen C.; Buchbinder, Susan; Sanchez, Jorge; McElrath, M. Juliana; Lemos, Maria P.

    2016-01-01

    Background Rectal and genital sampling in HIV prevention trials permits assessments at the site of HIV entry. Yet the safety and acceptability of circumcision and sigmoidoscopy (and associated abstinence recommendations) are unknown in uncircumcised men who have sex with men (MSM) at high risk of HIV infection. Methods Twenty-nine HIV-seronegative high-risk Peruvian MSM agreed to elective sigmoidoscopy biopsy collections (weeks 2 and 27) and circumcision (week 4) in a 28-week cohort study designed to mimic an HIV vaccine study mucosal collection protocol. We monitored adherence to abstinence recommendations, procedure-related complications, HIV infections, peripheral immune activation, and retention. Results Twenty-three (79.3%) underwent a first sigmoidoscopy, 21 (72.4%) were circumcised, and 16 (55.2%) completed a second sigmoidoscopy during the study period. All who underwent procedures completed the associated follow-up safety visits. Those completing the procedures reported they were well tolerated, and complication rates were similar to those reported in the literature. Immune activation was detected during the healing period (1 week post-sigmoidoscopy, 6 weeks post-circumcision), including increases in CCR5+CD4+T cells and α4β7+CD4+T cells. Most participants adhered to post-circumcision abstinence recommendations whereas reduced adherence occurred post-sigmoidoscopy. Conclusion Rectosigmoid mucosal and genital tissue collections were safe in high-risk MSM. Although the clinical implications of the post-procedure increase in peripheral immune activation markers are unknown, they reinforce the need to provide ongoing risk reduction counseling and support for post-procedure abstinence recommendations. Future HIV vaccine studies should also consider the effects of mucosal and tissue collections on peripheral blood endpoints in trial design and analysis. Trial Registration ClinicalTrials.gov NCT02630082 PMID:27536938

  1. Cost analysis of integrating the PrePex medical device into a voluntary medical male circumcision program in Zimbabwe.

    Directory of Open Access Journals (Sweden)

    Emmanuel Njeuhmeli

    Full Text Available BACKGROUND: Fourteen African countries are scaling up voluntary medical male circumcision (VMMC for HIV prevention. Several devices that might offer alternatives to the three WHO-approved surgical VMMC procedures have been evaluated for use in adults. One such device is PrePex, which was prequalified by the WHO in May 2013. We utilized data from one of the PrePex field studies undertaken in Zimbabwe to identify cost considerations for introducing PrePex into the existing surgical circumcision program. METHODS AND FINDINGS: We evaluated the cost drivers and overall unit cost of VMMC at a site providing surgical VMMC as a routine service ("routine surgery site" and at a site that had added PrePex VMMC procedures to routine surgical VMMC as part of a research study ("mixed study site". We examined the main cost drivers and modeled hypothetical scenarios with varying ratios of surgical to PrePex circumcisions, different levels of site utilization, and a range of device prices. The unit costs per VMMC for the routine surgery and mixed study sites were $56 and $61, respectively. The two greatest contributors to unit price at both sites were consumables and staff. In the hypothetical scenarios, the unit cost increased as site utilization decreased, as the ratio of PrePex to surgical VMMC increased, and as device price increased. CONCLUSIONS: VMMC unit costs for routine surgery and mixed study sites were similar. Low service utilization was projected to result in the greatest increases in unit price. Countries that wish to incorporate PrePex into their circumcision programs should plan to maximize staff utilization and ensure that sites function at maximum capacity to achieve the lowest unit cost. Further costing studies will be necessary once routine implementation of PrePex-based circumcision is established.

  2. Modeling the Impact of Uganda’s Safe Male Circumcision Program: Implications for Age and Regional Targeting

    Science.gov (United States)

    Kripke, Katharine; Vazzano, Andrea; Kirungi, William; Musinguzi, Joshua; Opio, Alex; Ssempebwa, Rhobbinah; Nakawunde, Susan; Kyobutungi, Sheila; Akao, Juliet N.; Magala, Fred; Mwidu, George; Castor, Delivette

    2016-01-01

    Background Uganda aims to provide safe male circumcision (SMC) to 80% of men ages 15–49 by 2016. To date, only 2 million men have received SMC of the 4.2 million men required. In response to age and regional trends in SMC uptake, the country sought to re-examine its targets with respect to age and subnational region, to assess the program’s progress, and to refine the implementation approach. Methods and Findings The Decision Makers’ Program Planning Tool, Version 2.0 (DMPPT 2.0), was used in conjunction with incidence projections from the Spectrum/AIDS Impact Module (AIM) to conduct this analysis. Population, births, deaths, and HIV incidence and prevalence were used to populate the model. Baseline male circumcision prevalence was derived from the 2011 AIDS Indicator Survey. Uganda can achieve the most immediate impact on HIV incidence by circumcising men ages 20–34. This group will also require the fewest circumcisions for each HIV infection averted. Focusing on men ages 10–19 will offer the greatest impact over a 15-year period, while focusing on men ages 15–34 offers the most cost-effective strategy over the same period. A regional analysis showed little variation in cost-effectiveness of scaling up SMC across eight regions. Scale-up is cost-saving in all regions. There is geographic variability in program progress, highlighting two regions with low baseline rates of circumcision where additional efforts will be needed. Conclusion Focusing SMC efforts on specific age groups and regions may help to accelerate Uganda’s SMC program progress. Policy makers in Uganda have already used model outputs in planning efforts, proposing males ages 10–34 as a priority group for SMC in the 2014 application to the Global Fund’s new funding model. As scale-up continues, the country should also consider a greater effort to expand SMC in regions with low MC prevalence. PMID:27410234

  3. Comparison of eutectic mixture of local anesthetics cream with dorsal penile nerve block using lignocaine for circumcision in infants

    Science.gov (United States)

    Mujeeb, Sabeen; Akhtar, Jamshed; Ahmed, Soofia

    2013-01-01

    Objective: Circumcision is a commonly performed surgical procedure but choice of anesthesia remained an issue of research and debate. This study was conducted to find out the effectiveness of the eutectic mixture of local anesthetic (EMLA) cream with dorsal penile nerve block (DPNB) using lignocaine, for reduction of pain during circumcision. Methodology: This was comparative study carried out in Surgical Unit B of National Institute of Child Health Karachi, from May 2008 to October 2008. Patients under six month of age were randomized in to two groups (EMLA and DPNB) of fifty patients each. The effectiveness of pain control was assessed by measuring the baseline heart rate (HR), respiratory rate (RR) and Neonatal infant Pain Scale (NIPS scale) before the start of procedure and measuring of these parameters for each step of circumcision. Independent sample t -test was used to compare means and repeated ANOVA was used to compare means of HR, RR, oxygen (O2) saturations and NIPS. Results: The mean age in both the groups was 2.3 months. There was no statistically significant difference in baseline parameters in both the groups except the respiratory rate, which was significantly raised in DPNB group (33 breaths/min in EMLA and 38 in DPNB P < 0.04). During circumcision there was significant increase in heart rate in DPNB group, especially in step three and step four (p < 0.04). Oxygen saturation dropped in both the groups (baseline saturation 98% up to 91% in step 4). While assessing NIPS scores in both the groups, statistically significant difference was found between NIPS at step two and step four in two groups (p < 0.04). Conclusions: The overall pain control was equal in both the groups, although NIPS score was higher in DPNB in step two and four of circumcision. There was difference in application and cost. EMLA was easy to apply but has increased cost; while DPNB required expertise. PMID:24353502

  4. Psychosocial Results from a Phase I Trial of a Nonsurgical Circumcision Device for Adult Men in Zimbabwe.

    Science.gov (United States)

    Kasprzyk, Danuta; Montaño, Daniel E; Hamilton, Deven T; Down, Kayla L; Marrett, Karl D; Tshimanga, Mufuta; Xaba, Sinokuthemba; Mugurungi, Owen

    2016-01-01

    Male circumcision (MC), an effective HIV prevention tool, has been added to Zimbabwe's Ministry of Health and Child Care HIV/AIDS Prevention Program. A Phase I safety trial of a nonsurgical male circumcision device was conducted and extensive psychosocial variables were assessed. Fifty-three men (18 and older) were recruited for the device procedure; 13 follow-up clinical visits were completed. Interviews conducted three times (before the procedure, at 2 weeks and 90 days post-procedure) assessed: Satisfaction; expectations; actual experience; activities of daily living; sexual behavior; and HIV risk perception. Using the Integrated Behavioral Model, attitudes towards MC, sex, and condoms, and sources of social influence and support were also assessed. Men (mean age 32.5, range 18-50; mean years of education = 13.6; 55% employed) were satisfied with device circumcision results. Men understand that MC is only partially protective against HIV acquisition. Most (94.7%) agreed that they will continue to use condoms to protect themselves from HIV. Pain ratings were surprisingly negative for a procedure billed as painless. Men talked to many social networks members about their MC experience; post-procedure (mean of 14 individuals). Minimal impact on activities of daily living and absenteeism indicate possible cost savings of device circumcisions. Spontaneous erections occurred frequently post-procedure. The results had important implications for changes in the pre-procedure clinical counseling protocol. Clear-cut counseling to manage pain and erection expectations should result in improved psychosocial outcomes in future roll-out of device circumcisions. Men's expectations must be managed through evidence-based counseling, as they share their experiences broadly among their social networks. PMID:26745142

  5. Veracity and rhetoric in paediatric medicine: a critique of Svoboda and Van Howe's response to the AAP policy on infant male circumcision.

    Science.gov (United States)

    Morris, Brian J; Tobian, Aaron A R; Hankins, Catherine A; Klausner, Jeffrey D; Banerjee, Joya; Bailis, Stefan A; Moses, Stephen; Wiswell, Thomas E

    2014-07-01

    In a recent issue of the Journal of Medical Ethics,Svoboda and Van Howe commented on the 2012 changein the American Academy of Pediatrics (AAP) policy on newborn male circumcision, in which the AAP stated that benefits of the procedure outweigh the risks. Svoboda and Van Howe disagree with the AAP conclusions. We show here that their arguments against male circumcision are based on a poor understanding of epidemiology,erroneous interpretation of the evidence, selective citation of the literature, statistical manipulation of data, and circular reasoning. In reality, the scientific evidence indicates that male circumcision, especially when performed in the newborn period, is an ethically and medically sound low-risk preventive health procedure conferring a lifetime of benefits to health and well-being.Policies in support of parent-approved elective newborn circumcision should be embraced by the medical,scientific and wider communities.

  6. Aspirations and realities in a North-South partnership for health promotion: lessons from a program to promote safe male circumcision in Botswana

    OpenAIRE

    Katisi, Masego; Daniel, Marguerite; Mittelmark, Maurice B.

    2016-01-01

    Background: International donors support the partnership between the Government of Botswana and two international organisations: U.S. Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership to implement Voluntary Medical Male Circumcision with the target of circumcising 80 % of HIV negative men in 5 years. Botswana Government had started integration of the program into its health system when international partners brought in the Models for Optimizing Volume an...

  7. Risk compensation is not associated with male circumcision in Kisumu, Kenya: a multi-faceted assessment of men enrolled in a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Christine L Mattson

    Full Text Available BACKGROUND: Three randomized controlled trials (RCTs have confirmed that male circumcision (MC significantly reduces acquisition of HIV-1 infection among men. The objective of this study was to perform a comprehensive, prospective evaluation of risk compensation, comparing circumcised versus uncircumcised controls in a sample of RCT participants. METHODS AND FINDINGS: Between March 2004 and September 2005, we systematically recruited men enrolled in a RCT of MC in Kenya. Detailed sexual histories were taken using a modified Timeline Followback approach at baseline, 6, and 12 months. Participants provided permission to obtain circumcision status and laboratory results from the RCT. We evaluated circumcised and uncircumcised men's sexual behavior using an 18-item risk propensity score and acquisition of incident infections of gonorrhea, chlamydia, and trichomoniasis. Of 1780 eligible RCT participants, 1319 enrolled (response rate = 74%. At the baseline RCT visit, men who enrolled in the sub-study reported the same sexual behaviors as men who did not. We found a significant reduction in sexual risk behavior among both circumcised and uncircumcised men from baseline to 6 (p<0.01 and 12 (p = 0.05 months post-enrollment. Longitudinal analyses indicated no statistically significant differences between sexual risk propensity scores or in incident infections of gonorrhea, chlamydia, and trichomoniasis between circumcised and uncircumcised men. These results are based on the most comprehensive analysis of risk compensation yet done. CONCLUSION: In the context of a RCT, circumcision did not result in increased HIV risk behavior. Continued monitoring and evaluation of risk compensation associated with circumcision is needed as evidence supporting its' efficacy is disseminated and MC is widely promoted for HIV prevention.

  8. 一次性包皮环切吻合器、商环及传统包皮环切术疗效比较%Effect comparison of Disposable Circumcision Suture Device,ShangRing and Circumcision

    Institute of Scientific and Technical Information of China (English)

    王潇然; 孙大伟; 尹文京; 王孟春; 王加强; 张玉宏; 郭建民; 李义; 廉吉虎; 刘炳晨

    2014-01-01

    目的:比较一次性包皮环切吻合器与商环及传统包皮环切术疗效比较。方法:将90例患者随机分为3组,传统包皮环切组、商环组及一次性环切吻合组(DCSD)。评估指标包括手术时间、失血量、术中疼痛评分、术后疼痛评分,术后疼痛持续时间、术后换药次数、术后水肿、切口裂开、术后出血、术后血中、术后再次手术、术后感染、愈合天数、术后瘢痕、术后粘连、阴茎外观满意评分、总体满意评分、费用情况等。结果:商环组及DCSD组术中失血量及手术时间显著低于传统组(P<0.001);DCSD组术中疼痛低于传统组及商环组(P<0.001);传统组术后疼痛高于其他两组(P<0.001);DCSD组及商环组对阴茎外观的满意度高于传统组(P<0.05);总体满意度DCSD组高于商环组及传统组(P<0.05)。结论:使用DCSD可以缩短手术时间及切口愈合时间,减轻术中术后疼痛,降低术后感染、术后瘢痕及术后粘连出现,提高患者对阴茎外观满意度及手术总体满意度。%Objective:To compare the effects of disposable circumcision suture device,Shangring and circumcision.Methods:90 patients were randomly divided into 3 groups: circumcision group,ShangRing group and disposable circumcision suture device(DCSD) group. Evaluation indicators included:operation time,blood loss,intraoperative pain score,postoperative pain score, the pain duration of postoperative,postoperative treatment,postoperative edema,incision dehiscence,postoperative bleeding, postoperative blood,reoperation after operation,postoperative infection,healing days,postoperative scar,postoperative adhesion, satisfactory evaluation of penis appearance,overall satisfactory evaluation,cost,etc.Results:Intraoperative blood loss and operation time of ShangRing group and DCSD group were all lower than that of circumcision group (P<0.001).Intraoperative pain of DCSD group was less than that of

  9. Informing the scaling up of voluntary medical male circumcision efforts through the use of theory of reasoned action: survey findings among uncircumcised young men in Swaziland.

    Science.gov (United States)

    Gurman, Tilly A; Dhillon, Preeti; Greene, Jessica L; Makadzange, Panganai; Khumlao, Philisiwe; Shekhar, Navendu

    2015-04-01

    Assessing predictors of intention to circumcise can help to identify effective strategies for increasing uptake of voluntary medical male circumcision (VMMC). Grounded in the theory of reasoned action (TRA), the current study of uncircumcised males ages 13-29 in Swaziland (N = 1,257) employed multivariate logistic regression to determine predictors of VMMC intention. The strongest predictors were strongly disagreeing/disagreeing that sex was more painful for a circumcised man (odds ratio [OR] = 4.37; p = < .007), a Christian man should not get circumcised (OR = 2.47; p < .001), and circumcision makes penetration more painful and difficult (OR = 2.44; p = .007). Several beliefs about enhanced sexual performance, normative beliefs (parents, sexual partner, and friends), and non-TRA-related factors (e.g., importance of plowing season to daily schedule) were also statistically significant predictors. TRA proved a useful theory to explore young men's intention to circumcise and can help inform interventions aimed at increasing uptake of VMMC. PMID:25915700

  10. A preliminary study of the sensory distribution of the penile dorsal and ventral nerves: implications for effective penile block for circumcision.

    LENUS (Irish Health Repository)

    Long, Ronan M

    2012-01-31

    OBJECTIVE: To determine the sensory innervation of the penis, as regional anaesthesia is often used either for postoperative analgesia or as the sole anaesthetic technique for circumcision. Since first described in 1978 the dorsal penile nerve block has become the standard technique, but some blocks are ineffective; a better understanding of the sensory innervation of the penis might improve the efficacy of the dorsal penile block technique. PATIENTS AND METHODS: In 13 men undergoing circumcision with local anaesthetic, cutaneous sensation was tested before and after infiltration of the dorsal aspect of the penis, and then again after infiltration of the ventral aspect. The area of anaesthesia was mapped using pin-prick sensation. RESULTS: Ten of the 13 patients showed a similar pattern of sensory distribution. After the dorsal block, the dorsal aspect of the shaft of the penis and glans penis became insensate. The ventral aspect of the shaft remained sensate up to and including the frenulum. After successful ventral infiltration all sensate areas became insensate and circumcision proceeded. In one case the frenulum and distal ventral foreskin was anaesthetized after the dorsal block and ventral infiltration was not required. No patient experienced pain during circumcision. CONCLUSION: For consistently successful regional anaesthesia of the foreskin in circumcision, a dorsal block must be used. This should be combined with ventral infiltration at the site of incision. This method will avoid inconsistencies and allow pain-free circumcision using local anaesthesia in most men.

  11. Acceptability of Voluntary Medical Male Circumcision (VMMC) among Male Sexually Transmitted Diseases Patients (MSTDP) in China.

    Science.gov (United States)

    Wang, Zixin; Feng, Tiejian; Lau, Joseph T F; Kim, Yoona

    2016-01-01

    Voluntary Medical Male circumcision (VMMC) is an evidence-based, yet under-utilized biomedical HIV intervention in China. No study has investigated acceptability of VMMC among male sexually transmitted diseases patients (MSTDP) who are at high risk of HIV transmission. A cross-sectional survey interviewed 350 HIV negative heterosexual MSTDP in Shenzhen, China; 12.0% (n = 42) of them were circumcised at the time of survey. When the uncircumcised participants (n = 308) were informed that VMMC could reduce the risk of HIV infection via heterosexual intercourse by 50%, the prevalence of acceptability of VMMC in the next six months was 46.1%. Adjusted for significant background variables, significant factors of acceptability of VMMC included: 1) emotional variables: the Emotional Representation Subscale (adjusted odds ratios, AOR = 1.13, 95%CI: 1.06-1.18), 2) cognitive variables derived from Health Belief Model (HBM): perceived some chance of having sex with HIV positive women in the next 12 months (AOR = 2.48, 95%CI: 1.15-5.33) (perceived susceptibility), perceived severity of STD infection (AOR = 1.06, 95%CI: 1.02-1.10), perceived benefit of VMMC in risk reduction (AOR = 1.29, 95%CI: 1.16-1.42) and sexual performance (AOR = 1.45, 95%CI: 1.26-1.71), perceived barriers against taking up VMMC (AOR = 0.88, 95%CI: 0.81-0.95), and perceived cue to action (AOR = 1.41, 95%CI: 1.23-1.61) and self-efficacy (AOR = 1.38, 95%CI: 1.26-1.35) related to taking up VMMC. The association between perceived severity of STD infection and acceptability was fully mediated by emotional representation of STD infection. The relatively low prevalence of circumcision and high acceptability suggested that the situation was favorable for implementing VMMC as a means of HIV intervention among MSTDP in China. HBM is a potential suitable framework to guide the design of future VMMC promotion. Future implementation programs should be conducted in STD clinic settings, taking the important findings of

  12. Acceptability of Voluntary Medical Male Circumcision (VMMC among Male Sexually Transmitted Diseases Patients (MSTDP in China.

    Directory of Open Access Journals (Sweden)

    Zixin Wang

    Full Text Available Voluntary Medical Male circumcision (VMMC is an evidence-based, yet under-utilized biomedical HIV intervention in China. No study has investigated acceptability of VMMC among male sexually transmitted diseases patients (MSTDP who are at high risk of HIV transmission. A cross-sectional survey interviewed 350 HIV negative heterosexual MSTDP in Shenzhen, China; 12.0% (n = 42 of them were circumcised at the time of survey. When the uncircumcised participants (n = 308 were informed that VMMC could reduce the risk of HIV infection via heterosexual intercourse by 50%, the prevalence of acceptability of VMMC in the next six months was 46.1%. Adjusted for significant background variables, significant factors of acceptability of VMMC included: 1 emotional variables: the Emotional Representation Subscale (adjusted odds ratios, AOR = 1.13, 95%CI: 1.06-1.18, 2 cognitive variables derived from Health Belief Model (HBM: perceived some chance of having sex with HIV positive women in the next 12 months (AOR = 2.48, 95%CI: 1.15-5.33 (perceived susceptibility, perceived severity of STD infection (AOR = 1.06, 95%CI: 1.02-1.10, perceived benefit of VMMC in risk reduction (AOR = 1.29, 95%CI: 1.16-1.42 and sexual performance (AOR = 1.45, 95%CI: 1.26-1.71, perceived barriers against taking up VMMC (AOR = 0.88, 95%CI: 0.81-0.95, and perceived cue to action (AOR = 1.41, 95%CI: 1.23-1.61 and self-efficacy (AOR = 1.38, 95%CI: 1.26-1.35 related to taking up VMMC. The association between perceived severity of STD infection and acceptability was fully mediated by emotional representation of STD infection. The relatively low prevalence of circumcision and high acceptability suggested that the situation was favorable for implementing VMMC as a means of HIV intervention among MSTDP in China. HBM is a potential suitable framework to guide the design of future VMMC promotion. Future implementation programs should be conducted in STD clinic settings, taking the important findings

  13. Acceptability of Voluntary Medical Male Circumcision (VMMC) among Male Sexually Transmitted Diseases Patients (MSTDP) in China.

    Science.gov (United States)

    Wang, Zixin; Feng, Tiejian; Lau, Joseph T F; Kim, Yoona

    2016-01-01

    Voluntary Medical Male circumcision (VMMC) is an evidence-based, yet under-utilized biomedical HIV intervention in China. No study has investigated acceptability of VMMC among male sexually transmitted diseases patients (MSTDP) who are at high risk of HIV transmission. A cross-sectional survey interviewed 350 HIV negative heterosexual MSTDP in Shenzhen, China; 12.0% (n = 42) of them were circumcised at the time of survey. When the uncircumcised participants (n = 308) were informed that VMMC could reduce the risk of HIV infection via heterosexual intercourse by 50%, the prevalence of acceptability of VMMC in the next six months was 46.1%. Adjusted for significant background variables, significant factors of acceptability of VMMC included: 1) emotional variables: the Emotional Representation Subscale (adjusted odds ratios, AOR = 1.13, 95%CI: 1.06-1.18), 2) cognitive variables derived from Health Belief Model (HBM): perceived some chance of having sex with HIV positive women in the next 12 months (AOR = 2.48, 95%CI: 1.15-5.33) (perceived susceptibility), perceived severity of STD infection (AOR = 1.06, 95%CI: 1.02-1.10), perceived benefit of VMMC in risk reduction (AOR = 1.29, 95%CI: 1.16-1.42) and sexual performance (AOR = 1.45, 95%CI: 1.26-1.71), perceived barriers against taking up VMMC (AOR = 0.88, 95%CI: 0.81-0.95), and perceived cue to action (AOR = 1.41, 95%CI: 1.23-1.61) and self-efficacy (AOR = 1.38, 95%CI: 1.26-1.35) related to taking up VMMC. The association between perceived severity of STD infection and acceptability was fully mediated by emotional representation of STD infection. The relatively low prevalence of circumcision and high acceptability suggested that the situation was favorable for implementing VMMC as a means of HIV intervention among MSTDP in China. HBM is a potential suitable framework to guide the design of future VMMC promotion. Future implementation programs should be conducted in STD clinic settings, taking the important findings of

  14. Effectiveness of and Financial Returns to Voluntary Medical Male Circumcision for HIV Prevention in South Africa: An Incremental Cost-Effectiveness Analysis.

    Directory of Open Access Journals (Sweden)

    Markus Haacker

    2016-05-01

    Full Text Available Empirical studies and population-level policy simulations show the importance of voluntary medical male circumcision (VMMC in generalized epidemics. This paper complements available scenario-based studies (projecting costs and outcomes over some policy period, typically spanning decades by adopting an incremental approach-analyzing the expected consequences of circumcising one male individual with specific characteristics in a specific year. This approach yields more precise estimates of VMMC's cost-effectiveness and identifies the outcomes of current investments in VMMC (e.g., within a fiscal budget period rather than of investments spread over the entire policy period.The model has three components. We adapted the ASSA2008 model, a demographic and epidemiological model of the HIV epidemic in South Africa, to analyze the impact of one VMMC on HIV incidence over time and across the population. A costing module tracked the costs of VMMC and the resulting financial savings owing to reduced HIV incidence over time. Then, we used several financial indicators to assess the cost-effectiveness of and financial return on investments in VMMC. One circumcision of a young man up to age 20 prevents on average over 0.2 HIV infections, but this effect declines steeply with age, e.g., to 0.08 by age 30. Net financial savings from one VMMC at age 20 are estimated at US$617 at a discount rate of 5% and are lower for circumcisions both at younger ages (because the savings occur later and are discounted more and at older ages (because male circumcision becomes less effective. Investments in male circumcision carry a financial rate of return of up to 14.5% (for circumcisions at age 20. The cost of a male circumcision is refinanced fastest, after 13 y, for circumcisions at ages 20 to 25. Principal limitations of the analysis arise from the long time (decades over which the effects of VMMC unfold-the results are therefore sensitive to the discount rate applied, and

  15. Herpes Simplex [corrected] Virus Type 2 Shedding From Male Circumcision Wounds in Rakai, Uganda.

    Science.gov (United States)

    Grabowski, Mary K; Kigozi, Godfrey; Gray, Ronald H; Armour, Benjamin; Manucci, Jordyn; Serwadda, David; Redd, Andrew D; Nalugoda, Fred; Patel, Eshan U; Wawer, Maria J; Quinn, Thomas C; Tobian, Aaron A R

    2015-11-15

    A prospective observational study of 176 men coinfected with human immunodeficiency virus and herpes simplex virus type 2 (HSV-2) was conducted to assess whether their sexual partners may be at an increased risk of HSV-2 from male circumcision (MC) wounds. Preoperative and weekly penile lavage samples were tested for penile HSV-2 shedding. Prevalence risk ratios (PRRs) were estimated using Poisson regression. Detectable penile HSV-2 shedding was present in 9.7% of men (17 of 176) before MC, compared with 12.9% (22 of 170) at 1 week (PRR, 1.33; 95% confidence interval [CI], .74-2.38) and 14.8% (23 of 155) at 2 weeks (PRR, 1.50; 95% CI, .86-2.62) after MC. HSV-2 shedding was lower among men with healed MC wounds (adjusted PRR, 0.62; 95% CI, .35-1.08). Men undergoing MC should be counseled on sexual abstinence and condom use.

  16. Voluntary medical male circumcision: an introduction to the cost, impact, and challenges of accelerated scaling up.

    Directory of Open Access Journals (Sweden)

    Catherine Hankins

    2011-11-01

    Full Text Available Scaling up voluntary medical male circumcision (VMMC for HIV prevention is cost saving and creates fiscal space in the future that otherwise would have been encumbered by antiretroviral treatment costs. An investment of US$1,500,000,000 between 2011 and 2015 to achieve 80% coverage in 13 priority countries in southern and eastern Africa will result in net savings of US$16,500,000,000. Strong political leadership, country ownership, and stakeholder engagement, along with effective demand creation, community mobilisation, and human resource deployment, are essential. This collection of articles on determining the cost and impact of VMMC for HIV prevention signposts the way forward to scaling up VMMC service delivery safely and efficiently to reap individual- and population-level benefits.

  17. Removal of foreskin remnants in circumcised adults for treatment of premature ejaculation

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Namavar

    2011-01-01

    Full Text Available Background and Aim : Premature ejaculation (PE is the most prevalent sexual dysfunction in every country. There are many types of treatment, but the main limitation of medical treatment for premature ejaculation is recurrence after withdrawal of medicine. The prepuce is a specific erogenous zone that contains a rich and complex network of nerves. Circumcision radically desensitizes the penis, but incomplete circumcision may cause premature ejaculation. We evaluate the effect of removal of foreskin remnants in adults on PE. Materials and Methods : The sensitive area of penile skin and the remaining parts of foreskin in adult men were recognized in 47 selective patients. Under local anesthesia, the remnant parts of foreskin were incised and removed. They were asked to fill the investigating questionnaire about the changes of intravaginal latency ejaculatory time (IVELT, patients and their sexual partners′ satisfaction with sexual life, control over ejaculation, and penile sensitivity, before and after treatment. Results : There were no signs of inflammation and no serious adverse reactions in all cases after operation. IVELT significantly increased from 64.25 before surgery to 731.49 sec after surgery (P<0.001. The percentage of postoperative satisfaction in both the patient and his partner significantly increased (P<0.001. After surgery, 95.7% of men had better control over their ejaculation. This surgery significantly decreased sensitivity of penis (P<0.001, but it did not change glans penis insensitivity. Conclusions : These results indicate that removal of foreskin remnants in adults is an effective modality in selective patients of PE.

  18. Safety, effectiveness and acceptability of the PrePex device for adult male circumcision in Kenya.

    Directory of Open Access Journals (Sweden)

    Paul J Feldblum

    Full Text Available To assess the safety, effectiveness and acceptability of the PrePex device for adult medical male circumcision (MMC in routine service delivery in Kenya.We enrolled 427 men ages 18-49 at one fixed and two outreach clinics. Procedures were performed by trained clinical officers and nurses. The first 50 enrollees were scheduled for six follow-up visits, and remaining men were followed at Days 7 and 42. We recorded adverse events (AEs and time to complete healing, and interviewed men about acceptability and pain.Placement and removal procedures each averaged between 3 and 4 minutes. Self-reported pain was minimal during placement but was fleetingly intense during removal. The rate of moderate/severe AEs was 5.9% overall (95% confidence interval [CI] 3.8%-8.5%, all of which resolved without sequelae. AEs included 5 device displacements, 2 spontaneous foreskin detachments, and 9 cases of insufficient foreskin removal. Surgical completion of MMC was required for 9 men (2.1%. Among the closely monitored first 50 participants, the probability of complete healing by Day 42 was 0.44 (95% CI 0.30-0.58, and 0.90 by Day 56. A large majority of men was favorable about their MMC procedure and would recommend PrePex to friends and family.The PrePex device was effective for MMC in Kenya, and well-accepted. The AE rate was higher than reported for surgical procedures there, or in previous PrePex studies. Healing time is longer than following surgical circumcision. Provider experience and clearer counseling on post-placement and post-removal care should lead to lower AE rates.ClinicalTrials.gov NCT01711411.

  19. Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe

    Science.gov (United States)

    Mangenah, Collin; Mavhu, Webster; Hatzold, Karin; Biddle, Andrea K; Ncube, Getrude; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M; Thirumurthy, Harsha

    2016-01-01

    ABSTRACT Background: The 14 countries that are scaling up voluntary male medical circumcision (VMMC) for HIV prevention are also considering early infant male circumcision (EIMC) to ensure longer-term reductions in HIV incidence. The cost of implementing EIMC is an important factor in scale-up decisions. We conducted a comparative cost analysis of EIMC performed by nurse-midwives and doctors using the AccuCirc device in Zimbabwe. Methods: Between August 2013 and July 2014, nurse-midwives performed EIMC on 500 male infants using AccuCirc in a field trial. We analyzed the overall unit cost and identified key cost drivers of EIMC performed by nurse-midwives and compared these with costing data previously collected during a randomized noninferiority comparison trial of 2 devices (AccuCirc and the Mogen clamp) in which doctors performed EIMC. We assessed direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training, and waste management costs) and indirect costs (capital and support personnel costs). We performed one-way sensitivity analyses to assess cost changes when we varied key component costs. Results: The unit costs of EIMC performed by nurse-midwives and doctors in vertical programs were US$38.87 and US$49.77, respectively. Key cost drivers of EIMC were consumable supplies, personnel costs, and the device price. In this cost analysis, major cost drivers that explained the differences between EIMC performed by nurse-midwives and doctors were personnel and training costs, both of which were lower for nurse-midwives. Conclusions: EIMC unit costs were lower when performed by nurse-midwives compared with doctors. To minimize costs, countries planning to scale up EIMC should consider using nurse-midwives, who are in greater supply than doctors and are the main providers at the primary health care level, where most infants are born. PMID:27413085

  20. Doubt, defiance, and identity: Understanding resistance to male circumcision for HIV prevention in Malawi.

    Science.gov (United States)

    Parkhurst, Justin O; Chilongozi, David; Hutchinson, Eleanor

    2015-06-01

    Global policy recommendations to scale up of male circumcision (MC) for HIV prevention tend to frame the procedure as a simple and efficacious public health intervention. However, there has been variable uptake of MC in countries with significant HIV epidemics. Kenya, for example, has embraced MC and has been dubbed a 'leader' by the global health community, while Malawi has been branded a 'laggard' in its slow adoption of a national programme, with a strong political discourse of resistance forming around MC. Regardless of any epidemiological or technical evidence, the uptake of international recommendations will be shaped by how a policy, and the specific artefacts that constitute that policy, intersect with local concerns. MC holds particular significance within many ethnic and religious groups, serving as an important rite of passage, but also designating otherness or enabling the identification of the social and political self. Understanding how the artefact of MC intersects with local social, economic, and political contexts, is therefore essential to understand the acceptance or resistance of global policy recommendations. In this paper we present an in-depth analysis of Malawi's political resistance to MC, finding that ethnic and religious divisions dominating recent political movements aligned well with differing circumcision practices. Political resistance was further found to manifest through two key narratives: a 'narrative of defiance' around the need to resist donor manipulation, and a 'narrative of doubt' which seized on a piece of epidemiological evidence to refute global claims of efficacy. Further, we found that discussions over MC served as an additional arena through which ethnic identities and claims to power could themselves be negotiated, and therefore used to support claims of political legitimacy.

  1. The new progress of circumcision operation mode%包皮环切术手术方式新进展

    Institute of Scientific and Technical Information of China (English)

    王骏

    2015-01-01

    As people living standard rise, They put forward higher requirements?for atient's effect on male circumcision and beautiful.In this paper,the author sums up 11 kinds of different operative methods of circumcision, and each has different characteristics, to provide more choices for surgeons.In the actual clinical operations, doctor can use them flexiblely.%目的:随着人们生活水平的提高,患者对包皮手术效果及外观提出更高的要求。本文总结归纳了11种包皮环切的不同术式,各有不同的特点,为外科医师提供了更多的选择,在实际的临床操作中,可以因地制宜地灵活运用。

  2. Ritual circumcision and risk of autism spectrum disorder in 0- to 9-year-old boys: national cohort study in Denmark

    Science.gov (United States)

    Simonsen, Jacob

    2015-01-01

    Objective Based on converging observations in animal, clinical and ecological studies, we hypothesised a possible impact of ritual circumcision on the subsequent risk of autism spectrum disorder (ASD) in young boys. Design National, register-based cohort study. Setting Denmark. Participants A total of 342,877 boys born between 1994 and 2003 and followed in the age span 0–9 years between 1994 and 2013. Main outcome measures Information about cohort members’ ritual circumcisions, confounders and ASD outcomes, as well as two supplementary outcomes, hyperkinetic disorder and asthma, was obtained from national registers. Hazard ratios (HRs) with 95% confidence intervals (CIs) associated with foreskin status were obtained using Cox proportional hazards regression analyses. Results With a total of 4986 ASD cases, our study showed that regardless of cultural background circumcised boys were more likely than intact boys to develop ASD before age 10 years (HR = 1.46; 95% CI: 1.11–1.93). Risk was particularly high for infantile autism before age five years (HR = 2.06; 95% CI: 1.36–3.13). Circumcised boys in non-Muslim families were also more likely to develop hyperkinetic disorder (HR = 1.81; 95% CI: 1.11–2.96). Associations with asthma were consistently inconspicuous (HR = 0.96; 95% CI: 0.84–1.10). Conclusions We confirmed our hypothesis that boys who undergo ritual circumcision may run a greater risk of developing ASD. This finding, and the unexpected observation of an increased risk of hyperactivity disorder among circumcised boys in non-Muslim families, need attention, particularly because data limitations most likely rendered our HR estimates conservative. Considering the widespread practice of non-therapeutic circumcision in infancy and childhood around the world, confirmatory studies should be given priority. PMID:25573114

  3. A comparison between plastibell circmncision and circumcision in children%小儿包皮环套术和环切术的临床比较

    Institute of Scientific and Technical Information of China (English)

    胡友主; 华尧楷

    2000-01-01

    目的:探讨治疗小儿包皮过长、包茎的较佳手术方式。方法:对318例小儿包茎、包皮过长随机分为环套术206例、环切术112例,并进行随访,比较其治疗效果。结果:手术时间分别为(9±1.5)和(28±5)min(P<0.001);并发症发生率分别为4.85%和15.18%(P<0.001);术后护理工作量,环套术组明显少于环切术组。结论:小儿环套术操作简单、耗时短、并发症少,值得推广。%Aim: To evaluate this two operation to manage phimosis and adherent prepuce. Methods: Three hundred and eighteen patients were randomised into two groups. Group 1 (n=206) underwent plastibell circumcision and group 2 ( n = 112) underwent circumcision. All patients were follow up for more than 4 weeks. The results were analyzed with u - test or chi - squre test. Results: The time spent for plastibell circumcision and circumcision were 9 + 1.5 and 28 + 5 minutes respectively (P<0.001); The overal complication rates were 4.85% and 15.18% respectively (P<0.001); The postoperative nursing with plastibell circumcision is simpler than that with circumcision. Conclusion: Plastibell circumcision is a preferred method for treatment of phimosis and adherent prepuce in children.

