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Sample records for circumcision female

  1. Female circumcision.

    Science.gov (United States)

    Abu Daia, J M

    2000-10-01

    It is uncertain when female circumcision was first practiced, but it certainly preceded the founding of both Christianity and Islam. A review of past and current historical, popular and professional literature was undertaken, and 4 types of female circumcision were identified. Typically female circumcision is performed by a local village practitioner, lay person or by untrained midwives. Female genital mutilation is not accepted by any religious or medical opinion, and is a violation of human rights against helpless individuals who are unable to provide informed consent and who must therefore be protected through education and legislation. Complications of female circumcision can present after many years. Any medical practitioner (either for adult or pediatric) can be confronted with this issue of female circumcision, even in countries where this custom is not present, thus mandating the understanding of this complex issue.

  2. Psychosocial and sexual aspects of female circumcision

    OpenAIRE

    S. Abdel-Azim

    2013-01-01

    Sexual behavior is a result of interaction of biology and psychology. Sexual excitement of the female can be triggered by stimulation of erotogenic areas; part of which is the clitoris. Female circumcision is done to minimize sexual desire and to preserve virginity. This procedure can lead to psychological trauma to the child; with anxiety, panic attacks and sense of humiliation. Cultural traditions and social pressures can affect as well the unexcised girl. Female circumcision can reduce fem...

  3. Psychosocial and sexual aspects of female circumcision

    Directory of Open Access Journals (Sweden)

    S. Abdel-Azim

    2013-09-01

    Full Text Available Sexual behavior is a result of interaction of biology and psychology. Sexual excitement of the female can be triggered by stimulation of erotogenic areas; part of which is the clitoris. Female circumcision is done to minimize sexual desire and to preserve virginity. This procedure can lead to psychological trauma to the child; with anxiety, panic attacks and sense of humiliation. Cultural traditions and social pressures can affect as well the unexcised girl. Female circumcision can reduce female sexual response, and may lead to anorgasmia and even frigidity. This procedure is now prohibited by law in Egypt.

  4. 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

  5. Female genital circumcision/mutilation: implications for female urogynaecological health.

    Science.gov (United States)

    Teufel, Katharina; Dörfler, Daniela Marianne

    2013-12-01

    "Female genital circumcision" or "female genital mutilation", as it is called more often, is an operation that is primarily carried out in Africa. Owing to migration, physicians are increasingly confronted with this issue in Western countries as well. A range of negative effects may result from this operation and this article aims to address consequences for female pelvic health. Special emphasis is placed on urogynaecological health consequences; in particular, on "voiding difficulties", "recurrent urinary tract infections" and "vesicovaginal fistula". All of these occur mostly in infibulated women, i.e. in women whose genitalia are sealed by the most severe form of circumcision. Some of the problems that may emerge as a result of the operation can be resolved by defibulation (i.e. surgical reopening of the sealed vulva). Female genital circumcision is a sensitive topic even in the area of research and reliable data are therefore scarce.

  6. The battle against female circumcision.

    Science.gov (United States)

    1981-09-01

    Most of Nigeria's estimated 50 million females have suffered female genital mutilation (FGM). Those who have escaped FGM either belong to nonmutilating tribes, are members of enlightened families, or have been overlooked for some reason. Nigerian girls who undergo FGM are told that the pain the suffer will be eased when they marry, but they are not told that this will likely occur because sexual intercourse will widen their vaginal opening or else it will be surgically widened. Many who submit their children to this mutilation have no clear idea about why it is called for except to claim that it protects a family's honor by proving virginity. A Yoruba scholar claims that FGM is used in that tribe to reduce a woman's sexual desires so that she will not engage in intercourse during the 18 months she breast feeds her baby (it is believed that sperm migrates to the mother's milk and can make the baby ill). Yoruba husbands have no curb on their sexual pleasure and may marry as many wives as they can afford. Yorubas mutilate girls when they are 2-8 years old. Ibos, on the other hand, mutilate young women when they are preparing for marriage as part of an initiation ceremony. Abohs mutilate women during their first pregnancy in the belief that this aids the safe delivery of the child by protecting it from contact with the "lethal" clitoris during delivery. While some argue for maintaining FGM because it is an African tradition, other harmful customs, such as facial scarification, have been eliminated.