  4. Piloting PrePex for Adult and Adolescent Male Circumcision in South Africa--Pain Is an Issue.

    Directory of Open Access Journals (Sweden)

    Limakatso Lebina

    Full Text Available The World Health Organisation and the Joint United Nations Programme on HIV/AIDS have recommended the scale-up of Medical Male Circumcision (MMC in countries with high HIV and low MMC prevalence. PrePex device circumcision is proposed as an alternate method for scaling up MMC.Evaluate safety and feasibility of PrePex in South Africa.A multisite prospective cohort PrePex study in adults and adolescents at three MMC clinics. Participants were followed-up 8 times, up to 56 days after PrePex placement.In total, 398 PrePex circumcisions were performed (315 adults and 83 adolescents their median ages were 26 (IQR: 22-30 and 16 years (IQR: 15-17, respectively. The median time for device placement across both groups was 6 minutes (IQR: 5-9 with the leading PrePex sizes being B (30% and C (35% for adults (18-45 years, and A (31% and B (38% for adolescents (14-17 years. Additional sizes (size 12-20 were rarely used, even in the younger age group. Pain of device application was minimal but that of removal was severe. However, described pain abated rapidly and almost no pain was reported 1 hour after removal. The Adverse Events rate were experienced by 2.7% (11/398 of all participants, three of which were serious (2 displacements and 1 self-removal requiring prompt surgery. None of the Adverse Events required hospitalization. The majority of participants returned to work within a day of device placement.Our study shows that PrePex is a safe MMC method, for males 14 years and above. PrePex circumcision had a similar adverse event rate to that reported for surgical MMC, but device removal caused high levels of pain, which subsided rapidly.

  5. Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland.

    Science.gov (United States)

    Maibvise, Charles; Mavundla, Thandisizwe R

    2014-09-01

    Swaziland is currently experiencing the worst impact of HIV and AIDS of any country in the world. In an effort to curb further spread of the virus, the country adopted mass male circumcision (MC) as recommended by the World Health Organization in 2007. Despite intense campaigns to promote the procedure over the past three years, the uptake of circumcision remains very low for reasons that are not very clear. The purpose of this study was to explore the reasons for the low uptake of MC in Swaziland despite the massive national MC campaigns. A qualitative research design was used, in which all men who were targeted by the mass MC campaign were eligible. Participants were identified as they came for sexual and reproductive health services at the Family Life Association of Swaziland (FLAS) Clinic, Mbabane. In-depth, individual face-to-face unstructured interviews were conducted to elicit the reasons why men were not going for circumcision. A total of 17 men were interviewed. Results showed that these reasons include fear of the procedure and the possible outcome, perception of no significant benefit of the procedure, impatience about waiting for the procedure or the healing process, religious/cultural beliefs, and worries about the fate of the foreskin. These reasons were attributed to misconceptions and lack of accurate and specific information about some aspects of the circumcision strategy of HIV preventions. Physiological changes and economic activities associated with adulthood were also found to be hindrances to MC uptake. The study recommended that a comprehensive description of the procedure and more precise facts and scientific bases of the MC strategy be incorporated and emphasised in the MC campaigns. Involvement of religious leaders will also facilitate clarification of religious or cultural misunderstandings or misconceptions. A focus on neonatal MC would also help.

  6. Learning that circumcision is protective against HIV: risk compensation among men and women in Cape Town, South Africa.

    Directory of Open Access Journals (Sweden)

    Brendan Maughan-Brown

    Full Text Available OBJECTIVES: We examined whether knowledge of the HIV-protective benefits of male circumcision (MC led to risk compensating behavior in a traditionally circumcising population in South Africa. We extend the current literature by examining risk compensation among women, which has hitherto been unexplored. METHODS: We used data on Xhosa men and women from the 2009 Cape Area Panel Study. Respondents were asked if they had heard that MC reduces a man's risk of contracting HIV, about their perceived risk of contracting HIV, and condom use. For each gender group we assessed whether risk perception and condom use differed by knowledge of the protective benefits of MC using bivariate and then multivariate models controlling for demographic characteristics, HIV knowledge/beliefs, and previous sexual behaviors. In a further check for confounding, we used data from the 2005 wave to assess whether individuals who would eventually become informed about the protective benefits of circumcision were already different in terms of HIV risk perception and condom use. RESULTS: 34% of men (n=453 and 27% of women (n=690 had heard that circumcision reduces a man's risk of HIV infection. Informed men perceived slightly higher risk of contracting HIV and were more likely to use condoms at last sex (p<0.10. Informed women perceived lower HIV risk (p<0.05, were less likely to use condoms both at last sex (p<0.10 and more generally (p<0.01, and more likely to forego condoms with partners of positive or unknown serostatus (p<0.01. The results were robust to covariate adjustment, excluding people living with HIV, and accounting for risk perceptions and condom use in 2005. CONCLUSIONS: We find evidence consistent with risk compensation among women but not men. Further attention should be paid to the role of new information regarding MC, and drivers of HIV risk more broadly, in modulating sexual behavior among women.

  7. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial.

    Directory of Open Access Journals (Sweden)

    2005-11-01

    Full Text Available BACKGROUND: Observational studies suggest that male circumcision may provide protection against HIV-1 infection. A randomized, controlled intervention trial was conducted in a general population of South Africa to test this hypothesis. METHODS AND FINDINGS: A total of 3,274 uncircumcised men, aged 18-24 y, were randomized to a control or an intervention group with follow-up visits at months 3, 12, and 21. Male circumcision was offered to the intervention group immediately after randomization and to the control group at the end of the follow-up. The grouped censored data were analyzed in intention-to-treat, univariate and multivariate, analyses, using piecewise exponential, proportional hazards models. Rate ratios (RR of HIV incidence were determined with 95% CI. Protection against HIV infection was calculated as 1 - RR. The trial was stopped at the interim analysis, and the mean (interquartile range follow-up was 18.1 mo (13.0-21.0 when the data were analyzed. There were 20 HIV infections (incidence rate = 0.85 per 100 person-years in the intervention group and 49 (2.1 per 100 person-years in the control group, corresponding to an RR of 0.40 (95% CI: 0.24%-0.68%; p < 0.001. This RR corresponds to a protection of 60% (95% CI: 32%-76%. When controlling for behavioural factors, including sexual behaviour that increased slightly in the intervention group, condom use, and health-seeking behaviour, the protection was of 61% (95% CI: 34%-77%. CONCLUSION: Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa. (Preliminary and partial results were presented at the International AIDS Society 2005 Conference, on 26 July 2005, in Rio de Janeiro, Brazil..

  8. Female Infertility

    Science.gov (United States)

    Infertility means not being able to get pregnant after at least one year of trying (or 6 ... woman keeps having miscarriages, it is also called infertility. Female infertility can result from age, physical problems, ...

  9. Single-arm evaluation of the AccuCirc device for early infant male circumcision in Botswana.

    Science.gov (United States)

    Plank, Rebeca M; Wirth, Kathleen E; Ndubuka, Nnamdi O; Abdullahi, Rasak; Nkgau, Maggie; Lesetedi, Chiapo; Powis, Kathleen M; Mmalane, Mompati; Makhema, Joseph; Shapiro, Roger; Lockman, Shahin

    2014-05-01

    : Existing devices for early infant male circumcision (EIMC) have inherent limitations. We evaluated the newly developed AccuCirc device by circumcising 151 clinically well, full-term male infants with birth weight ≥2.5 kg within the first 10 days of life from a convenience sample in 2 hospitals in Botswana. No major adverse events were observed. There was 1 local infection, 5 cases of minor bleeding, and 1 case of moderate bleeding. In 3 cases, the device made only partial incisions that were completed immediately by the provider without complications. Parental satisfaction was high: >96% of mothers stated that they would circumcise a future son. The pre-assembled, sterile AccuCirc kit has the potential to overcome obstacles related to supply chain management and on-site instrument disinfection that can pose challenges in resource-limited settings. In our study, the AccuCirc was safe and it should be considered for programmatic EIMC in resource-limited settings. PMID:24594500

  10. Comparison of curative effects between Holy-loop circumcision and CBV-loop circumcision in children%两种包皮去除环在小儿包皮环切术中的应用体会

    Institute of Scientific and Technical Information of China (English)

    樊念念; 刘勇; 王鹏; 靳风烁; 张克勤; 聂志林

    2011-01-01

    目的 比较两种包皮去除环在小儿包皮环切术中的应用效果.方法 回顾性分析425例患儿行圣环切除(A组),445例患儿行CBV钟式包皮去除环切除(B组)的临床资料;对比两组患儿手术时间、术中术后出血量、术后并发症情况.结果 两组患儿术中及术后出血量无统计学差异(P>0.05),B组在包皮环脱落时间、术后感染率、术后疼痛情况等方面优于A组(P<0.05),但其手术时间长于A组(P<0.05).结论 在小儿包皮去除环中,CBV包皮去除环效果优于圣环,值得临床推广.%Objective To compare curative effects between Holy - loop circumcision and CBV - loop circumcision in children.Methods 870 children with phimosis or redundant prepuce were enrolled in this study.Among them,425 patients received Holy - loop circumcision ( group A ), while other 445 ones received CBV - loop circumcision ( group B ).Operative time, intraoperative and postoperative bleeding volume, and postoperative complications were compared between the two groups.Results Intraoperative and postoperative bleeding volume had no significant differences between group A and B.Group B had shorter shedding time of annulus praeputialis,lighter postoperative pain and lower infection rate of incision than those in group B ( P < 0.05 ), although it had longer operative time ( P < 0.05 ).Conclusion CBV - loop appears to have better effectiveness than Holy - loop on child circumcision.Therefore, it is worth clinical promotion.

  11. Clinical Comparative Study of Shang Ring Circumcision and Scissors Circumcision%对比商环包皮环切术与剪刀法包皮环切术的临床研究

    Institute of Scientific and Technical Information of China (English)

    李文光

    2015-01-01

    Objective To study and analyze the operation effect of Shang ring circumcision and scissors circumcision. Methods 208 patients accepted the Shang ring circumcision were the experimental group,and 120 patients accepted scissors circumcision were the control group in our hospital from 2011 to 2013. And to analyzed the clinical operation treatment in these patients and to clinical operation treatment in these patients. Results The operation time, postoperative pain and operation hemorrhage in the experimental group were excel ent than these in the control group(P<0.05). Rates of incision edge edema,chalaza crosses short and adverse reaction in the experimental group were lower than these in the control group(P<0.05). Conclusion The Shang ring circumcision although need long healing time,the high cost of operation,but it has the neat operation incision,short operation time, good hemostatic effect and low adverse reaction.%目的:研究分析商环包皮环切术与剪刀法包皮环切术的临床疗效效果。方法选择2011~2013年我院接收的208例接受商环包皮环切术患者作为实验组,120例剪刀法包皮环切术患者作为对照组,对这些患者的临床手术治疗情况进行对比分析,探讨手术效果。结果实验组患者手术时间、术后疼痛、手术出血等情况优于常规手术患者,P<0.05。实验组患者切口边缘水肿和系带过短的发生率低于对照组,不良反应发生率也低于对照组,P<0.05。结论商环包皮环切术虽然愈合时间长,手术费用高,但是手术切口整齐,手术时间短,止血效果好,不良反应率低。

  12. Time to complete wound healing in HIV-positive and HIV-negative men following medical male circumcision in Kisumu, Kenya: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    John H Rogers

    Full Text Available BACKGROUND: While voluntary medical male circumcision (VMMC has been shown to be protective against HIV-acquisition, the procedure may place men and their partners at risk of HIV infection in the period following circumcision if sex is resumed before the wound is healed. This prospective cohort study evaluates post-circumcision wound healing to determine whether the 42-day post-circumcision abstinence period, recommended by the World Health Organization and adopted by VMMC programs, is optimal. METHODS AND FINDINGS: Men were circumcised by forceps-guided method and their post-circumcision wounds examined weekly for seven weeks and at 12 weeks. Time to complete healing was recorded in completed weeks since circumcision, and its associations with baseline covariates were assessed by Kaplan-Meier methods and Cox Proportional Hazard Models. A total of 215 HIV-negative and 108 HIV-positive men aged 18-35 years (median 26, IQR 23-30 were enrolled. 97.1% of scheduled follow-up visits were completed. At week 4, 59.3% of HIV-positive men and 70.4% of age-matched HIV-negative men were healed. At week 6, these percentages rose to 93.4% in HIV-positive men and 92.6% in age-matched HIV-negative men. There was no difference in the hazard of healing between 108 HIV-positive and 108 age-matched HIV-negative men (HR 0.91 95% CI 0.70-1.20. Early post-operative infection was associated with delayed healing in both HIV-positive and HIV-negative men (HR 0.48 95% CI 0.23-1.00. CONCLUSIONS: Our results indicate that the WHO recommendation for 42-days post-circumcision sexual abstinence should be maintained for both HIV-positive and HIV-negative men. It is important to stress condom use upon resumption of sex in all men undergoing circumcision.

  13. Female genital mutilation of a karyotypic male presenting as a female with delayed puberty

    Directory of Open Access Journals (Sweden)

    Gisselsson D

    2006-03-01

    Full Text Available Abstract Background Female genital mutilation (FGM is commonly practiced mainly in a belt reaching from East to West Africa north of the equator. The practice is known across socio-economic classes and among different ethnic, religious, and cultural groups. Few studies have been appropriately designed to measure the health effects of FGM. However, the outcome of FGM on intersex individuals has never been discussed before. Case presentation The patient first presented as a female with delayed puberty. Hormonal analysis revealed a normal serum prolactin level of 215 Mu/L, a low FSH of 0.5 Mu/L, and a low LH of 1.1 Mu/L. Type IV FGM (Pharaonic circumcision had been performed during childhood. Chromosomal analysis showed a 46, XY karyotype and ultrasonography verified a soft tissue structure in the position of the prostate. Conclusion FGM pose a threat to the diagnosis and management of children with abnormal genital development in the Sudan and similar societies.

  14. Meaning-making of female genital cutting: children's perception and acquired knowledge of the ritual.

    Science.gov (United States)

    Schultz, Jon-Håkon; Lien, Inger-Lise

    2013-01-01

    How do girls who have undergone female genital cutting understand the ritual? This study provides an analysis of the learning process and knowledge acquired in their meaning-making process. Eighteen participants were interviewed in qualitative indepth interviews. Women in Norway, mostly with Somali or Gambian backgrounds, were asked about their experiences of circumcision. Two different strategies were used to prepare girls for circumcision, ie, one involving giving some information and the other keeping the ritual a secret. Findings indicate that these two approaches affected the girls' meaning-making differently, but both strategies seemed to lead to the same educational outcome. The learning process is carefully monitored and regulated but is brought to a halt, stopping short of critical reflexive thinking. The knowledge tends to be deeply internalized, embodied, and morally embraced. The meaning-making process is discussed by analyzing the use of metaphors and narratives. Given that the educational outcome is characterized by limited knowledge without critical reflection, behavior change programs to end female genital cutting should identify and implement educational stimuli that are likely to promote critical reflexive thinking.

  15. The safety of adult male circumcision in HIV-infected and uninfected men in Rakai, Uganda.

    Directory of Open Access Journals (Sweden)

    Godfrey Kigozi

    2008-06-01

    Full Text Available BACKGROUND: The objective of the study was to compare rates of adverse events (AEs related to male circumcision (MC in HIV-positive and HIV-negative men in order to provide guidance for MC programs that may provide services to HIV-infected and uninfected men. METHODS AND FINDINGS: A total of 2,326 HIV-negative and 420 HIV-positive men (World Health Organization [WHO] stage I or II and CD4 counts > 350 cells/mm3 were circumcised in two separate but procedurally identical trials of MC for HIV and/or sexually transmitted infection prevention in rural Rakai, Uganda. Participants were followed at 1-2 d and 5-9 d, and at 4-6 wk, to assess surgery-related AEs, wound healing, and resumption of intercourse. AE risks and wound healing were compared in HIV-positive and HIV-negative men. Adjusted odds ratios (AdjORs were estimated by multiple logistic regression, adjusting for baseline characteristics and postoperative resumption of sex. At enrollment, HIV-positive men were older, more likely to be married, reported more sexual partners, less condom use, and higher rates of sexually transmitted disease symptoms than HIV-negative men. Risks of moderate or severe AEs were 3.1/100 and 3.5/100 in HIV-positive and HIV-negative participants, respectively (AdjOR 0.91, 95% confidence interval [CI] 0.47-1.74. Infections were the most common AEs (2.6/100 in HIV-positive versus 3.0/100 in HIV-negative men. Risks of other complications were similar in the two groups. The proportion with completed healing by 6 wk postsurgery was 92.7% in HIV-positive men and 95.8% in HIV-negative men (p = 0.007. AEs were more common in men who resumed intercourse before wound healing compared to those who waited (AdjOR 1.56, 95% CI 1.05-2.33. CONCLUSIONS: Overall, the safety of MC was comparable in asymptomatic HIV-positive and HIV-negative men, although healing was somewhat slower among the HIV infected. All men should be strongly counseled to refrain from intercourse until full wound

  16. Innovative Demand Creation for Voluntary Medical Male Circumcision Targeting a High Impact Male Population: A Pilot Study Engaging Pregnant Women at Antenatal Clinics in Kampala, Uganda

    Science.gov (United States)

    Semeere, Aggrey S.; Castelnuovo, Barbara; Bbaale, Denis S.; Kiragga, Agnes N.; Kigozi, Joanita; Muganzi, Alex M.; Coutinho, Alex G.

    2016-01-01

    Background: Circumcision has been shown to be an effective method of HIV prevention; however, only 28% of Ugandan men aged 15–49 years are circumcised. There is a paucity of data on the role of intimate partners in generating demand for voluntary medical male circumcision (VMMC). We conducted a pilot study to assess the feasibility of a partner-focused intervention targeting males >25 years. Methods: Among pregnant women in their third trimester attending antenatal care we evaluated the impact of a pilot behavior change intervention on VMMC through a quasi-experimental approach. We observed VMMC numbers among spouses of women as per standard practice (comparison phase), and after introducing a behavioral change communication package (intervention phase). Logistic regression was used to compare the odds of VMMC uptake between comparison and intervention phases. We used qualitative methods to evaluate the casual chain using a thematic approach. Results: Of the 601 women studied, 90% articulated the health benefits of VMMC and 99% expressed interest in their spouse getting circumcised. Women's knowledge was not increased by the intervention. Four men were circumcised in the comparison and 7 in the intervention phase. The intervention was not associated with higher odds of circumcision (odds ratio 1.5, 95% CI: 0.3 to 6.0, P = 0.65). We interviewed 117 individuals overall with the main enablers for VMMC being: free VMMC, transport reimbursement, and health benefits. Deterrents included misconceptions, lost wages and fear of pain. Most of the uncircumcised men interviewed reported interest in VMMC. Conclusions: Our pilot intervention had no significant impact on increasing VMMC demand. The study demonstrated the feasibility of pregnant women engaging their spouses to discuss VMMC. PMID:27404008

  17. A Phase II Randomized Controlled Trial Comparing Safety, Procedure Time, and Cost of the PrePex™ Device to Forceps Guided Surgical Circumcision in Zimbabwe

    Science.gov (United States)

    Tshimanga, Mufuta; Mangwiro, Tonderayi; Mugurungi, Owen; Xaba, Sinokuthemba; Murwira, Munyaradzi; Kasprzyk, Danuta; Montaño, Daniel E.; Nyamukapa, Daisy; Tambashe, Basile; Chatikobo, Pesanai; Gundidza, Patricia; Gwinji, Gerald

    2016-01-01

    Background The World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS promote MC (male circumcision) as a key HIV prevention strategy where HIV prevalence and incidence are high and MC prevalence is low. In Zimbabwe, to achieve the 1.26 million circumcisions needed to be performed by 2015 to achieve optimal MC coverage, a new approach was needed. The primary objective of the current trial was to assess the performance (safety, procedure time, and cost) of the PrePex device compared to forceps-guided surgical circumcision. Methods and Findings This Phase II, randomized, open-label trial in Zimbabwe involved healthy, non-circumcised adult male volunteers who were randomly assigned to the PrePex device (n = 160) or surgical arm (n = 80). Three doctors and 4 nurses, all certified on both circumcision methods, performed the procedures. The PrePex device procedure involves a plastic ring with a rubber O-ring that necrotizes the foreskin to facilitate easy and minimally invasive removal. Total procedure time was the primary endpoint. Adverse event (AE) data were also gathered for 90 days post-procedure. All 80 participants in the surgical arm and 158 participants in the PrePex arm achieved complete circumcision. The total procedure time for the PrePex device was approximately one-third of the total surgical procedure (4.8 minutes, Standard Deviation [SD]: 1.2 versus 14.6 minutes; SD: 4.2; pcircumcision. The PrePex device has great potential for use in overburdened health systems and in resource-limited settings and is recommended for use in rapid scale-up of adult MC in Zimbabwe. Trial Registration ClinicalTrials.gov NCT01956370 PMID:27227679

  18. Effect of lidocaine-prilocaine eutectic mixture of local anaesthetic cream compared with oral sucrose or both in alleviating pain in neonatal circumcision procedure

    Directory of Open Access Journals (Sweden)

    Reem Al Qahtani

    2014-01-01

    Full Text Available Background: Neonatal circumcision is one of the oldest and most frequently performed surgical procedures on males. Newborns demonstrate strong endogenous reaction to pain and therefore modalities are being explored for optimum pain relief during circumcision. Pediatric nurses have a vital role for the use of these modalities and minimising the pain response during the neonatal minor procedures. Aim: The aim of this study was to assess the effectiveness of eutectic mixture of local anaesthetic (EMLA cream compared with oral sucrose and both in alleviating pain in neonatal circumcision. Materials and Methods: This study was conducted in the Day Care Surgery Department of Maternity and Children Hospital, Dammam City, KSA. 90 full-term newborn males who underwent circumcision were divided randomly into three groups (30 each. Each group was assigned to receive a different type of analgesics such as EMLA cream (Group A, oral sucrose (Group B or combination of EMLA cream and oral sucrose (Group C. Neonatal pain agitation and sedation scale (N-PASS was used 5 min before, during and 5 min after the circumcision procedure to assess the neonatal response to pain. Results: N-PASS scores were significantly lower in Group C (median Group C = 5.2, Group A = 5.8, Group B = 8.5; P< 0.001. The endogenous response to pain in terms of escalation of heart rate and reduction in O 2 saturation were minimal among Group C (P < 0.0001. Duration of crying was comparable among all the groups. Conclusion: The combination of sucrose and EMLA cream revealed a higher analgesic effect and minimal adverse response to pain than either EMLA cream or sucrose alone during neonatal circumcision.

  19. Analysis of Zhuhai city residents circumcision and sexual health knowledge%珠海市居民包皮环切与性健康知识调查分析

    Institute of Scientific and Technical Information of China (English)

    龚鉴; 肖伟华; 潘杨; 李玉荣

    2014-01-01

    Objective To Understand zhuhai residents' perception of circumcision, accept intend, influence factors, as well as to the circumcision to prevent AIDS sexually transmitted disease knowledge, beliefs, and behaviors. Methods Using stratified random sampling method to extract investigation object, and using self-designed questionnaires to investigate. results Via television, radio and book, newspaper, magazines, most of respondents gaining knowledge about HiV/aids, venereal disease, 67.3% and 63.3% respectively;67.8% of respondents can complete answers to three main route of transmission, aids, 57.2%of respondents answered the spread of sexually transmitted diseases can completely correct way; only 47.8% of respondents can distinguish between "wrapping is too long" and “phimosis”, can all cognitive wrapping is too long or phimosis’ 7 kind of harm is only 15.8%;Most of the men and women are considered surgical treatment wrapping is too long or phimosis treatment should be taken, 77.8% and 82.3% respectively;in for circumcision operation, risk, prognosis and its complications, etc., of the female respondents cognitive significantly better than men. Conclusion In circumcision and sexual health education propaganda to the public, should with television, newspapers, magazines, radio and book, family planning, health education and other public institutions at the same time to strengthen health propaganda, carry out publicity through various channels, including wrapping is too long or the dangers of phimosis, circumcision operation, risk, prognosis and its complications such as all aspects of the knowledge popularization, and use the women in the family housewife role within the family of circumcision and sexual health education.%目的:了解和掌握珠海市居民对于包皮环切手术的认知、接受意愿、影响因素,以及对包皮环切预防艾滋病性病知识、信念和行为现状。方法采用分层随机抽样方法

  20. Long-term follow-up for Shang Ring male circumcision

    Institute of Scientific and Technical Information of China (English)

    Cheng Yue; Wu Kerong; Yan Zejun; Yang Shuwei; Li Fang; Su Xinjun

    2014-01-01

    Background Shang Ring male circumcision (MC) is a safe surgery with good short-term effects.This retrospective study was performed to investigate the long-term result of patients who had undergone Shang Ring MC.Methods A total of 103 patients who underwent the surgery were recruited in the study.Before and after the surgery,a questionnaire inquiring sexual function and sexual satisfaction was filled up.Face-to-face interview was executed.Physical examination of the external genitals was performed and complications were evaluated.Results The median follow-up duration was 19.1 months (range from 9 to 28 months).The mean width of penile mucosa was (9.3±2.5) mm.The mean width of scar was (3.7±1.6) mm.No tender pain was found in participants when palpating the penis.No significant or functional complication was observed except of mucosa asymmetry in one case and scar hyperplasia in two cases.The postoperative sexual function did not differ from the preoperative one,although partners showed better satisfaction toward sexual life.Conclusion Shang Ring MC represents a good long-term cosmetic result with no significant complication or adverse effects on sexual function.

  1. Comparison of the Efficacy of Disposable Circumcision Anastomat and Conventional Circumcision%一次性包皮环切吻合器与传统包皮环切术的疗效比较

    Institute of Scientific and Technical Information of China (English)

    刘贻洪

    2016-01-01

    目的:探讨应用一次性包皮环切吻合器与传统包皮环切术的疗效比较。方法对比一次性包皮环切吻合器(DCSD)与传统包皮环切术治疗包茎与包皮过长的疗效。结果两组手术的手术时间、术中失血量及术后满意度比较差异有统计学意义(P <0.05)。结论一次性包皮环切吻合器较传统包皮环切术操作简单、无需缝合,术中出血少,外观满意,患者易于接受。%Objective To explore the application of disposable circumcision ring cutting anastomat with traditional wrapping ring resection of clinical curative effect comparison. Methods Contrast disposable circumcision ring cut stapler (DCSD) with traditional wrapping ring cutting the efficacy of surgery for the treatment of phimosis and redundant prepuce. Results Two groups of surgery operative time, intraoperative blood loss and postoperative satisfaction, the difference was statistically significant (P<0.05). Conclusion Disposable circumcision anastomat than traditional wrapping annulus to cut has the advantages of simple operation, no suture, less bleeding appearance was satisfactory, and is easy to be accepted by patients.

  2. Meaning-making of female genital cutting: children’s perception and acquired knowledge of the ritual

    Directory of Open Access Journals (Sweden)

    Schultz JH

    2013-04-01

    Full Text Available Jon-Håkon Schultz, Inger-Lise Lien Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway Abstract: How do girls who have undergone female genital cutting understand the ritual? This study provides an analysis of the learning process and knowledge acquired in their meaning-making process. Eighteen participants were interviewed in qualitative indepth interviews. Women in Norway, mostly with Somali or Gambian backgrounds, were asked about their experiences of circumcision. Two different strategies were used to prepare girls for circumcision, ie, one involving giving some information and the other keeping the ritual a secret. Findings indicate that these two approaches affected the girls' meaning-making differently, but both strategies seemed to lead to the same educational outcome. The learning process is carefully monitored and regulated but is brought to a halt, stopping short of critical reflexive thinking. The knowledge tends to be deeply internalized, embodied, and morally embraced. The meaning-making process is discussed by analyzing the use of metaphors and narratives. Given that the educational outcome is characterized by limited knowledge without critical reflection, behavior change programs to end female genital cutting should identify and implement educational stimuli that are likely to promote critical reflexive thinking. Keywords: female genital cutting, metaphors, health education, immigrants

  3. Female sexuality.

    Science.gov (United States)

    Rao, T S Sathyanarana; Nagaraj, Anil Kumar M

    2015-07-01

    Sex is a motive force bringing a man and a woman into intimate contact. Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships. Though generally, women are sexually active during adolescence, they reach their peak orgasmic frequency in their 30 s, and have a constant level of sexual capacity up to the age of 55 with little evidence that aging affects it in later life. Desire, arousal, and orgasm are the three principle stages of the sexual response cycle. Each stage is associated with unique physiological changes. Females are commonly affected by various disorders in relation to this sexual response cycle. The prevalence is generally as high as 35-40%. There are a wide range of etiological factors like age, relationship with a partner, psychiatric and medical disorders, psychotropic and other medication. Counseling to overcome stigma and enhance awareness on sexuality is an essential step in management. There are several effective psychological and pharmacological therapeutic approaches to treat female sexual disorders. This article is a review of female sexuality. PMID:26330647

  4. Female infertility

    International Nuclear Information System (INIS)

    Infertility, defined as 1 year of unprotected intercourse without conception, is becoming of increasingly important medical concern. Fertility in both the male and the female is at its peak in the twenties. Many couples today have postponed marriage and/or childbearing into their 30s until careers are established, but at that point fertility may be diminished. The current epidemic of venereal disease has been associated with an increasing incidence of tubal scarring. In addition, the use of intrauterine devices (IUDs) and birth control pills for contraception have let to later problems with pelvic inflammatory disease (PID) and ovulation disturbances. The problem of infertility intensifies as the number of babies available for adoption decreases. Therefore, it is estimated that approximately 10-20% of couples will eventually seek medical attention for an infertility-related problem. Fortunately, marked improvements in the results of tubal surgery are concurrently occurring secondary to refinements in microsurgical techniques, and many medical alternatives to induce ovulation are being developed. The male factor causes infertility in 30-40 % of couples, and the female factor is responsible in approximately 50% of couples. No cause is found in 10-20% of couples. This chapter discusses the role of coordinated imaging in the diagnosis and therapy of infertility in the female

  5. Female genital mutilation: prevalence, perceptions and effect on women's health in Kersa district of Ethiopia

    Directory of Open Access Journals (Sweden)

    Gebremichael MW

    2012-02-01

    Full Text Available Wondimu Shanko Yirga1,2, Nega Assefa Kassa2, Mengistu Welday Gebremichael2, Arja R Aro31University of Southern Denmark, Faculty of Health Sciences, Esbjerg, Denmark; 2Haramaya University College of Health Sciences, Harar, Ethiopia; 3University of Southern Denmark, Unit for Health Promotion Research, Esbjerg, DenmarkBackground: Female genital mutilation (FGM is nontherapeutic surgical modification of the female genitalia. It is an ancient tradition in large parts of Africa, including Ethiopia, especially in the eastern part of the country. This study aimed to identify the prevalence, perceptions, perpetuators, reasons for conducting FGM, and factors associated with this practice with regard to women's health.Methods: Community-based cross-sectional house-to-house interviews were conducted during 2008 among 858 females of reproductive age (15–49 years, in Kersa district, East Hararge, Oromia region, Ethiopia. Proportions and Chi-square tests were used to describe the data and logistic regression was used to describe statistical associations. Statistical significance was set at P < 0.05.Results: FGM was reported to be known by 327 (38.5% of the interviewees. The majority (n = 249, 76.1% reported that local healers were the main performers of FGM, and 258 (78.9% respondents stated that the clitoris was the part removed during circumcision. The main reason for the practice of FGM was reduction of female sexual hyperactivity (reported by 198 women [60.3%]. Circumcision of daughters was reported by 288 (88.1% respondents, and this showed a statistically significant association with the Christian religion (P = 0.003, illiteracy (P = 0.01, and Amhara ethnicity (P = 0.012. The majority of the respondents (792, 92.3% were themselves circumcised and 68.8% did not know of any health-related problems associated with FGM.Conclusion: In spite of FGM being a common practice in the study area, only one third of the respondents stated that they knew about it

  6. The comparison of clinical curative effects between plastibell circumcision and circumcision%包皮环套术与包皮环切术的临床疗效对比

    Institute of Scientific and Technical Information of China (English)

    陈士洲; 邓大溢; 林长丰; 庞工占

    2011-01-01

    目的 比较包皮环套术与包皮环切术的临床疗效.方法 门诊对587例包皮过长及包茎患者,按门诊单双日随机分组,分别行包皮环套术352例(A组)和传统包皮环切术组235例(B组),对比分析两组的手术时间、术中及术后出血量、术后并发症等情况.结果 平均手术时间:A组(6.23±0.21)min,B组(31.41±3.52)min;术中出血量:A组(1.2±0.31)ml,B组(10.72±2.14)ml;术后出血:A组0例,B组4例;术后感染:A组6例,B组8例.两种术式的手术时间、术中出血量差异有统计学意义(P<0.01),其他指标差异无统计学意义(P>0.05).结论 包皮环套术治疗包皮过长及包茎操作简单、出血少,花费少,受术者易于接受,值得推广.%Objective To compare the clinical curative effects between plastibell circumcision and circumcision. Methods A total of 587 patients,including 507 with redundant prepuce and 80 with phimosis, were randomly assigned to receive the plastibell circumcision (group A,n =352) and conventional surgical procedures(group B,n =235). Comparisons were made between the two groups in terms of the operative time,intraoperative and postoperative blood loss,and the postoperative complications. Results The average operative time: (6.23 ±0.21 )min for group A and (31.41 ± 3.52 )ml for group B. These two parameters were statistically significant differences the two parameters ( P < 0.01 ), but not in postoperative blood less and other complacations. Conclusion Plastibell circumcision is simple and convenient with shorter operative time, less blood loss, lower expenses and acceptance of the patients. Thus ,it is worthy of clinical practice.

  7. Voluntary medical male circumcision: a framework analysis of policy and program implementation in eastern and southern Africa.

    OpenAIRE

    Dickson, Kim E; Tran, Nhan T.; Samuelson, Julia L.; Emmanuel Njeuhmeli; Peter Cherutich; Bruce Dick; Tim Farley; Caroline Ryan; Hankins, Catherine A.

    2011-01-01

    Editors' Summary Background Every year, more than 2.5 million people (mostly in sub-Saharan Africa) become infected with HIV, the virus that causes AIDS. There is no cure for HIV/AIDS and no HIV vaccine. Consequently, global efforts to combat HIV/AIDS are concentrating on evidence-based prevention strategies such as voluntary medical male circumcision (VMMC). Circumcision—the removal of the foreskin, a loose fold of skin that covers the head of the penis—reduced HIV transmission through sexua...

  8. FEMALE PSEUDOHERMAPHRODITISM

    Directory of Open Access Journals (Sweden)

    AL. Bulotta

    2012-01-01

    Full Text Available Introduction. 21α-hydroxylase deficiency is the most frequent cause of virilization in patients with female karyotype due to exposure of a female fetus to excess of androgen. We report anatomical and cosmetic results of feminizing genital reconstruction of two related patients (second cousin with XX karyotype born with urogenital sinus anomalies (UGS and not treated at birth. Materials and Metods. Patient 1 is 6-years old with ambiguous genitalia graded as Prader V and never undergone therapy or surgery. Patient 2 is 10-years old, graded as Prader IV and subjected to hormonal therapy and clitoral amputation at the age of 6. Mobilization of urogenital sinus, pull-through of vagina and tubulization of urethra was performed in both after placement of Foley chateters in vagina and bladder by cisto-vaginoscopy. Genitoplasty involved refashioning the tissues to create minora and majora labia and, after removal of corpora, partial clitorectomy was carried in patient 1 and clitoridal reconstruction in patient 2. Result. Vaginal introitus was positioned in the vestibule region below urethral meatus. Foley chateters was removed after two weeks in narcosis and the cosmetic and anatomic result was good. Conclusion. Goals of feminizing genitoplasty are to restore, soon as possible, anatomy achieving a more feminine appareance with a vagina for menstruation, to preserve reproductive capacity and to prevent urological sequelae but it’s also important to contribute in a development of a more stable gender identity. This procedure in two stage, based on an accurate diagnosis, is good to create feminine genital appareance in children with female pseudohermaphroditism expecially if not treated at birth.

  9. Human papillomavirus infection in couples with female low-grade intraepithelial cervical lesion.

    Science.gov (United States)

    Simon, Philippe; Roumeguere, Thierry; Christophe Noël, Jean

    2010-11-01

    Low-grade squamous intraepithelial lesions (LSIL) are frequently found during cervical cancer screening. Usually they are associated with a human papillomavirus (HPV) infection. Does the high-transmission rate of HPV infection to the male partner represent a clinical risk for him? Are preventive measures to be taken to prevent the occurrence of male diseases? More than 80% of all LSIL are associated with HPV infections. The prevalence of HPV infection in males can range up to 40%, with 60% of the male partners of LSIL female patients presenting with penile flat lesions. The spontaneous cure rate for male infections is very high (90% at 5 years) but negative consequences in females (cervical high-grade lesion and cervical cancer) are frequent. Their male counterparts are far rarer but in some patients can require deleterious treatment. Transmission prevention by the use of condoms and circumcision is discussed. The effectiveness of HPV vaccination in this situation has not been validated. PMID:20646823

  10. 包皮环扎术、传统环切术及维吾尔族割礼三种术式疗效比较%Comparison of therapeutic effect of foreskin cerclage,traditional circumcision and the Uygur "circumcision"

    Institute of Scientific and Technical Information of China (English)

    刘虎; 王鹏; 丁木拉提·巴吐汗

    2008-01-01

    The outpatient service data of 2889 cases of phimosis or redundant prepuce treated in our hospital and the follow-up data of 1660 cases of the Uygur"circumcision"from April 2002 to April 2007were retrospectively analyzed.The therapeutic effect of foreskin cerclage,traditional circumcision and Uygur"circumcision"were compared.The incidence of postoperative complications of foreskin cerclage group was the lowest,the incidence of postoperative complications of traditional circumcision group was lower than that of the Uygur"circumcision"group.%回顾分析2002年4月至2007年4月采用包皮环扎术(1224例)和传统环切术(1665例)治疗包茎及包皮过长患者、行维吾尔族割礼者(1660例)的随访资料,比较3种术式的治疗效果.手术后外观满意无并发症率分别为99.51%(1218/1224),92.61%(1542/1665)和88.80%(1474/1660),手术并发症发生率环扎术组最低0.49%(6/1224),传统环切术组为7.39%(123/1665),低于割礼组的11.20%(186/1660).

  11. Health complications of female genital mutilation in Sierra Leone

    Directory of Open Access Journals (Sweden)

    Bjälkander O

    2012-07-01

    Full Text Available Owolabi Bjälkander,1 Laurel Bangura,2 Bailah Leigh,3 Vanja Berggren,1 Staffan Bergström,1 Lars Almroth11Division of Global Health, Department of Public Health, Karolinska Institutet, Stockholm, Sweden; 2Inter Africa Committee, Sierra Leone; 3Department of Community Health, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra LeoneAbstract: Sierra Leone has one of the highest rates of female genital mutilation (FGM in the world, and yet little is known about the health consequences of the practice.Purpose: To explore whether and what kind of FGM-related health complications girls and women in Sierra Leone experience, and to elucidate their health care-seeking behaviors.Patients and methods: A feasibility study was conducted to test and refine questionnaires and methods used for this study. Thereafter, a cross-section of girls and women (n = 258 attending antenatal care and Well Women Clinics in Bo Town, Bo District, in the southern region and in Makeni Town, Bombali District, in the northern region of Sierra Leone were randomly selected. Participants answered interview-administrated pretested structured questionnaires with open-ended-questions, administrated by trained female personnel.Results: All respondents had undergone FGM, most between 10 and 14 years of age. Complications were reported by 218 respondents (84.5%, the most common ones being excessive bleeding, delay in or incomplete healing, and tenderness. Fever was significantly more often reported by girls who had undergone FGM before 10 years of age compared with those who had undergone the procedure later. Out of those who reported complications, 187 (85.8% sought treatment, with 89 of them visiting a traditional healer, 75 a Sowei (traditional circumciser, and 16 a health professional.Conclusion: The high prevalence rate of FGM and the proportion of medical complications show that FGM is a matter for public health concern in Sierra Leone. Girls who

  12. The application of health education in the circumcision%健康教育在包皮环切术的应用

    Institute of Scientific and Technical Information of China (English)

    彭英

    2013-01-01

    the aim is to discuss the effect of health education in the circumcision. Method: by retrospectively analyzing the 70 circumcisions conducted by our outpatient operating room and testing the effect of health education which were carried out before, during and after the operation respectively. Result: 68 out of 70 circumcisions belong to class-A healing. Class-A healing rate is 97.1%. Conclusion: correct and comprehensive health education plays an important role in the circumcision patient’s recovery.%  目的探讨健康教育在包皮环切术中的作用.方法回顾性分析我院门诊包皮环切术70例,术前、术中、术后行健康教育.结果70例中术后甲级愈合68例.甲级愈合率97.14%.结论正确全面的健康教育对行包皮环切术病人的愈合具有重要作用.

  13. [Circumcision in the newborn child and risk of urinary tract infection during the first year of life. A meta-analysis].

    Science.gov (United States)

    Amato, D; Garduño-Espinosa, J

    1992-10-01

    To assess if neonatal circumcision may decrease the incidence of urinary tract infection (UTI), published papers on these topics were reviewed, to address their methodological shortcomings, and to analyze them in individual and grouped form. A systematic search of the papers on circumcision and UTI was conducted in Index Medicus (1975-1991) and MEDLINE (1988-1991). Six papers were included in the meta-analysis because all of them presented original data obtained from groups of patients. All of the elected articles were considered in individual and grouped form to calculate odds ratio (OR) and confidence interval at 95% (CI 95%). The number of patients included in each paper ranged from 112 to 219,775. Clustering of the articles enabled us to obtain a global sample number of 221,799 patients. In each individual article there was a higher risk of UTI in uncircumcised patients (OR from 10.82 to 156.42). Global risk obtained from the six clustered papers was of 13.05 with a CI 95% from 10.86 to 15.70. Uncircumcised males have low risk of UTI during their first year of life, but the risk may decrease even more with circumcision. This conclusion may not be considered as definitive because of the methodological shortcomings of the papers reviewed. Recommendation of routinely circumcision to all newborns in not justified with these data.

  14. Cost drivers for voluntary medical male circumcision using primary source data from sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Lori Bollinger

    Full Text Available BACKGROUND: As voluntary medical male circumcision (VMMC programs scale up, there is a pressing need for information about the important cost drivers, and potential efficiency gains. We examine those cost drivers here, and estimate the potential efficiency gains through an econometric model. METHODS AND FINDINGS: We examined the main cost drivers (i.e., personnel and consumables associated with providing VMMC in sub-Saharan Africa along a number of dimensions, including facility type and service provider. Primary source facility level data from Kenya, Namibia, South Africa, Tanzania, Uganda, and Zambia were utilized throughout. We estimated the efficiency gains by econometrically estimating a cost function in order to calculate the impact of scale and other relevant factors. Personnel and consumables were estimated at 36% and 28%, respectively, of total costs across countries. Economies of scale (EOS is estimated to be eight at the median volume of VMMCs performed, and EOS falls from 23 at the 25th percentile volume of VMMCs performed to 5.1 at the 75th percentile. CONCLUSIONS: The analysis suggests that there is significant room for efficiency improvement as indicated by declining EOS as VMMC volume increases. The scale of the fall in EOS as VMMC volume increases suggests that we are still at the ascension phase of the scale-up of VMMC, where continuing to add new sites results in additional start-up costs as well. A key aspect of improving efficiency is task sharing VMMC procedures, due to the large percentage of overall costs associated with personnel costs. In addition, efficiency improvements in consumables are likely to occur over time as prices and distribution costs decrease.

  15. A Phase II Randomized Controlled Trial Comparing Safety, Procedure Time, and Cost of the PrePex™ Device to Forceps Guided Surgical Circumcision in Zimbabwe.

    Directory of Open Access Journals (Sweden)

    Mufuta Tshimanga

    Full Text Available The World Health Organization (WHO and the Joint United Nations Program on HIV/AIDS promote MC (male circumcision as a key HIV prevention strategy where HIV prevalence and incidence are high and MC prevalence is low. In Zimbabwe, to achieve the 1.26 million circumcisions needed to be performed by 2015 to achieve optimal MC coverage, a new approach was needed. The primary objective of the current trial was to assess the performance (safety, procedure time, and cost of the PrePex device compared to forceps-guided surgical circumcision.This Phase II, randomized, open-label trial in Zimbabwe involved healthy, non-circumcised adult male volunteers who were randomly assigned to the PrePex device (n = 160 or surgical arm (n = 80. Three doctors and 4 nurses, all certified on both circumcision methods, performed the procedures. The PrePex device procedure involves a plastic ring with a rubber O-ring that necrotizes the foreskin to facilitate easy and minimally invasive removal. Total procedure time was the primary endpoint. Adverse event (AE data were also gathered for 90 days post-procedure. All 80 participants in the surgical arm and 158 participants in the PrePex arm achieved complete circumcision. The total procedure time for the PrePex device was approximately one-third of the total surgical procedure (4.8 minutes, Standard Deviation [SD]: 1.2 versus 14.6 minutes; SD: 4.2; p<0.00001. There were 2 AEs for 2 participants (rate of 1.3%, 95% Confidence Interval: 0.0025-4.53%, which were resolved with simple intervention. The AEs were device related, including 1 case of pain leading to device removal and 1 case of removal of the device.The trial supports previous studies' conclusions that the PrePex procedure is safe, quick, easy to apply, and effective in terms of procedure time as an alternative to traditional surgical circumcision. The PrePex device has great potential for use in overburdened health systems and in resource-limited settings and is

  16. Voluntary Medical Male Circumcision for HIV Prevention in Malawi: Modeling the Impact and Cost of Focusing the Program by Client Age and Geography

    Science.gov (United States)

    Kripke, Katharine; Chimbwandira, Frank; Mwandi, Zebedee; Matchere, Faustin; Schnure, Melissa; Reed, Jason; Castor, Delivette; Sgaier, Sema

    2016-01-01

    Background In 2007, the World Health Organization (WHO) recommended scaling up voluntary medical male circumcision (VMMC) in priority countries with high HIV prevalence and low male circumcision (MC) prevalence. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), an estimated 5.8 million males had undergone VMMC by the end of 2013. Implementation experience has raised questions about the need to refocus VMMC programs on specific subpopulations for the greatest epidemiological impact and programmatic effectiveness. As Malawi prepared its national operational plan for VMMC, it sought to examine the impacts of focusing on specific subpopulations by age and region. Methods We used the Decision Makers’ Program Planning Toolkit, Version 2.0, to study the impact of scaling up VMMC to different target populations of Malawi. National MC prevalence by age group from the 2010 Demographic and Health Survey was scaled according to the MC prevalence for each district and then halved, to adjust for over-reporting of circumcision. In-country stakeholders advised a VMMC unit cost of $100, based on implementation experience. We derived a cost of $451 per patient-year for antiretroviral therapy from costs collected as part of a strategic planning exercise previously conducted in- country by UNAIDS. Results Over a fifteen-year period, circumcising males ages 10–29 would avert 75% of HIV infections, and circumcising males ages 10–34 would avert 88% of infections, compared to the current strategy of circumcising males ages 15–49. The Ministry of Health’s South West and South East health zones had the lowest cost per HIV infection averted. Moreover, VMMC met WHO’s definition of cost-effectiveness (that is, the cost per disability-adjusted life-year [DALY] saved was less than three times the per capita gross domestic product) in all health zones except Central East. Comparing urban versus rural areas in the country, we found that circumcising men in urban

  17. Voluntary Medical Male Circumcision for HIV Prevention in Malawi: Modeling the Impact and Cost of Focusing the Program by Client Age and Geography.

    Directory of Open Access Journals (Sweden)

    Katharine Kripke

    Full Text Available In 2007, the World Health Organization (WHO recommended scaling up voluntary medical male circumcision (VMMC in priority countries with high HIV prevalence and low male circumcision (MC prevalence. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS, an estimated 5.8 million males had undergone VMMC by the end of 2013. Implementation experience has raised questions about the need to refocus VMMC programs on specific subpopulations for the greatest epidemiological impact and programmatic effectiveness. As Malawi prepared its national operational plan for VMMC, it sought to examine the impacts of focusing on specific subpopulations by age and region.We used the Decision Makers' Program Planning Toolkit, Version 2.0, to study the impact of scaling up VMMC to different target populations of Malawi. National MC prevalence by age group from the 2010 Demographic and Health Survey was scaled according to the MC prevalence for each district and then halved, to adjust for over-reporting of circumcision. In-country stakeholders advised a VMMC unit cost of $100, based on implementation experience. We derived a cost of $451 per patient-year for antiretroviral therapy from costs collected as part of a strategic planning exercise previously conducted in- country by UNAIDS.Over a fifteen-year period, circumcising males ages 10-29 would avert 75% of HIV infections, and circumcising males ages 10-34 would avert 88% of infections, compared to the current strategy of circumcising males ages 15-49. The Ministry of Health's South West and South East health zones had the lowest cost per HIV infection averted. Moreover, VMMC met WHO's definition of cost-effectiveness (that is, the cost per disability-adjusted life-year [DALY] saved was less than three times the per capita gross domestic product in all health zones except Central East. Comparing urban versus rural areas in the country, we found that circumcising men in urban areas would be both cost

  18. Sutureless Adult Voluntary Male Circumcision with Topical Anesthetic: A Randomized Field Trial of Unicirc, a Single-Use Surgical Instrument.

    Directory of Open Access Journals (Sweden)

    Justin Shenje

    Full Text Available The World Health Organization has solicited rapid and minimally invasive techniques to facilitate scale-up of voluntary medical male circumcision (VMMC.Non-blinded randomized controlled field trial with 2:1 allocation ratio.75 adult male volunteers.Outpatient primary care clinic.Open surgical circumcision under local anesthetic with suturing vs. Unicirc disposable instrument under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive.Intraoperative duration.Intraoperative and postoperative pain; adverse events; time to healing; patient satisfaction; cosmetic result.The intraoperative time was less with the Unicirc technique (median 12 vs. 25 min, p < 0.001. Wound healing and cosmetic results were superior in the Unicirc group. Adverse events were similar in both groups.VMMC with Unicirc under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive is rapid, heals by primary intention with superior cosmetic results, and is potentially safer and more cost-effective than open surgical VMMC.Clinicaltrials.gov NCT02443792.

  19. The characteristics of circular disposable devices and in situ devices for optimizing male circumcision: a network meta-analysis.

    Science.gov (United States)

    Fan, Yu; Cao, Dehong; Wei, Qiang; Tang, Zhuang; Tan, Ping; Yang, Lu; Liu, Liangren; Liu, Zhenhua; Li, Xiang; Xue, Wenbin

    2016-01-01

    In situ device (ISD) and circular disposable device (CDD) are used for optimizing male circumcision (MC), but evidence to explore the characteristics of these two devices is insufficient. In order to explore this issue systematically and provide reliable evidence, ten published randomized controlled trials (RCTs) exploring the safety and efficacy of ISDs and CDDs were included (involving 4649 men). Moderate quality of the RCTs included was found after assessment. Pairwise meta-analyses and network meta-analyses were processed in stata 13.0 and AIDDS v1.16.6 respectively. According to the outcomes that were statistically significant in both pairwise and network meta-analyses, ISD was found to have less intraoperative blood loss (IB), less operative time (OT) and less incidence of wound bleeding (WB) than conventional circumcision (CC); ISD was found to have less WB but more wound healing time (WHT) than CDD; CDD was found to have less IB and less OT than CC. CDD tended to have the best wound healing condition and least pain experience; ISD tended to have the least IB, least OT, least WB, and highest satisfaction rate. With their own superiorities in many aspects, CDD and ISD are both safe and effective devices for optimizing MC. PMID:27156368

  20. Male circumcision and its association with HIV infection and sexually transmitted diseases: evidence from 18 demographic and health surveys in sub-Saharan Africa.

    Science.gov (United States)

    Gebremedhin, Samson

    2011-01-01

    The study aimed to assess the association between male circumcision and HIV infection and STDs. The issue is controversial as various studies reported conflicting findings. A cross-sectional comparative study based on the secondary data of 18 Demographic Health Surveys (DHS), carried out in Sub-Saharan Africa starting from 2003, was conducted. From all surveys, information on 70 554 males aged 15 - 59 years was extracted. The association between male circumcision and HIV infection and STD symptoms (genital discharge or genital ulcer/sore) was assessed using binary logistic regression. Adjustment was made for sexual history and basic socio-demographic variables. The weighted prevalence of HIV among men 15 - 59 years was 3.1%. In the bivariate analysis uncircumcised status was significantly associated with risk of HIV, with odds ratio (OR) of 4.12 (95% CI: 3.85 - 4.42). The association was even more significant (4.95 (95% CI: 4.57-5.36)) after adjustment for number of lifetime sexual partners and socio-demographic variables. The risk associated with uncircumcised status is significantly lower among younger men aged 15 - 29 years than those in 30 - 59-year age category. About 5.5% of the study subjects reported either genital discharge or genital sore/ulcer in the preceding 12 months of the surveys. Circumcision status was not significantly associated with either of the symptoms, with adjusted OR of 1.07 (95% CI: 0.99 - 1.15). The study concludes that there is a strong association between uncircumcised status and HIV infection. Hence, male circumcision can be considered as a possible way of reducing the spread of HIV infection in areas where the practice is rare. A comprehensive study to assess the association between circumcision and different types of STDs is recommended.

  1. Knowledge, attitude and practice of female genital mutilation among doctors and nurses in Bayelsa state, Niger-Delta of Nigeria

    Directory of Open Access Journals (Sweden)

    Oyeyemi A.S

    2013-01-01

    Full Text Available Background: Female genital mutilation (FGM is a harmful traditional practice that is deeply rooted in Africa. It has been outlawed in Bayelsa state of Nigeria but there is evidence that its performance by traditional circumcisers and health professionals continues. Aim: The study aimed to determine the knowledge, attitude and practice of FGM among doctors and nurses/midwives practising in public secondary and tertiary hospitals in Bayelsa state. Methods: One hundred and ninety seven (197 structured questionnaires were administered to all available doctors and nurses/midwives in the study hospitals for self-completion. Epi-Info version 3.5.1 was used to analyse data. Results: All the respondents were aware of FGM. A higher proportion of nurses/midwives than doctors had ever been asked and had ever treated patients with complications of FGM. More than 90% of respondents said it was not a good practice. Out of the 70 female respondents, 19 (27.1% said they were circumcised. Only one nurse/midwife admitted to performing FGM presently. Conclusion: Doctors and nurses/midwives practicing in the study hospitals were well aware of FGM and were favourably disposed towards its elimination. Efforts should be made to reinforce this position.

  2. Female Reproductive System

    Science.gov (United States)

    ... Things to Know About Zika & Pregnancy Female Reproductive System KidsHealth > For Parents > Female Reproductive System Print A ... or sperm. continue Components of the Female Reproductive System Unlike the male, the human female has a ...

  3. 应用商环治疗儿童包皮过长和包茎的体会%Circumcision anastomat in the treatment of phimosis and redundant prepuce in children

    Institute of Scientific and Technical Information of China (English)

    李兴华; 郑少斌

    2011-01-01

    目的:总结应用商环在儿童包茎及包皮过长治疗中的经验.方法:对2008~2010年551例儿童包茎、包皮过长手术(商环组342例,传统环切组209例)进行回顾性分析.结果:与传统环切相比,商环具有手术时间短(P<0.05)、不需包扎、切口工整等优点,但也具有伤口愈合时间长(P<0.05)、疼痛更明显等缺点(P<0.05).结论:儿童包皮过长、包茎手术,应用商环与传统手术比较二者各有优缺点,但是商环优点更明显、更可行.%Objective: To summarize the experience in the application of circumcision anastomat in the treatment of phimosis and redundant prepuce in children.Methods: A total of 551 children with phimosis or redundant prepuce were treated by circumcision from 2008 to 2010, 342 with circumcision anastomat and the other 209 by traditional circumcision.Their clinical data were retrospectively analyzed.Results: Compared with traditional circumcision, circumcision with the anastomat showed the advantages of less operation time (P < 0.05), fewer complications, no need for dressing, and better cosmetic appearance, but it also exhibited the disadvantages of longer healing time (P < 0.05) and more obvious postoperative pain (P < 0.05).Conclusion: Circumcision with the anastomat and traditional circumcision for the treatment of phimosis and redundant prepuce in children each have their own advantages and disadvantages, but the former is more advantageous and more feasible clinically.

  4. Prevalence and associated factors of female genital mutilation among Somali refugees in eastern Ethiopia: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Deressa Wakgari

    2009-07-01

    Full Text Available Abstract Background Eastern Ethiopia hosts a substantial number of refugees originated from Somalia. Female genital mutilation (FGM is a common practice in the area, despite the campaigns to eliminate it. Methods A cross-sectional study was conducted among 492 respondents sampled from three refugee camps in Somali Regional State, Eastern Ethiopia, to determine the prevalence and associated factors of FGM. Data were collected using pre-tested structured questionnaires. Results Although the intention of the parents to circumcise their daughters was high (84%, 42.4% of 288 ≤12 girls were reported being undergone FGM. The prevalence increased with age, and about 52% and 95% were circumcised at the age of 7–8 and 11–12 years, respectively. Almost all operations were performed by traditional circumcisers (81% and birth attendants (18%. Clitoral cutting (64% and narrowing of the vaginal opening through stitching (36% were the two common forms of FGM reported by the respondents. Participation of the parents in anti-FGM interventions is statistically associated with lower practice and intention of the procedures. Conclusion FGM is widely practised among the Somali refugee community in Eastern Ethiopia, and there was a considerable support for the continuation of the practice particularly among women. The findings indicate a reported shift of FGM from its severe form to milder clitoral cutting. More men than women positively viewed anti-FGM interventions, and fewer men than women had the intention to let their daughters undergo FGM, indicating the need to involve men in anti-FGM activities.

  5. Comparative study on the effects of Plastibell device circumcision and conventional circumcision in treatment of the excess foreskin and phimosis%包皮环套术及传统包皮环切术的应用效果对比

    Institute of Scientific and Technical Information of China (English)

    廖波; 李雨根; 程树林; 杨雪松; 余晓东; 邓显忠

    2011-01-01

    Objective To evaluate the effects of plastibell device circumcision and conventional circumcision on treating the excess foreskin and phimosis of adult or children. Methods Total of 197 adults and children patients, with excess foreskin or phimosis were treated with plastibell device or conventional circumcision. Followed up for 3 months, pain intensity after surgery l~10 days was recorded using visual analog scales (VAS) method, and postoperative complications were also recorded. The incidence of complications was calculated for comparative analysis. Results The operation time and bleeding volume of plastibell device circumcision was significantly lower than that of traditional circumcision. The VAS score of adult patients treated with plastibell device circumcision were significantly higher than that of children in the 1,3,7 days after surgery, and children conventional circumcision group's VAS scores were significantly higher than that of the plastibell group. In adult, the incidence of postoperative edema of the foreskin in the plastibell and conventional group were 21% and 10% respectively, but in children, the incidence were 5% and 15% respectively. Conclusion For treatment of children with prepuce or phimosis, the plastibell device circumcision might be better method. But the effects of plastilbell device circumcision on adult patient might be worse than on children patients. Plastjbell device circumcision was the best choice if patients required good appearance after circumcision or shorter operation time.%目的 对比分析包皮环套术和包皮环切术两种术式在治疗成人与儿童包皮过长或包茎中的应用效果.方法 临床上顺序收集成人(18~35岁)及儿童(6~13岁)包皮过长或包茎患者197例,予以包皮环套术或包皮环切术.术后随访3个月,采用视觉模拟评分法(VAS)记录患者术后ld至10d的疼痛强度,同时记录各组患者的常见术后并发症情况,计算并发症发

  6. Comparison of clinical curative effects between Shang Ring circumcision and conventional circumcision%商环包皮环切术与传统包皮环切术的临床疗效比较

    Institute of Scientific and Technical Information of China (English)

    梁平; 王亮; 李沙丹; 王庆堂; 杨航; 曹文锋; 刘吉文; 夏荣妍

    2012-01-01

    Objective To compare and analyze the clinical curative effects of Shang Ring and conventional circumcision on redundant prepuce and phimosis. Methods 166 patients with redundant prepuce and phimosis were randomly divided into two groups and received conventional circumcision( conventional group,n = 86 )or Shang Ring circumcison( Shang Ring group,n = 80 ). Comparison and analysis were made in operative time, perioperative blood loss, postoperative pain degree and postoperative complications between the two groups. Results In Shang Ring group,the operative time was( 4.78 ±1. 11 )min;perioperative blood loss was( 1.06 ±0. 23 ) ml;the VAS score of postoperative pain was 1.09 ±0.72,which were all significantly lower than those in the conventional group( P < 0.05 ). Otherwise the incidence of postoperative bleeding,infection,and foreskin malformation in Shang Ring group was lower than that in the conventional group( P < 0.05 ). But the incidence of hydrophallus in Shang Ring group was higher than that in the conventional group( P <0. 05 ). Conclusion Shang Ring circumcision is relatively simple,micro - invasive,safe and has less pain for the patients. Its clinical curative effect is better than that of the conventional circumcision.%目的 对比分析商环包皮环切术与传统包皮环切术治疗包皮过长及包茎的临床疗效.方法 对166例包皮过长及包茎患者随机分组,分别行传统包皮环切术86例(传统组)和商环包皮环切术80例(商环组),对比分析两组的手术时间、术中出血量、术后疼痛程度及术后并发症等情况.结果 商环组手术时间(4.78±1.11)min,术中出血量(1.06±0.23)ml,术后疼痛VAS评分(1.09±0.72)分,均显著低于传统组(P<0.05);且商环组在术后出血、感染、包皮畸形发生率等方面也低于传统组(P<0.05),但术后阴茎水肿发生率高于传统组(P<0.05).结论 商环包皮环切术操作简单、微创、安全,患者痛苦小,较传统包皮环切术临床疗效好.

  7. 一次性包皮环切缝合器与传统包皮环切术的临床疗效比较研究%Efficacy comparison of stapler circumcision and conventional circumcision

    Institute of Scientific and Technical Information of China (English)

    高海峰; 杜浩; 王伟; 李天明; 于广海

    2016-01-01

    Objective To compare the clinical efficacy of stapler circumcision and conventional circumcision in patient with redundant prepuce or phimosis.Methods Totally 210 patients with redundant prepuce or phimosis who underwent stapler circumcision (suture group,122 cases) and conventional circumcision (conventional operation group,88 cases) from March 2013 to March 2015 were enrolled and followed up for 1-2 months.The operation duration,intraoperative blood loss,intraoperative and postoperative 24 h pain visual analogue scale (VAS) score,healing time,incidence of complications and satisfaction rate of appearance.Results The operation duration,intraoperative blood loss,intraoperative and postoperative 24 h VAS scores,healing time,incidence of complications were significantly lower,the satisfaction rate of appearance was significantly higher in stapler group than those in conventional surgery group [(7.1 ± 1.5) min vs (23.6 ± 5.2) min,(2.3 ± 1.2) ml vs (15.7±2.6) ml,(0.8±0.8) scores vs (2.4±1.2) scores,(1.8 ±1.0) scores vs (4.9±1.4) scores,(13 ±4) dvs(16±3) d,4.1% (5/122) vs 18.2% (16/88),96.7% (118/122) vs86.4% (76/88)](P < 0.05).Conclusion Stapler circumcision has shorter operation duration,less blood loss,less pain,lower incidence of complications and higher satisfaction rate of appearance compared with conventional circumcision.%目的 比较一次性包皮环切缝合器与传统环切术治疗成人包皮过长及包茎的临床疗效.方法 对2013年3月至2015年3月于辽宁省大连市中心医院行包皮手术的210例成年患者进行分析,其中122例采用一次性包皮环切缝合器(缝合器组),88例采用传统包皮环切术(传统手术组),所有患者术后随访1~2个月,比较2组患者的手术时间、术中出血量、术中及术后24h视觉模拟评分法(VAS)评分、伤口愈合时间、术后并发症发生率及外观满意度.结果 缝合器组手术时间、术中出血量、术中及术后24 h VAS评分、

  8. 几种包皮环切术式的临床观察比较%Comparison of clinical observation on Three circumcision procedures

    Institute of Scientific and Technical Information of China (English)

    杨槐; 陈波特; 赵永斌; 吴实坚

    2012-01-01

    目的:探讨不同方法行包皮环切术的临床效果.方法:回顾性分析2008年1月至2011年8月采用不同方法行包皮环切术的临床资料1 247例.其中传统包皮环切术982例、激光袖套状包皮环切术123例、包皮环环扎术142例,并对其手术平均耗时、水肿消退期时间、术后并发症如术后创口出血、术后感染、术后线头反应、术后伤口裂开、再次手术率,进行临床观察比较.结果:传统包皮环切术组的手术时间(26.8±5.9) min及术后水肿消退时间(13.8±4.5)d分别介于激光袖套状包皮环切术组和包皮环环扎术组之间,3组比较差异均有统计学意义(P<0.05).在术后并发症发生率和再次手术情况方面,传统包皮环切术组分别是0.7%(7/982)和0.2% (2/982),激光袖套状包皮环切术组分别是4.9%(6/123)和0.8%(1/123),包皮环环扎术组分别是12.9%(16/142)和4.2%(6/142),3组手术方式对比差异也具有统计学意义(P<0.05),传统包皮环切术组并发症及再次手术的发生率均最小.结论:激光袖套状包皮环切术手术耗时长、术后恢复期长、术后并发症多.包皮环环扎术手术耗时短、术后恢复快、不残留线头、外形美观,但感染率高,一旦感染伤口易裂开,必须控制感染后重新清创缝合.传统包皮环切术比较包皮环环扎术手术耗时、术后水肿消退期虽长,但术后并发症少,再次手术率低,较为安全可靠.%Objective To access the clinical effects of three different circumcision procedures. Methods A retrospective analysis was conducted of all patients who received circumcision in General Hospital of Guangzhou Military Command from January 2008 through August 2011. Of all the 1247 patients, nine hundred and eighty-two received traditional circumcision (traditional circumcision group, Group A), one hundred and twenty-three received laser sleeve circumcision (laser sleeve circumcision group, Group B), and 142 received

  9. Factors Associated With Delayed Healing in a Study of the PrePex Device for Adult Male Circumcision in Kenya

    Science.gov (United States)

    Odoyo-June, Elijah; Bailey, Robert C.; Jou Lai, Jaim; Weiner, Debra; Combes, Stephanie; Hart, Catherine; Fischer, Shelly; Obiero, Walter; Cherutich, Peter

    2016-01-01

    Objectives: To explore factors associated with healing requiring more than 6 weeks after placement of the PrePex device for adult medical male circumcision. Methods: We enrolled 427 men ages 18–49 years in an observational study of PrePex at 1 urban and 2 peripheral clinics in western Kenya. Participants were scheduled for device removal at day 7 and a follow-up visit at day 42 (allowable range, 40–44) at which the provider recorded wound status, with complete healing defined as a dry wound without any scab, later confirmed by site investigator review of digital penile photographs. We performed univariate and multivariate logistic regression to explore associations between selected demographic, surgical, and follow-up factors and delayed healing (not healed by day 42 visit). Results: Of the 427 men, 341 completing a day 42 visit with physical examination and recorded healing status were included. Fifty-four percent of included men were healed by day 42 visit. Factors associated with delayed healing in univariate analysis and remaining significant in the multivariate analysis were as follows: age 25 years or older [odds ratio (OR): 1.8; 95% confidence interval (CI): 1.4 to 2.4], an adverse event by day 44 (OR: 1.4; 95% CI: 1.03 to 2.0), and severe pain during device removal (protective association: OR: 0.7; 95% CI: 0.5 to 0.99). Conclusions: Older age (25+ years), occurrence of an adverse event, and lesser self-reported pain at device removal were associated with delayed wound healing. If confirmed by larger surveillance studies, these results should be incorporated into the counseling given to male circumcision clients. PMID:27331586

  10. Vasectomy as a proxy: extrapolating health system lessons to male circumcision as an HIV prevention strategy in Papua New Guinea

    Directory of Open Access Journals (Sweden)

    Tynan Anna

    2012-09-01

    Full Text Available Abstract Background Male circumcision (MC has been shown to reduce the risk of HIV acquisition among heterosexual men, with WHO recommending MC as an essential component of comprehensive HIV prevention programs in high prevalence settings since 2007. While Papua New Guinea (PNG has a current prevalence of only 1%, the high rates of sexually transmissible diseases and the extensive, but unregulated, practice of penile cutting in PNG have led the National Department of Health (NDoH to consider introducing a MC program. Given public interest in circumcision even without active promotion by the NDoH, examining the potential health systems implications for MC without raising unrealistic expectations presents a number of methodological issues. In this study we examined health systems lessons learned from a national no-scalpel vasectomy (NSV program, and their implications for a future MC program in PNG. Methods Fourteen in-depth interviews were conducted with frontline health workers and key government officials involved in NSV programs in PNG over a 3-week period in February and March 2011. Documentary, organizational and policy analysis of HIV and vasectomy services was conducted and triangulated with the interviews. All interviews were digitally recorded and later transcribed. Application of the WHO six building blocks of a health system was applied and further thematic analysis was conducted on the data with assistance from the analysis software MAXQDA. Results Obstacles in funding pathways, inconsistent support by government departments, difficulties with staff retention and erratic delivery of training programs have resulted in mixed success of the national NSV program. Conclusions In an already vulnerable health system significant investment in training, resources and negotiation of clinical space will be required for an effective MC program. Focused leadership and open communication between provincial and national government, NGOs and

  11. Microbial diversity of genital ulcer disease in men enrolled in a randomized trial of male circumcision in Kisumu, Kenya.

    Directory of Open Access Journals (Sweden)

    Supriya D Mehta

    Full Text Available BACKGROUND: Medical male circumcision (MMC reduces the risk of genital ulcer disease (GUD in men by 50%. In Ugandan and Kenyan trials, a sexually transmissible agent was not identified in 50-60% of GUD specimens by polymerase chain reaction (PCR assay. We sought to better define the etiology of GUD in men participating in the Kenyan trial and examine how MMC affects GUD etiology. METHODS: We defined GUD of unknown etiology as negative for HSV (type 1 and type 2, T. pallidum, and H. ducreyi by PCR, and negative for HSV-2 and T. pallidum by serology. We identified bacterial microbiota in a subset of 59 GUD specimens using multitag pyrosequencing of the 16S rRNA gene, and compared results by unknown vs. STI-associated etiology. Statistical analysis employed Bray-Curtis similarity measure of bacterial community by etiology, hierarchical clustering and logistic regression. RESULTS: In 59 GUD specimens from 59 men, 23 (39% had unknown etiology. Bacterial diversity was greater in GUD of unknown than STI etiology (p = 0.01. Fusobacteria (Fusobacterium spp. and Sneathia spp. were more commonly detected in men with GUD of unknown etiology [adjusted OR = 5.67; 95% CI: 1.63-19.8] as were Oxobacter spp. and Anaerovorax spp. [adjusted OR = 3.12; 95% CI: 0.83-11.7]. Sequences from these four anaerobic bacterial taxa were more often detected in uncircumcised men than circumcised men (p<0.05. CONCLUSIONS: Anaerobic bacteria are more common in genital ulcers of uncircumcised men. The specific anaerobic bacteria associated with GUD of unknown etiology have cytotoxic properties that can exacerbate epithelial disruptions leading to ulcer-like appearance. MMC may reduce GUD through a reduction in these anaerobic bacteria.

  12. Perspectives of Parents and Health Care Workers on Early Infant Male Circumcision Conducted Using Devices: Qualitative Findings From Harare, Zimbabwe

    Science.gov (United States)

    Mavhu, Webster; Hatzold, Karin; Ncube, Getrude; Fernando, Shamiso; Mangenah, Collin; Chatora, Kumbirai; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M

    2016-01-01

    ABSTRACT Background: The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend early infant male circumcision (EIMC) for prevention of HIV. Here, we present findings from a qualitative study in Zimbabwe that assessed parental and health care workers' perspectives of EIMC conducted using devices. Methods: This qualitative study was nested within a trial of EIMC devices. Between January and May 2013, we held 4 focus group discussions (FGDs) and 12 in-depth interviews with parents and 12 in-depth interviews with clinicians (7 trial clinicians and 5 non-trial clinicians). We also conducted 95 short telephone interviews with parents who had arranged to bring their sons for EIMC but then defaulted. Results: Parents who had adopted EIMC spoke of their initial anxieties about the procedure. Additionally, they commented on both the procedure and outcome. Parents who decided against EIMC cited fear of harm, specifically the infant's death, penile injury, and excessive pain. Misperceptions about male circumcision in general and EIMC specifically were a significant barrier to EIMC adoption and were prevalent among health care workers as well as parents. In particular, the findings suggest strong parental concerns about the fate of the discarded foreskin. Parents who chose EIMC for their newborn sons felt that the procedure was safe and expressed satisfaction with the outcome. For their part, health care workers largely thought that EIMC was safe and that the outcome was aesthetically pleasing. They also felt that it would be feasible to offer wide-scale EIMC for HIV prevention in the public sector; they recommended strategies to increase EIMC uptake, in addition to highlighting a few concerns. Conclusions: The qualitative study enables us to better understand parental and health care workers' perspectives of EIMC conducted using devices, especially their perspectives on EIMC safety, feasibility, acceptability, and barriers. These findings

  13. Analysis on curative effect and safety of Shang ring circumcision%商环包皮切除术的疗效及安全性分析

    Institute of Scientific and Technical Information of China (English)

    肖卫忠; 潘森

    2016-01-01

    Objective To compare the curative effect and safety of Shang ring circumcision and conventional circumcision .Methods Retrospectively analyzed the clinical data of 329 adult patients who were admitted into our hospital from January 2013 to May 2015, including 205 cases of Shang ring circumcision and 124 cases of conventional circumcision .The operation time , intraoperative and postoperative VAS pain scores , intraoperative bleeding , wound healing time , complications , and degree of penile appearances and overall satisfaction between the two groups were compared .Results Compared with conventional circumcision , Shang ring circumcision was associated with shorter oper-ative time, less intraoperative blood loss , lower intraoperative and postoperative VAS pain scores , lower adverse event rate , higher penile ap-pearances and overall satisfaction , and the difference was statistically significant (P<0.05).Conclusion Shang ring circumcision may be a safer and more effective choice in comparison with conventional circumcision for male patients , as it can shorten the time of operation and save the cost of health care .%目的:比较商环包皮切除术与传统包皮切除术的临床效果及手术安全性。方法回顾性分析2013年1月至2015年5月于我院行包皮切除术的329例成年患者的临床资料,其中205例行商环包皮切除术,另外124例行传统包皮环切术,对比分析2组手术时间、术中及术后VAS疼痛评分、术中出血量、切口愈合时间、并发症以及阴茎外观满意度和总体满意度。结果商环包皮切除术在手术时间、术中出血量、术中及术后疼痛评分、总体并发症发生率、阴茎外观满意度及总体满意度上均明显优于传统包皮切除术,差异具有统计学意义(P<0.05)。结论与传统包皮切除术相比,商环包皮切除术具有更好的手术效果和较高的安全性,并能明显缩短手术时间,节约医疗成本。

  14. Analysis of circumcision with shang ring device in 653 cases%中国商环包皮环切手术653例分析

    Institute of Scientific and Technical Information of China (English)

    严景民; 郭和清; 刘永胜; 潘广新; 邢继章; 周高标; 姚志勇; 李迪; 史济洲

    2013-01-01

    目的 探讨中国商环包皮环切的手术治疗效果.方法 收集2008年7月至2011年8月应用中国商环行包皮环切术653例的临床资料进行回顾性分析.结果 653例中,650例成功行中国商环包皮环切术,手术时间平均(6±1)min,术中无出血,带环期间无出血、血肿形成、切口裂开、感染、商环脱落等;3例手术失败,改行传统包皮环切术.行商环包皮环切术者术后7~10d取环,648例伤口甲级愈合,2例伤口延期愈合.术后随访9~24个月,包皮外形美观,切缘整齐光滑,可见线状环行瘢痕,无狭窄环行成.结论 中国商环包皮环切术具有手术方式标准化、操作简单、手术时间短、无出血、痛苦小、术后外形美观等优点,是包皮环切术的一种有效治疗手段.%Objective To investigate the therapeutic results of circumcision with Shang Ring as an alternative therapy of conventional circumcision.Methods We retrospectively evaluated the clinical data and investigated the size of Shang Ring,operation time,bleeding,wound dehiscence,infection and departure of the Shang Ring after circumcision with Shang Ring in 653 patients between July 2008 and August 2011.Results Circumcision with Shang Ring was successful in 650 patients,the mean operation time was(6 ± 1) min.There was no bleeding in operation,and without bleeding,haematoma,wound dehiscence,infection or departure of the Shang ring after circumcision.The ring was removed 7 to 10 days postoperatively.Among them,delayed wound healing occurred in 2 cases.Circumcision with Shang Ring was failed and then conventional circumcision was performed in 3 cases.The shape was good and cutting edge was regular,and only a linear scar without stenosis was seen during the follow-up of 9 to 24 months.Conclusion Circumcision with Shang Ring under the guidance of standard procedure has the advantages of simple procedure,short operation time,no bleeding,little pain and satisfactory appearance.

  15. Delivering PrePex Medical Male Circumcision Services Through a Mobile Clinic: The Experience From a Pilot Project in North West Province, South Africa.