  7. Circumcision

    Science.gov (United States)

    Foreskin removal; Removal of foreskin; Newborn care - circumcision; Neonatal care - circumcision ... general anesthesia so the boy is asleep and pain free. The foreskin is removed and stitched onto ...

  8. 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.

  9. 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 ...

  10. Circumcision

    Science.gov (United States)

    ... of a reconstructive operation. continue The Pros and Cons On the plus side, circumcised infants are less ... facts about circumcision and weigh the pros and cons. In addition to considering the medical factors, religious ...

  11. The relation of female circumcision to sexual behavior in Kenya and Nigeria.

    Science.gov (United States)

    Mpofu, Sibonginkosi; Odimegwu, Clifford; De Wet, Nicole; Adedini, Sunday; Akinyemi, Joshua

    2016-06-29

    One of the reasons for the perpetuation of female circumcision is that it controls female sexuality. In this study, the authors examined the relationship between female circumcision and the sexual behavior of women in Kenya and Nigeria. Data on women who were aware of circumcision and were circumcised were extracted from the Kenya Demographic and Health Survey of 2008-09 as well as the Nigeria Demographic and Health Survey of 2008. The sample size was 7,344 for Kenya and 16,294 for Nigeria. The outcome variables were age at first intercourse and total lifetime number of sexual partners. The study hypothesis was that women who were circumcised were less likely to have initiated sex early and to have only one sex partner. Cox proportional hazards regression and Poisson regression were used to examine the relations of female circumcision and other selected variables to sexual behavior. No association was observed between female circumcision and the outcomes for sexual behavior of women in Kenya and Nigeria. The argument of sexual chastity is insufficient to sustain the perpetuation of female circumcision.

  12. Male and female viewpoints on female circumcision in Ekpeye, Rivers State, Nigeria.

    Science.gov (United States)

    Briggs, L A

    2002-12-01

    One hundred and ninety five male and female volunteers across the social strata were interviewed using structured questionnaire. Data were analysed using frequency tables. The study revealed that 74.7% of female respondents were circumcised. They believe that the practice would help prevent sexual promiscuity, curb sexual desires and that it is a custom they cannot do without. Most of the men would not marry an uncircumcised female, while a substantial number of the respondents would like to circumcise their daughters. Community effort to eradicate the practice is very minimal. Based on the findings, it is suggested that communities where female genital mutilation (FGM) is practiced as a social norm should be involved in eradication campaigns with support from national and international organisations.

  13. Modern liberalism, female circumcision, and the rationality of traditions.

    Science.gov (United States)

    Bishop, Jeffrey P

    2004-08-01

    Tolerance is at the heart of Western liberalism, permitting mutually exclusive ideas and practices to coexist peacefully with one another, without the proponents of the differing ideas and practices killing one another. Yet, nothing challenges tolerance like the practice of sunna, female circumcision, clitorectomy, or genital mutilation. In this essay, I critique the Western critics of the practices, not in order to defend these practices, but rather to show that Western liberalism itself does not offer transcultural and transtemporal principles, for these principles only cohere within the tradition of liberalism. The Western critique of sunna often maps onto the bodies of African women Western symbolic notions of sexual and political freedom, as symbolized in the clitoris. The practices of sunna cohere within the web of beliefs, the tradition, of those who practice them and, thus, are rationally justified within those traditions. I offer Alasdair MacIntyre's notion of moral inquiry as a guide through the complex world of cultural and moral dialogue between differing traditions.

  14. 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.

  15. 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.

  16. Final report on position of female circumcision in Nigeria.

    Science.gov (United States)

    Adelaja, O A

    1981-01-01

    Survey data reveal that female genital mutilation (FGM) is being practiced in most Nigerian states, usually on babies and young girls but occasionally during wedding preparations or 7 months into the first pregnancy. Among the few tribes that mutilate women after marriage, husbands carry out the deed. Usually, FGM is performed on a group of girls, but it can also be performed on one girl in her home. The mutilator, who is paid a token fee, uses a knife or a razor. Post-mutilation treatment includes application of a variety of traditional methods. The most usual immediate complication is bleeding but other complications include tearing, septicemia, fistula development, stenosis, delayed second-stage labor, tetanus, urinary obstruction, and dyspareunia. Reasons cited for FGM include tradition, the belief that FGM curbs female promiscuity, and the belief that a baby whose head touches a clitoris during delivery will die. A prominent 1981 newspaper article on the subject reported the view of a physician that the practice ought to be eradicated and the view of a mutilator that it is not likely to be stopped.

  17. 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.

  18. 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

  19. [Legal aspects of ritual circumcision].

    Science.gov (United States)

    Schreiber, M; Schott, G E; Rascher, W; Bender, A W

    2009-12-01

    Female circumcision (genital mutilation) is a criminal violation of human rights under German law. Even with consent of the person to be circumcised and/or her legal representative this procedure must not be carried out since a consent to female circumcision is unethical and therefore void. As much consent as there is on female circumcision the legal situation with ritual male circumcision is very unclear. In practice and unnoticed by the public male circumcision is carried out - be it for medical or ritual reasons - without deeper-going reflexions on the clearness of the medical indication or the legal situation with ritual circumcision. From the medical aspect there are big differences between female and male circumcision but also certain parallels. Various reasons, partly founded in prejudice and misinformation, make people refrain from regarding circumcision of boys also as illegal. Contrary to the prevailing opinion male circumcision also represents a bodily harm which a doctor can only carry out after a preoperative interview and with the consent of the affected person. Since ritual male circumcision does not serve the wellbeing of a child it is not possible for the parents to give their consent to the circumcision in lieu of the child. Male circumcision is only permitted if the child has given his consent and is thus only legally permitted if the child has reached an age at which he is mature enough to understand the meaning and extent of such an action which is hardly the case before he has completed his 16 (th) year.

  20. 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.

  1. 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

  2. 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.

  3. 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

  4. 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.

  5. 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.

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

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    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.

  7. 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

  8. 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.

  9. [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.

  10. Successful cultural change: the example of female circumcision among Israeli Bedouins and Israeli Jews from Ethiopia.

    Science.gov (United States)

    Belmaker, R H

    2012-01-01

    Female genital mutilation (FGM) is practiced in many areas of the world, including the Middle East, Africa and Australia. Although it is most common in Muslim populations it is not a dictate of Islam. In the 1980s this practice was reported among Bedouin tribes, originally nomadic, in the southern area of Israel. Almost all of the women interviewed in the first study intended to continue the practice by performing FGM on their daughters including educated women who were teachers, dental assistants or university students. A second study was therefore done based in the obstetrical clinic where only women from tribes reporting to undergo FGM were examined for signs of FGM by an experienced gynecologist, in the presence of an Arabic-speaking female nurse and translator, as part of a gynecologic examination that was indicated for other reasons. In no cases was clitoridectomy or any damage to the labia found. All women had a small scar from a 1cm. incision somewhere on the labia or prepuce of the clitoris. this study concluded that the importance of the ritual in this population was unrelated to its severity. the ritual had apparently become over time a small symbolic scar, even though this population continued to believe in its importance. By contrast, a group of Ethiopian Jews who had immigrated to Israel was interviewed by an Amharic translator, and examined during routine gynecological examination in the same manner as the Bedouin group above. In Ethiopia, FGM is universal among Christian, Muslim and Jewish groups. All women interviewed reported that FGM was universal in Ethiopia, but none intended to continue this practice with their daughters. All stated that this was a practice that would be left behind in their country of origin. On physical examination many of the women had amputation of the clitoris. The conclusion of this study was that the severity of the operation performed had no relation to the social and cultural adherence to the operation, since the

  11. Male circumcision: An overview

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    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.

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

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    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

  13. 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.

  14. [Medical and legal aspects of genital mutilation and circumcision. Part II: Male circumcision].