    Science.gov (United States)

    Kufa, Tendesayi; Chetty-Makkan, Candice; Maraisane, Mpho; Charalambous, Salome; Chihota, Violet; Toledo, Carlos

    2016-06-01

    We describe the implementation of a pilot project to demonstrate the safety and feasibility of providing PrePex circumcision from a mobile clinic. We analyzed available project diary entries and staff meeting minutes to identify challenges encountered. The main challenges identified were (1) daily time constraints because of setting up procedures, (2) transportation logistics for clients when the mobile clinic had moved to a different location, (3) integration and coordination of staff responsibilities, and (4) recruitment for PrePex services in the mobile clinic. The provision of PrePex device circumcision through a mobile clinic was feasible but careful planning and review of operational procedures were needed to resolve the implementation challenges. PMID:27331594

  16. 袖套式包皮环切术与传统包皮环切术治疗包皮过长的疗效比较研究%Comparative effectiveness research of sleeve circumcision technique and traditional circumcision in the treatment of redundant prepuce

    Institute of Scientific and Technical Information of China (English)

    张新磊

    2015-01-01

    目的:分析袖套式包皮环切术与传统包皮环切术治疗包皮过长的疗效.方法:收治包皮过长患者60例,随机分为观察组和对照组各30例.对照组给予传统包皮环切术治疗,观察组给予袖套式包皮环切术治疗.比较两组的手术各项指标和并发症.结果:观察组的手术时间、术后疼痛时间、术中出血量和术后并发症均明显少于对照组(P<0.05).结论:袖套式包皮环切术治疗包皮过长具有显著的疗效,能够减少术后并发症.%Objective:To analyze the curative effect of sleeve circumcision technique and traditional circumcision in the treatment of redundant prepuce.Methods:60 patients with redundant prepuce were selected.They were randomly divided into the observation group and the control group with 30 cases in each.The control group was given traditional circumcision treatment.The observation group was given sleeve circumcision technique treatment.The operation indicators and complications of two groups were compared. Results:The operation time,postoperative pain time,intraoperatve blood soss and postoperative complications of the observation group were significantly less than those of the control group(P<0.05).Conclusion:The sleeve circumcision technique in the treatment of redundant prepuce has a significant effect,can reduce the postoperative complications.

  17. 广西部分男男性行为者包皮环切术接受意愿分析%ACCEPTABILITY OF MALE CIRCUMCISION AMONG MEN WHO HAVE SEX WITH MEN IN GUANGXI

    Institute of Scientific and Technical Information of China (English)

    蓝光华; 刘伟; 黄玉满; 梁浩

    2011-01-01

    目的:了解广西男男性行为人群对包皮环切术的接受意愿情况.方法:利用滚雪球法招募302名男男性行为者(MSM),并进行包皮体检和面对面问卷调查.结果:302名MSM中,平均男性性伴数中位数为3.5个,19.5%与女性有过性关系,41.1%最近1年接受过HIV检测,18.5%自述最近1年出现过性病相关症状.与男性发生性关系时每次都是用安全套的比例为46.1%,与女性发生性关系时每次都是用安全套的比例为37.3%.既往12.3%接受过包皮环切术,主要原因为包皮过长、父母安排、能预防艾滋病等.25.7%未接受包皮环切术者愿意接受包皮环切术,多因素回归分析结果显示,包皮长度(OR=2.63,95%CI 1.93~3.58)、最近6个月与女性发生过性关系(OR=0.38,95%CI 0.16~0.91)与包皮环切术接受意愿比较差异有统计学意义(P<0.05).结论:MSM是艾滋病的高风险人群和桥梁人群,包皮过长和与女性有过性关系的MSM更愿意接受包皮环切术.%Objective: To learn the willing of male circumcision (MC) among men who have sex with men (MSM) in Guangxi. Methods:To recruit 302 MSM by snow-balling. Questionnaire interviews and foreskin check were administrated to MSM participants. Results:Overall 302 MSM attended the survey. The average of male sex partner was 3. 5; 19. 5% of MSM had female sexual partners;41. 1% of MSM had received HIV test; 18. 5% of MSM appeared sexually transmitted disease (STD) related symptoms in the past year. The proportions of condom use each time in male-male sex and male female sex were 46. 1 % and 37. 3% respectively; 12. 3% of MSM experienced MC. The reasons of MS were prepuce redundant, parents arrangement, for the HIV prevention; 25. 7% of uncircumcised MSM were willing to accept MC. In multiple regression analysis, the foreskin length (OR=2. 63, 95% CI 1. 93-3. 58), the last six months had sexual relations with women (OR = 0. 38, 95% CI 0. 16-0. 91) were significantly associated with the

  18. Normal Female Reproductive Anatomy

    Science.gov (United States)

    ... historical Searches are case-insensitive Reproductive System, Female, Anatomy Add to My Pictures View /Download : Small: 720x756 ... Large: 3000x3150 View Download Title: Reproductive System, Female, Anatomy Description: Anatomy of the female reproductive system; drawing ...

  19. Adverse events profile of PrePex a non-surgical device for adult male circumcision in a Ugandan urban setting.

    Directory of Open Access Journals (Sweden)

    Moses Galukande

    Full Text Available BACKGROUND: Safe Male Circumcision is a proven approach for partial HIV prevention. Several sub Saharan African countries have plans to reach a prevalence of 80% of their adult males circumcised by 2015. These targets require out of ordinary organization, demand creation, timely execution and perhaps the use of SMC devices. OBJECTIVE: To profile Adverse Events rate and acceptance of PrePex, a non surgical device for adult male circumcision. METHODS: A prospective study, conducted at International Hospital Kampala, Uganda, between August and October 2012. Ethical approval was obtained from Uganda National Council of Science and Technology. RESULTS: Of 1,040 men received to undergo SMC, 678 opted for PrePex, 36 were excluded at an initial physical examination screening. 642 were enrolled and consented, and another 17 were excluded before device placement. 625 underwent the procedure. Average age was 24 years (± 7. Twelve moderate AEs occurred among 10 participants 12/625, (1.9%. These were all reversible. Five had device displacement, one had an everted foreskin; five had bleeding after the device was removed and one had voiding difficulties. The majority (279 out of 300 of men interviewed complained of some pain within the week of placement. Mean pain score at device placement (using visual analogue scale was 0.5, at device removal 4.5 and within 2 min of removal the pain score was 1.4. Over 70% of the devices were placed and removed by non-physician clinicians. Presented with a choice, 60% of men chose PrePex over surgical SMC. Close to 90% would recommend the device to their friends. Odour from the necrotic skin was a concern. Removals done 1-2 days earlier than day 7 were beneficial and conferred no extra risk. CONCLUSION: AEs of a moderate or severe nature associated with PrePex were low and reversible. PrePex is feasible for mass safe male circumcision scaling up.

  20. 电切法袖套式包皮环切术200例临床分析%Electric cutting sleeve circumcision : clinical analysis of 200 cases

    Institute of Scientific and Technical Information of China (English)

    邹义华; 陈晓峰; 陈善群

    2012-01-01

    Objective:To evaluate the safety and effect of electric cutting sleeve circumcision for treatment of patients with redundant prepuce and phimosis. Method: Using electric cutting sleeve circumcision in 200 cases, the curative effect, complications and their prevention measures were analyzed. Result:The 200 cases of electric cutting sleeve circumcision show little bleeding, neat cutting, slight postoperative wound edema, little scar and satisfactory appearance of penis. Conclusion: With more satisfactory curative effect and fewer complications, Electric sleeve circumcision for treatment of patients with redundant prepuce and phimosis is worthy of clinical application.%目的:探讨电切法袖套式包皮环切术治疗包皮过长与包茎患者的安全性与疗效.方法:采用电切法袖套式包皮环切术治疗包皮过长与包茎患者200例,分析手术效果、并发症及其预防措施.结果:200例电切法袖套式包皮环切术出血少、切缘整齐,术后包皮水肿轻微,切口均一期愈合,癜痕少,阴茎外观满意.结论:电切法袖套式包皮环切术治疗包皮过长与包茎患者效果满意,并发症少,值得临床推广.

  1. Surgical Efficiencies and Quality in the Performance of Voluntary Medical Male Circumcision (VMMC) Procedures in Kenya, South Africa, Tanzania, and Zimbabwe

    OpenAIRE

    Dino Rech; Bertrand, Jane T; Nicholas Thomas; Margaret Farrell; Jason Reed; Sasha Frade; Christopher Samkange; Walter Obiero; Kawango Agot; Hally Mahler; Delivette Castor; Emmanuel Njeuhmeli

    2014-01-01

    INTRODUCTION: This analysis explores the association between elements of surgical efficiency in voluntary medical male circumcision (VMMC), quality of surgical technique, and the amount of time required to conduct VMMC procedures in actual field settings. Efficiency outcomes are defined in terms of the primary provider's time with the client (PPTC) and total elapsed operating time (TEOT). METHODS: Two serial cross-sectional surveys of VMMC sites were conducted in Kenya, Republic of South Afri...

  2. How much does it cost to improve access to voluntary medical male circumcision among high-risk, low-income communities in Uganda?

    Directory of Open Access Journals (Sweden)

    Bruce Larson

    Full Text Available The Ugandan Ministry of Health has endorsed voluntary medical male circumcision as an HIV prevention strategy and has set ambitious goals (e.g., 4.2 million circumcisions by 2015. Innovative strategies to improve access for hard to reach, high risk, and poor populations are essential for reaching such goals. In 2009, the Makerere University Walter Reed Project began the first facility-based VMMC program in Uganda in a non-research setting. In addition, a mobile clinic began providing VMMC services to more remote, rural locations in 2011. The primary objective of this study was to estimate the average cost of performing VMMCs in the mobile clinic compared to those performed in health facilities (fixed sites. The difference between such costs is the cost of improving access to VMMC.A micro-costing approach was used to estimate costs from the service provider's perspective of a circumcision. Supply chain and higher-level program support costs are not included.The average cost (US$2012 of resources used per circumcision was $61 in the mobile program ($72 for more remote locations compared to $34 at the fixed site. Costs for community mobilization, HIV testing, the initial medical exam, and staff for performing VMMC operations were similar for both programs. The cost of disposable surgical kits, the additional upfront cost for the mobile clinic, and additional costs for staff drive the differences in costs between the two programs. Cost estimates are relatively insensitive to patient flow over time.The MUWRP VMMC program improves access for hard to reach, relatively poor, and high-risk rural populations for a cost of $27-$38 per VMMC. Costs to patients to access services are almost certainly less in the mobile program, by reducing out-of-pocket travel expenses and lost time and associated income, all of which have been shown to be barriers for accessing treatment.

  3. The Economic and Epidemiological Impact of Focusing Voluntary Medical Male Circumcision for HIV Prevention on Specific Age Groups and Regions in Tanzania

    Science.gov (United States)

    2016-01-01

    Background Since its launch in 2010, the Tanzania National Voluntary Medical Male Circumcision (VMMC) Program has focused efforts on males ages 10–34 in 11 priority regions. Implementers have noted that over 70% of VMMC clients are between the ages of 10 and 19, raising questions about whether additional efforts would be required to recruit men age 20 and above. This analysis uses mathematical modeling to examine the economic and epidemiological consequences of scaling up VMMC among specific age groups and priority regions in Tanzania. Methods and Findings Analyses were conducted using the Decision Makers’ Program Planning Tool Version 2.0 (DMPPT 2.0), a compartmental model implemented in Microsoft Excel 2010. The model was populated with population, mortality, and HIV incidence and prevalence projections from external sources, including outputs from Spectrum/AIDS Impact Module (AIM). A separate DMPPT 2.0 model was created for each of the 11 priority regions. Tanzania can achieve the most immediate impact on HIV incidence by circumcising males ages 20–34. This strategy would also require the fewest VMMCs for each HIV infection averted. Circumcising men ages 10–24 will have the greatest impact on HIV incidence over a 15-year period. The most cost-effective approach (lowest cost per HIV infection averted) targets men ages 15–34. The model shows the VMMC program is cost saving in all 11 priority regions. VMMC program cost-effectiveness varies across regions due to differences in projected HIV incidence, with the most cost-effective programs in Njombe and Iringa. Conclusions The DMPPT 2.0 results reinforce Tanzania’s current VMMC strategy, providing newfound confidence in investing in circumcising adolescents. Tanzanian policy makers and program implementers will continue to focus scale-up of VMMC on men ages 10–34 years, seeking to maximize program impact and cost-effectiveness while acknowledging trends in demand among the younger and older age groups

  4. The PrePex device is unlikely to achieve cost-savings compared to the forceps-guided method in male circumcision programs in sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Walter Obiero

    Full Text Available BACKGROUND: Male circumcision (MC reduces the risk of heterosexual HIV acquisition in men by approximately 60%. MC programs for HIV prevention are currently being scaled-up in fourteen countries in sub-Saharan Africa. The current standard surgical technique for MC in many sub-Saharan African countries is the forceps-guided male circumcision (FGMC method. The PrePex male circumcision (PMC method could replace FGMC and potentially reduce MC programming costs. We compared the potential costs of introducing the PrePex device into MC programming to the cost of the forceps-guided method. METHODS: Data were obtained from the Nyanza Reproductive Health Society (NRHS, an MC service delivery organization in Kenya, and from the Kenya Ministry of Health. Analyses are based on 48,265 MC procedures performed in four Districts in western Kenya from 2009 through 2011. Data were entered into the WHO/UNAIDS Decision Makers Program Planning Tool. The tool assesses direct and indirect costs of MC programming. Various sensitivity analyses were performed. Costs were discounted at an annual rate of 6% and are presented in United States Dollars. RESULTS: Not including the costs of the PrePex device or referral costs for men with phimosis/tight foreskin, the costs of one MC surgery were $44.54-$49.02 and $54.52-$55.29 for PMC and FGMC, respectively. CONCLUSION: The PrePex device is unlikely to result in significant cost-savings in comparison to the forceps-guided method. MC programmers should target other aspects of the male circumcision minimum package for improved cost efficiency.

  5. Association of Low-Risk Human Papillomavirus Infection with Male Circumcision in Young Men: Results from a Longitudinal Study Conducted in Orange Farm (South Africa

    Directory of Open Access Journals (Sweden)

    Chloé Tarnaud

    2011-01-01

    Full Text Available Background. Low-Risk Human Papillomavirus (LR-HPV genotypes 6 and 11 cause genital warts. This study investigated the association of LR-HPV infection with male circumcision (MC. Methods. We used data from the South African MC trial conducted among young men. Urethral swabs, collected among intervention (circumcised and control (uncircumcised groups, were analyzed using HPV linear array. Adjusted LR-HPV prevalence rate ratio (aPPR and Poisson mean ratio (aPMR of number of LR-HPV genotypes were estimated using log-Poisson regression, controlling for background characteristics, sexual behaviour, and HIV and HSV-2 statuses. Results. Compared to controls, LR-HPV prevalence and mean number of genotypes were significantly lower among the intervention group ((8.5% versus 15.8%; aPRR: 0.54, P<.001 and (0.33 versus 0.18; aPMR: 0.54, P<.001, resp.. Mean number of LR-HPV genotypes increased with number of lifetime sexual partners and decreased with education level and consistent condom use. Conclusions. This study shows a reduction in LR-HPV infection among circumcised men.

  6. 采用包皮环切缝合器与商环行包皮环切术的疗效比较%Comparative study of the circumcision techniques curative effect between circumcision suture device and Shang Ring

    Institute of Scientific and Technical Information of China (English)

    陈深泉; 张启飞; 张伟健

    2015-01-01

    目的:比较采用一次性包皮环切缝合器与商环行包皮环切术治疗包皮过长或包茎的临床疗效。方法回顾性分析采用一次性包皮环切缝合器手术及商环包皮环切吻合器手术各112例患者的临床资料,比较两种术式的手术时间、术中出血量、术后并发症等指标。结果一次性包皮环切缝合器与商环包皮环切吻合器的手术时间分别为(6.1±0.8)min、(6.5±1.7)min;术中出血量分别为(2.0±0.0)mL、(1.0±0.0)mL;两组间差异比较无统计学意义(P >0.05)。而两组的术后并发症上切口疼痛的发生率分别为21.43%、50.89%;术后血肿的发生率分别为14.29%、6.25%;系带区切口水肿发生率分别为8.04%、25.89%;愈合时间分别为(8.0±1.7)d、(14.0±1.2)d;以上差异均有统计学意义(P <0.05)。结论两种手术方式各有优缺点,在术式选择前应向患者作详细说明,建议学龄期小儿患者选用商环内环内置法,而青春期男性及成人患者可选择一次性包皮环切缝合器环切术。%Objective To compare the clinical effectiveness among disposable circumcisionsuture device and Shang Ring in treating redundant prepuce and phimosis.Methods The clinical data of 224 cases of circumcisions done by disposable circumcision suture device(n =112)and Shang Ring(n =112)were retrospective1y analyzed. Operation time,intra -operational bleeding and postoperative complications among two techniques were compared. Results Disposable circumcision suture operation and Shang ring circumcision without significant difference in the operation time and intra -operational bleeding.There result was (6.1 ±0.8)min vs (6.5 ±1.7)min and (2.0 ±0.0)mL vs (1.8 ±0.0)mL(P >0.05).The incidence of postoperative complications with incision pain rate was 21.43% vs 50.89%,infection rate was 14.29% vs 6.25%,frenum area incision edema rate was 8

  7. 应用一次性包皮环切缝合器与传统包皮环切术、包皮环切吻合术的临床对比研究%Comparative study of the application of disposable circumcision suture device,conventional circumcision and circumcisionanastomosis

    Institute of Scientific and Technical Information of China (English)

    马然; 孙文学; 张晨辰; 蒋新国; 李良; 车玉胤; 张波

    2015-01-01

    Objectives:To compare the clinical effects of conventional circumcision,disposable circumci-sion anastomosis and disposable circumcision suture device (DCSD)in the treatment of redundant prepuce and phi-mosis.Methods:The clinical data of 147 patients with redundant prepuce or phimosis,50 treated by conventional circumcision,49 by disposable circumcision anastomosis and 48 by DCSD were reviewed.The operation time,intra-operative blood loss,2 -hour and 7 -day postoperative visual analogue scores,postoperative complications,prepu-tial edema,incision healing time,degrees of patients’satisfaction with penile appearance and perioperative cost of the three groups were documented and compared.Results:As for the operation time,intraoperative blood loss and patients’satisfaction with penile appearance,disposable circumcision anastomosis and DCSD were significantly bet-ter than conventional circumcision (P <0.05).The 7 -day postoperative visual analogue score,incision healing time and preputial edema in the conventional circumcision and DCSD groups were significantly lower than these in the disposable circumcision anastomosis group (P <0.05).The 2 -hour postoperative visual analogue score in the conventional circumcision and DCSD groups was significantly higher than it in the disposable circumcision anastomo-sis group (P <0.05).The perioperative cost in the conventional circumcision group,disposable circumcision anas-tomosis group and DCSD group were (543.8 ±33.9 )¥,(1137.6 ±99.9 )¥ and (1253.4 ±652.6 )¥respectively.There was significant differences among the three kinds of operation (P <0.05 ).Conclusion:Each of the three circumcision methods has its own advantages and disadvantages.The DCSD is the simplest with short operation time,few blood loss,satisfied postoperative appearance of the penile,less pain and less postopera-tive complications,however,the wound healing time is long,and the cost is high.%目的:比较传统包皮环切术、包皮环切吻合

  8. Experience of exterior and interior circumcise in circumsision%内外双环切包皮成形术的临床应用

    Institute of Scientific and Technical Information of China (English)

    马乐; 施泽宏; 王仁芹

    2015-01-01

    Objective To evaluate the effects of exterior and interior circumcise in redundant and phimosis. Methods 128 patients in outpatient department were included,42 patients were treated by traditional circumcision,86 patients were treated by interior and interior circumcise.To observe the pennies appearance,pain of the penis erection postoperation,self-estimation of patients. Results Exterior and interior circumcise could reserve the tissue between internal plate and out plate to largest extent and also get nice appearance.Light pain of the penis erection,enlargement of the diameter of penis. Conclusion Exterior and interior circumcise is a simple,practical method,it can enlarge the diameter of penis and get nice experience.%目的:探讨内外双环切包皮成形术在包皮过长及包茎中的临床运用效果.方法:对笔者所在科室2014年9月-2015年6月收治的128例包皮过长及包茎患者,42例运用激光行传统包皮环切术,86例行激光内外双环切包皮成形术,术后观察对比外观、勃起疼痛情况及患者自我评价.结果:内外双环切包皮成形术可以最大程度地保留内外板间的包皮组织,外观平整美观,勃起疼痛轻,龟头下阴茎直径有一定程度增大,患者满意度高.结论:内外双环切包皮成形术是一种简单、实用的手术方法,在获得良好外观的同时,增大龟头下阴茎直径,值得临床推广.

  9. Female genital mutilation in African and African American women's literature

    Directory of Open Access Journals (Sweden)

    Darja Marinšek

    2007-12-01

    Full Text Available The article builds on the existing dispute between African and African American women writers on the competence of writing about female genital mutilation (FGM, and tries to determine the existence and nature of the differences between the writings of these two groups. The author uses comparative analysis of two popular African and African American novels, comparing their ways of describing FGM, its causes and consequences, the level ob objectivity and the style of the narrations.This is followed by a discussion on the reasons for such differences, incorporating a larger circle of both African and African American women authors, at the same time analysing the deviance within the two groups. While the differences between African American writers are not that great, as they mostly fail to present the issue from different points of view, which is often the result of their lack of direct knowledge of the topic, African authors' writing is in itself discovered to be ambivalent and not at all invariable. The reasons for such ambivalence are then discussed in greater context, focusing on the effect of the authors' personal contact with circumcision as well as their knowledge and acceptance of Western values. The author concludes by establishing the African ambivalent attitude towards FGM, which includes different aspects of the issue, as the most significant difference between their and African American writers' description of this practice.

  10. Female genital cutting: an evidence-based approach to clinical management for the primary care physician.

    Science.gov (United States)

    Hearst, Adelaide A; Molnar, Alexandra M

    2013-06-01

    The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician. We reviewed original research, population-based studies, and legal research from PubMed, Scopus, CINAHL plus, PsycINFO, and Legal Trac. The terms searched included female genital cutting, female genital circumcision, and female genital mutilation alone and with the term complications or health consequences; no limit on date published. Legal databases were searched using the above terms, as well as international law and immigration law. Editorials and review articles were excluded. This review discusses the different types of FGC, important cultural considerations for physicians caring for patients with FGC, the common early and late medical complications and their management, and psychosocial issues associated with FGC. Current laws pertaining to FGC are briefly reviewed, as well as implications for patients seeking asylum status in the United States because of FGC. Finally, the article presents evidence-based, culturally sensitive approaches to discussions of FGC with girls and women for whom this is an issue. PMID:23726401

  11. Female genital mutilation/cutting: risk management and strategies for social workers and health care professionals

    Directory of Open Access Journals (Sweden)

    Costello S

    2015-12-01

    Full Text Available Susan Costello School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia Abstract: Female genital mutilation/cutting (FGM/C is a traditional practice originating in Africa. Its worst forms cause irreparable harm to girls and women and have no medical justification. Based on a literature review of global responses to FGM/C and conversations with Australian women who migrated from FGM/C practicing countries, this paper provides some background on FGM/C and its epidemiology, outlining its prevalence, types, and health risks and complications for women and girls. It discusses risk-prevention strategies, first, for health practitioners in identifying, screening, and supporting women affected by FGM/C and, second, for welfare and social workers and health care professionals to identify, work with, and prevent girls from being cut. Consistent with international trends in addressing the risks of FGM/C, the paper suggests practice responses for coordinated responses between professionals, communities from practicing countries, and governments of different countries. Keywords: female genital mutilation, female genital cutting, female circumcision, child protection, risk management 

  12. 流动人口包皮环切健康教育干预效果评价%Intervention effect of health education on circumcision among migrant population

    Institute of Scientific and Technical Information of China (English)

    李君; 钟朝晖; 唐晓君; 文静; 刘晨煜; 秦波; 李革

    2012-01-01

    目的 评价在流动人口中开展包皮环切手术相关知识健康宣教的效果.方法 于2010年5月-2011年6月采用流行病学现场干预试验,对重庆市流动人口采用发放健康宣教纸质和音像材料、大学生志愿者宣教、专家讲座等干预方法进行综合干预,干预后6个月进行干预效果评估.结果 干预前后调查对象包皮环切手术知识得分分别为(4.64 ±0.13)和(8.41±0.03)分,差异有统计学意义(F=88.21,P<0.001);手术原因及益处为预防生殖器炎症或肿瘤、预防艾滋病及其他性传播疾病、保护性伴侣生殖健康的知晓率干预前分别为38.00%( 209/550)、32.91%(181/550)、45.64%(251/550),干预后分别为66.91%(368/550)、67.27%(370/550)、56.88%(311/550),差异均有统计学意义(x2 =50.553、82.811、13.538,P<0.001);多因素logistic回归分析结果表明,干预前后知识得分的主要影响因素是:身边是否有人做过包皮环切手术和包皮环切手术相关知识基线得分.结论 流动人口对包皮环切手术相关知识掌握较差,健康宣传教育可以有效提高其包皮环切手术知识水平.%Objective To evaluate the effect of health education about circumcision related knowledge on circumcision among migrant population. Methods Comprehensive epidemiological intervention activities were conducted among migrant population in Chongqing city from May 2010 to June 2011. The intervention methods included providing paper and audio-visual materials of health education, lectures by college student volunteers and experts. The evaluation on the effect of the health education was conducted after six months. Results The average score of circumcision knowledge before and after the intervention was 4.64 ±0. 12 and 8.41 ±0. 033,with a significant difference(F = 88. 210,P <0. 001). The knowledge rates of the benefit,best period and complication of circumcision were higher than before after the intervention. Logistic

  13. Voluntary medical male circumcision: a framework analysis of policy and program implementation in eastern and southern Africa.

    Directory of Open Access Journals (Sweden)

    Kim E Dickson

    2011-11-01

    Full Text Available BACKGROUND: Following confirmation of the effectiveness of voluntary medical male circumcision (VMMC for HIV prevention, the World Health Organization and the Joint United Nations Programme on HIV/AIDS issued recommendations in 2007. Less than 5 y later, priority countries are at different stages of program scale-up. This paper analyzes the progress towards the scale-up of VMMC programs. It analyzes the adoption of VMMC as an additional HIV prevention strategy and explores the factors may have expedited or hindered the adoption of policies and initial program implementation in priority countries to date. METHODS AND FINDINGS: VMMCs performed in priority countries between 2008 and 2010 were recorded and used to classify countries into five adopter categories according to the Diffusion of Innovations framework. The main predictors of VMMC program adoption were determined and factors influencing subsequent scale-up explored. By the end of 2010, over 550,000 VMMCs had been performed, representing approximately 3% of the target coverage level in priority countries. The "early adopter" countries developed national VMMC policies and initiated VMMC program implementation soon after the release of the WHO recommendations. However, based on modeling using the Decision Makers' Program Planning Tool (DMPPT, only Kenya appears to be on track towards achievement of the DMPPT-estimated 80% coverage goal by 2015, having already achieved 61.5% of the DMPPT target. None of the other countries appear to be on track to achieve their targets. Potential predicators of early adoption of male circumcision programs include having a VMMC focal person, establishing a national policy, having an operational strategy, and the establishment of a pilot program. CONCLUSIONS: Early adoption of VMMC policies did not necessarily result in rapid program scale-up. A key lesson is the importance of not only being ready to adopt a new intervention but also ensuring that factors

  14. 不同包皮环切术治疗包皮过长的临床效果分析%Clinical effect analysis of different circumcision surgery in the treatment of phimosis

    Institute of Scientific and Technical Information of China (English)

    黎秋生; 温裕庆; 李荣兴; 钟毅; 张炜强; 傅丽琴; 林宙

    2016-01-01

    Objectives To explore and analyze the clinical effect of Shang ring circumcision and traditional circumcision surgery in the treatment of phimosis. Methods A retrospective analysis was conducted of all patients who received circumcision in Longyan County First Hospital from July 2014 through February 2016.Of all the 1400 patients.Adopt double outpatient service group,randomly divided into Shang ring group and traditional surgery group,seven hundred and eighty received traditional circumcision(traditional circumcision group, Group A), six hundred and twenty received Shang ring group(Shang ring group, Group B).Speciifc data regarding average operation time, wound bleeding,edema subsidise time,infection,wound burst,healing time,etc and and reoperation rate were recorded and analysed. Results Shang Ring circumcision signiifcantly reduced the operation time and intra-operative blood loss as compared with conventional circumcisions (P<0.05). But the edema subsidise time,postoperative healing time,wound burst and reoperation rate was worse than in the traditional circumcision group(P<0.05). As for the surgeons`postoperative complications infection traditional circumcision group showed similar effects to Shang Ring circumcision. Conclusions The Shang ring circumcision is simpliifed and improvement of traditional surgery,with a short time, less bleeding,But traditional circumcision group is still our clinicians to master the best, the most familiar with operation, surgical complications of at least one operation.%目的:对比商环包皮环切吻合术和传统手术治疗包皮过长的疗效分析。方法:回顾性分析我院2014年7月至2016年2月采用两种不同方法行包皮环切术的临床资料1400例。采用单双门诊分组,A组传统包皮环切术780例、B组商环包皮环切吻合术620例,并对其手术平均时间、出血量、水肿消退期时间、术后感染、术后伤口裂开、术后愈合时间、再次手术率进行临床

  15. Treatment of redundant prepuce and phimosis with disposable circumcision suture device versus ShangRingTM circumcision device%一次性包皮环切缝合器与商环治疗包皮过长和包茎的疗效对比分析

    Institute of Scientific and Technical Information of China (English)

    杨克冰; 朱选文; 张士更; 黄晓军; 陈刚; 傅骏; 朱红卫; 吕伯东

    2014-01-01

    目的:比较分析一次性包皮环切缝合器和商环治疗包皮过长和包茎的临床疗效。方法选取行包皮环切术的290例患者,应用一次性包皮环切缝合器手术145例(A组),应用商环手术145例(B组)。分别观察两组手术时间、术中及术后勃起疼痛评分、术中出血量、切口愈合时间、术后并发症(水肿、出血、感染、切口开裂)及患者满意度。结果两组患者手术时间及术后疼痛评分的差异均无统计学意义(均P>0.05),术中勃起疼痛评分、术中出血量、切口愈合时间及术后并发症发生率的差异均有统计学意义(P<0.05或0.01)。结论两种包皮环切术均获得满意效果。一次性包皮环切缝合器法可明显减轻围手术期疼痛,缩短切口愈合时间,降低术后(水肿、出血、感染、切口开裂)等并发症的发生率;而商环手术后出血和皮下血肿发生率较少。%Objective To compare the application of disposable circumcision suture device with ShangRingTM circumci-sion device in treatment of redundant prepuce and phimosis. Methods Two hundred and ninety patients with redundant pre-puce and phimosis were enrol ed in the study, among whom 145 patients underwent circumcision with disposable circumcision suture device(group A) and another 145 patients with ShangRingTM circumcision device(group B). The operative time, erectile pain score (VAS) during and after the operating, intraoperative bleeding volume, duration of wound healing, postoperative complications (edema, incision bleeding, infection, dehiscence) and satisfaction of patients were observed and compared be-tween two groups. Results There were no significant differences in operative time and erectile pain score (VAS) after the op-erating between two groups(P>0.05). The pain score (VAS) during the operating was lower, the intraoperative bleeding vol-ume was less, the duration of wound healing was shorter and the

  16. Hybrid forum or network? The social and political construction of an international 'technical consultation': male circumcision and HIV prevention.

    Science.gov (United States)

    Giami, Alain; Perrey, Christophe; Mendonça, André Luiz de Oliveira; de Camargo, Kenneth Rochel

    2015-01-01

    The technical consultation in Montreux, organised by World Health Organization and UNAIDS in 2007, recommended male circumcision as a method for preventing HIV transmission. This consultation came out of a long process of releasing reports and holding international and regional conferences, a process steered by an informal network. This network's relations with other parties is analysed along with its way of working and the exchanges during the technical consultation that led up to the formal adoption of a recommendation. Conducted in relation to the concepts of a 'hybrid forum' and 'network', this article shows that the decision was based on the formation and consolidation of a network of persons. They were active in all phases of this process, ranging from studies of the recommendation's efficacy, feasibility and acceptability to its adoption and implementation. In this sense, this consultation cannot be described as the constitution of a 'hybrid forum', which is characterised by its openness to a debate as well as a plurality of issues formulated by the actors and of resources used by them. On the contrary, little room was allowed for contradictory discussions, as if the decision had already been made before the Montreux consultation.

  17. Female reproductive disorders

    DEFF Research Database (Denmark)

    Crain, D Andrew; Janssen, Sarah J; Edwards, Thea M;

    2008-01-01

    To evaluate the possible role of endocrine-disrupting compounds (EDCs) on female reproductive disorders emphasizing developmental plasticity and the complexity of endocrine-dependent ontogeny of reproductive organs. Declining conception rates and the high incidence of female reproductive...

  18. Female reproductive disorders

    DEFF Research Database (Denmark)

    Crain, D Andrew; Janssen, Sarah J; Edwards, Thea M;

    2008-01-01

    To evaluate the possible role of endocrine-disrupting compounds (EDCs) on female reproductive disorders emphasizing developmental plasticity and the complexity of endocrine-dependent ontogeny of reproductive organs. Declining conception rates and the high incidence of female reproductive disrupti......To evaluate the possible role of endocrine-disrupting compounds (EDCs) on female reproductive disorders emphasizing developmental plasticity and the complexity of endocrine-dependent ontogeny of reproductive organs. Declining conception rates and the high incidence of female reproductive...

  19. Female genital mutilation/cutting and issues of sexuality in Egypt.

    Science.gov (United States)

    Fahmy, Amel; El-Mouelhy, Mawaheb T; Ragab, Ahmed R

    2010-11-01

    Female genital mutilation/cutting (FGM/C), officially referred to as female circumcision and at community level as tahara (cleanliness), is still prevalent in Egypt. This study was designed to examine the role of female sexuality in women's and men's continued support for FGM/C, and their perceptions of its sexual consequences. The study was conducted in 2008-09 in two rural communities in Upper Egypt and a large slum area in Cairo. Qualitative data were collected from 102 women and 99 men through focus group discussions and interviews. The clitoris was perceived to be important to, and a source of, sexual desire rather than sexual pleasure. FGM/C was intended to reduce women's sexual appetite and increase women's chastity, but was generally not believed to reduce women's sexual pleasure. Men and women framed sexual pleasure differently, however. While men, especially younger men, considered sexual satisfaction as a cornerstone of marital happiness, women considered themselves sexually satisfied if there was marital harmony and their socio-economic situation was satisfactory. However, sexual problems, including lack of pleasure in sex and sexual dissatisfaction, for whatever reasons, were widespread. We conclude that political commitment is necessary to combat FGM/C and that legal measures must be combined with comprehensive sexuality education, including on misconceptions about FGM/C. PMID:21111362

  20. Are Female Supervisors More Female-Friendly?

    OpenAIRE

    Steven Bednar; Dora Gicheva

    2014-01-01

    We introduce the idea that easily inferable demographic characteristics such as gender may not be sufficient to define type in the supervisor-employee mentoring relationship. We use longitudinal data on athletic directors at NCAA Division I programs to identify through observed mobility the propensity of top-level administrators to hire and retain female head coaches, above and beyond an organization's culture. We show that supervisor gender appears to be unrelated to female friendliness in t...

  1. 重庆市成年男性对包皮环切手术认知水平的调查%The Analysis on Cognitive Level of Circumcision in Adult Male of Chongqing

    Institute of Scientific and Technical Information of China (English)

    李君; 钟朝晖; 唐晓君; 秦波; 文静; 刘晨煜; 李革

    2012-01-01

    Objective To investigate the knowledge level of Circumcision in adult male of Chongqing, provide the scientific basis for developing circumcision health education materials. Methods This study investigated the related knowledge level of circumcision with Inhabitants and migrants which applied multi-stage stratified cluster sampling method during November to December in 2009. Results In 1502 investigator objects, 83. 36% participants had heard about circumcision, the awareness of people whose age between 27 -35 and high education were higher than other people (all P <0. 05) . 35. 70% participants had known that too long wrapping will cause the phallic cancer, 18. 30% participants had known that circumcision can prevent AIDS and other sexually transmitted diseases, 31. 70% participants thought that circumcision can improve sexual function. There was 43.94% of population were willing to accept the circumcision, the willingness of circumcision of crowd with different education had statistical difference (P <0. 05) , the willingness of circumcision of inhabitants were higher than migrants ( P < 0. 05 ) . Conclusion People in this area have low circumcision related knowledge, the cognitive level is "widely heard but lack of understanding" stage, we should develop nichetargeting health education materials, improve health education and increase the circumcision rate.%目的 了解重庆市成年男性对包皮环切手术的认知水平,为开发包皮环切手术健康宣教材料提供科学依据.方法 于2009年11月-12月采用多阶段分层整群抽样方法,对重庆市常住人口和流动人口对包皮环切手术相关知识的认知水平作现况调查.结果 在1502名调查对象中,83.36%的人听说过包皮环切手术,年龄为27~35岁、文化程度为大专及以上的人群较其他人群知晓率更高(P均<0.05).35.70%的人群知道包皮过长有致阴茎癌的危险,18.30%的人知道包皮环切可以预防艾

  2. 包皮自动切除环在包皮环切中的应用%The prepuce circumcision to automatic cutting ring in the application

    Institute of Scientific and Technical Information of China (English)

    李权书; 王永

    2012-01-01

      Objective:To automatically cut the ring foreskin circumcision technique, for the effect of postoperative observation.Methods:The automatic removal of prepuce circular circumcision in 538 cases .Results:use of the prepuce excision ring technology in automatic 5-8 minutes of operation, and in reducing edema, reduce infection, prevention of painful nodules, patients on postoperative appearance satisfaction rate of 98%.Conclusions:Application of automatic cutting ring foreskin circumcision has the advantages of simple operation, rapid, less pain, less bleeding, postoperative appearance satisfaction is high, the subject easy to accept the advantages, suitable for the majority of patients.%  目的:以包皮自动切除环进行包皮环切技术,进行术后的效果观察。方法:采用包皮自动切除环行包皮环切术538例,结果:使用包皮自动切除环技术能在5-8分钟内完成手术,并且在减轻水肿、减少感染、预防痛性结节,受术者对术后外观满意率为98%。结论:应用包皮自动切除环进行包皮环切术具有操作简单、快速、痛苦小、不出血,术后外观满意度高、受术者易于接受等优点,适于大多数患者。

  3. A Cross Sectional Study of the Prevalence of Preputial and Penile Scrotal Abnormalities among Clients Undergoing Voluntary Medical Male Circumcision in Soweto, South Africa

    Science.gov (United States)

    Mukudu, Hillary; Otwombe, Kennedy; Laher, Fatima; Lazarus, Erica; Manentsa, Mmatsie; Lebina, Limakatso; Mapulanga, Victor; Bowa, Kasonde; Martinson, Neil

    2016-01-01

    Objective Medical device use is currently approved for males without preputial or major penile scrotal abnormalities for voluntary medical male circumcision (VMMC). We determined the prevalence of preputial abnormalities at a busy VMMC centre in Soweto, South Africa. Methods This was a cross-sectional record review at a high-volume VMMC centre in South Africa. We collated pre-circumcision demographic and genital examination findings from clients 8 years and older who had undergone VMMC from 01 May 2013 to 30 April 2014. Logistic regression was used to determine factors associated with preputial abnormalities. Findings During the review period, 6861 circumcisions were conducted and 37.1% (n = 2543) were 8–13 year olds. Median age was 15 years (IQR: 12–23 years). Fifteen percent (n = 1030) had preputial abnormalities or major penile scrotal abnormalities. Age-specific prevalence of preputial or major genital abnormalities were 27.3%, 10.6% and 6.0% in 8–13, 14–18 and > 18 year olds respectively. The odds of preputial or major penile scrotal abnormality were higher in younger clients aged 8–13 years (OR = 5.9; 95% CI = 4.8–7.1) and 14–18 years (OR = 1.9; 95% CI = 1.5–2.4) compared to older clients above18 years and in those testing for HIV outside our clinic network (OR = 1.9; 95% CI = 1.4–2.7). Conclusion The high prevalence of preputial and penile scrotal abnormalities observed suggests a need for VMMC sites to provide for both open surgical and devices methods in the provision of VMMC services. This is especially so among young male subjects presenting themselves for VMMC services at the various sites being developed in sub Saharan African countries. PMID:27253372

  4. Household-based HIV counseling and testing as a platform for referral to HIV care and medical male circumcision in Uganda: a pilot evaluation.

    Directory of Open Access Journals (Sweden)

    Henry Tumwebaze

    Full Text Available BACKGROUND: Combination HIV prevention initiatives incorporate evidence-based, biomedical and behavioral interventions appropriate and acceptable to specific populations, aiming to significantly reduce population-level HIV incidence. Knowledge of HIV serostatus is key to linkages to HIV care and prevention. Household-based HIV counseling and testing (HBCT can achieve high HIV testing rates. We evaluated HBCT as a platform for delivery of combination HIV prevention services in sub-Saharan Africa. METHODS: We conducted HBCT in a semi-urban area in southwestern Uganda. All adults received standard HIV prevention messaging. Real-time electronic data collection included a brief risk assessment and prevention triage algorithm for referrals of HIV seropositive persons to HIV care and uncircumcised HIV seronegative men with multiple sex partners to male circumcision. Monthly follow-up visits for 3 months were conducted to promote uptake of HIV care and male circumcision. RESULTS: 855 households received HBCT; 1587 of 1941 (81.8% adults were present at the HBCT visit, 1557 (98.1% of those present were tested and received HIV results, of whom, 46.5% were men. A total of 152 (9.8% were HIV seropositive, for whom the median CD4 count was 456 cells/µL, and 50.7% were newly-identified as HIV seropositive. Three months after HBCT, 88.5% of HIV seropositive persons had attended an HIV care clinic; among those with CD4 counts <250 cells/µL, 71.4% initiated antiretroviral therapy. Among 123 HIV seronegative men with an HIV+ partner or multiple partners, 62.0% were circumcised by month 3. CONCLUSIONS: HBCT achieves high levels of knowledge of HIV serostatus and is an effective platform for identifying at-risk persons and achieving higher uptake of HIV prevention and care services through referrals and targeted follow-up than has been accomplished through other single focus strategies.

  5. Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014

    Science.gov (United States)

    Kripke, Katharine; Samuelson, Julia; Schnure, Melissa; Dalal, Shona; Farley, Timothy; Hankins, Catherine; Thomas, Anne G.; Reed, Jason; Stegman, Peter; Bock, Naomi

    2016-01-01

    Background In 2007, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries across eastern and southern Africa for scaling up voluntary medical male circumcision (VMMC) services. Several years into this effort, we reflect on progress. Methods Using the Decision Makers’ Program Planning Tool (DMPPT) 2.1, we assessed age-specific impact, cost-effectiveness, and coverage attributable to circumcisions performed through 2014. We also compared impact of actual progress to that of achieving 80% coverage among men ages 15–49 in 12 VMMC priority countries and Nyanza Province, Kenya. We populated the models with age-disaggregated VMMC service statistics and with population, mortality, and HIV incidence and prevalence projections exported from country-specific Spectrum/Goals files. We assumed each country achieved UNAIDS’ 90-90-90 treatment targets. Results More than 9 million VMMCs were conducted through 2014: 43% of the estimated 20.9 million VMMCs required to reach 80% coverage by the end of 2015. The model assumed each country reaches the UNAIDS targets, and projected that VMMCs conducted through 2014 will avert 240,000 infections by the end of 2025, compared to 1.1 million if each country had reached 80% coverage by the end of 2015. The median estimated cost per HIV infection averted was $4,400. Nyanza Province in Kenya, the 11 priority regions in Tanzania, and Uganda have reached or are approaching MC coverage targets among males ages 15–24, while coverage in other age groups is lower. Across all countries modeled, more than half of the projected HIV infections averted were attributable to circumcising 10- to 19-year-olds. Conclusions The priority countries have made considerable progress in VMMC scale-up, and VMMC remains a cost-effective strategy for epidemic impact, even assuming near-universal HIV diagnosis, treatment coverage, and viral suppression. Examining circumcision coverage by five

  6. Silencing women's sexuality: global AIDS policies and the case of the female condom

    Directory of Open Access Journals (Sweden)

    Anny JTP Peters

    2013-07-01

    Full Text Available Introduction: The female condom is the only evidence-based AIDS prevention technology that has been designed for the female body; yet, most women do not have access to it. This is remarkable since women constitute the majority of all HIV-positive people living in sub-Saharan Africa, and gender inequality is seen as a driving force of the AIDS epidemic. In this study, we analyze how major actors in the AIDS prevention field frame the AIDS problem, in particular the female condom in comparison to other prevention technologies, in their discourse and policy formulations. Our aim is to gain insight into the discursive power mechanisms that underlie the thinking about AIDS prevention and women's sexual agency. Methods: We analyze the AIDS policies of 16 agencies that constitute the most influential actors in the global response to AIDS. Our study unravels the discursive power of these global AIDS policy actors, when promoting and making choices between AIDS prevention technologies. We conducted both a quantitative and qualitative analysis of how the global AIDS epidemic is being addressed by them, in framing the AIDS problem, labelling of different categories of people for targeting AIDS prevention programmes and in gender marking of AIDS prevention technologies. Results: We found that global AIDS policy actors frame the AIDS problem predominantly in the context of gender and reproductive health, rather than that of sexuality and sexual rights. Men's sexual agency is treated differently from women's sexual agency. An example of such differentiation and of gender marking is shown by contrasting the framing and labelling of male circumcision as an intervention aimed at the prevention of HIV with that of the female condom. Conclusions: The gender-stereotyped global AIDS policy discourse negates women's agency in sexuality and their sexual rights. This could be an important factor in limiting the scale-up of female condom programmes and hampering

  7. 不同护理方法对中国商环包皮环切术后患者切口愈合的影响%Effect of different wound coping method on circumcision healing for patients with Chinese Shang ring circumcision

    Institute of Scientific and Technical Information of China (English)

    罗春华; 杜合英; 方立; 苏新军; 胡勤波; 汪云颖; 程跃

    2015-01-01

    Objective To compare different nursing methods impacting on the wound healing effects of circumcision for patients with Chinese Shang ring circumcision. Methods A total of 144 male patients with Chinese Shang ring circumcision were randomly divided into A and B group by coin tossing. The patients of A group received circumcised dressing to wrap wound with dressing change 3 times/week;the patients of B group had no dressing for wound to exposure wound and keep wound dry. Followed interviewed 2 months after operation, we compared the incision edema, the infection, rate of incision rupture, postoperative pain, wound healing time, satisfaction of incision appearance and so other indexes between two groups. Results The patients in the group B suffered less pain when erected in 2 weeks after operation (P0. 05). Conclusions To exposure the incision and keep it dry after Chinese Shang ring circumcision can minimize the level of pain and length of wound healing, and is worthy to promote.%目的:比较不同护理方法在成年男性中国商环包皮环切术后切口愈合护理中应用效果的区别。方法选择行中国商环包皮环切术成年男性患者144例,采用掷硬币的方式随机分为包扎组和免包扎两组,包扎组患者采用专用包皮贴包扎切口,每周换药3次;免包扎组为暴露手术切口,嘱患者保持切口干燥。术后随访2个月,比较两组术后包皮水肿、切口感染、切口裂开比例、术后疼痛、术后切口愈合时间、术后外观满意度等指标之间差异。结果免包扎组患者术后2周内清晨勃起疼痛程度均较包扎组减轻,差异均有统计学意义(P0.05)。结论中国商环包皮环切术后采用暴露切口,保持干燥的方法,能减轻患者术后疼痛程度,缩短术后愈合时间,值得推广应用。

  8. 一次性包皮环切缝合器与包皮环环切术的临床疗效比较%Clinical Curative Effect Comparison of Disposable Circumcision Suture Device and Circumcision

    Institute of Scientific and Technical Information of China (English)

    陶美满; 郭涛; 周留正; 朱贵如

    2015-01-01

    目的:对一次性包皮环切缝合器与包皮环环切术的疗效进行分析。方法:选择笔者所在医院门诊2014年1月-2015年3月预约包皮过长、包茎患者162例,依据患者自愿原则进行分组治疗,其中80例包皮过长和包茎患者行包皮环(商环)包皮环切术(包皮环组),另外82例行包皮环切缝合术(缝合器组),对手术时间、出血量、伤口愈合时间、术后疼痛、术后并发症及术后外观满意度等进行对比分析。结果:缝合器组与包皮环组手术时间、术中出血量方面比较,差异均无统计学意义(P>0.05),但缝合器组术后疼痛、感染、水肿、伤口愈合时间均显著低于包皮环组(P0.05).Otherwise there were significant differences existed in the postoperative pain score,infection, the incidence of hydrophallus,time to wound healing between two groups(P<0.05).Conclusion:The procedure with disposable circumcision suture device is much more simpler,micro-invasive,safer,has less pain and good outlook.So it is worth popularizing.

  9. Female feticide in India.

    Science.gov (United States)

    Ahmad, Nehaluddin

    2010-01-01

    Women are murdered all over the world. But in India a most brutal form of killing females takes place regularly, even before they have the opportunity to be born. Female feticide--the selective abortion of female fetuses--is killing upwards of one million females in India annually with far-ranging and tragic consequences. In some areas, the sex ratio of females to males has dropped to less than 8000:1000. Females not only face inequality in this culture, they are even denied the right to be born. Why do so many families selectively abort baby daughters? In a word: economics. Aborting female fetuses is both practical and socially acceptable in India. Female feticide is driven by many factors, but primarily by the prospect of having to pay a dowry to the future bridegroom of a daughter. While sons offer security to their families in old age and can perform the rites for the souls of deceased parents and ancestors, daughters are perceived as a social and economic burden. Prenatal sex detection technologies have been misused, allowing the selective abortions of female offspring to proliferate. Legally, however, female feticide is a penal offence. Although female infanticide has long been committed in India, feticide is a relatively new practice, emerging concurrently with the advent of technological advancements in prenatal sex determination on a large scale in the 1990s. While abortion is legal in India, it is a crime to abort a pregnancy solely because the fetus is female. Strict laws and penalties are in place for violators. These laws, however, have not stemmed the tide of this abhorrent practice. This article will discuss the socio-legal conundrum female feticide presents, as well as the consequences of having too few women in Indian society.

  10. Observation Clinical Effect of Dismiss Clearing and Bind up Circumcision in Children%小儿免拆线免包扎包皮环切术临床效果观察

    Institute of Scientific and Technical Information of China (English)

    仲华维; 张志江; 努尔; 郑虹

    2016-01-01

    目的:评价小儿包皮环切术免拆线、免包扎疗法的临床价值。方法治疗组采用包皮环切术,免拆线免包扎方法,对照组采用传统包皮环切术。结果治疗组术后无需拆线及去除包扎敷料而痛苦少,术后出血、水肿与对照组无明显差别。结论小儿包皮环切术免拆线、免包扎疗法痛苦少、费用低、易被患儿接受,疗效确切。%Objective To evaluation clinical effect of dismiss clearing and bind up circumcision in children.Methods The treatment group using circumcision from the stitches from bandaging methods, the control group used traditional circumcision. Results The treatment groups were less painful without suture removal and removal of wound dressings, postoperative bleeding, edema and no signiifcant difference in the control group.Conclusion Circumcision suture removal, bandaging less pain-free, low cost, easy to be received, and effective, and at the grass-roots promotion.

  11. Female Pattern Hair Loss

    OpenAIRE

    Herskovitz, Ingrid; Tosti, Antonella

    2013-01-01

    Context: Female pattern hair loss (FPHL) also known as female androgenetic alopecia is a common condition afflicting millions of women that can be cosmetically disrupting. Prompt diagnosis and treatment are essential for obtaining optimal outcome. This review addresses the clinical presentation of female pattern hair loss, its differential diagnosis and treatment modalities. Evidence Acquisition: A) Diffuse thinning of the crown region with preservation of the frontal hairline (Ludwig’s type)...

  12. Withstanding trauma: the significance of Emma Eckstein's circumcision to Freud's Irma dream.

    Science.gov (United States)

    Bonomi, Carlo

    2013-07-01

    The author considers the medical rationale for Wilhelm Fliess's operation on Emma Eckstein's nose in February 1895 and interprets the possible role that this played in Freud's dream of Irma's injection five months later. The author's main argument is that Emma likely endured female castration as a child and that she therefore experienced the surgery to her nose in 1895 as a retraumatization of her childhood trauma. The author further argues that Freud's unconscious identification with Emma, which broke through in his dream of Irma's injection with resistances and apotropaic defenses, served to accentuate his own "masculine protest". The understanding brought to light by the present interpretation of Freud's Irma dream, when coupled with our previous knowledge of Freud, allows us to better grasp the unconscious logic and origins of psychoanalysis itself.(1.) PMID:23824652

  13. Circumcision with “no-flip Shang Ring” and “Dorsal Slit” methods for adult males: a single-centered, prospective, clinical study

    Science.gov (United States)

    Lei, Jun-Hao; Liu, Liang-Ren; Wei, Qiang; Xue, Wen-Ben; Song, Tu-Run; Yan, Shi-Bing; Yang, Lu; Han, Ping; Zhu, Yu-Chun

    2016-01-01

    This paper was aimed to compare the clinical effectiveness and safety of adult male circumcision using the Shang Ring™ (SR) with the no-flip technique compared with Dorsal Slit (DS) surgical method. A single-centered, prospective study was conducted at the West China Hospital, where patients were circumcised using the no-flip SR (n = 408) or the DS (n = 94) procedure. The adverse events (AEs) and satisfaction were recorded for both groups, and ring-removal time and percentage of delayed removals were recorded for the SR group. Finally, complete follow-up data were collected for 76.1% of patients (SR: n = 306; DS: n = 76). The average ring-removal time for the SR group was 17.62 ± 6.30 days. The operation time (P flip SR method was found to be superior to the DS method for its short operation time (<5 min), involving less pain, bleeding, infection, and resulting in a satisfactory appearance. However, the time for recovery from edema took longer, and patients may wear device for 2–3 weeks after the procedure. PMID:26585694

  14. Female Athlete Triad

    Science.gov (United States)

    ... periods Learn more about healthy eating habits and healthy lifestyle choices Other Organizations Female Athlete Triad Coalition Questions to Ask Your Doctor ... female athlete triad? How do I strike a balance between my desire to be healthy and my desire to win? Could there be ...

  15. The Female Athlete Triad

    Science.gov (United States)

    Sherman, Roberta Trattner; Thompson, Ron A.

    2004-01-01

    The Female Athlete Triad is a syndrome of the interrelated components of disordered eating, amenorrhea, and osteoporosis. Sometimes inadvertently, but more often by willful dietary restriction, many female athletes do not ingest sufficient calories to adequately fuel their physical or sport activities, which can disrupt menstrual functioning,…

  16. Female intrasexual competition decreases female facial attractiveness.

    OpenAIRE

    Fisher, Maryanne L

    2004-01-01

    Evolutionary theory predicts that female intrasexual competition will occur when males of high genetic quality are considered to be a resource. It is probable that women compete in terms of attractiveness since this is one of the primary criteria used by men when selecting mates. Furthermore, because hormones influence the mate-selection process, they may also mediate competition. One competitive strategy that women use is derogation--any act intended to decrease a rival's perceived value. To...

  17. Female sexual dysfunction in female genital mutilation.

    Science.gov (United States)

    Elneil, Sohier

    2016-01-01

    Female genital mutilation (FGM), otherwise known as female genital cutting (FGC), is currently very topical and has become a significant global political issue. The impact of FGM on the lives of women and girls is enormous, as it often affects both their psychology and physical being. Among the complications that are often under-reported and not always acknowledged is female sexual dysfunction (FSD). FSD presents with a complex of symptoms including lack of libido, arousability and orgasm. This often occurs in tandem with chronic urogenital pain and anatomical disruption due to perineal scarring.To treat FSD in FGM each woman needs specifically directed holistic care, geared to her individual case. This may include psychological support, physiotherapy and, on occasion, reconstructive surgery. In many cases the situation is complicated by symptoms of chronic pelvic pain, which can make treatment increasingly difficult as this issue needs a defined multidisciplinary approach for its effective management in its own right. The problems suffered by women with FGM are wholly preventable, as the practice need not happen. The current global momentum to address the social, cultural, economic and medical issues of FGM is being supported by communities, governments, non-governmental agencies (NGOs) and healthcare providers. It is only by working together that the practice can be abolished and women and girls may be free from this practice and its associated consequences.

  18. Female sexual dysfunction in female genital mutilation.

    Science.gov (United States)

    Elneil, Sohier

    2016-01-01

    Female genital mutilation (FGM), otherwise known as female genital cutting (FGC), is currently very topical and has become a significant global political issue. The impact of FGM on the lives of women and girls is enormous, as it often affects both their psychology and physical being. Among the complications that are often under-reported and not always acknowledged is female sexual dysfunction (FSD). FSD presents with a complex of symptoms including lack of libido, arousability and orgasm. This often occurs in tandem with chronic urogenital pain and anatomical disruption due to perineal scarring.To treat FSD in FGM each woman needs specifically directed holistic care, geared to her individual case. This may include psychological support, physiotherapy and, on occasion, reconstructive surgery. In many cases the situation is complicated by symptoms of chronic pelvic pain, which can make treatment increasingly difficult as this issue needs a defined multidisciplinary approach for its effective management in its own right. The problems suffered by women with FGM are wholly preventable, as the practice need not happen. The current global momentum to address the social, cultural, economic and medical issues of FGM is being supported by communities, governments, non-governmental agencies (NGOs) and healthcare providers. It is only by working together that the practice can be abolished and women and girls may be free from this practice and its associated consequences. PMID:26759415

  19. Analysis on the safety of clinical applications of disposable circumcision suture device for circumcision%一次性包皮环切缝合器行包皮环切术的临床推广安全性分析

    Institute of Scientific and Technical Information of China (English)

    唐松喜; 周辉良; 何彦丰; 张兵; 曹林升; 罗义麒

    2015-01-01

    Objectives To explore the technique of disposable circumcision suture device for circumcision in order to improve the surgery quality and security.Methods One hundred and forty-five patients with long prepuce and phimosis underwent circumcision using disposable circumcision suture device.Patients were followed at day 1,and 7,14,21 and 1 month after the procedure.Complications such as bleeding,edema and outcones were assessed.Results All operation was performed using the new device successfully.Operation time was between 7 ~ 15 mins.35 patients were found mild hematoma during the surgery;19 patients with active? bleeding in the cutting edge and 11 with dehiscence of incisions needed to suture;17 patients acquired additional trimming with scissors or blade due to incompletely cutting-off;After operation,there were 57 cases black? ecchymosis,19 cases mild edema,3 cases disruption of wound,2 cases wound infection and 1 case massive hemorrhage in the penis.The remaining staples of 14 cases after one month were manually removed.All the incision healed well after one month,there was no persistent pain,local infection,ischemic necrosis of balanus.Conclusions In order to ensure the operation safety and quality,we must pay attention to some details,though the disposable circumcision suture device for circumcision is simple and easily performed.%目的 探讨一次性包皮环切缝合器行包皮环切术过程中的手术细节,提高临床推广的安全性.方法 对145例包皮过长和包茎的男性患者,应用一次性包皮环切缝合器进行包皮环切术,术后1、7、14、21d及1个月回访,观察出血、水肿等常见并发症并评估手术效果.结果 所有患者均完成手术,手术时间7 ~ 15min.术中切缘轻微血肿35例,切缘活动性出血需缝扎19例,切割不完全需补充剪除17例,切缘裂开需要缝合11例.术后阴茎头及系带处出现青黑色瘀斑57例,局部包皮轻微水肿19例,切口裂开3例,切口感染2例,

  20. “狼和”包皮环切吻合器与传统包皮环切术的临床疗效对比研究(附494例)%Comparative Study on Clinical Efficacy between Langhe Circumcision Suture Device and Conventional Circumcision:Analysis of 494 Cases

    Institute of Scientific and Technical Information of China (English)

    代晓飞; 崔亮; 张讯; 靖万林; 韩旭; 孙晓俊; 李景敏

    2016-01-01

    目的:分析比较应用"狼和"包皮环切吻合器与传统包皮环切术的临床疗效。方法依门诊单双日将包皮过长及包茎患者分为吻合器组(324例)和传统组(170例)。比较两组手术时间、术中出血量、术中疼痛评分、术后24h疼痛评分、切口愈合情况、满意度及并发症。结果手术均顺利完成。吻合器组和传统组的手术时间分别为(8.30±1.12)min和(23.21±3.43)min(<0.05);术中出血量分别为(1.05±0.60)ml和(5.62±3.21)ml(<0.05),术中疼痛评分分别为(1.10±0.45)分和(3.35±1.62)分(<0.05),术后24h疼痛评分分别为(2.31±0.74)分和(5.08±1.80)分(<0.05),切口愈合时间分别为(7.2±2.2)d和(9.1±1.8)d(<0.05),满意度分别为97.8%和91.2%(<0.05)并发症分别为1.5%和3.5%。结论"狼和"包皮吻合器是一项简便易行、安全有效、微创、满意度高的包皮环切手术方式,值得临床推广。%Objective To compare the clinical efficacy between Langhe circumcision suture device and conventional circumcision. Methods Patients with redundant prepuce and phimosis were divided into disposable circumcision suture device group (n=324) and conventional circumcision group (n=170) according to the odd or even of the hospitalizing time. We observed the surgical duration, blood loss, intraoperative pain score, postoperative 24h pain score, wound healing time, postoperative satisfaction and complications between the two groups. Results The surgical duration, blood loss, intraoperative pain score, postoperative 24h pain score, wound healing time, postoperative satisfaction and complications were (8.30±1.12)min, (1.05±0.60)ml, 1.10±0.45, 2.31±0.74,(7.2±2.2)d, 97.8% and 1.5% in the disposable circumcision suture device group as compare with (23.21±3.43)min, (5.62±3.21)ml, 3.35±1.62, 5.08±1.80, (9.1±1.8)d, 91.2% and 3.5% in the conventional group respectively

  1. 三种包皮环切术的临床比较与分析%Clinical Comparison of Three Ways of Male Circumcision

    Institute of Scientific and Technical Information of China (English)

    杜青山; 郑涛; 张帆; 祝强; 张旭

    2012-01-01

    Objective: To evaluate the clinical advantages of improved one clamp circumcision. Methods: There were 870 cases with the operation of circumcision in our hospital from December 2009 to March 2012, which categorized into 3 groups, unproved one clamp circumcision (n=470 group A), traditional one clamp circumcision (n=337 group B) and sleeve circumcision (n=63, group C). Indices including operation time, operative pain incidence, frenum injury rate, satisfaction rate of postoperative appearance and complications incidence of hematoma, edema, delay healing and stenosis of incision were compared and analyzed among 3 groups. Results: The operation time (min), the pain incidence in group A were significantly lower than group B and C (20.88± 4.96 vs 26.6± 6.48 vs 56.22± 7.09,5.5% vs 28.2% vs 100%, respectively. P<0.01), while the incidence of edema in group C was lower than the other 2 groups(1.6% vs 10.9% vs 14.8% P<0.01). The incidence of frenum injury, hematoma and stenosis in group A were lower than group B(0 vs 3.6% ,0.4% vs 5.9% ,0 vs 0.9% P<0.01). The satisfaction rate of postoperative appearance in group A was higher than the other 2 groups (98.1% vs 93.2% vs 95.2% P<0.01). There is no difference among the 3 groups in the incidence of delay healing of incision. Conclusions: An optimal choice of ways of male circumcision should be determined according to the individual characters of patients. The improved one clamp circumcision is clinical applicable as its advantages of wider indications, shorter operation time, safer frenum, better postoperative appearance in the most cases of redundant prepuce and phimosis.%目的:观察并评价改良后一钳式环切法临床应用优势.方法:回顾2009年12月至2012年3月间在我院实施的870例包皮环切术资料,对比分析改良一钳法(470例)、传统一钳法(337例)、袖套切除法(63例)三组术式在手术时间、术中疼痛发生率、系带损伤率、患者对外观满意率及并发症(血肿

  2. Ideal female brow aesthetics.

    Science.gov (United States)

    Griffin, Garrett R; Kim, Jennifer C

    2013-01-01

    The concept of the ideal female eyebrow has changed over time. Modern studies examining youthful brow aesthetics are reviewed. An analysis of ideal female brow characteristics as depicted in the Western print media between 1945 and 2011 was performed. This analysis provided objective evidence that the ideal youthful brow peak has migrated laterally over time to lie at the lateral canthus. There has been a nonstatistically significant trend toward lower and flatter brows. These findings are discussed in relation to current concepts of female brow aging, with repercussions regarding endoscopic brow lift and aesthetic forehead surgery.

  3. Willingness of Circumcision and Its Influencing Factors among General Population in Chongqing%重庆市男性包皮环切术接受意愿及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    文静; 唐晓君; 钟朝晖; 李君; 刘晨煜; 李革; 秦波

    2011-01-01

    目的了解包皮环切术在重庆市男性接受意愿及影响因素,为在该市推广包皮环切术提供依据.方法 采用多阶段分层随机抽样,对重庆市4个区(九龙坡区、渝中区、大渡口区、巴南区)共760人进行包皮环切术接受意愿性等问卷调查.结果 包皮环切术接受率为46.9%,不同年龄、文化程度和职业男性居民接受率比较差异有统计学意义(P<0.05).多因素非条件Logistic回归分析显示,包皮环切术是否增加未来性生活满意度[OR=1.419,95%CI(1.027,1.960)]、身边是否有亲戚朋友或者同学做过该手术[OR=1.686,95%CI(1.210,2.351)]、包茎或包皮过长易致阴茎癌[OR=1.555,95%CI(1.114,2.168)]、自己是否有包茎或包皮过长[OR=28.071,95%CI(14.829,53.138)]是包皮环切术接受意愿的主要影响因素.结论 包皮环切术的作用与该手术的接受意愿有一定的关系,特别是该手术对性功能方面的影响;其次,还应该加强关于包皮过长或包茎的危害及该手术适应证的宣传,增强男性居民对自身生殖健康的了解;在宣传该手术时,可以采用同伴教育的宣传方式进行.%Objective To explore the willingness of circumcision and its influencing factors among the general population in Chongqing. Methods A questionnaire - hased survey was conducted among 760 residents in 4 districts of Chongqing ( Jiulongpo District, Yuzhong District, Dadukou District, and Banan District ). Subjects were enrolled by multi - stage stratified random sampling. Results 46. 9% of the respondents were willing to receive circumcision, and this proportion was different among respondents at different ages and with different hackground ( education levels , jobs, and others ) ( P <0. 05 ) . The willingness of circumcision was mainly influenced by factors including concerns about whether the circumcision can mcrease future satisfaction to sexual life [ OR = 1. 419, 95% CI ( 1. 027, 1. 960 )], whether the respondents

  4. Qualitative study of male circumcision about HIV prevention among medical students in western China%我国西部地区医学大学生对包皮环切预防HIV的定性研究

    Institute of Scientific and Technical Information of China (English)

    石艺; 王倩; 唐晓君; 蒋俊俊; 邓伟; 杨晓波; 哈木拉提·吾甫尔; 秦波; 梁浩

    2013-01-01

    目的 比较广西、新疆和重庆3所医科大学的男性学生对包皮环切术作为HIV的一项干预措施的知、信、行信息,为相应宣传材料及推广模式的开发研究提供一些基础数据.方法 选择广西、新疆和重庆3地18岁及以上未做过包皮环切的医科大学学生各30人,进行40 min左右的结构式个人深入访谈.结果 在3个地区中,仅有12人知道包皮环切术可以“预防HIV感染”;约84% (76/90)的人认为“包茎或包皮过长者”是做包皮环切手术的主要原因;65%(58/90)的人能说出包皮环切相关知识.当知道包皮环切术预防HIV的流行病证据及生物学机制,并被告之可免费手术后,广西、新疆和重庆3省均有2/3的人明确愿意接受手术,并愿意作为顶层设计的志愿者参与课题研究.被访者对艾滋病相关知识有所了解,但缺乏对艾滋病的重视.结论 引导医学大学生在思想上真正重视艾滋病,普及包皮环切手术预防HIV的相关研究成果,将是包皮环切术在该人群中推广的关键.%OBJECTIVE To compare the cognition, attitude and behavior towards circumcision as an intervention for HIV prevention among medical students in Guangxi, Xinjiang and Chongqing medical university, and to provide based data for developing promotional materials and spreading models. METHODS 30 male medical students were recruited from Guangxi, Xinjiang and Chongqing each. Information about acceptability, cognition, attitude and behavior of male circumcision was collected by 40-minute face to face interview. RESULTS Only twelve men could correctly answered the effectiveness of circumcision for HIV prevention in these three cities. 84% (76/90) of the interviewees considered that circumcision is for the primary reason of phimosis or redundant prepuce, and 65% (58/90) of interviewees had certain knowledge of circumcision. After some epidemi-ological evidences and biological mechanisms of circumcision were

  5. 3种包皮环切术的临床疗效分析%Shang Ring, sleeve and conventional circumcisions for redundant prepuce and phimosis:A comparative study of 918 cases

    Institute of Scientific and Technical Information of China (English)

    王荣; 陈伟军; 史文华; 薛一峰

    2013-01-01

    Objective: To compare the clinical effects of conventional, sleeve and Shang Ring circumcisions in the treatment of redundant prepuce and phimosis. Methods: We reviewed the clinical data of 918 patients with redundant prepuce or phimosis, 279 treated by conventional circumcision, 354 by sleeve circumcision and 285 by Shang Ring circumcision. We documented the preopera-tive characteristics, intra-operative blood loss, operation time, 4-hour and 7-day postoperative visual analogue scores, surgeons'satisfaction , incision healing time, degrees of preputial edema, postoperative complications, patients' satisfaction with penile appearance and peri-operative cost, and compared them among the three groups. Results: Shang Ring circumcision significantly reduced the operation time and intra-operative blood loss as compared with conventional and sleeve circumcisions (P <0. 05). The postoperative incision healing time was (18.6 ±5.2) d in the conventional circumcision group, (11.4 ±3.7) din the sleeve circumcision group and (20.3±5.7) d in the Shang Ring circumcision group, significantly shorter in the sleeve group than in the other two ( P < 0.05). As for the surgeons'satisfaction, postoperative complications, degree of preputial edema and patients'satisfaction with penile appearance, sleeve circumcision showed similar effects to Shang Ring circumcision but significantly better than conventional circumcision ( P < 0.05). The 7-day postoperative visual analogue score and peri-operative cost were significantly lower in the conventional and sleeve cir-cumcision groups than in the Shang Ring group (P < 0.05). Conclusion: Each of the three circumcision methods has its own advantages and disadvantages. The treatment decision should be individualized and based on a comprehensive consideration of the patients' age and economic status as well as surgeons'advice and surgical skills.%目的:比较传统包皮环切术、袖套状包皮切除术和包皮环切吻合术治疗

  6. Implementation of adolescent-friendly voluntary medical male circumcision using a school based recruitment program in rural KwaZulu-Natal, South Africa.

    Directory of Open Access Journals (Sweden)

    Carl Montague

    Full Text Available BACKGROUND: Epidemiological data from South Africa demonstrate that risk of human immunodeficiency virus (HIV infection in males increases dramatically after adolescence. Targeting adolescent HIV-negative males may be an efficient and cost-effective means of maximising the established HIV prevention benefits of voluntary medical male circumcision (VMMC in high HIV prevalence-, low circumcision practice-settings. This study assessed the feasibility of recruiting male high school students for VMMC in such a setting in rural KwaZulu-Natal. METHODS AND FINDINGS: Following community and key stakeholder consultations on the acceptability of VMMC recruitment through schools, information and awareness raising sessions were held in 42 high schools in Vulindlela. A three-phase VMMC demand-creation strategy was implemented in partnership with a local non-governmental organization, ZimnadiZonke, that involved: (i community consultation and engagement; (ii in-school VMMC awareness sessions and centralized HIV counselling and testing (HCT service access; and (iii peer recruitment and decentralized HCT service access. Transport was provided for volunteers to the Centre for the AIDS Programme of Research in South Africa (CAPRISA clinic where the forceps-guided VMMC procedure was performed on consenting HIV-negative males. HIV infected volunteers were referred to further care either at the CAPRISA clinic or at public sector clinics. Between March 2011 and February 2013, a total of 5165 circumcisions were performed, the majority (71% in males aged between 15 and 19 years. Demand-creation strategies were associated with an over five-fold increase in VMMC uptake from an average of 58 procedures/month in initial community engagement phases, to an average of 308 procedures/month on initiation of the peer recruitment-decentralized service phase. Post-operative adverse events were rare (1.2%, mostly minor and self-resolving. CONCLUSIONS: Optimizing a high volume

  7. Study on Perioperative Care of Patients Treated With Circumcision Surgery%包皮手术患者的围手术期护理探析

    Institute of Scientific and Technical Information of China (English)

    马美艳

    2015-01-01

    Objective To explore perioperative care of patients treated with circumcision surgery.MethodsSelected 45 patients treated with circumcision surgery who are received and treated in hospital from November 2013 to December 2014 and divide them into two groups according to hospitalization sequence with 24 patients in study group and 21 patients in control group, patients in study group were given perioperative care, while patients in control group were given conventional care intervention, and then care effects of two groups was compared.ResultsPatients’ satisfaction rate, treatment efficacy and complication incidence in study group were much better than counterparts in control group, there is a differential between these two groups, and such a differential has statistic value (P<0.05). Conclusionperioperative care is of significance for patients treated with circumcision surgery, which is conducive to improving patients’ satisfaction with treatment, to increasing treatment efficacy and to decrease complication incidence.%目的:探讨包皮手术患者的围手术期护理探析。方法选取2013年11月~2014年12月我院接诊的45例包皮手术患者,按照入院的先后顺序分为24例实验组和21例对照组,实验组给予围手术期护理,对照组采用常规护理干预,观察两组患者的护理效果。结果实验组患者的护理满意度、治疗总有效率及并发症的发生率明显优于对照组,P<0.05,差异有统计学意义。结论包皮手术患者采用围手术期护理的效果显著,可以有效提高患者的满意度,提高治疗效果,降低并发症的发生率。

  8. Plasticbell Circumcision for 800 Children with Phimosis%小儿包皮环切术套环法800例体会

    Institute of Scientific and Technical Information of China (English)

    王传学

    2014-01-01

    Objective To evaluate the experience of plastibell circumcision for the treatment of phimosis in children .Methods A ret-rospectively study was carried out for 800 cases with phimosis in children undergone plastibell circumcision in recent 10 years.Results The effect was satisfying in all of the patients.The shedding time of plastibell was 7 to 20 days.The surgical complications included hemor-rhage in four , inflammation of foreskin in eight , not shed of plastibell in five , laceration of foreskin in three , plastibell insetting into coro-nary sulcus in four , and urinary retention in two.Conclusion The plastibell circumcision was a good alterative for phimosis in children with short operation time, little bleeding amount, small trauma, less complications, less pain and convenient nursing.%目的:总结包皮环切术套环法治疗小儿包皮过长的经验。方法对2003~2013年来我院行包皮环切术套环法治疗小儿包皮过长的800例患儿行回顾性分析。结果800例行小儿包皮环切术套环法患儿术后效果良好。套环脱落时间为7~20d,脱落后切缘整齐,外形美观。26例出现不同程度的并发症。其中,术后出血4例;包皮感染、红肿8例;套环不脱落5例;包皮撕裂3例;包皮环嵌入冠状沟4例;尿潴留2例。结论小儿包皮环切术套环法具有手术时间短,手术出血少,创伤小,并发症少,患儿痛苦小,术后护理方便等优点,手术简单易于推广。

  9. PrePex Male Circumcision: Follow-Up and Outcomes during the First Two Years of Implementation at the Rwanda Military Hospital.

    Directory of Open Access Journals (Sweden)

    Albert Ndagijimana

    Full Text Available PrePex Male Circumcision (MC has been demonstrated as an effective and scalable strategy to prevent HIV infection in low- and middle-income countries. This study describes the follow-up and outcomes of clients who underwent PrePex MC between January 2011 and December 2012 with weekly follow-up at the Rwanda Military Hospital, the first national hospital in Rwanda to adopt PrePex.Data on 570 clients age 21 to 54 were extracted from patient records. We compared socio-demographic and clinical characteristics, the operator's qualification, HIV status, pain before and after device removal, urological status, device size and follow-up time between clients who were formally discharged and those who defaulted. We reported bivariate associations between each covariate and discharge status, number of people with adverse events by discharge status, and time to formal discharge or defaulting using life table methods. Data were entered into Epidata and analyzed with Stata v 13.Among study participants, 96.5% were circumcised by non-physician operators, 85.4%were under 30 years, 98.9% were HIV-negative and 97.9% were without any urological problems that could delay the healing time. Most (70.7% defaulted before formal discharge. Pain before (p<0.001 and after PrePex device removal (p = 0.001 were associated with discharge status, although very few cases were reported, and pain was more commonly missing among defaulters. Twenty-seven adverse events were reported (7 formally discharged, 20 defaulters. Median follow-up time was seven weeks among formally discharged and six weeks among defaulters (p<0.001.Given that all socio-demographic and most clinical characteristics were not associated with defaulting, we hypothesize that clients stopped returning once they determined they were healed. We recommend less frequent follow-up protocols to encourage clinical visits until formal discharge. Based on these results and recommendations, we believe PrePex MC is a

  10. Female pattern baldness

    Science.gov (United States)

    ... Administration (FDA) to treat female pattern baldness is minoxidil: It is applied to the scalp. For women, the 2% solution or 5% foam is recommended. Minoxidil may help hair grow in about 1 in ...