    Science.gov (United States)

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

    2011-01-01

    In the last few years, male circumcision has become the subject of controversial discussion. On the one hand, medical and hygienic arguments, ideology, freedom of religion, cultural identity and social adequacy are claimed by those supporting male circumcision. On the other hand, the justification of this practice also has to be critically scrutinized just as the question whether the parents have the right to consent to the operation. Today, opinions range from those who claim that religion and culture alone justify the practice to those who consider circumcision of minors unable to give their consent as bodily injury subject to punishment. In contrast to female genital mutilation, most positions do not postulate that circumcision violates morality. If the person concerned is able to give his consent, freedom of religion may also justify circumcision after weighing its pros and cons as well as its risks and potential side effects.

  15. Routine neonatal circumcision?

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    Tran, P. T.; Giacomantonio, M.

    1996-01-01

    Routine neonatal circumcision is still a controversial procedure. This article attempts to clarify some of the advantages and disadvantages of neonatal circumcision. The increased rate of penile cancer among uncircumcised men appears to justify the procedure, but that alone is not sufficient justification. The final decision on neonatal circumcision should be made by parents with balanced counsel from attending physicians.

  16. Community-based study of circumcision practices in Nigeria

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    Lukman Olajide Abdur-Rahman

    2012-01-01

    Full Text Available Background: Circumcision practice around the world has various implications and has generated a lot of debate about the pros and cons of the practice. Nigeria is one of the countries where male and female circumcision practice still occurs however, there has been claim of reduction in female genital cutting. Congregational or ′group′ circumcision prevails in some communities as a means of upholding traditions and commemoration of festive period. Objective: To determine the pattern of circumcision practice and identify factors affecting the practice in Ilorin community. Materials and Methods: The study was a descriptive, cross sectional study conducted among parents of under-5 children of both the sexes using pre-tested, semi-structured questionnaires, which were administered to the respondents by trained research assistants over a six-week period. Clinical examination of genital area in index child of each respondent was done by a pediatric surgeon, who was the principal investigator. Results: Three hundred and ninety three (93% respondents completed the questionnaire and the same number of index children′s external genitalia was examined by the pediatric surgeon. The mean age of respondents was 33.2±9.3 years, and the main source of family income was private enterprises and civil services. The circumcision status of fathers was 100%, mothers, 65.6%, and overall female-child circumcision rate was 46.7%. Though, most of the index children were delivered at health centers (72.3%, the circumcisions were performed at almost equal frequencies by traditional circumcisionists (39.8% and doctors (39.2%, with more than half of the circumcision being done outside the hospital. The mean age at circumcision was 22 ±0.69 months, with 73.9% of girls as against 91.7% boys being circumcised by the age of five years. Family choice was the main determinant of the age at circumcision and the circumcisionist. Female circumcision was done by traditional

  17. Pros and cons of circumcision: an evidence-based overview.

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    Friedman, B; Khoury, J; Petersiel, N; Yahalomi, T; Paul, M; Neuberger, A

    2016-09-01

    Based on three large randomized controlled trials (RCTs) conducted in Africa, it can clearly be stated that circumcision lowers the risk of infection with the human immunodeficiency virus (HIV) and some sexually transmitted infections (STIs) among males in settings of high HIV and STI endemicity. Similar effects on STI risk may exist for females, although this may result from an indirect effect of decreasing risk of infection among male partners. It is unknown whether circumcision prevents HIV acquisition in men who have sex with men (MSM), although there might be a protective effect for men who engage mainly in insertive anal intercourse. When the effects of adult circumcision on sexual function and satisfaction of men are examined, high-quality evidence strongly supports lack of harm. Whether circumcision alters sexual satisfaction of female partners is not known as fewer and smaller studies reported conflicting results. Circumcision rarely causes serious complications if practiced by trained practitioners, in a sterile setting, and with a proper follow-up. These conclusions are limited by the lack of high-quality data from areas outside of Africa. RCTs have not been conducted to assess the effects of circumcising infants or MSM. Circumcision has well-proven benefits for people residing in areas with high prevalence of STIs, including HIV, and is not unethical for those who choose to be circumcised or have their children circumcised on religious, social, or cultural grounds. For many others, a definite pro or con recommendation, based on a risk-benefit ratio, cannot be made.

  18. Circumcision: Pros and cons

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    Burgu Berk

    2010-01-01

    Full Text Available 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.

  19. 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.

  20. Male circumcision for the prevention of acquisition and transmission of sexually transmitted infections: the case for neonatal circumcision.

    Science.gov (United States)

    Tobian, Aaron A R; Gray, Ronald H; Quinn, Thomas C

    2010-01-01

    The American Academy of Pediatrics (AAP) male circumcision policy states that while there are potential medical benefits of newborn male circumcision, the data are insufficient to recommend routine neonatal circumcision. Since 2005, however, 3 randomized trials have evaluated male circumcision for prevention of sexually transmitted infections. The trials found that circumcision decreases human immunodeficiency virus acquisition by 53% to 60%, herpes simplex virus type 2 acquisition by 28% to 34%, and human papillomavirus prevalence by 32% to 35% in men. Among female partners of circumcised men, bacterial vaginosis was reduced by 40%, and Trichomonas vaginalis infection was reduced by 48%. Genital ulcer disease was also reduced among males and their female partners. These findings are also supported by observational studies conducted in the United States. The AAP policy has a major impact on neonatal circumcision in the United States. This review evaluates the recent data that support revision of the AAP policy to fully reflect the evidence of long-term health benefits of male circumcision.

  1. Exploring drivers for safe male circumcision: Experiences with health education and understanding of partial HIV protection among newly circumcised men in Wakiso, Uganda

    Science.gov (United States)

    Daniel, Marguerite; Atuyambe, Lynn Muhimbuura; Makumbi, Fredrick Edward; Sandøy, Ingvild Fossgard

    2017-01-01

    Introduction About 2.5 million men have voluntarily been circumcised since Uganda started implementing the WHO recommendation to scale up safe male circumcision to reduce HIV transmission. This study sought to understand what influences men's circumcision decisions, their experiences with health education at health facilities and their knowledge of partial HIV risk reduction in Wakiso district. Methods Data were collected in May and June 2015 at five public health facilities in Wakiso District. Twenty-five in-depth interviews were held with adult safe male circumcision clients. Data were analysed using thematic network analysis. Findings Safe male circumcision decisions were mainly influenced by sexual partners, a perceived need to reduce the risk of HIV/STIs, community pressure and other benefits like hygiene. Sexual partners directly requested men to circumcise or indirectly influenced them in varied ways. Health education at facilities mainly focused on the surgical procedure, circumcision benefits especially HIV risk reduction, wound care and time to resumption of sex, with less focus on post-circumcision sexual behaviour. Five men reported no health education. All men reported that circumcision only reduces and does not eliminate HIV risk, and could mention ways it protects, although some extended the benefit to direct protection for women and prevention of other STIs. Five men thought social marketing messages were ‘misleading’ and feared risk compensation within the community. Conclusions Participants reported positive community perception about safe male circumcision campaigns, influencing men to seek services and enabling female partners to impact this decision-making process. However, there seemed to be gaps in safe male circumcision health education, although all participants correctly understood that circumcision offers only partial protection from HIV. Standard health education procedures, if followed at health facilities offering safe male

  2. Circumcision revision in male children

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    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.

  3. [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.

  4. Complications of Circumcision

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    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.

  5. 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.

  6. Bloodless, sutureless circumcision

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    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.

  7. 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.

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

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    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.

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

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    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.