  11. Fertility Preservation for Female

    Institute of Scientific and Technical Information of China (English)

    Jack Huang; Seang Lin Tan; Ri-Cheng Chian

    2006-01-01

    Preservation of female fertility is an important issue today. However, there are few effective clinical options for preserving female fertility. Firstly, conventional in vitro fertilization (IVF) followed by embryo cryopreservation is an accepted procedure but is not applicable to all women. Embryo freezing is suitable only for women with a male partner and may not be acceptable to some patients due to moral and religious reasons. Ovarian tissue freezing is another option of female fertility preservation but is an invasive procedure and the efficacy of this technique remains to be determined.Oocyte cryopreservation is also method for fertility preservation. Egg freezing is minimally invasive and can avoid the ethical and moral concerns related to cryopreservation of embryos. However, conventional slow freezing/rapid thawing methods are associated with low survival of oocytes. Recent development in vitrification of oocytes appears promising. Therefore, vitrification of unfertilized eggs may be a novel method to preserve female fertility.

  12. Self catheterization - female

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000144.htm Self catheterization - female To use the sharing features on ... incontinence - vaginal sling procedures Patient Instructions Kegel exercises - self-care Multiple sclerosis - discharge Stroke - discharge Urinary catheters - ...

  13. Postadolescent acne in females.

    Science.gov (United States)

    Holzmann, R; Shakery, K

    2014-01-01

    Acne in the adult female often presents as a chronic condition that can have a considerable negative psychological, social and emotional impact on the affected individual. Estimated prevalence rates of adult female acne vary widely according to study type. Case reports and clinical examinations estimate the prevalence of clinical acne at 10-12%, while survey estimates of physiological disease states are as high as 54%. Two subtypes of adult female acne may be defined according to time of onset: 'persistent' and 'late-onset', accounting for approximately 80 and 20% of cases, respectively. Postadolescent acne is generally mild-to-moderate in severity and presents with more inflammatory lesions and fewer comedones compared to adolescent acne. Furthermore, the impact of acne on the quality of life is often greater in adult females than in younger individuals. Despite these important differences, the key principles of acne treatment in the adult female do not differ significantly from those of other age groups. However, specific characteristics relating to the adult female should be considered when selecting a treatment regimen. PMID:24280643

  14. 阴茎中部无针麻醉袖套式包皮环切治疗包皮过长%Mid-Penis Sleeve Circumcision with Needle-Free Jet Anaesthesia for the treatment of patients with redundant prepuce

    Institute of Scientific and Technical Information of China (English)

    张伟; 申岩; 杨文增; 穆银静; 崔振宇

    2011-01-01

    Objectives To investigate mid-penis sleeve circumcision with needle-free jet anaesthesia for the treatment of patients with redundant prepuce and observe the therapeutic effect.Methods Methods outpatient circumcision 80 cases with DPNB(dorsal of penis nerve blocked)anaesthesia were randomly divided into two groups,group A(40 cases)was underwent mid-penis sleeve circumcision with needle-free jet anaesthesia,group B(40cases)was done dorsal slit circumcision with traditional DPNB,to study the difference in Anaesthetic Volume,the time of take effect,visual analogue scale(VAS),bleeding voluroue,the condition of foreskin hydropsia,operative incision healing.appearance satisfication percentage.Results Group A has statistical difference to Group B in all ahove mentioned index.Conclusions Mid-penis sleeve circumcision with needle-free jet anaesthesia has many advantages over the dorsal slit circumcision with traditional DPNB,deserving generally clinical application.%目的 探讨阴攀中部无针麻醉袖套式包皮环切治疗包皮过长的效果.方法 选择包皮过长患者105例,随机分成A,B两组,A组40例,行阴茎中部无针麻醉袖套式包皮环切术,8组40例行传统阻滞麻醉及背侧切开环切术.对两组在麻醉剂量、起效时间、视觉模拟麻醉疼痛评分、出血量、水肿、切口愈合、外观满意度等方面进行比较.结果两组所有对比项目在两组之间的差异均有统计学意义.结论 阴茎中部无针麻醉袖套式包皮切除治疗包皮过长比传统阻滞麻醉及背侧切开环切术更具有优越性,值得临床推广.

  15. Prevalence and associated factors of behavioral intention for risk compensation following voluntary medical male circumcision among male sexually transmitted diseases patients in China.

    Science.gov (United States)

    Wang, Zixin; Feng, Tiejian; Lau, Joseph T F

    2016-10-01

    Risk compensation was an important concern of voluntary medical male circumcision (VMMC) promotion campaigns. No study investigated risk compensation following VMMC among male sexually transmitted diseases patients (MSTDP). A cross-sectional survey interviewed 308 uncircumcised MSTDP in Shenzhen, China. 26.9% of them intended to perform at least one of the five types of risk compensation behaviors following VMMC. In the summary stepwise model, provision of incorrect response to HIV/sexually transmitted diseases knowledge items (multivariate odds ratios (ORm) = 2.30), genital herpes infection (ORm = 3.19), Risk Reduction Score for Unprotected Sex, and Negative Condom Attitudes Scale (ORm = 1.13) were significantly associated with behavioral intention to perform at least one type of risk compensation behavior following VMMC. The results provided a framework for developing related interventions. Prevention of risk compensation should be an essential component of VMMC promotion for all MSTDP, irrespective of their intention for VMMC.

  16. Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review

    Science.gov (United States)

    Van Lith, Lynn M.; Mallalieu, Elizabeth C.; Waxman, Aliza; Hatzhold, Karin; Marcell, Arik V.; Kasedde, Susan; Lija, Gissenge; Hasen, Nina; Ncube, Gertrude; Samuelson, Julia L.; Bonnecwe, Collen; Seifert-Ahanda, Kim; Njeuhmeli, Emmanuel; Tobian, Aaron A. R.

    2016-01-01

    Background Voluntary medical male circumcision (VMMC) is a critical HIV prevention tool. Since 2007, sub-Saharan African countries with the highest prevalence of HIV have been mobilizing resources to make VMMC available. While implementers initially targeted adult men, demand has been highest for boys under age 18. It is important to understand how male adolescents can best be served by quality VMMC services. Methods and Findings A systematic literature review was performed to synthesize the evidence on best practices in adolescent health service delivery specific to males in sub-Saharan Africa. PubMed, Scopus, and JSTOR databases were searched for literature published between January 1990 and March 2014. The review revealed a general absence of health services addressing the specific needs of male adolescents, resulting in knowledge gaps that could diminish the benefits of VMMC programming for this population. Articles focused specifically on VMMC contained little information on the adolescent subgroup. The review revealed barriers to and gaps in sexual and reproductive health and VMMC service provision to adolescents, including structural factors, imposed feelings of shame, endorsement of traditional gender roles, negative interactions with providers, violations of privacy, fear of pain associated with the VMMC procedure, and a desire for elements of traditional non-medical circumcision methods to be integrated into medical procedures. Factors linked to effective adolescent-focused services included the engagement of parents and the community, an adolescent-friendly service environment, and VMMC counseling messages sufficiently understood by young males. Conclusions VMMC presents an opportune time for early involvement of male adolescents in HIV prevention and sexual and reproductive health programming. However, more research is needed to determine how to align VMMC services with the unique needs of this population. PMID:26938639

  17. Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review.

    Directory of Open Access Journals (Sweden)

    Michelle R Kaufman

    Full Text Available Voluntary medical male circumcision (VMMC is a critical HIV prevention tool. Since 2007, sub-Saharan African countries with the highest prevalence of HIV have been mobilizing resources to make VMMC available. While implementers initially targeted adult men, demand has been highest for boys under age 18. It is important to understand how male adolescents can best be served by quality VMMC services.A systematic literature review was performed to synthesize the evidence on best practices in adolescent health service delivery specific to males in sub-Saharan Africa. PubMed, Scopus, and JSTOR databases were searched for literature published between January 1990 and March 2014. The review revealed a general absence of health services addressing the specific needs of male adolescents, resulting in knowledge gaps that could diminish the benefits of VMMC programming for this population. Articles focused specifically on VMMC contained little information on the adolescent subgroup. The review revealed barriers to and gaps in sexual and reproductive health and VMMC service provision to adolescents, including structural factors, imposed feelings of shame, endorsement of traditional gender roles, negative interactions with providers, violations of privacy, fear of pain associated with the VMMC procedure, and a desire for elements of traditional non-medical circumcision methods to be integrated into medical procedures. Factors linked to effective adolescent-focused services included the engagement of parents and the community, an adolescent-friendly service environment, and VMMC counseling messages sufficiently understood by young males.VMMC presents an opportune time for early involvement of male adolescents in HIV prevention and sexual and reproductive health programming. However, more research is needed to determine how to align VMMC services with the unique needs of this population.

  18. Implications of the fast-evolving scale-up of adult voluntary medical male circumcision for quality of services in South Africa.

    Directory of Open Access Journals (Sweden)

    Dino Rech

    Full Text Available BACKGROUND: The scale-up of voluntary medical male circumcision (VMMC services in South Africa has been rapid, in an attempt to achieve the national government target of 4.3 million adult male circumcisions for HIV prevention by 2016. This study assesses the effect of the scale-up on the quality of the VMMC program. METHODS AND FINDINGS: This analysis compares the quality of services at 15 sites operational in 2011 to (1 the same 15 sites in 2012 and (2 to a set of 40 sites representing the expanded program in 2012. Trained clinicians scored each site on 29 items measuring readiness to provide quality services (abbreviated version of the WHO Quality Assessment [QA] Guide and 29 items to assess quality of surgical care provided (pre-op, surgical technique and post-op based on the observation of VMMC procedures at each site. Declines in quality far outnumbered improvements. The negative effects in terms of readiness to provide quality services were most evident in expanded sites, whereas the declines in provision of quality services tended to affect both repeat sites and expanded sites equally. Areas of notable concern included the monitoring of adverse events, external supervision, post-operative counselling, and some infection control issues. Scores on quality of surgical technique tended to be among the highest across the 58 items observed, and the South Africa program has clearly institutionalized three "best practices" for surgical efficiency. CONCLUSIONS: These findings demonstrate the challenges of rapidly developing large numbers of new VMMC sites with the necessary equipment, supplies, and protocols. The scale-up in South Africa has diluted human resources, with negative effects for both the original sites and the expanded program.

  19. Female physicist doctoral experiences

    Science.gov (United States)

    Dabney, Katherine P.; Tai, Robert H.

    2013-06-01

    The underrepresentation of women in physics doctorate programs and in tenured academic positions indicates a need to evaluate what may influence their career choice and persistence. This qualitative paper examines eleven females in physics doctoral programs and professional science positions in order to provide a more thorough understanding of why and how women make career choices based on aspects both inside and outside of school and their subsequent interaction. Results indicate that female physicists experience conflict in achieving balance within their graduate school experiences and personal lives and that this then influences their view of their future careers and possible career choices. Female physicists report both early and long-term support outside of school by family, and later departmental support, as being essential to their persistence within the field. A greater focus on informal and out-of-school science activities for females, especially those that involve family members, early in life may help influence their entrance into a physics career later in life. Departmental support, through advisers, mentors, peers, and women’s support groups, with a focus on work-life balance can help females to complete graduate school and persist into an academic career.

  20. Promoting the female condom.

    Science.gov (United States)

    Cornman, H

    1997-01-01

    AIDS is spreading most rapidly among women, who often cannot negotiate the use of a male condom with reluctant partners. Recent findings from 6 countries, however, indicate that women can draw upon peer support to help them negotiate female condom use with reluctant partners. These findings come from Family Health International's (FHI) AIDS Control and Prevention (AIDSCAP) Project's introduction of the female condom to women through peer support groups in Kenya and Brazil, and the Joint UN Program on HIV/AIDS' (UNAIDS) coordinated studies in Costa Rica, Indonesia, Mexico, and Senegal on sexual negotiation, women's empowerment, and the female condom, also using group education sessions. The US Agency for International Development recently committed $100,000 toward the purchase of 150,000 female condoms for operations research and familiarization in countries where officials have not been exposed to the method. More than 130 participants from 19 countries attended FHI's May 1-2, 1997, conference on the female condom convened in Arlington, Virginia. PMID:12292734

  1. Circuncisão masculina e infecção pelo HIV: uma polêmica mundial sem voz brasileira Male circumcision and HIV infection: an international debate with no Brazilian participation

    Directory of Open Access Journals (Sweden)

    Euclides Ayres de Castilho

    2004-02-01

    Full Text Available Os autores trazem para reflexão a questão da circuncisão masculina como fator de proteção para infecção pelo HIV. Em breve histórico da abordagem do problema, na literatura mundial, identificam a ausência de pesquisas brasileiras sobre o tema. Por fim, problematizam a situação, lembrando que circuncisão masculina autodeclarada é passível de erros de classificação de relevante magnitude, implicando, por isso, vícios nas estimativas de riscos.The authors discuss male circumcision as a protective factor against HIV transmission. The absence is noted of Brazilian data published in the international literature regarding this issue. Finally, it is emphasized that self-declared circumcision status is subject to substantial misclassification with the generation of biased risk estimates.

  2. Female athlete triad update.

    Science.gov (United States)

    Beals, Katherine A; Meyer, Nanna L

    2007-01-01

    The passage of Title IX legislation in 1972 provided enormous opportunities for women to reap the benefits of sports participation. For most female athletes, sports participation is a positive experience, providing improved physical fitness, enhanced self-esteem, and better physical and mental health. Nonetheless, for a few female athletes, the desire for athletic success combined with the pressure to achieve a prescribed body weight may lead to the development of a triad of medical disorders including disordered eating, menstrual dysfunction, and low bone mineral density (BMD)--known collectively as the female athlete triad. Alone or in combination, the disorders of the triad can have a negative impact on health and impair athletic performance.

  3. Effect comprasion of QuillTM device for modified sleeve circumcision with subcutaneous suture and traditional circumcision%双向倒刺自缝线无瘢痕包皮环切术与传统包皮环切术的效果比较

    Institute of Scientific and Technical Information of China (English)

    黄珍林; 顾朝辉; 贾占奎; 丁映辉; 丁亚飞; 金志波; 杨锦建

    2016-01-01

    目的 探讨双向倒刺自缝线无瘢痕包皮环切术治疗包茎及包皮过长的的临床应用价值.方法 选取246例包茎及包皮过长患者作为研究对象,将其随机分为无瘢痕包皮环切术治疗组129例(A组)和传统包皮环切术治疗组117例(B组),比较两组患者的手术时间、术中出血量、术后愈合时间、术后并发症及满意度等指标.结果 A组手术时间及术中出血量与B组比较差异无统计学意义(P>0.05),术后并发症发生率为4.1%,明显低于B组的16.4%,满意度为97.6%明显高于B组的78.4%,术后愈合时间为(7±3)d,明显低于B组的(12±2)d,差异均有统计学意义(P<0.05).结论 无瘢痕包皮环切术能明显减少术后并发症,缩短术后愈合时间,提高满意度.%Objective To discuss the safety and feasibility of treatment for male circumcision using modified sleeve circumcision with subcutaneous suture.Methods Following the randomized controlled experiment method,246 patients were randomly divided into two groups:group A (modified sleeve circumcision with subcutaneous suture) and group B (traditional circumcision).The operative time,the intraoperative blood loss,the postoperative complications and degree of satisfaction were analyzed and compared between the two groups.Results There was no statistically significant difference in operative time,and intraoperative blood loss between groups A and B.The rate of postoperative complications in groups A and B was 4.1% and 16.4%;the satisfaction rate was 97.6% and 78.4%;mean healing time was (7 ± 3) days and (12 ± 2) days,respectively.The differences were all statistically significant (P<0.05).Conclusion QuillTM device for modified sleeve circumcision with subcutaneous suture can reduce rate of postoperative complications and healing time,increase the rate of satisfaction,and is worthy of clinical use.

  4. Female hair restoration.

    Science.gov (United States)

    Unger, Robin H

    2013-08-01

    Female hair loss is a devastating issue for women that has only relatively recently been publicly acknowledged as a significant problem. Hair transplant surgery is extremely successful in correcting the most cosmetically problematic areas of alopecia. This article discusses the surgical technique of hair transplantation in women in detail, including pearls to reduce postoperative sequelae and planning strategies to ensure a high degree of patient satisfaction. A brief overview of some of the medical treatments found to be helpful in slowing or reversing female pattern hair loss is included, addressing the available hormonal and topical treatments. PMID:24017982

  5. 包皮环切结合吻合器的应用治疗包皮过长%Effects of the operation of foreskin treated with circumcision anastomat

    Institute of Scientific and Technical Information of China (English)

    徐渊; 江岳方; 吴斌

    2011-01-01

    目的:探讨使用一次性包皮环切吻合器治疗包茎、包皮过长的临床应用效果。方法:随机将220例包茎、包皮过长患者分成一次性包皮环切吻合器(A组,112)与常规包皮环切(B组,108)两组,比较其优缺点及疗效。结果:A组比B组的手术时间短、出血少、术后不需拆线、术后感染率低、术后创缘整齐,外形美观。结论:应用一次性包皮环切吻合器行包皮环切术,手术简单,并发症少,患者痛苦小,易推广。%Objective To evaluate the curative effects of the operation of foreskin treated with circumcision anastomat. Methods 220 cases of foreskin patients were randomised to Group A (112 cases) treated with foreskin circumcision anastomat and Group B (108 cases) treated with traditional circumcision. Efficacy and advantages were compared. Results The operating time and intraoperative blood loss were significantly shorter and lower in the Group A compared to Group B. Post-operative complications including infection and appearance between two groups were significantly difference. Conclusion The study shows that the circumcision anastomat is a safe, simple and efficient method with fewer complications. The method is more superior than traditional operation.

  6. Curative effect observation of chitin medical wound paste for postoperative incision healing of circumcision%甲壳质医用创面贴对包皮环切术后切口愈合的疗效观察

    Institute of Scientific and Technical Information of China (English)

    邓敏

    2014-01-01

    目的:观察甲壳质医用创面贴用于包皮环切术后对切口愈合的疗效。方法120例包皮环切患者随机分为两组,观察组于包皮环切后用甲壳质医用创面贴贴敷切口;对照组术后采用常规纱布敷料包扎处理伤口。结果观察组切口愈合情况明显优于对照组(P<0.05),术后并发症的发生明显降低(P<0.05)。结论包皮环切后应用甲壳质医用创面贴安全有效,具有良好的促进切口愈合、减少切口水肿及预防感染和瘢痕发生的治疗效果,值得推广。%Objective To observe the curative efficacy of chitin medical wound paste for incision healing of after circumcision. Methods A total of 120 patients received circumcision were randomly divided into 2 groups. The observation group was treated with Chitin medical wound paste after circumcision, and the control group was treated with conventional gauze wound dressing. Results Compared with control group, wound healing was markedly better in the observation group (P<0.05), and the incidence of postoperative complications decreased significantly (P<0.05). Conclusion Application of chitin medical wound paste after circumcision is safe and effective, which has a good promotion of incision healing, prevention of edema and infection and incision scar. Therefore it is worthy of clinical application.

  7. Sequential Cross-Sectional Surveys in Orange Farm, a Township of South Africa, Revealed a Constant Low Voluntary Medical Male Circumcision Uptake among Adults despite Demand Creation Campaigns and High Acceptability

    Science.gov (United States)

    Marshall, Esaie; Rain-Taljaard, Reathe; Tsepe, Motlalepule; Monkwe, Cornelius; Hlatswayo, Florence; Tshabalala, Simphiwe; Khela, Simphiwe; Xulu, Lindo; Xaba, Dumazile; Molomo, Tebogo; Malinga, Thobile; Puren, Adrian; Auvert, Bertran

    2016-01-01

    Background WHO recommends a male circumcision (MC) prevalence rate higher than 80% to have a substantial impact on the HIV-AIDS epidemic in Eastern and Southern Africa. Orange Farm, a township in South Africa, has a free-for-service voluntary medical male circumcision (VMMC) clinic in operation since 2008. Following an intense campaign from 2008 to 2010, MC prevalence rate increased to 55.4% (ANRS-12126). Ongoing and past VMMC campaigns focused on youths, through school talks, and adults at a community level. The main objective of the study was to assess the change in MC prevalence rate among adults aged 18–19 and 18–49 years in the past 5 years. Methods A cross-sectional survey (ANRS-12285) was conducted among a random sample of 522 adult men in 2015. MC status and characteristics of participants were collected through a genital examination and a face-to-face questionnaire. Results MC prevalence rate among young adult men aged 18–19 years increased markedly from 61.2% (95%CI: 57.4% to 65.0%) in 2010 to 87.5% (76.0% to 94.6%) in 2015 (pcircumcised. However, we estimated that only 4.6% (11/237; 2.5% to 7.9%) of the uncircumcised men underwent circumcision in 2015, despite 117/185 (63.2%; 95%CI: 56.1% to 69.9%) who reported that they were definitely willing to become circumcised. Conclusions In Orange Farm, VMMC campaigns were successful among the youth and led to a sufficiently high MC prevalence rate to have a substantial impact in the future on the HIV-AIDS epidemic. However, despite high acceptability and a free VMMC service, VMMC campaigns since 2010 have failed to increase MC prevalence rate among adults to above 80%. These campaigns should be revisited. PMID:27427957

  8. STUDY ON METHODS OF HEALTH EDUCATION FOR MALE CIRCUMCISION AMONG DRUG ADDICTS IN CHONGQING%重庆市美沙酮服药者包皮环切术健康教育方式研究

    Institute of Scientific and Technical Information of China (English)

    李凌竹; 窦贵旺; 秦波; 何有志; 王婷; 李革

    2011-01-01

    Objective :To discuss methods of health education for male circumcision among drug addicts in Chongqing, provide basis for disseminating the education widely among the population and increase the rate of circumcision to prevent AIDS. Methods: We selected from three clinics 437 male drug addicts who had not undergone circumcision and were willing to participant in the research as the study subjects. Subjects in three clinics received the health education with three different methods; general education,special Ⅰ education and special Ⅱ education . Questionnaire survey was conducted for the willingness of circumcision before and after health education to see the changes in the willingness for accepting circumcision and their favorite methods receiving health education. Factors influencing willingness of circumcision was studied with Logistic multiple regression analysis. Results: Except occupation, indicators of the general demographic characteristics of the subjects from different clinics with different methods of health education showed no significant difference ( P < 0. 05 ). According to the result of Logistic multiple regression analysis, redundant prepuce and having no idea of the complications was the factors influencing willingness of accepting circumcision. Fundamental information of AIDS was the most favorite content the subjects were interested in,then the relationship between circumcision and AIDS prevention and the basic knowledge of circumcision. Almost half (48% ) of the subjects preferred to paper documentation as the method of receiving health education. The difference of willingness to accept circumcision before and after the education was statistically significant ( P < 0. 05 ) in subjects received any education method. However, the special Ⅰ and special Ⅱ had better effects. Conclusion: Health education on circumcision is effective, and the effects of special Ⅰ and Ⅱ are sound. Medical practitioners can choose different methods to

  9. Female Genital Mutilation

    Science.gov (United States)

    ... problems (depression, anxiety, post-traumatic stress disorder, low self-esteem, etc.). Health complications of female genital mutilation Who is at risk? Procedures are mostly carried out on young girls sometime between infancy and adolescence, and occasionally on adult women. More than 3 ...

  10. Perspectives on Female Entrepreneurs

    DEFF Research Database (Denmark)

    Kuada, John Ernest; Janulevièienë, Rûta

    2003-01-01

    The aim of this paper is to compare the contents of the academic evidence and debate on female entrepreneurship in the West with the current stream of research and thinking in the Central and Eastern European Countries with a view to identifying similarities and differences in thoughts and findin...

  11. Rehabilitation of Female Prisoners

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    CHINESE women imprisoned for various crimes undergo a reeducation and rehabilitation program which often results in repentance for past wrongdoings, and providing an avenue for them to make a fresh start. Female prisoners study general education courses, learn basic legal concepts and working skills as part of a rehabilitation program that helps reintigrate them into society upon release.

  12. Perceptual Characteristics of Female Voices.

    Science.gov (United States)

    Batstone, Susan; Tuomi, Seppo K.

    1981-01-01

    Male and females listeners rated 21 young female voices on seven scales representing unique vocal features. Voices were described as "passive", or traditionally female, and "active," characterized as "lively,""colorful," and "sexy." Females found active characteristics more salient; males preferred the passive characteristics. Implications for…

  13. Female Genital Cutting: shattering the debate yet still violating human rights

    Directory of Open Access Journals (Sweden)

    Celine Jacquemin

    2010-04-01

    Full Text Available

    Summary: The international fight against the various forms of female circumcision, or the mutilation of the genitals of women and children, has many different aspects. Although no religious text from any religion suggests the practice, still in many countries the torture of young girls and women continue. Even though there is an assumption that the phenomenon is exclusive to the developing world, many practices in the West, such as vaginal and vulvar surgeries, as well as changes to the face and body of women can be included in the same tendency to portray women as impure, incomplete, and in need of improvement so that she can be accepted by prospective husbands.

  14. Intention toward the continuation of female genital mutilation in Bale Zone, Ethiopia

    Directory of Open Access Journals (Sweden)

    Bogale D

    2015-01-01

    Full Text Available Daniel Bogale,1 Desalegn Markos,2 Muhammedawel Kaso1 1Department of Public Health, 2Department of Nursing, College of Medicine and Health Sciences, Madawalabu University, Bale Goba, Ethiopia Background: Female genital mutilation (FGM is a harmful traditional practice that is deeply rooted in Africa. It is associated with health complications and human rights violations. Research on intention for the continuation of FGM and the social determinants underpinning this practice are scarce. Therefore, this study intended to assess the intention of women toward the continuation of FGM among Bale Zone reproductive-age women.Methods: A community-based cross-sectional study design supplemented by qualitative methods was conducted in 2014. A total of 634 reproductive-age women were involved in the quantitative part of the study. The respondents were drawn from five randomly selected districts of Bale Zone. The total sample was allocated proportionally to each district based on the number of reproductive-age women it has. Purposive sampling method was used for qualitative study. Then, data were collected using a pretested and structured questionnaire. The collected data were analyzed by Statistical Package for Social Sciences for Windows version 16.0. Multiple logistic regressions were carried out to examine the existence of a relationship between intentions for the continuation of FGM and selected determinant factors.Results: This study revealed that 26.7% of the respondents had intention for the continuation of FGM. Religion, safeguarding virginity, tradition, and social values were the major reasons for the perpetuation of this practice. Circumcised respondents and those who were not able to read and write were ~3 (adjusted odds ratio = 2.89, 95% confidence interval = [1.33, 6.20] and 7.58 (adjusted odds ratio = 7.58, 95% confidence interval = [3.47, 16.54] times more likely intending the continuation of FGM than uncircumcised and those who

  15. Effect of compound prescription cortex phellodendri chinensis fluid on postoperative wound anastomosis nail loss in patients with circumcision by disposable circumcision suture device%复方黄柏液在一次性包皮切割缝合器术后脱钉的应用

    Institute of Scientific and Technical Information of China (English)

    刘磊; 景治安; 刘彦军; 李纪华; 冯占启; 胡和平

    2015-01-01

    Objective To discuss cause and treatment measures of the postoperative failed to fully automatic nail in patients with circumcision by disposable circumcision suture device, so as to improve the quality of the circumcision.Methods 182 cases received circumcision by disposable circumcision suture device were randomly selected from September 2014 to March 2015 in the hospital and divided into control group ( n =86 ) and treatment group (n=96).All the patients received oral antibiotics for three days conventionally.Patients in control group were dressing with 0.1%iodine after treatment, dressing change every two or three days, while the treatment group soaking with 30 mL to 40 mL compound prescription cortex phellodendri chinensis fluid for 15 min two times per day.The postoperative wound anastomosis nail loss effect in two groups were compared.Results The time of complete nail loss in patients soaking with compound prescription cortex phellodendri chinensis fluid was significantly shorter than that in patients dressing with 0.1% iodine (P<0.05), but there was no significantly difference of the first time to lose nail between two groups.The rate of complete nail loss in treatment group was 94 cases (97.9%), which was significantly higher than 68 cases (79.1%) in control group (χ2 =16.47,P<0.05). The adverse reactions were mild of two groups.Conclusion The compound prescription cortex phellodendri chinensis fluid has exact effect on postoperative wound anastomosis nail loss and recovery in patients’ with circumcision by disposable circumcision suture device.%目的:探讨一次性包皮环切缝合器行包皮环切手术不能完全脱钉的原因和应对方法,进一步提高包皮环切手术的质量。方法收集2014年9月~2015年3月于郑州市第一人民医院使用一次性包皮环切缝合器行包皮环切手术182例,随机分为对照组(n=86)和治疗组(n=96)。所有患者均常规给予口服抗生素3 d

  16. Crossing borders: discussing the evidence relating to the mental health needs of women exposed to female genital mutilation.

    Science.gov (United States)

    Mulongo, Peggy; McAndrew, Sue; Hollins Martin, Caroline

    2014-08-01

    The terms 'Female Circumcision' (FC), 'FG Cutting' (FGC) and 'FG Mutilation' (FGM) refer to procedures involving the partial or total removal of the external female genitalia for non-medical reasons. In practicing countries, FGC/FC is more widely used, as it is believed to be inoffensive, providing more impartial ways of discussing the practice. Positive beliefs about FC/FGC include virginity, marriage prospects, family reputation, or passage to adulthood. Regardless of terminology, the practice exists in at least 28 African counties, and a few Asian and Middle Eastern countries. In Western society, FGM is considered a breach of human rights, being outlawed in a number of countries. With immigration trends, FGC is now prominent in Western society among practicing communities. While the past decade has seen an increase in studies and recommendations for health-care support related to the physical health consequences of FGM, little is known about the psychological impact and its management. For many girls and women, FGC is a traumatic practice, transforming it to FGM and affecting their mental health. This discussion paper focuses on evidence relating to the mental health consequences of FGM, therapeutic interventions, and the mental health nurse's role in addressing the needs of this group of women. PMID:24548699

  17. Sequential Cross-Sectional Surveys in Orange Farm, a Township of South Africa, Revealed a Constant Low Voluntary Medical Male Circumcision Uptake among Adults despite Demand Creation Campaigns and High Acceptability

    Science.gov (United States)

    Marshall, Esaie; Rain-Taljaard, Reathe; Tsepe, Motlalepule; Monkwe, Cornelius; Hlatswayo, Florence; Tshabalala, Simphiwe; Khela, Simphiwe; Xulu, Lindo; Xaba, Dumazile; Molomo, Tebogo; Malinga, Thobile; Puren, Adrian; Auvert, Bertran

    2016-01-01

    Background WHO recommends a male circumcision (MC) prevalence rate higher than 80% to have a substantial impact on the HIV-AIDS epidemic in Eastern and Southern Africa. Orange Farm, a township in South Africa, has a free-for-service voluntary medical male circumcision (VMMC) clinic in operation since 2008. Following an intense campaign from 2008 to 2010, MC prevalence rate increased to 55.4% (ANRS-12126). Ongoing and past VMMC campaigns focused on youths, through school talks, and adults at a community level. The main objective of the study was to assess the change in MC prevalence rate among adults aged 18–19 and 18–49 years in the past 5 years. Methods A cross-sectional survey (ANRS-12285) was conducted among a random sample of 522 adult men in 2015. MC status and characteristics of participants were collected through a genital examination and a face-to-face questionnaire. Results MC prevalence rate among young adult men aged 18–19 years increased markedly from 61.2% (95%CI: 57.4% to 65.0%) in 2010 to 87.5% (76.0% to 94.6%) in 2015 (p<0.001). In the same period, among men aged 18–49 years, MC prevalence rate varied slightly from 55.4% (53.6% to 57.1%) to 56.7% (52.4% to 60.9%). In 2015, 84.9% (79.2% to 89.5%) of uncircumcised adult men reported that they were willing to be circumcised. However, we estimated that only 4.6% (11/237; 2.5% to 7.9%) of the uncircumcised men underwent circumcision in 2015, despite 117/185 (63.2%; 95%CI: 56.1% to 69.9%) who reported that they were definitely willing to become circumcised. Conclusions In Orange Farm, VMMC campaigns were successful among the youth and led to a sufficiently high MC prevalence rate to have a substantial impact in the future on the HIV-AIDS epidemic. However, despite high acceptability and a free VMMC service, VMMC campaigns since 2010 have failed to increase MC prevalence rate among adults to above 80%. These campaigns should be revisited. PMID:27427957

  18. 青年男性接受包皮环切术的影响因素研究及认知情况分析%The influence factors of young men who accept circumcision research and cognitive analysis

    Institute of Scientific and Technical Information of China (English)

    罗津; 曾春明; 李羽佳; 谢皓空

    2014-01-01

    Objective Analysis and research on young men knowledge of circumcision, and the influence factors of circumcision. Methods 100 circumcised and 100 uncircumcised young men were recruited into this research. A questionnaire designed by ourselves is adopted. Results The principal reason give by circumcised men is to improve penile hygiene (79%),and followed reasons are to help improve sexual function and suggestion for doctor (30%and 28%). For uncircumcised men,the main reasons are not knowing the exact medical benefits (37%), and being anxious about post-operative pain and post-operative complications (30% and 21%). Conclusion It is necessary to strengthened the propaganda and instruction of prepuce and circumcision knowledge in young crowd.%目的:分析青年男性对包皮及包皮环切术知识的掌握程度以及接受包皮环切术的影响因素。方法选取我院泌尿外科门诊已行和未行包皮环切术的青年男性各100名,采用自行设计的问卷进行调查。结果已行包皮环切术的男性接受该手术的原因依次为:使阴茎更卫生、期望提高性功能和医生的建议,分别占79%,30%,28%;未行包皮环切术的主要原因是不清楚包皮环切术的益处、担心术后疼痛和术后并发症,分别占37%,30%和21%。结论有必要加强青年人群包皮及包皮环切术相关知识的宣教工作。

  19. Evaluating the cost of adult voluntary medical male circumcision in a mixed (surgical and PrePex site compared to a hypothetical PrePex-only site in South Africa

    Directory of Open Access Journals (Sweden)

    Hae-Young Kim

    2015-12-01

    Full Text Available Background: Several circumcision devices have been evaluated for a safe and simplified male circumcision among adults. The PrePex device was prequalified for voluntary male medical circumcision (VMMC in May 2013 by the World Health Organization and is expected to simplify the procedure safely while reducing cost. South Africa is scaling up VMMC. Objective: To evaluate the overall unit cost of VMMC at a mixed site vs. a hypothetical PrePex-only site in South Africa. Design: We evaluated the overall unit cost of VMMC at a mixed site where PrePex VMMC procedure was added to routine forceps-guided scalpel-based VMMC in Soweto, South Africa. We abstracted costs and then modeled these costs for a hypothetical PrePex-only site, at which 9,600 PrePex circumcisions per year could be done. We examined cost drivers and modeled costs, varying the price of the PrePex device. The healthcare system perspective was used. Results: In both sites, the main contributors of cost were personnel and consumables. If 10% of all VMMC were by PrePex at the mixed site, the overall costs of the surgical method and PrePex were similar – US$59.62 and $59.53, respectively. At the hypothetical PrePex-only site, the unit cost was US$51.10 with PrePex circumcisions having markedly lower personnel and biohazardous waste management costs. In sensitivity analysis with the cost of PrePex kit reduced to US$10 and $2, the cost of VMMC was further reduced. Conclusions: Adding PrePex to an existing site did not necessarily reduce the overall costs of VMMC. However, starting a new PrePex-only site is feasible and may significantly reduce the overall cost by lowering both personnel and capital costs, thus being cost-effective in the long term. Achieving a lower cost for PrePex will be an important contributor to the scale-up of VMMC.

  20. Hormones and female sexuality

    OpenAIRE

    Bjelica Artur L.; Kapamadžija Aleksandra; Maticki-Sekulić Milana

    2003-01-01

    Introduction In contrast to animal species in which linear relationships exist between hormonal status and sexual behaviour sexuality in human population is not determined so simply by the level of sexual steroids. The article analyses female sexuality in the light of hormonal status. Administration of sexual steroids during pregnancy and sexual differentiation High doses of gestagens, especially those with high androgen activity, widely used against miscarriages may lead to tomboys, but with...

  1. FEMALE ENTREPRENEURSHIP IN AFGHANISTAN

    OpenAIRE

    MAGNUS HOLMÉN; THAW TAR MIN; EMILIA SAARELAINEN

    2011-01-01

    This paper analyzes the motivations of eight female Afghan entrepreneurs to start up their own business and the problems they encountered during start-up and operations. Income generation was the most important push factor but pull factors including desire for independence and autonomy were also important. However, in contrast to studies in other countries, the desire for achievement was not emphasized. An unexpected finding was the emphasis on the desire to help non-family members by running...