  10. Discourses of masculinity, femininity and sexuality in Uganda's Stand Proud, Get Circumcised campaign.

    Science.gov (United States)

    Rudrum, Sarah; Oliffe, John L; Benoit, Cecilia

    2017-02-01

    This paper analyses discourses of masculinity, femininity and sexuality in Stand Proud, Get Circumcised, a public health campaign promoting circumcision as an HIV-prevention strategy in Uganda. The campaign includes posters highlighting the positive reactions of women to circumcised men, and is intended to support the national rollout of voluntary medical male circumcision. We offer a critical discourse analysis of representations of masculinity, femininity and sexuality in relation to HIV prevention. The campaign materials have a playful feel and, in contrast to ABC (Abstain, Be faithful, Use condoms) campaigns, acknowledge the potential for pre-marital and extra-marital sex. However, these posters exploit male anxieties about appearance and performance, drawing on hegemonic masculinity to promote circumcision as an idealised body aesthetic. Positioning women as the campaign's face reasserts a message that women are the custodians of family health and simultaneously perpetuates a norm of estrangement between men and their health. The wives' slogan, 'we have less chance of getting HIV', is misleading, because circumcision only directly prevents female-to-male HIV transmission. Reaffirming hegemonic notions of appearance- and performance-based heterosexual masculinity reproduces existing unsafe norms about masculinity, femininity and sexuality. In selling male circumcision, the posters fail to promote an overall HIV-prevention message.

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

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    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.

  12. 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.

  13. Neonatal circumcision: new recommendations & implications for practice.

    Science.gov (United States)

    Simpson, Elizabeth; Carstensen, Jean; Murphy, Patrick

    2014-01-01

    Neonatal male circumcision is the most common surgical procedure performed on pediatric patients. While the rate of neonatal circumcision in the United States has been dropping, circumcision continues to be frequent, ranging from 42% to 80% among various populations. While the cultural debate over circumcision continues, recent evidence of medical benefits led to a revision of the American Academy of Pediatrics (AAP) circumcision policy statement. In contrast to the 1999 AAP policy statement, the 2012 policy asserts that the preventive benefits of neonatal circumcision outweigh the risk of the procedure, which is well tolerated when performed by trained professionals, under sterile conditions, and with appropriate pain management. This Circumcision Policy Statement has also been endorsed by the American College of Obstetricians and Gynecologists and a similar policy statement is in place from the American Urologic Association. Despite the new recognized health benefits found by the 2012 Task Force of Circumcision (TFOC), circumcision remains controversial even among medical professionals. Other well recognized medical organizations including The American Academy of Family Practice and some international pediatric societies have not adopted such a strong endorsement of circumcision. The policy statements from these organizations continue to more closely resemble the 1999 AAP policy statement that stated, "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision." In this review we will summarize historical, cultural and ethical factors in neonatal circumcision and briefly compare common surgical techniques including anesthesia. In addition, we will discuss recent information regarding the benefits and risks of neonatal circumcision. Finally, we will discuss the financial reimbursement of practitioners and the benefits of standardized

  14. 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

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    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.

  15. Decline in male circumcision in South Korea

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    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

  16. 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

  17. 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.

  18. Circumcision: Perspective in a Nigerian teaching hospital

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    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.

  19. Prepuce: Phimosis, Paraphimosis, and Circumcision

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    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.

  20. Co-infection of human immunodeficiency virus and sexually transmitted infections in circumcised and uncircumcised cases in India

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    Charu Nayyar

    2014-01-01

    Full Text Available Background: Acquired Immunodeficiency Syndrome (AIDS, is now one of the greatest challenges facing the world. Sexual transmission is the primary route of human immunodeficiency virus infection worldwide. Male circumcision is being considered as strategy to reduce the burden of HIV/AIDS. Material and Methods: The present study was conducted on 200 HIV positive clients. They were screened for bacterial causes of STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis. Results: There were 138 males and 62 females. The males were examined and the circumcision status was observed. In the females, circumcision status of their male partners was observed. The coinfection of HIV and STIs in circumcised and uncircumcised cases was found out. Diagnosis was made using standard tests. A total of 23% cases were diagnosed to have HIV -STI coinfection. Most common diagnosed diseases were Chlamydia (10%, Gonorrhoea (9%, Bacterial Vaginosis (4.8% and Syphilis (2.5%. The coinfection rate in uncircumcised cases was found to be higher (29.2% in males and 39.2% in females as compared to the circumcised cases (14.2% in males and 13.6% in females. Conclusion: The present study suggests that circumcision is a protective factor for acquisition of STIs in HIV positive clients but other factors like sexual behaviours, use of barrier contraceptives, drug abuse etc also play a role.

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

    OpenAIRE

    Donatus Ignatius Chidiebere Osuorah

    2015-01-01

    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 det...

  2. The Islamic view on female circumcision

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    Ali Gomaa

    2013-09-01

    The fundamental principle is that both men and women are honored members of creation, possessing equality with respect to spirituality and worship. Following from this spiritual and legal equality is the equity envisioned by Islam in the social relations between men and women. Socially, the relationship between them is one of complementarity, and not of competition. As the Qur’an says, “And in no wise covet those things in which Allah Hath bestowed His gifts More freely on some of you than on others: To men is allotted what they earn, and to women what they earn: But ask Allah of His bounty”. From this follows the concept of social equity, and not identity. This standpoint maintains the distinction between men as men, and women as women, a distinction which has come under attack from some materialist philosophies. Either of the two genders fulfills its role in life in accordance with its natural specificities and responsibilities.

  3. 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)

  4. Bupivacaine versus lidocaine analgesia for neonatal circumcision

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    Stolik-Dollberg Orit C

    2005-05-01

    Full Text Available Abstract Background Analgesia for neonatal circumcision was recently advocated for every male infant, and its use is considered essential by the American Academy of Pediatrics. We compared the post-operative analgesic quality of bupivacaine to that of lidocaine for achieving dorsal penile nerve block (DPNB when performing neonatal circumcision. Methods Data were obtained from 38 neonates following neonatal circumcision. The infants had received DPNB analgesia with either lidocaine or bupivacaine. The outcome variable was the administration by the parents of acetaminophen during the ensuing 24 hours. Results Seventeen infants received lidocaine and 19 received bupivacaine DPNB. Ten infants in the lidocaine group (59% were given acetaminophen following circumcision compared to only 3 (16% in the bupivacaine group (P 2 = 20.6; P = 0.006. Conclusion DPNB with bupivacaine for neonatal circumcision apparently confers better analgesia than lidocaine as judged by the requirement of acetaminophen over the ensuing 24-hour period.

  5. 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

  6. Women's beliefs about male circumcision, HIV prevention, and sexual behaviors in Kisumu, Kenya.

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    Thomas H Riess

    Full Text Available It is important to understand how women's sexual practices may be influenced by male circumcision (MC as an HIV prevention effort. Women's beliefs about MC and sexual behaviour will likely influence the scale-up and uptake of medical MC. We conducted qualitative interviews with 30 sexually active women in Kisumu, Kenya. Women discussed MC related to perceived health benefits, condom use, sexual behaviour, knowledge of susceptibility to HIV and sexually transmitted infections (STIs, circumcision preference, and influence on circumcision uptake. Respondents had a good understanding of the partial protection of MC for acquisition of HIV for men. Women perceived circumcised men as cleaner, carrying fewer diseases, and taking more time to reach ejaculation. Male's circumcision status is a salient factor for women's sexual decision making, including partner choice, and condom use. It will be important that educational information affirms that MC provides only partial protection against female to male transmission of HIV and some STIs; that other HIV and STI prevention methods such as condoms need to be used in conjunction with MC; that MC does not preclude a man from having HIV; and that couples should develop plans for not having sex while the man is healing.

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

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    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.

  8. General Practitioner Knowledge Levels About Circumcision

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    Levent Cankorkmaz

    2011-09-01

    Full Text Available Objective: This study was carried out to investigate knowledge levels of general practitioners and their thoughts about circumcision in Middle Anatolia.Materials and Methods: This descriptive and cross-sectional study was carried out with 247 general practitioners working in Sivas. A questionnaire was prepared by the authors using previous reports. Questionnaires were sent to subjects by post. One hundred and seventy eight general practitioners (57 women, 121 men responded and were included in the study. For statistical analysis, Chi-square test was used and p<0.05 value was accepted as significant.Results: 42.1% of subjects believed that circumcision should be performed between 2 and 6 years of age. 2.2% of subjects declared that circumcision could be done at home and 7.3% believed that the location of the operation is not important. 9.6% of subjects believed that the person who performs the circumcision does not have to be a doctor. 21.3% of subjects believed that circumcision could be performed without anesthesia during the newborn period because of undeveloped pain sensation. Conclusion: This study demonstrated that general practitioners, who are the most easily accessible health staff for information about health, do not have updated information about the way to perform circumcision and its necessity. Therefore, it is concluded that education programs about circumcision for general practitioners must be continued and updated.