  2. Wllingness to accept circumcision and its influence factors among floating population%流动人口包皮环切接受意愿及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    李君; 钟朝晖; 唐晓君; 文静; 刘晨煜; 李革; 奏波

    2011-01-01

    目的 了解重庆市流动人口包皮环切手术的接受意愿及其影响因素.方法采用随机整群抽样方法抽取750名流动人口,自行设计调查问卷对其进行调查.结果750名调查对象中,有41.07%愿意接受包皮环切手术;年龄为22 ~ 29岁(P=0.02)、文化程度为大专及其以上(P<0.001)的人群较其他人群更愿意接受手术;回归分析结果表明,流动人口包皮环切接受意愿的主要影响因素为:是否知晓包皮过长或包茎可以引起尿道感染( OR=7.949,95% CI= 1.297~48.729)、是否知晓手术的并发症(OR =0.111,95% CI=o.022~0.575)、自己是否有包皮过长或包茎(OR =4 826.936,95% CI= 590.718~3 942 860)、最近1个月是否发生过性行为(OR= 72.02,95% CI= 5.428~955.570).结论包皮环切术在重庆地区流动人口中的接受意愿较高,而实际环切率较低,主要原因是对相关知识的认知不够.%Objective To study the wllingness to accept circumcision and its influence factors among floating population in Chongqing city. Methods Totally 750 floating males selected with random cluster sampling were surveyed with a self-administered questionnaire. Results There were 41. 07% of the floating persons likely to accept the circumcision. Persons aged 22-29 years(P= 0.02) and with the education level of college or higher(P =0.000) were more likely to accept circumcision. Regression analysis showed the influence factors of accepting circumcision were the knowledge of wrapping grow or phimosis inducing urinary tract infection(odds ratio[ OR] = 7. 949,95% confidence interval[ CI] : 1. 297 -48.729), knowledge of surgical complications of circumcision ( OR = 0. 111,95% C/:0. 022 - 0. 575 ); knowledge of wrapping grow or phimosis( OR =4826. 936,95%CI:590. 718 -3 942 860) ,and having sexual behaviour during previous month (OR = 72.02,95 % CI: 5.428 - 955. 570). Conclusion There is a high acceptance rate of circumcision among floating male population

  3. Evaluation of progress with using community conversation as a strategy to encourage district level abandonment of female genital mutilation and/or cutting in 10 districts in Ethiopia

    Directory of Open Access Journals (Sweden)

    Ellen Alem

    2013-09-01

    Full Text Available Background: Female genital mutilation and/or cutting (FGM/C, whilst widespread, is declining in Ethiopia; 81% of 45–49-year-old women were circumcised in a 2005 survey, and 62%of 15–19-year-olds.Objectives: This evaluation examined progress in abandoning FGM/C in ten woredas(districts where strategy based on the social convention theory had led to official declarations of abandonment and assessed if the strategy could accelerate the declining trend of the FGM/C practice in Ethiopia.Method: Quantitative and qualitative instruments collected data from a document review, a household survey (1275 households, in-depth and key informant interviews and focus group discussions.Results: Overall, there were encouraging results in terms of awareness creation and behavioural change to some extent. Sixty-nine percent of women and 41% of girls interviewed perceived a decline in the practice (range 40% – 90% after the declaration. Seventy-six percent of women said they would not circumcise girls in the future. The involvement of influential people such as religious leaders, elders, health extension workers, and law enforcement officials in the teaching contributed immensely to the awareness creation. However, some districts reports indicated the practice had gone underground. The costs of facilitating the strategy varied from USD 3 to 7 per person, with better results where costs were higher. The abandonment events tended to costaround 25% of total costs, an area where cost efficiency can be improved.Conclusion: The evaluation has informed the dialogue around the development of the country’s first national budgeted strategy that aims to accelerate the abandonment of all harmful traditionalpractices.

  4. Female-female aggression and female mate choice on black grouse leks.

    Science.gov (United States)

    Karvonen; Rintamäki; Alatalo

    2000-05-01

    We studied female-female aggression in relation to female mate choice in black grouse, Tetrao tetrix, in central Finland, in 1994-1998. Aggression occurred on average every other minute when there was more than one female on a territory, and aggressive behaviour was most prominent when several females attended the lek. Interactions tended to be proportionally most frequent on the territories of the highest-ranking males, although not significantly so. Females that were chased by other females did not mate with lower-ranking males than their aggressors did. Furthermore, chased females were only rarely (6% of cases) forced to move off the territory by agonistic interactions and copulations were disrupted by other females even less often (3% of cases). The choice of a mating territory did not depend on the outcome of aggression even though the aggressors were more likely to mate on the territory where aggression occurred than elsewhere. There was a marginally significant tendency for aggressors to mate earlier in the season. Females placed themselves further away from other females on the territory when soliciting a copulation than just before aggression. Our results suggest that aggression between females does not effectively constrain female choice in black grouse. Its function may be to aid females to secure undisturbed mating opportunities for themselves rather than to prevent others from mating with a particular male. Copyright 2000 The Association for the Study of Animal Behaviour.

  5. 我国西部地区外来务工者对包皮环切预防HIV认知和行为的定性研究%Qualitative study on circumcision cognition and practice for HIV prevention among immigrant workers in western China

    Institute of Scientific and Technical Information of China (English)

    石艺; 梁浩; 陈坚; 王蕾; 王倩; 蒋俊俊; 秦波; 哈木拉提·吾甫尔; 柳智豪; 杨晓波

    2012-01-01

    Objective To compare the cognition, attitude and behavior towards circumcision as an intervention for HIV prevention among immigrant workers in the west of China, and provide theoretical basis for developing intervention materials and models. Methods 30 immigrant workers in each region were recruited from Guangxi, Chongqing, and Xinjiang. Information about acceptability, cognition, attitude and behavior of male circumcision were collected by face to face interview for about 40 minutes. Results Only 8 men could correctly answer the effectiveness of circumcision for HIV prevention in all three areas. The most interviewees (21/30) from Guangxi and Chongqing considered that circumcision was just for phimosis or redundant prepuce, and some interviewees (12/30) from Xinjiang had certain knowledge of circumcision. After an introduction on circumcision, half of the interviewees expressed their willingness to take a free charge circumcision surgery. Having the problem of phimosis or redundant prepuce, considering circumcision is benefit for reproductive health or sex life, positive attitude on circumcision were associated with an improved acceptability of circumcision. The interviewees were lack of correct knowledge and attitude towards AIDS, and unsafe sexual behaviors were more popular among them. Conclusion Insufficient knowledge about AIDS and circumcision appeared to be one of the major obstacles against the popularization of circumcision surgery.%目的 了解我国西部外来务工者对包皮环切术作为HIV预防措施的认知和行为情况,为相关宣传材料开发及模式推广研究提供理论数据.方法 选择广西壮族自治区、重庆市和新疆维吾尔族自治区18岁及以上未做过包皮环切的男性外来务工者各30人,进行个人深入访谈.结果 3个地区中,仅有8人知道包皮环切术可以预防HIV感染.广西壮族自治区和重庆大多数被访者(21/30)认为包茎或包皮过长者才有必要行包皮环切术

  6. The Applicability of Behaviour Change in Intervention Programmes Targeted at Ending Female Genital Mutilation in the EU: Integrating Social Cognitive and Community Level Approaches.

    Science.gov (United States)

    Brown, Katherine; Beecham, David; Barrett, Hazel

    2013-01-01

    With increased migration, female genital mutilation (FGM) also referred to as female circumcision or female genital cutting is no longer restricted to Africa, the Middle East, and Asia. The European Parliament estimates that up to half a million women living in the EU have been subjected to FGM, with a further 180,000 at risk. Aware of the limited success of campaigns addressing FGM, the World Health Organization recommended a behavioural change approach be implemented in order to end FGM. To date, however, little progress has been made in adopting a behaviour change approach in strategies aimed at ending FGM. Based on research undertaken as part of the EU's Daphne III programme, which researched FGM intervention programmes linked to African communities in the EU (REPLACE), this paper argues that behaviour change has not been implemented due to a lack of understanding relating to the application of the two broad categories of behaviour change approach: individualistic decision-theoretic and community-change game-theoretic approaches, and how they may be integrated to aid our understanding and the development of future intervention strategies. We therefore discuss how these can be integrated and implemented using community-based participatory action research methods with affected communities. PMID:23983698

  7. The Applicability of Behaviour Change in Intervention Programmes Targeted at Ending Female Genital Mutilation in the EU: Integrating Social Cognitive and Community Level Approaches

    Directory of Open Access Journals (Sweden)

    Katherine Brown

    2013-01-01

    Full Text Available With increased migration, female genital mutilation (FGM also referred to as female circumcision or female genital cutting is no longer restricted to Africa, the Middle East, and Asia. The European Parliament estimates that up to half a million women living in the EU have been subjected to FGM, with a further 180,000 at risk. Aware of the limited success of campaigns addressing FGM, the World Health Organization recommended a behavioural change approach be implemented in order to end FGM. To date, however, little progress has been made in adopting a behaviour change approach in strategies aimed at ending FGM. Based on research undertaken as part of the EU’s Daphne III programme, which researched FGM intervention programmes linked to African communities in the EU (REPLACE, this paper argues that behaviour change has not been implemented due to a lack of understanding relating to the application of the two broad categories of behaviour change approach: individualistic decision-theoretic and community-change game-theoretic approaches, and how they may be integrated to aid our understanding and the development of future intervention strategies. We therefore discuss how these can be integrated and implemented using community-based participatory action research methods with affected communities.

  8. The young female athlete.

    Science.gov (United States)

    Hurvitz, Michal; Weiss, Ram

    2009-12-01

    Participation of adolescents and young women in strenuous sports activity may lead to various metabolic and psychological derangements of clinical relevance to the endocrinologist. The most common manifestations encountered in practice are primary and secondary amenorrhea, reduced bone mineral density and eating disorders. The occurrence of all three together has been named "the athletic triad". The underlying hormonal drivers that lead to some of these manifestations are the reduced leptin level as well as the persistent low grade stress response commonly observed in such females. "Exercise-related female reproductive dysfunction" (ERFRD), can possibly include short-term (infertility) and long-term (osteoporosis) consequences. Functional hypothalamic amenorrhea, a manifestation of ERFRD in adolescence, is an integrated response to the combination of excessive physical and emotional stress, exercise, and/or reduced food intake characterized by decreased endogenous GNRH secretion. The primary aim of treating these athletes should be the prevention of the development of any component of the triad as well as the whole complex by educating athletes, trainers, parents and health care professionals about proper nutrition and safe training. The long term prognosis is good. However, significant long term morbidity may affect these young women later in life. PMID:20118893

  9. Prevalence and associated factors of behavioral intention for risk compensation following voluntary medical male circumcision among male sexually transmitted diseases patients in China.

    Science.gov (United States)

    Wang, Zixin; Feng, Tiejian; Lau, Joseph T F

    2016-10-01

    Risk compensation was an important concern of voluntary medical male circumcision (VMMC) promotion campaigns. No study investigated risk compensation following VMMC among male sexually transmitted diseases patients (MSTDP). A cross-sectional survey interviewed 308 uncircumcised MSTDP in Shenzhen, China. 26.9% of them intended to perform at least one of the five types of risk compensation behaviors following VMMC. In the summary stepwise model, provision of incorrect response to HIV/sexually transmitted diseases knowledge items (multivariate odds ratios (ORm) = 2.30), genital herpes infection (ORm = 3.19), Risk Reduction Score for Unprotected Sex, and Negative Condom Attitudes Scale (ORm = 1.13) were significantly associated with behavioral intention to perform at least one type of risk compensation behavior following VMMC. The results provided a framework for developing related interventions. Prevention of risk compensation should be an essential component of VMMC promotion for all MSTDP, irrespective of their intention for VMMC. PMID:27120407

  10. Voluntary medical male circumcision: matching demand and supply with quality and efficiency in a high-volume campaign in Iringa Region, Tanzania.

    Directory of Open Access Journals (Sweden)

    Hally R Mahler

    2011-11-01

    Full Text Available The government of Tanzania has adopted voluntary medical male circumcision (VMMC as an important component of its national HIV prevention strategy and is scaling up VMMC in eight regions nationwide, with the goal of reaching 2.8 million uncircumcised men by 2015. In a 2010 campaign lasting six weeks, five health facilities in Tanzania's Iringa Region performed 10,352 VMMCs, which exceeded the campaign's target by 72%, with an adverse event (AE rate of 1%. HIV testing was almost universal during the campaign. Through the adoption of approaches designed to improve clinical efficiency-including the use of the forceps-guided surgical method, the use of multiple beds in an assembly line by surgical teams, and task shifting and task sharing-the campaign matched the supply of VMMC services with demand. Community mobilization and bringing client preparation tasks (such as counseling, testing, and client scheduling out of the facility and into the community helped to generate demand. This case study suggests that a campaign approach can be used to provide high-volume quality VMMC services without compromising client safety, and provides a model for matching supply and demand for VMMC services in other settings.

  11. Scientific Advice, Traditional Practices and the Politics of Health-Care : The Australian Debate over Public Funding of Non-Therapeutic Circumcision, 1985

    Directory of Open Access Journals (Sweden)

    Robert Darby

    2011-12-01

    Full Text Available In 1985 the Australian Government sought to delete circumcision of infants from the benefits payable under its newly established universal health scheme, Medicare. Although the decision had been recommended by the government's health advisers and was welcomed by medical authorities, it was soon reversed after protests from Jewish community leaders. I present a detailed narrative of this affair and explain why a decision based on sound medical knowledge advice was rescinded after quite mild objections. The answer is found to lie partly in contingent factors, such as the details of the policy change, the personalities of the government figures involved, and problems with implementation and communication; and partly in the sensibilities of the ethnic/religious communities most directly affected. I dispel the misconception that the original decision aroused widespread opposition and show, on the contrary, that it was based on good advice, represented sound public policy, and was widely supported. I conclude that the episode may have useful lessons for other governments seeking to implement or resist policy changes that affect the sensitivities of cultural minorities.

  12. Circumcision Complications Associated with the Plastibell Device and Conventional Dissection Surgery: A Trial of 586 Infants of Ages up to 12 Months

    Directory of Open Access Journals (Sweden)

    Seyed Abdollah Mousavi

    2008-01-01

    Full Text Available Conventional dissection surgery (CDS or using the Plastibell device (PD is the method most frequently employed for circumcision. The aim of this study was to evaluate two methods in terms of the incidence of complications in infants of ages up to 12 months. In a prospective study, 586 infants equal to or less than 12 months were studied from 2002 to 2008, and complications between the two groups were assessed. The overall rates of complications in CDS and PD groups were 1.95% and 7.08%, respectively. In each group, the rate of complications was not different among children who had a normal weight, compared to those of a lower or upper (10% weight. There was a significant positive correlation between the age and weight of subjects within the time of ring separation (<.001. The results of this study suggest the PD method for neonates and low-weight infants with thin prepuce and the CDS for other infants.

  13. Male circumcision for protection against HIV infection in sub-Saharan Africa: the evidence in favour justifies the implementation now in progress.

    Science.gov (United States)

    Wamai, Richard G; Morris, Brian J; Bailey, Robert C; Klausner, Jeffrey D; Boedicker, Mackenzie N

    2015-01-01

    This article responds to a recent 'controversy study' in Global Public Health by de Camargo et al. directed at three randomised controlled trials (RCTs) of male circumcision (MC) for HIV prevention. These trials were conducted in three countries in sub-Saharan Africa (SSA) and published in 2005 and 2007. The RCTs confirmed observational data that had accumulated over the preceding two decades showing that MC reduces by 60% the risk of HIV infection in heterosexual men. Based on the RCT results, MC was adopted by global and national HIV policy-makers as an additional intervention for HIV prevention. Voluntary medical MC (VMMC) is now being implemented in 14 SSA countries. Thus referring to MC for HIV prevention as 'debate' and viewing MC through a lens of controversy seems mistaken. In their criticism, de Camargo et al. misrepresent and misinterpret current science supporting MC for HIV prevention, omit previous denunciations of arguments similar to theirs, and ignore evidence from ongoing scientific research. Here we point out the flaws in three areas de Camargo et al. find contentious. In doing so, we direct readers to growing evidence of MC as an efficacious, safe, acceptable, relatively low-cost one-off biomedical intervention for HIV prevention.

  14. Female Bladder Outlet Obstruction.

    Science.gov (United States)

    Hoffman, Daniel S; Nitti, Victor W

    2016-04-01

    The non-specific symptoms the patients express upon the presentation of female bladder outlet obstruction make it a challenge to diagnose. There are subtle differences between the obstructed patient and those whose bladders are underactive and/or fail to mount a detrusor contraction. These disparities can be extracted through a thorough history and examination. At times, the clinician may utilize nomograms, non-invasive uroflow, and urodynamics with the addition of fluoroscopy to establish the diagnosis of obstruction. Management of the obstruction depends on the nature of the condition, whether functional or anatomical. The increase in the number of sling procedures performed to treat stress urinary incontinence has resulted in a rise in the number of iatrogenic obstructions. The temporal relationship between surgery and obstruction is the key to identifying the problem. PMID:26902625

  15. Female Sexual Arousal Disorders

    DEFF Research Database (Denmark)

    Giraldi, Annamaria; Rellini, Alessandra H; Pfaus, James;

    2012-01-01

    Introduction.  Definitions and terminology for female sexual arousal disorder (FSAD) are currently being debated. While some authors have suggested that FSAD is more a subjective response rather than a genital response, others have suggested that desire and arousal disorders should be combined in...... psychological disorders, as well as to discuss different medical and psychological assessment and treatment modalities. Methods.  The experts of the International Society for Sexual Medicine's Standard Committee convened to provide a survey using relevant databases, journal articles, and own clinical experience...... comorbid with other sexual problems and are of biopsychosocial etiology. In the assessment, a thorough sexological history as well as medical and gynecological history and examination are recommended. Treatment should be based on of the symptoms, clinical findings and, if possibly, on underlying etiology...

  16. Hormones and female sexuality

    Directory of Open Access Journals (Sweden)

    Bjelica Artur L.

    2003-01-01

    Full Text Available Introduction In contrast to animal species in which linear relationships exist between hormonal status and sexual behaviour sexuality in human population is not determined so simply by the level of sexual steroids. The article analyses female sexuality in the light of hormonal status. Administration of sexual steroids during pregnancy and sexual differentiation High doses of gestagens, especially those with high androgen activity, widely used against miscarriages may lead to tomboys, but without differences in sexual orientation. However, it has been observed that the frequency of bisexual and lesbian women is higher in women with congenital adrenogenital syndrome. Hormones sexual desire and sexuality during menstrual cycle It has been established that sexual desire, autoeroticism and sexual fantasies in women depend on androgen levels. There are a lot of reports claiming that sexual desire varies during the menstrual cycle. Hormonal contraception and sexuality Most patients using birth control pills present with decreased libido. But, there are reports that progestagens with antiandrogenic effect in contraceptive pills do not affect sexual desire. Hormonal changes in peri- and postmenopausal period and sexuality Decreased levels of estrogen and testosterone in older women are associated with decreased libido, sensitivity and erotic stimuli. Sexuality and hormone replacement therapy Hormonal therapy with estrogen is efficient in reference to genital atrophy, but not to sexual desire. Really increased libido is achieved using androgens. Also, therapy with dehydroepiandrosterone (DHEA and tibolone have positive effects on female libido. Conclusion Effect of sexual steroids on sexual sphere of women is very complex. The association between hormones and sexuality is multidimensional, as several hormones are important in regulation of sexual behaviour. Still, it should be pointed out that sexuality is in the domain of hormonal, emotional

  17. The Effect of Circumcision on Infection of High-risk Human Papilloma Virus in Adult Males%包皮环切术对男性高危型HPV感染的预防作用研究

    Institute of Scientific and Technical Information of China (English)

    方卫; 孙杰明; 甘伟胜; 陈俭; 陈武强; 肖艺

    2013-01-01

      目的探讨包皮环切术对男性高危型HPV感染的预防作用。方法收集我院2001年6月至2010年6月十年间普外门诊行包皮环切术的患者临床资料276例,另取我院体检中心体检的包皮过长而未行包皮环切术的健康男性276例作为对照。HPV-DNA分型基因芯片检测高危型HPV病毒的表达。结果552例受试者中共检测到高危型HPV感染157例,感染率为28.4%。治疗前治疗组感染80例,感染率为29.0%;对照组感染77例,感染率为27.9%,两组之间无显著性差异(P>0.05)。包皮环切术后2年,治疗组高危型HPV感染率从29.0%减少到11.9%,二者之间具有显著性差异(P<0.05)。对照组为29.3%,与治疗前无显著性改变(P>0.05)。结论包皮环切术可以预防男性高危型HPV的感染,值得积极推广应用。%Objective To investigate the clinical effects of circumcision on infection of high-risk human papilloma virus(HPV) in adult males. Methods A total of 276 adult males with circumcision were collected and analyzed in our hospital. Another 276 phimosis without circumcision were recruited in the control group. The high-risk HPV was detected by HPV-DNA genotyping chip. Results 157 cases were infected by high-risk HPV in 552 phimosis, and the infection rate was 28.4%. Before circumcision, 80 cases were infected by high-risk HPV with an infection rate of 29.0%in treatment group, and 77 cases were infected by high-risk HPV with an infection rate of 27.9%in control group. There was no significant difference between the two groups(P>0.05). After circumcision, the infection rate of high-risk HPV was significantly decreased from 29.0%to 11.9%in treatment group (P0.05). Conclusion Circumcision can effectively reduce high-risk HPV infection, and which was worthy to promote the clinical application.

  18. 包皮环切术对减少男性高危型人乳头瘤病毒感染的作用研究%Effect of circumcision in reducing high-risk human papilloma virus infection

    Institute of Scientific and Technical Information of China (English)

    董文; 廖蓓; 黄海; 姚友生; 黄健

    2011-01-01

    目的 了解包皮环切术在减少成年男性高危型人乳头瘤病毒(HPV)感染中的作用.方法 通过对128例已婚成年男性包皮环切术前及术后2年尿道分泌物高危型HPV的检测,观察手术前后高危型HPV感染率的变化,并同期选择128例包皮过长而未行包皮环切术的已婚成年男性为对照组,比较2组高危型HPV感染率的差异.结果 2组患者入组时高危型HPV的感染率相当,具有可比性.其中包皮环切术组术前高危型HPV的感染率为27.3%,术后2年复测高危型HPV的感染率降为12.5%,差异有统计学意义(x2=8.839,P=0.005);对照组第1次检测高危型HPV的感染率为28.1%,2年后再次检测时感染率为25.0%,二者比较差异无统计学意义(x2=0.350,P=0.671).结论 包皮环切术能够明显降低成年男性高危型HPV的感染率,在我国积极推广包皮环切术对预防高危型HPV感染相关疾病的发生可能具有重要作用.%Objective To understand the effect of circumcision in reducing high-risk human papilloma virus (HPV) infection in male adults. Methods One hundred and twenty-eight married adults with phimosis who underwent circumcision enrolled in the case group and high-risk HPV of urethral discharge specimens were detected before and 2 years after operation. A total of 128 cases of phimosis without circumcision were recruited in the control group. High-risk HPV infection rates were compared between the two groups. Results The highrisk HPV infection rates in the two groups were comparable at baseline. In the circumcision group, high-risk HPV infection rate was 27. 3% preoperative and it significantly decreased to 12.5% two years after operation( x2 =8. 839 ,P =0. 005). In the control group,high risk HPV infection rate was 28. 1% at baseline and it was 25.0%two years later, with no significant difference (x2 =0.320,P = 0.671).Conclusion Circumcision can significantly reduce high-risk HPV infection. Promoting circumcision actively in our

  19. 非穆斯林男性吸毒者包皮环切术接受意愿调查%Willingness to take circumcision among non-Muslim male drug users

    Institute of Scientific and Technical Information of China (English)

    黄永迪; 巴哈古丽·阿尔斯郎; 许瑞玮; 严卫丽; 哈木拉提·吾甫尔; 杨蕾; 王倩; 王琛琛; 翟啸虎; 严恺; 樊于生; 阿依丁·西热牙孜旦; 哈木拉提·吐送

    2013-01-01

    目的 了解非穆斯林男性吸毒者对包皮环切术的接受意愿及其影响因素.方法 采用横断面调查研究,于2010年1-11月对新疆乌鲁木齐市350名非穆斯林男性吸毒者进行问卷调查.结果 350名非穆斯林男性吸毒人员中,55.1% (193/350)有意愿接受包皮环切术,其中74.6% (144/193)完全是出于个人意愿,其次是医生的建议、周围朋友的影响、配偶或女友的支持和父母的安排,分别占15.5% (30/193)、13.0% (25/193)、11.9% (23/193)和8.8%(17/193);有44.8%(157/350)不愿意接受,其中,87.9%(138/157)认为没有必要、不影响健康;不愿意选择该手术的人有93.0%(146/157)完全是出于个人意愿;多因素logistic回归分析结果显示,身边有亲戚朋友或者同学做过该手术(OR=2.071,95% CI=1.043 ~4.110)和感觉自己包茎或包皮过长(OR=9.355,95%CI=4.607 ~ 18.993)与包皮环切术的接受意愿相关.结论 该人群中大部分人有意愿接受包皮环切术,但其预防艾滋病的相关知识了解不够.%Objective To examine the willingness, knowledge, and attitude to male circumcision and factors affecting the willingness among non-Muslim male drug users in Xinjiang Uygur Autonomous Region. Methods A cross-sectional questionnaire survey was conducted from January to October 2010 in Urumqi. Results Among 350 representative samples of non-Muslim male drug users,55. 1% (193) reported the willingness to take circumcision. The main reasons for the willingness were to improve genital hygiene,to prevent penile cancer,and to treat foreskin or phimosis. Multivari-ate analyses indicated that those with family member or friends circumcised(odds ratio[ OR] = 2. 071,95% confidence intervale [95 %CI]:1. 043 -4. 110) and self-judgement of redundant prepuce or phimosis(OR =9. 355,95% CI: 4. 607 -18. 993) were more likely to take circumcision. Conclusion More than half of non-Muslim male drug users are absolutely willing to take

  20. 含肾上腺素的肿胀麻醉技术在袖套式包皮环切术中的应用%Application of tumescent anesthesia with adrenaline for sleeve circumcision

    Institute of Scientific and Technical Information of China (English)

    施问国; 牟北平; 郑玉林; 李罡; 高炎

    2011-01-01

    目的:探讨含肾上腺素的肿胀麻醉技术在袖套式包皮环切术中的安全性和有效性.方法:应用含肾上腺素30μg、利多卡因60mg共6ml肿胀液行肿胀麻醉,对170例受术者实施袖套式包皮环切术.结果:所有受术者麻醉满意,麻醉维持4~7h.术中皮下小动脉、小静脉痉挛,切断的小血管断端无流血,术后无反应性出血,皮肤无坏死,切口一期愈合.结论:袖套式包皮环切术时含肾上腺素30μg的肿胀麻醉方法是一种安全,简单和有效的麻醉方法.%Objective To explore the safety and efficacy of tumescent anesthesia with adrenaline for sleeve circumcision. Methods 170 cases of sleeve circumcision were performed under 6ml of tumescent anesthesia solution containing adrenaline 30μg and lidocaine 60mg. Results Satisfactory anesthesia results were obtained in all cases.Intraoperative subcutaneous arterioles and venules are in spasm and cut without bloodshed. Incisions were all healed in one stage with no infection, no delayed haemorrage and no adrenaline-induced skin necrosis. Conclusions The tumescent anesthesia with adrenaline 30μg is safe, simple and effective for sleeve circumcision.

  1. 全程护理干预在小儿包皮环切术中应用效果的研究%Application Effect of Whole Nursing Intervention to Pediatric Circumcision

    Institute of Scientific and Technical Information of China (English)

    孙海春; 傅晓玲; 董兴敏

    2015-01-01

    Objective To study the application effect of whole nursing intervention to pediatric circumcision. Methods 100 cases with pediatric circumcision were selected and equally divided into the control group and the observation group with 50 cases in each. The control group were given the conventional nursing, while the observation group were given whole nursing intervention. And the nursing efficacy was compared between the two groups. Results The differences in degree of edema, swelling time, fear and nursing satisfaction and other indicators between the two groups were statistically significant(P<0.05). Conclusion Whole nurs-ing intervention applied to pediatric circumcision has satisfactory effect, therefore it is worthy of application and promotion.%目的:研究全程护理干预在小儿包皮环切术中应用效果。方法取100例小儿包皮环切术病例根据随机数字表法将其均分为对照组与观察组各50例,对照组采取常规护理模式,观察组患儿则接受全程护理干预,对比两组护理效果。结果两组水肿程度、水肿时间、恐惧情绪及护理满意度等指标差异有统计学意义(P<0.05)。结论在小儿包皮环切术中,全程护理干预方案应用效果满意,值得推广使用。

  2. Clincal observation on the treatment of redundant prepuce by sleeve circumcision%套袖式包皮环切术治疗包皮过长的临床观察

    Institute of Scientific and Technical Information of China (English)

    韦炳朝

    2012-01-01

      目的观察套袖式包皮环切术治疗包皮过长的临床疗效.方法80例包皮过长患者行套袖式包皮环切术,观察患者早期术后并发症、术后3个月性生活状况及手术满意度情况.结果80例患者术后3 d 出现包皮轻度水肿占31.3%,术后轻度疼痛占20%,术后3个月随访患者性功能均无减退,对手术满意者占95%.结论套袖式包皮环切术术后并发症少,不影响术后性功能,患者满意度高.%  Objective To observe the clinical effect of treament for patients of redundant prepuce by sleeve circumcision. Methods Study 80 cases of redundant prepuce by sleeve circumcision on the postoperative complication in the early time after operation, the status of sexual life and satisfaction of the patient 3 months after operation. Results 80 cases had foreskin mild edema in 31.3%, mild pain in 20% three days after surgery .All the patients had no decline in sexual life ,and accounted for 95% of surgical satisfaction after three months follow-up. Conclusion Sleeve circumcision has fewer postoperative complications, no affect sexual function and higher patient satisfaction .

  3. Clinical Analysis of Hemorrhoidal Mucosa Circumcision Stapling Surgery for Hemorrhoids Degree Ⅳ%痔上黏膜环切钉合术对Ⅳ度内痔的临床分析

    Institute of Scientific and Technical Information of China (English)

    齐红光

    2015-01-01

    ObjectiveTo analyze mucosal circumcision stapling hemorrhoid treatment of the clinical effect of the Ⅳ hemorrhoids.Methods 100 cases of Ⅳ hemorrhoids patients in this study were randomly divided into control group and treatment group, 50 cases. The control group underwent conventional hemorrhoidectomy treatment, the treatment group underwent hemorrhoidal mucosa circumcision stapling surgery treatment, comparative analysis of the efficacy and recurrence rates between the two groups.Results The treatment group was 96%, which was significantly higher (80%), the difference was statisticaly significant (P < 0.05).Conclusion Hemorrhoidal mucosa circumcision stapling treatment of degree Ⅳ hemorrhoids, recurrence rate, good therapeutic effect.%目的:分析痔上黏膜环切钉合术治疗Ⅳ度内痔的临床效果。方法选取100例Ⅳ度内痔患者为研究对象,将其随机分为对照组和治疗组各50例。对照组行传统痔切除术治疗,治疗组行痔上黏膜环切钉合术治疗,对比分析两组的疗效及复发率。结果治疗组总有效率为96%,显著高于对照组(80%),差异有统计学意义(P <0.05)。结论采用痔上黏膜环切钉合术治疗Ⅳ度内痔,复发率低、治疗效果好。

  4. Research on Influencing Factors and Circumcision Acceptance Willingness of Adult Males in Chongqing%重庆市成年男性包皮环切术接受意愿及其影响因素分析

    Institute of Scientific and Technical Information of China (English)

    刘晨煜; 钟朝晖; 唐晓君; 秦波; 李革; 李君; 文静

    2011-01-01

    Objective To understand the adult male's acceptance of circumcision and its influencing factors in Chongqing, so as to provide scientific evidences for developing male circumcision extension programs and health education materials. Methods The circumcision acceptance of adult males from 18 to 45 years old in Chongqing was investigated by using multistage stratified cluster sampling method. Results Among 1 502 subjects, 661 males persisted in their willingness to do circumcision, and the operation acceptance rate was 44.01%; the acceptance rate in the 18-30 age group was higher than that in the 31-45 age group; the higher the education level, the higher the acceptance of the circumcision; and workers and businessmen had greater willingness to accept than farmers. The multivariate logistic regression analysis showed that the positive factors affecting acceptance rate were "being aware that the circumcision is suitable for phimosis and redundant prepuce" (OR=21.01,95%CI 14.21 to 31.06), "being told by friends who had circumcision before" (OR=1.65, 95%CI 1.25 to 2.19), and "being realized on the risk of phimosis and redundant prepuce" (OR=1.43, 95%CI 1.01 to 2.02); while the negative factors were "being worried about the surgical complications" (OR=0.69, 95%CI 0.50 to 0.95) and "being afraid of the ridicule from people around" (OR=0.63, 95%CI 0.40 to 0.99). Conclusion The willingness rate of adult males to accept circumcision was low in Chongqing; the publicity and education should be strengthened, and the good social atmosphere should be built for increasing the willingness rate of accepting circumcision.%目的 了解重庆市成年男性包皮环切术接受意愿现状及其影因素,为制定包皮环切推广模式及开发健康教育材料提供科学依据.方法 采用分层多级整群随机抽样方法对重庆市18~45岁成年男性进行包皮环切术的接受意愿进行调查.结果 共调查了1 502名成年男性,其中661人表示愿意做包皮

  5. The socio-cultural-symbolic nexus in the perpetuation of female genital cutting: a critical review of existing discourses

    Directory of Open Access Journals (Sweden)

    Esho, Tammary

    2011-12-01

    Full Text Available Female Genital Cutting (FGC, also known as Female Genital Mutilation (FGM and Female Circumcision (FC, continues to be a prevalent practice in many parts of the world and especially in Africa. This is somewhat perplexing given the concerted efforts aimed at eradicating this practice. This article argues that the perpetuation of FGC is due to the unintended effects of marginalization experienced by individuals and groups of women as a result of the approach of some of the anti-FGC global discourses and policies put forward to eradicate the practice. This, we argue, happens when the social structure that provides such groups and individuals with a sense of identity and belonging breaks down. Therefore, the attack on what practicing communities consider to be of crucial cultural value causes a re-focus on the practice resulting in a re-formulation and re-invention of these practices in a bid to counter the feelings of alienation. FGC is thus reframed and reconstructed as a reaction against these campaigns. This article intends to investigate the socio-cultural-symbolic nexus surrounding the practice of FGC, its meaning and implications with respect to its continued existence. It draws examples mainly from communities in Kenya that practice FGM as a rite of passage into adulthood. Herein, perhaps, lies the driving force behind the practice in this contemporary age: it carries a lot of significance with respect to transformational processes, and it is seen as crucial in the representation of the body, identity and belonging. The aim of this article is not to defend FGC’s continuation, but rather to explore the interplay between its changing socio-cultural dimensions as a counter-reaction to the eradication discourse and policies. In this way we will try to explore some of the factors that lay behind its perpetuation.

  6. UNITED NATION'S RESOLUTION ON ELIMINATION OF FEMALE GENITAL RITUAL: A LEGITIMATE RESPONSE TO A HUMAN RIGHTS PROBLEM OR WHAT?

    Science.gov (United States)

    Nnamuchi, Obiajulu

    2014-12-01

    A recent United Nations' (U.N.) Resolution, "Intensifying Global Efforts for the Elimination of Female Genital Mutilations," urging all countries to enact legislation outlawing female circumcision or female genital ritual (FGR) signals a disturbingly new frontier in the polemic surrounding the ancient cultural practice. Never before has the apex global institution lent its imprimatur to a project whose foundation is profoundly muddled in uncertainties and murkiness. That the Resolution received an instantaneous and near-universal acclaim as a necessary protective weapon against supposed assault on the human rights of women is not news. After all, aside from essentially validating extant legislative frameworks in several countries, the proclamation fits seamlessly with decades-long agitations of activists, scholars and media pundits of one stripe or the other. What is absurd--indeed, the real news--is continued neglect of calls for a rethinking of the criminalization fervor currently gripping the world, for a reassessment of the evidence trumpeted by abolitionists as justificatory of their unbridled interference in what practicing communities revere as a sacred cultural rite. Relying on the premise that claims regarding harmful impact of FGR, the fulcrum upon which eradication forces depend for their activism, cannot be substantiated, this paper argues that prohibitory regimes based thereon, whether at the U.N. or country level, is per se a violation of the human rights of the women purportedly sought to be protected. Human rights (including, in this case, its self-appointed "apostles"), cannot, as a popular Igbo maxim admonishes, become "outsiders who wept louder than the bereaved." This is the prism from which this paper analyzes the on-going supranational crusade to suppress FGR. It is a critique of extant FGR legal and policy regimes, an instance of which is the U.N. Resolution, as unrepresentative of legitimate advancement of human rights. PMID:27351048

  7. The Female Athlete Triad.

    Science.gov (United States)

    Weiss Kelly, Amanda K; Hecht, Suzanne

    2016-08-01

    The number of girls participating in sports has increased significantly since the introduction of Title XI in 1972. As a result, more girls have been able to experience the social, educational, and health-related benefits of sports participation. However, there are risks associated with sports participation, including the female athlete triad. The triad was originally recognized as the interrelationship of amenorrhea, osteoporosis, and disordered eating, but our understanding has evolved to recognize that each of the components of the triad exists on a spectrum from optimal health to disease. The triad occurs when energy intake does not adequately compensate for exercise-related energy expenditure, leading to adverse effects on reproductive, bone, and cardiovascular health. Athletes can present with a single component or any combination of the components. The triad can have a more significant effect on the health of adolescent athletes than on adults because adolescence is a critical time for bone mass accumulation. This report outlines the current state of knowledge on the epidemiology, diagnosis, and treatment of the triad conditions. PMID:27432852

  8. CERN's first female firefighter

    CERN Multimedia

    Alizée Dauvergne

    2010-01-01

    Until recently, the women's changing room in the Fire Station, built in 2005, has always been empty. With the arrival of Séverine Peverelly, CERN's first female firefighter, it now has a purpose. Séverine Peverelly took up her post as a firefighter in April. Séverine, who comes from Gap in France, took up her post as a firefighter in the CERN fire brigade at the beginning of April. "We were looking for a new member," explains David Peyron, Head of the Fire and Rescue Service. It didn't matter if it was a man or a woman; we needed a firefighter with the right skills, and Séverine just happened to have them." With ten years experience working in French fire services, Séverine was looking for a new challenge. "What attracted me to CERN was the international dimension, because that creates additional challenges," she explains. And these can be considerable! For one thing, every country has its own way of worki...

  9. The limited effectiveness of legislation against female genital mutilation and the role of community beliefs in Upper East Region, Ghana.

    Science.gov (United States)

    Ako, Matilda Aberese; Akweongo, Patricia

    2009-11-01

    Female genital mutilation (FGM) has long been practised in many communities in the Upper East Region of Ghana. Although the Ghanaian state has a long tradition of supporting women's rights, it has not been successful in eradicating FGM, despite a law against the practice in an amendment to the Criminal Code in 1994 and the Domestic Violence Act 2003. This qualitative study in the Upper East Region examined the role of the state in stopping the practice of FGM through legal means, and why FGM continues to be practised in the community. In-depth interviews were conducted with six state officials, a circumciser, the president of a women's advocacy organisation, and semi-structured interviews with 32 community members. Although FGM has been criminalised, political support to ensure that the law is effectively implemented has been lacking. FGM education and eradication must be given more priority and significant funding by the Ghanaian state. For interventions to be effective, legal measures need to be combined with social measures. Communities practising FGM must be involved in the planning and implementation of anti-FGM interventions. Successful eradication of the practice is possible if education and dialogue between state institutions, gender and human rights groups and practising communities is strengthened. PMID:19962637

  10. Mental health problems associated with female genital mutilation

    Science.gov (United States)

    Knipscheer, Jeroen; Vloeberghs, Erick; van der Kwaak, Anke; van den Muijsenbergh, Maria

    2015-01-01

    Aims and method To study the mental health status of 66 genitally mutilated immigrant women originating from Africa (i.e. Somalia, Sudan, Eritrea and Sierra Leone). Scores on standardised questionnaires (Harvard Trauma Questionnaire-30, Hopkins Symptom Checklist-25, COPE-Easy, Lowlands Acculturation Scale) and demographic and psychosocial correlates were analysed. Results A third of the respondents reported scores above the cut-off for affective or anxiety disorders; scores indicative for post-traumatic stress disorder were presented by 17.5% of women. Type of circumcision (infibulation), recollection of the event (a vivid memory), coping style (avoidance, in particular substance misuse) and employment status (lack of income) were significantly associated with psychopathology. Clinical implications A considerable minority group, characterised by infibulated women who have a vivid memory of the circumcision and cope with their symptoms in an avoidant way, reports to experience severe consequences of genital circumcision. In terms of public healthcare, interventions should target these groups as a priority. PMID:26755984

  11. Female pattern hair loss

    Directory of Open Access Journals (Sweden)

    Archana Singal

    2013-01-01

    Full Text Available Female pattern hair loss (FPHL is a common cause of hair loss in women characterized by diffuse reduction in hair density over the crown and frontal scalp with retention of the frontal hairline. Its prevalence increases with advancing age and is associated with significant psychological morbidity. The pathophysiology of FPHL is still not completely understood and seems to be multifactorial. Although androgens have been implicated, the involvement of androgen-independent mechanisms is evident from frequent lack of clinical or biochemical markers of hyperandrogenism in affected women. The role of genetic polymorphisms involving the androgen and estrogen receptors is being increasingly recognized in its causation and predicting treatment response to anti-androgens. There are different clinical patterns and classifications of FPHL, knowledge of which facilitates patient management and research. Chronic telogen effluvium remains as the most important differential diagnosis. Thorough history, clinical examination, and evaluation are essential to confirm diagnosis. Patients with clinical signs of androgen excess require assessment of biochemical parameters and imaging studies. It is prudent to screen the patients for metabolic syndrome and cardiovascular risk factors. The treatment comprises medical and/or surgical modalities. Medical treatment should be initiated early as it effectively arrests hair loss progression rather than stimulating regrowth. Minoxidil continues to be the first line therapy whereas anti-androgens form the second line of treatment. The progressive nature of FPHL mandates long-term treatment for sustained effect. Medical therapy may be supplemented with cosmetic concealment in those desirous of greater hair density. Surgery may be worthwhile in some carefully selected patients.

  12. Female Consciousness in Jane Eyre

    Institute of Scientific and Technical Information of China (English)

    鲁存

    2014-01-01

    Charlotte Bront is a remarkable women writer in the 19th-century English literature. Jane Eyre received comprehensive attention. This thesis analyzes main characters from three aspects, Jane Eyre’s female consciousness, pursuit of equality, freedom and presents the limitation in Jane Eyre. It also examines the nature of Charlotte Bront?’s pioneering female consciousness and demonstrates its positive development.

  13. Female Superintendent Longevity in California

    Science.gov (United States)

    Rohlfing, Tracy

    2011-01-01

    The purpose of this study was to investigate, through narrative inquiry (Clandinin & Connelly, 2000), the leadership evolution of five female superintendents in California with longevity of 5 or more years in their current school district positions. The research question addressed was, "How do California female superintendents evolve to…

  14. Diagnostic Testing for Female Infertility

    Science.gov (United States)

    ... American Society for Reproductive Medicine Diagnostic Testing for Female Infertility An evaluation of a woman for infertility is ... or suspected male infertility problems Any evaluation for infertility should be ... as well as female partners. The least invasive methods that can detect ...

  15. Dispelling Myths about Female Potential.

    Science.gov (United States)

    Sloane, Ethel

    1980-01-01

    Discussed are several myths and stereotypes about female physiology. Also included are new technical advances concerning the female reproduction physiology, new techniques in hormone measurement, hypotholomic-pituitary-ovarian axis, hormones and the monthly cycles, dysmenorrhea, menopause, infertility, and future areas for investigation about the…

  16. Surgical efficiencies and quality in the performance of voluntary medical male circumcision (VMMC procedures in Kenya, South Africa, Tanzania, and Zimbabwe.

    Directory of Open Access Journals (Sweden)

    Dino Rech

    Full Text Available INTRODUCTION: This analysis explores the association between elements of surgical efficiency in voluntary medical male circumcision (VMMC, quality of surgical technique, and the amount of time required to conduct VMMC procedures in actual field settings. Efficiency outcomes are defined in terms of the primary provider's time with the client (PPTC and total elapsed operating time (TEOT. METHODS: Two serial cross-sectional surveys of VMMC sites were conducted in Kenya, Republic of South Africa, Tanzania and Zimbabwe in 2011 and 2012. Trained clinicians observed quality of surgical technique and timed 9 steps in the VMMC procedure. Four elements of efficiency (task-shifting, task-sharing [of suturing], rotation among multiple surgical beds, and use of electrocautery and quality of surgical technique were assessed as explanatory variables. Mann Whitney and Kruskal Wallis tests were used in the bivariate analysis and linear regression models for the multivariate analyses to test the relationship between these five explanatory variables and two outcomes: PPTC and TEOT. The VMMC procedure TEOT and PPTC averaged 23-25 minutes and 6-15 minutes, respectively, across the four countries and two years. The data showed time savings from task-sharing in suturing and use of electrocautery in South Africa and Zimbabwe (where task-shifting is not authorized. After adjusting for confounders, results demonstrated that having a secondary provider complete suturing and use of electrocautery reduced PPTC. Factors related to TEOT varied by country and year, but task-sharing of suturing and/or electrocautery were significant in two countries. Quality of surgical technique was not significantly related to PPTC or TEOT, except for South Africa in 2012 where higher quality was associated with lower TEOT. CONCLUSIONS: SYMMACS data confirm the efficiency benefits of task-sharing of suturing and use of electrocautery for decreasing TEOT. Reduced TEOT and PPTC in high volume

  17. Assessing Odor Level when Using PrePex for HIV Prevention: A Prospective, Randomized, Open Label, Blinded Assessor Trial to Improve Uptake of Male Circumcision.

    Directory of Open Access Journals (Sweden)

    Vincent Mutabazi

    Full Text Available The PrePex is a WHO--prequalified medical device for adult male circumcision for HIV prevention. The Government of Rwanda was the first country to implement the PrePex device and acts as the leading center of excellence providing training and formal guidelines. As part of the Government's efforts to improve PrePex implementation, it made efforts to improve the psychological acceptability of device by men, thus increasing uptake with VMMC in sub-Saharan Africa. Some men who underwent the PrePex procedure complained of foreskin odor while wearing the PrePex 3-7 days after it was placed. This complaint was identified as potential risk for uptake of the device. Researchers from Rwanda assumed there is a possible relation between the level of foreskin odor and patient foreskin hygiene technique. The Government of Rwanda decided to investigate those assumptions in a scientific way and conduct a trial to test different hygiene-cleaning methods in order to increase the acceptability of PrePex and mitigate the odor concern. The main objective of the trial was to compare odor levels between three arms, having identical personal hygiene but different foreskin hygiene techniques using either clear water with soap during a daily shower, soapy water using a syringe, or chlorhexidine using a syringe. One hundred and one subjects were enrolled to the trial and randomly allocated into three trial arms. Using chlorhexidine solution daily almost completely eliminated odor, and was statistically significant more effective that the other two arms. The trial results suggest that odor from the foreskin, while wearing the PrePex device, could be related to the growth of anaerobic bacteria, which can be prevented by a chlorhexidine cleaning method. This finding can be used to increase acceptability by men when considering PrePex as one of the leading methods for HIV prevention in VMMC programs.

  18. Assessing Odor Level when Using PrePex for HIV Prevention: A Prospective, Randomized, Open Label, Blinded Assessor Trial to Improve Uptake of Male Circumcision.

    Science.gov (United States)

    Mutabazi, Vincent; Bitega, Jean Paul; Ngeruka, Leon Muyenzi; Karema, Corine; Binagwaho, Agnes

    2015-01-01

    The PrePex is a WHO--prequalified medical device for adult male circumcision for HIV prevention. The Government of Rwanda was the first country to implement the PrePex device and acts as the leading center of excellence providing training and formal guidelines. As part of the Government's efforts to improve PrePex implementation, it made efforts to improve the psychological acceptability of device by men, thus increasing uptake with VMMC in sub-Saharan Africa. Some men who underwent the PrePex procedure complained of foreskin odor while wearing the PrePex 3-7 days after it was placed. This complaint was identified as potential risk for uptake of the device. Researchers from Rwanda assumed there is a possible relation between the level of foreskin odor and patient foreskin hygiene technique. The Government of Rwanda decided to investigate those assumptions in a scientific way and conduct a trial to test different hygiene-cleaning methods in order to increase the acceptability of PrePex and mitigate the odor concern. The main objective of the trial was to compare odor levels between three arms, having identical personal hygiene but different foreskin hygiene techniques using either clear water with soap during a daily shower, soapy water using a syringe, or chlorhexidine using a syringe. One hundred and one subjects were enrolled to the trial and randomly allocated into three trial arms. Using chlorhexidine solution daily almost completely eliminated odor, and was statistically significant more effective that the other two arms. The trial results suggest that odor from the foreskin, while wearing the PrePex device, could be related to the growth of anaerobic bacteria, which can be prevented by a chlorhexidine cleaning method. This finding can be used to increase acceptability by men when considering PrePex as one of the leading methods for HIV prevention in VMMC programs.

  19. Comparison of three intervention models for promoting circumcision among migrant workers in western China to reduce local sexual transmission of HIV.

    Directory of Open Access Journals (Sweden)

    Chuanyi Ning

    Full Text Available OBJECTIVE: Three models for promoting male circumcision (MC as a preventative intervention against HIV infection were compared among migrant worker populations in western China. METHODS: A cohort study was performed after an initial cross-sectional survey among migrant workers in three provincial level districts with high HIV prevalence in western China. A total of 1,670 HIV seronegative male migrants were cluster-randomized into three intervention models, in which the dissemination of promotional materials and expert- and volunteer-led discussions are conducted in one, two, and three stage interventions. Changes in knowledge of MC, acceptability of MC, MC surgery uptake, and the costs of implementation were analyzed at 6-month and 9-month follow-up visits. RESULTS: All three models significantly increased the participants' knowledge about MC. The three-stage model significantly increased the acceptability of MC among participants and led to greatest increase in MC uptake. At the end of follow-up, 9.2% (153/1,670 of participants underwent MC surgery; uptake among the one-, two-, and three-stage models were 4.9%, 9.3%, and 14.6%, respectively. Multivariable Cox regression analysis showed that three-stage model was the most effective method to scale up MC, with RR = 2.0 (95% CI, 1.3-3.1, P=0.002 compared to the on-site session model. The two-stage intervention model showed no significant difference with either the on-site session model (RR=1.5, 95% CI, 0.92-2.4, P=0.12 or three-stage model (P=0.10. CONCLUSIONS: A three-stage intervention with gradual introduction of knowledge led to the significantly increase in MC uptake among migrant workers in western China, and was also the most cost-effective method among the three models.

  20. Progress in the clinical studies of male circumcision using the Shang Ring%中国商环(Shang Ring)男性包皮环切技术临床应用研究进展

    Institute of Scientific and Technical Information of China (English)

    吕年青; 李石华; David Sokal; 程跃; 彭弋峰; Mark Barone; 黄翼然; Marc Goldstein

    2011-01-01

    男性包皮环切能显著降低男性阴茎一阴道性交获得性HIV感染风险大约60%,被WHO和联合国艾滋病规划署(UNAIDS)推荐作为HIV预防策略中的一个重要干预措施.寻求一种更加安全、有效和可接受的男性包皮环切器械和手术方法,以便能够满足加快执行扩大包皮环切预防HIV感染项目的需求,已经成为相关国际组织,特别是非洲国家政府公共卫生事业的当务之急.2008年中国商环(Shang Ring)包皮环切标准化手术方案的建立,以及应用这个标准化手术方案和手术培训在中国以及2009年和2010年在肯尼亚实施中国商环成人包皮环切手术获得有用的和有意义的临床数据,证明了中国商环包皮环切术的诸多优势.手术培训手册和教学视频的多次修订为培训医护人员提供了更加准确的教学指南.经过多家相关国际机构专家的考察和评估,中国商环包皮环切技术已经成为支持在非洲HIV高发地区扩大包皮环切服务预防HIV感染项目最具潜力的候选包皮环切器械之一.可以预计,中国商环包皮环切技术的成功应用将会在改变数百万非洲人的生活方式的同时,也为中国男科学与泌尿外科学医生在包皮环切与HIV预防和生殖健康相关的临床研究领域提供了丰富的机会.本文报告了2008年2月至2010年底期间中国商环包皮环切技术临床应用的国际和国内研究进展.%Male circumcision can reduce men's risk of HIV infection from heterosexual intercourse by 60% and is therefore recommended as an important strategy for HIV prevention in Africa by WHO and UNAIDS. However, rapid expansion of male circumcision efforts could be greatly facilitated by a safer, more effective and acceptable male circumcision surgical technique or device. Shang Ring is a simple technique developed in China. It allows a circumcision to be completed with minimal bleeding, without suturing, and in only 3 -5 min and

  1. 改良包皮环扎术治疗小儿包皮过长和包茎的临床疗效%The clinical effect of improved circumcision cerclage in the treatment of infantile redundant prepuce and phimosis

    Institute of Scientific and Technical Information of China (English)

    杨正荣

    2014-01-01

    Objective:To investigate the clinical effects of modified foreskin cerclage in the treatment of redundant prepuce and phimosis.Methods:42 patients with redundant prepuce and phimosis were selected from June 2012 to July 2013.They were randomly divided them into the observation group and the control group.The control group were taken the traditional circumcision cerclage treatment.The observation group with the modified circumcision cerclage treatment,for the redundant prepuce children we give them turn over wrapping directly,separated adhesion,and removed the calculus prepuce,for the phimosis children we expansed the foreskin foreign export of them of firstly,then turn over the wrapping.Results:In the observation group after the treatment of modified circumcision cerclage,we achieved good clinical effect,and the total efficiency of the treatment was 95.24%, among them 15 cases were cured,effective in 5 cases,invalid in 1 case;While in the control group used circumcision cerclage treatment,the total effective rate was only 47.62%,of which 7 cases were cured,effective in 3 cases,invalid in 11 cases.The two groups had statistical significance between the above indexes in contrast difference(P<0.05).Conclusion:The improved circumcision in the treatment of children with redundant prepuce and phimosis has a good clinical effect.It can restore the children health effectively;the curative effect is exactly;it can prevent postoperative bleeding and preputial adhesions;so it is worth the clinical promotion.%目的:探讨改良包皮环扎术治疗小儿包皮过长和包茎的临床效果。方法:2012年6月-2013年7月收治包皮过长和包茎患儿42例,将其随机分为观察组和对照组,对照组采取传统包皮环扎术治疗,观察组采取改良包皮环扎术进行治疗,对于包皮过长患儿直接上翻包皮,分离粘连,并清除包皮结石,对于包茎患儿则先对其包皮外口进行扩张,再上翻包皮进行治疗。

  2. 包皮环切与微波疗法联合治疗尖锐湿疣%Combination of Circumcision and Microwave in Treatment of Genital Warts in Uncircumcised Patients

    Institute of Scientific and Technical Information of China (English)

    樊翌明; 马泽; 吴志华; 李顺凡; 陈秋霞

    2003-01-01

    Objective: To investigate the efficacy of combination of circumcision and microwave on genital warts in uncircumcised men.Methods: A randomized, prospective study of 109uncircumcised adult men with genital warts was conducted in a STD clinic in Zhanjiang, Guangdong. One group (n=54) received microwave therapy only, while the other group (n=55) was taken the combination of circumcision and microwave therapy. The recurrences were observed at the end of months 3, 6 and 12, and operative complications were also recorded.Results: There were no significant differences in the mean age and duration of the disease between two groups (P>0.05). No serious operative complications were documented. The recurrence rate in circumcision plus microwave group was markedly lower than that in microwave group (12.7% vs 29.6%, P<0.05),while the differences in early and late recurrences between two groups showed no statistical significance (P>0.05).Conclusion: Circumcision can be safely performed under local anesthesia in an outpatient setting. Combination of circumcision and microwave can produce excellent effect as well as less tissue damage,therefore, it may be ideal for uncircumcised patients with extensive condylomas.%目的 对未接受过包皮环切手术的尖锐湿疣患者,给予微波与包皮环切联合治疗,并观察其疗效.方法 随机抽取某性病门诊109名未做过包皮环切手术的成年尖锐湿疣患者,将其分为两组进行前瞻性研究.一组(54人)接受单纯微波疗法,另一组(55人)接受微波与包皮环切联合疗法.我们观察到在第3,6和12个月后有复发出现,并记录术后合并症的发生情况.结果 两组间的平均年龄和病程无显著性差异(P>0.0 5).未发现严重的术后并发症.微波与包皮环切联合治疗组的复发率明显低于单纯微波治疗组(12.7%和29.6%,P<0.05),而两组间早期与后期的复发率差异无统计学意义(P>0.05).结论 包皮环切术是一种安全的

  3. The female runner: gender specifics.

    Science.gov (United States)

    Lynch, Stacy L; Hoch, Anne Z

    2010-07-01

    There has been a tremendous increase in the number of female runners of all ages and abilities in the past 35 years. Women who participate in running and sports are generally healthier and have higher self-esteem. However, unique medical and orthopedic issues exist for the female runner. This article reviews the history of women in sports, physiologic and biomechanic differences between genders, the pregnant runner, knee osteoarthritis, an update on the female athlete triad and the relationship between amenorrhea and endothelial dysfunction associated with athletics. PMID:20610034

  4. Female genital mutilation in Djibouti.

    Science.gov (United States)

    Martinelli, M; Ollé-Goig, J E

    2012-12-01

    The practice of female genital mutilation (we will use the latest definition adopted by WHO/UNFP: female genital mutilation/cutting or FGM/C) is still widespread in 28 African countries. The World Health Organisation (WHO) estimates that more than two million females undergo some form of genital mutilation every year. Its negative health impact and its ethical and human rights aspects have been discussed and attempts to eliminate it have been the objectives of several meetings promoted by national and international organisations thanks to an increased awareness related to FGM/C in those countries practicing it and also, maybe due to the number of Africans migrating to industrialized countries. We review the present situation in Djibouti, a small country in the Horn of Africa, where 98 % of the female population has suffered different forms of FGM/C. PMID:23515242

  5. TC in female pelvic cancer

    International Nuclear Information System (INIS)

    This presentation is about the role of imaging in the female pelvis. The CT is an important key in the diagnosis of gynecological malignant pathologies such as Ovarian, endometrial cervical, bladder, vaginal and vulvar cancer

  6. Eating Disorders among Female Athletes.

    Science.gov (United States)

    Borgen, Jorunn Sundgot; Corbin, Charles B.

    1987-01-01

    The paper describes a study of 168 college women to determine the extent to which preoccupation with weight and tendencies toward eating disorders are problems among female athletes. Results are presented. (Author/MT)

  7. Observation on the Effect of Shang Ring in the Circumcision of Patients with Diabetes%商环在糖尿病患者包皮环切术中的疗效观察

    Institute of Scientific and Technical Information of China (English)

    刘翔; 耿和; 吴宗林; 施华娟; 朱洪炜; 唐炯; 张涛

    2013-01-01

    目的:评估商环在糖尿病患者包皮环切术中的临床疗效及其安全性.方法:选择54例拟行包皮环切术的糖尿病合并包茎的患者,其中26例采用传统包皮环切术(对照组),28例采用商环包皮环切术(商环组),分析和比较两组患者的手术时间、术中出血量、术后疼痛程度、术后恢复时间和术后感染的发生率.结果:对照组与商环组患者的手术时间分别为(28±7)和(9±2)分钟(P<0.05),术中出血量分别为(6.2±2.0)和(0.4±0.5)ml(P<0.05),术后疼痛视觉模拟评分分别为(5.3±1.5)和(3.9±1.3)分(P<0.05),术后恢复时间分别为(12±4)和(19±5)天(P<0.05),术后感染率分别为7.7%和10.7%(P>0.05).与传统组相比,商环组患者的手术时间显著缩短,术中出血显著减少,术后疼痛显著减轻,术后恢复时间显著延长,但术后感染率无明显增加.结论:对糖尿病患者采用商环行包皮环切术,手术时间短、出血少,疼痛轻,术后恢复时间较长但护理方便,术后感染率无明显增加,是一项便捷、安全、有效的手术方式.%Objective: To assess the clinical efficacy and safety of Shang Ring in the circumcision of patients with diabetes. Methods: A total of 54 males with diabetes and phimosis who were going to be treated with circumcision were selected, in which 26 cases were treated with traditional circumcision and 28 cases were treated with the Shang Ring circumcision. The operation time, intraoperative bleeding amount, postoperative pain degree, postoperative recovery time and incidence of postoperative infection were observed and compared between two groups. Results: In the control group and the Shang Ring group, the operation times were (28± 7) and (9± 2) minutes respectively, the intraoperative bleeding amounts were (6.2± 2.0) and (0.4± 0.5) ml respectively, the postoperative pain scores were (5.3± 1.5) and (3.9± 1.3) respectively, the postoperative recovery time were (12± 4) and

  8. A study on health education model of spreading circumcision to preventing AIDS%推广包皮环切手术预防艾滋病的健康教育模式研究

    Institute of Scientific and Technical Information of China (English)

    李君; 钟朝晖; 唐晓君; 文静; 刘晨煜; 秦波; 李革

    2012-01-01

    Objective To evaluate the intervention effecc of different health education models, explore the suitable education model of spreading circumcision. Methods Applying epidemiology intervention test, testees in each group received different health education intervention model by random principle. Six months later, the effect of different models was comparatively analyzed. Results The average knowledge score of each group was improved after intervening education(beforeintervcning:3.99±0.14, 3.68±0.15, 3.58±0.14; after intervening:4.93±0,14, 4.9<5±0.14, 5.66±0.11), the score of group intervened by education model 3 was higher than that of other groups ( F=10.302, P<0.001). The willingness circumcision rate (x2=57.90,P<0.001, the willingness circumcision rate of each group: 57.3%, 52.4%, 30.8%) and the actual circumcision rate (.x2=67.643,P<0.001 the actual circumcision rate of each group: 24.9%, 10.5%, 4.7%) of group intervened by education model 1 were higher than those of other groups. Conclusion For improving the circumcision related knowledge level, education mode 3 is the best choice; For improving the circumcision rate, education modell is priority.%目的 评价不同健康教育模式干预效果,探讨人群包皮环切手术健康宣教的适宜模式.方法 对调查对象流行病学现场干预试验,遵循随机化原则分为3个干预小组,对3个小组分别采用模式一、模式二和模式三进行健康宣教健康宣教,于干预后6个月进行干预效果评估,比较和评价不同模式的干预效果.结果 干预后各小组的知识水平较干预前均有不同程度的提高(干预前各小组的知识得分分别为:3.99±0.14、3.68±0.15、3.58±0.14;干预后:4.93±0.14、4.96±0.14、5.66±0.11),采用模式三干预的小组包皮环切手术相关知识得分高于模式一和模式二干预的小组(F=10.302,P<0.001).模式一干预的小组包皮环切手术接受意愿(x2=57.905,P<0.001,各小

  9. Acceptability and related factors of male circumcision among farmer workers in coal mine%煤矿农民工包皮环切术接受性及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    蒋俊俊; 梁旭; 杨晓波; 邓伟; 韦波; 张志勇; 柳志豪; 梁浩

    2011-01-01

    目的 研究农民工对包皮环切术的接受性,并分析其接受性影响因素.方法 采用整群抽样方法选取广西壮族自治区百色市煤矿中569名男性农民工作为研究对象,通过一对一问卷调查收集其包皮环切术的接受性及其影响因素.结果 研究对象中有包皮环切意愿的占25.13%(143/569);当研究对象被告知包皮环切并发症小、可预防艾滋病性病和保护生殖健康、检查时发现有包皮过长或包茎、手术免费时,农民工对包皮环切术的接受性有较大改变,分别为43.23%、58.52%、70.12%、48.86%,与告知前比较差异有统计学意义;单因素分析显示,婚姻状况、包皮环切术知识、人类免疫缺陷病毒(HIV)抗体检测等6个因素与包皮环切的接受性有关;多因素分析显示,未婚者、自觉有包皮过长或包茎、进行过HIV抗体检测者更愿意接受手术,其OR(95%CI)值分别为2.37(1.30~4.32)、8.19(4.25~15.77)、1.95(1.15~3.32).结论 广西农民工包皮环切术接受意愿较低,艾滋病和包皮环切术相关知识知晓率低及担心手术安全性和费用是主要影响因素.%Objective To explore the acceptability of male circumcision and its related factors among farmer workers in coal mine. Methods Questionnaire survey on the acceptability of male circumcision (MC) and its related factors was conducted among farmer workers in a coal mine in Guangxi Zhuang Autonomous Region with random cluster sampling. Resuits A total of 569 male farmer workers were selected. Among the interviewees,25. 13% ( 143/569)expressed the willingness to accept MC. When knowing that the operation would be free of charge and with few complication and could prevent AIDS and sexually transmitted diseases(STDS), more interviewees expressed the willingness to accept MC with a significantly increased acceptable rate. Univariate analysis showed that the acceptability of MC was associated with marital status,knowledge on male

  10. Comparison of Clinical Observation on Three Circumcision Procedures:Traditional, Plastibell and Disposable Peritomy Anastomoses Device%传统法、商环法及一次性包皮环切缝合器行包皮环切术的临床比较

    Institute of Scientific and Technical Information of China (English)

    董怀生

    2015-01-01

    Objective: To access the clinical effects and surgery complication of three different circumcision procedures of traditional, plastibell and disposable peritomy anastomoses device.Method: A retrospective analysis was conducted for 258 patients who received circumcision in our hospital from October 2012 to June 2014. In 258 cases, 81 cases were operated surgery with traditional, 129 cases with plastibell and 48 cases with disposable peritomy anastomoses device circumcision. The effect and surgery complication were compared.Result: Plastibell and disposable peritomy anastomoses device circumcision had obvious advantage on operation time, bleeding, prepuce edema and patient satisfaction rate when compared with traditional circumcision (P0.05), while both had shorter healing time when compared with plastebell circumcision (P<0.05).Conclusion: Plastibell and disposable peritomy anastomoses device circumcision have advantage over traditional circumcision on operation time, postoperation pain, postoperation hematoma and patient satisfaction, but inferior on healing time. The selection of different methods for circumcision should give carefully consideration according to the patient’s wills and actual situation to reach the best results.%目的:对比分析传统法、商环法及一次性包皮环切缝合器行包皮环切术的疗效及手术并发症的发生率。方法:回顾性分析本院行传统法、商环法及一次性包皮环切缝合器行包皮环切术在手术疗效和并发症等方面比较情况。结果:商环法及一次性包皮环切缝合器行包皮环切术在手术时间、手术出血、术后包皮水肿发生率、术后手术满意度方面较,传统法包皮环切术有明显优势,三组比较差异均有统计学意义(P<0.05);而传统法及一次性包皮环切缝合器行包皮环切术在术后愈合时间较商环包皮环切术有明显优势,传统法的术后愈合时间与一次性包皮

  11. QUALITATIVE STUDY ON WILLINGNESS FOR ACCEPTING MALE CIRCUMCISION IN DRUG ADDICTS ON METHADONE MAINTENANCE TREATMENT IN CHONGQING%重庆美沙酮门诊男性服药者包皮环切术接受意愿定性研究

    Institute of Scientific and Technical Information of China (English)

    李凌竹; 窦贵旺; 秦波; 王婷; 李革

    2012-01-01

    目的:了解重庆市美沙酮门诊男性服药者包皮环切术接受意愿.方法:在2009年10月至2009年12月期间选取50名美沙酮门诊男性服药者,采用个人深入访谈的方式对每位服药者进行个人访谈,归纳总结美沙酮门诊男性服药者包皮环切术接受意愿.结果:50名访谈对象中,9名访谈对象自觉包皮过长,其中7位愿意进行包皮环切术.在自觉无包皮过长情况的41名访谈对象中,22名在进行包皮环切术能预防艾滋病的前提下愿意(或考虑)进行包皮环切手术.在医疗机构和医疗费用的访问中,24名愿意进行手术的访谈对象选择三甲医院进行手术,并且有23名的访谈对象认为费用不应超过一千元.结论:包皮过长和行包皮环切术后,预防艾滋病能提高包皮环切术的接受意愿.医疗花费能部分影响包皮环切术接受意愿.在包皮环切术的推广中着重提高包皮过长检出率;强调该手术对艾滋病的预防作用和降低医疗花费,能够提高该人群包皮环切术接受意愿.%Objective: To understand the situation on willingness of accepting male circumcision in drug addicts on methadone maintenance treatment ( MMT) in Chongqing, and provide information for the establishment of a good extension model of male circumcision. Methods: Individual in - depth interviews were conducted among 50 drug addicts from October to December in 2009, the willingness for accepting male circumcision in drug addicts on methadone maintenance treatment( MMT) were summaried. Results: Nine drug addicts believed that they had redundant prepuce, and 7 of them accepted male circumcision. However, 22 of 41 drug addicts who had not redundant prepuce accepted male circumcision if this surgery was a way to prevent AIDS. Most of the drug addicts who accepted male circumcision chose Three -A hospitals for their surgeries, and more than half thought that the cost should be less than 1000 RMB. Conclusion: Redundant prepuce

  12. 保留浅静脉系统的微创包皮环切术%Minimally invasive circumcision with superficial vein reservation

    Institute of Scientific and Technical Information of China (English)

    杨平; 周轶群; 刘天一

    2011-01-01

    目的 探讨保留阴茎皮下浅静脉网络包皮环切术的方法及其临床效果.方法 设计包皮近端和远端切口线均位于外板皮肤,在放大4倍的显微镜下操作,按显微外科操作原则,剪开皮肤至浅筋膜,修剪去除外板皮肤,尽可能完整保留皮下浅静脉血管网和皮下筋膜组织.结果 本组28例患者,术后随访2~6个月,阴茎消肿,无臃肿状态,外形满意,尤其是保留了完整的浅静脉网络,在性生活中无阴茎感觉异常及勃起障碍等并发症.结论 保留阴茎皮下浅静脉网络的包皮环切术是治疗包皮过长的理想方法,值得临床推广应用.%Objective To investigate the method and clinical effects of circumcision with superficial vein network reservation of the penis. Methods Both the foreskin proximal and distal incision lines were designed in the outer plate skin. Under the microscope with four times magnification, the operation was conducted by cutting the skin along the designed lines to the superficial fascia, removing the outer plate skin and reserving completely the subcutaneous superficial vein network and fascia as far as possible. Results Twenty-eight patients were followed up for 2 to 6 months. All of the patients were satisfied with the appearance of their penis and no swell were observed. None of those patients complained about penis paresthesia or erectile dysfunction.Conclusion Satisfying appearances could be achieved by our surgical techniques and the complications such as penile edema and sexual dysfunction could be avoided.

  13. Female genital mutilation in Britain.

    Science.gov (United States)

    Black, J A; Debelle, G D

    1995-06-17

    The practice of female genital mutilation predates the founding of both Christianity and Islam. Though largely confined among Muslims, the operation is also practiced in some Christian communities in Africa such that female genital mutilation takes place in various forms in more than twenty African countries, Oman, Yemen, the United Arab Emirates, and by some Muslims in Malaysia and Indonesia. In recent decades, ethnic groups which practice female genital mutilation have immigrated to Britain. The main groups are from Eritrea, Ethiopia, Somalia, and Yemen. In their own countries, an estimated 80% of women have had the operation. Female genital mutilation has been illegal in Britain since 1985, but it is practiced illegally or children are sent abroad to undergo the operation typically at age 7-9 years. It is a form of child abuse which poses special problems. The authors review the history of female genital mutilation and describe its medical complications. Assuming that the size of the population in Britain of ethnic groups which practice or favor female genital mutilation remains more or less unchanged, adaptation and acculturation will probably cause the practice to die out within a few generations. Meanwhile, there is much to be done. A conspiracy of silence exists in medical circles as well as widespread ignorance. Moreover, none of a number of well-known obstetric and pediatric textbooks mentions female genital mutilation, while the National Society for the Prevention of Cruelty to Children has neither information nor instructional material. It is high time that the problem was more widely and openly discussed. PMID:7787654

  14. Impact of circumcision on the sexual function of adult patients with phimosis%包皮环切术对成年包茎患者性功能的影响

    Institute of Scientific and Technical Information of China (English)

    韩精超; 白焱; 张继伟; 夏溟; 蔡建良; 何群

    2015-01-01

    Objectives:To investigate the adult patients’sexual life after phimosis circumcision.Meth-ods:216 patients were investigated on erectile function changes,masturbation frequency,frequency of sexual inter-course,sexual intercourse,pain during intercourse,and other aspects by questionnaire before and after circumcision respectively.Results:There was no obvious difference in the postoperative International Index of Erectile Function-5 (IIEF -5)and the frequency of sexual intercourse,but the difference in sexual intercourse,pain during inter-course and masturbation frequency were statistically significant.Conclusion:Circumcision can improve the erectile function in patients with phimosis,prolong sexual intercourse,reduce the frequency of painful intercourse and mas-turbation,thereby enhancing their sexual satisfaction.%目的:评价包皮环切术对成年包茎患者性功能的影响。方法:采用问卷调查的方法对216例施行包皮环切术的成年包茎患者手术前后勃起功能、手淫频率、性交频率、性交时间、性交疼痛等方面的变化进行随访。结果:手术前后患者国际勃起功能指数-5(IIEF -5)、性交频率之间的差异均无统计学意义,而性交时间、性交疼痛和手淫频率之间的差异均有统计学意义。结论:包皮环切术对改善包茎患者性功能有一定帮助,可延长性交时间,减少性交疼痛和手淫频率,提高性生活的质量。

  15. Long-term benefits of male circumcision for reproductive health in China%推广男性包皮环切术对降低生殖道感染促进生殖健康的意义

    Institute of Scientific and Technical Information of China (English)

    吕年青; 谷翊群; 夏术阶; 王一飞; 李石华

    2012-01-01

    男性包皮环切能显著降低60%男性阴茎-阴道性交获得性HIV感染风险,被WHO和联合国艾滋病规划署推荐为HIV预防策略中的一个重要干预措施.越来越多的研究已经证实,男性包皮环切也能降低人乳头瘤病毒、单纯疱疹病毒2型和其他性传播疾病感染风险,降低前列腺癌风险,为男女性生殖健康提供长远的益处.然而,男性包皮环切对促进两性生殖健康的长远益处与可接受性在中国一直被低估.最近累积的研究证据提示,男性包皮环切术,特别是应用创新的男性包皮环切术,例如中国商环将在HIV预防和促进人类生殖健康中发挥十分重要的作用,本文即对上述问题进行阐述.%Male circumcision (MC) can reduce HIV transmission through heterosexual intercourse by 60% and is therefore recommended as an important strategy for HIV prevention by WHO and UNAIDS. Several observational and epidemiological studies have also demonstrated significant reduction in the risk of human papillomavirus, herpes simplex virus 2 as well as the incidence of other sexual transmitted infections and prostate cancer with male circumcision, providing long - term healthy benefits for both men and women. However, the long term benefits and the acceptability of MC are currently underestimated in China. Recently, accumulated evidence shows that the ShangRing device for simplified adult circumcision may play an important role in preventing HIV transmission and promoting reproductive health for both men and women in China.

  16. Effect of sleeve circumcision at the base of penis in the treatment of redundant prepuce in children%阴茎根部袖套样包皮环切术治疗小儿包皮过长疗效观察

    Institute of Scientific and Technical Information of China (English)

    李松涛

    2014-01-01

    目的::比较阴茎根部包皮袖套样环切术与传统包皮环切术治疗小儿包皮过长的疗效。方法:分别采用阴茎根部包皮袖套样环切术(A组)52例,传统包皮环切术(B组)60例,治疗小儿包皮过长。观察2组手术时间、术中出血量、术后疼痛持续时间、术后并发症及术后6个月阴茎外观满意度情况。结果:A组手术时间长于B组(P<0.01)。 A组术后疼痛持续时间和术中出血量均较B组减少(P<0.01)。结论:阴茎根部包皮袖套样环切术在小儿包皮过长手术中具有明显的优势,是一种安全、有效的包皮环切技术,有良好的应用前景。%Objective:To compare the clinical effects of sleeve circumcision at the base of penis and conventional circumcision in the treatment of redundant prepuce in children. Methods:One hundred and twelve children with redundant prepuce were treated with sleeve circumcision at the base of penis ( group A ) 52 cases, and conventional circumcision ( group B ) 60 cases. The operation time, intraoperative blood loss,postoperative pain time,postoperative complication and postoperative 6-month satisfaction of penile appearance between two groups were compared. Results:The difference of the operation time between two groups had no statistically significant (P<0.01). The intraoperative blood loss and postoperative pain in group A were better than those in group B(P < 0. 01). Conclusions:The effects of sleeve circumcision at the base of penis in the treatment of redundant prepuce in children are good,which is a safe and effective circumcision technology,and has a good application prospect.

  17. Female Fitness in the Blogosphere

    Directory of Open Access Journals (Sweden)

    Jesper Andreasson

    2013-07-01

    Full Text Available This article analyzes self-portrayals and gender constructions among female personal trainers within an Internet-mediated framework of fitness culture. The empirical material comes from a close examination of three strategically selected blogs. The result shows that some of the blogs clearly build upon what Connell calls emphasized femininity, as a means of legitimizing and constructing appropriate female fitness. In addition, there are also tendencies of sexualization in text and imagery present. As such, these self-representations are framed within a cultural history of body fitness dominated by stereotypical ways of perceiving masculinity and femininity. However, this does not capture the entire presentation of the self among the analyzed fitness bloggers. The blogs also point in the direction of ongoing negotiations and subversions of traditional gender norms. Among other things, they show how irony and humor are used as a means of questioning normative gender constructions while empowering female fitness and bodyliness.

  18. Immune Aspects of Female Infertility

    Directory of Open Access Journals (Sweden)

    Andrea Brazdova

    2016-05-01

    Full Text Available Immune infertility, in terms of reproductive failure, has become a serious health issue involving approximately 1 out of 5 couples at reproductiv