  9. "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.

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    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.

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

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    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.

  11. Polyarticular septic arthritis following septic circumcision.

    Science.gov (United States)

    Millar, Tim M; McGrath, Patrick; McConnachie, Charles C

    2007-01-01

    Ritual circumcision during an initiation ceremony for young adults is common practice in parts of South Africa. We report on a case of polyarticular septic arthritis in a seventeen-year-old man following septicaemia after circumcision, resulting in severe fixed flexion deformities of both knees. This case illustrates an unusual cause of polyarticular septic arthritis and the treatment difficulties associated with delayed presentation. It is also a reminder of the consequences of untreated acute septic arthritis.

  12. 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.

  13. Parental circumcision preferences and early outcome of plastibell circumcision in a Nigerian tertiary hospital

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    Okechukwu Hyginus Ekwunife

    2015-01-01

    Full Text Available Background: Parents are central in decisions and choices concerning circumcision of their male children and plastibell circumcision is a widely practiced technique. This study determined parental preferences for male neonatal and infant circumcisions and evaluate the early outcomes of plastibell circumcisions in a tertiary centre. Patients and Methods: This is a prospective study on consecutive male neonates and infants who were brought for circumcisions at Nnamdi Azikiwe University Teaching Hospital Nnewi, South-East Nigeria and their respective parents between January 2012 and December 2012. Data on demography, parental choices and early outcome of plastibell circumcision were obtained and analysed. Results: A total of 337 requests for circumcisions were made for boys with age range of 2-140 days. Culture and religion were the most common reasons for circumcision requests in 200 (59.3% and 122 (36.2%, respectively, other reasons were medical, cosmesis, to reduce promiscuity and just to follow the norm. Most parents, 249 (73.9% preferred the procedure to be performed on the 8 th day and 88.7% would like the doctors to perform the procedure while 84.6% preferred the plastibell method. Among those who had circumcision, 114 complied with follow-up schedules and there were complications in 22 (19.3% patients. Parents assessed the early outcome as excellent, very good, good and poor in 30.7%, 45.6%, 18.4% and 5.3% of the patients, respectively. Conclusion: Parents request for male circumcision in our environment is largely for cultural and religious reasons; and prefer the procedure to be performed by a physician. Plastibell method is well known and preferred and its outcome is acceptable by most parents.

  14. Electrosurgery use in circumcision in children: Is it safe?

    Science.gov (United States)

    Altokhais, Tariq Ibrahim

    2017-01-01

    Circumcision is one of the most common procedures performed worldwide. Bleeding is one of the most common complications following male circumcision, and to decrease the risk of bleeding, electrosurgery may be utilized. However, the use of diathermy on the penis is controversial, and there are reported complications due to the use of electrosurgery for circumcision. The aim of this review is to evaluate the utilization and relative safety of monopolar and bipolar electrosurgery for circumcision in children. PMID:28216919

  15. 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.

  16. Reported Male Circumcision Practices in a Muslim-Majority Setting

    Science.gov (United States)

    Iftikhar, Sundus

    2017-01-01

    Introduction. Male circumcision is a recommended practice in Muslim tradition. It is important to ensure that this procedure is performed as safely as possible in these communities. Methods. Five hundred adult men and women with at least one male child less than 18 years were interviewed in Karachi, Pakistan, regarding details of their child's circumcision. The survey focused on actual and perceived delays in circumcision and perceptions about appropriate age and reasons and benefits and complications of the procedure. Circumcisions done after two months of age were defined as delayed. Results. Religious requirement was the primary reason for circumcision in 92.6% of children. However, 89.6% of respondents were of the opinion that circumcision had medical benefits as well. Half of the children (54.1%) had delayed circumcision (range 2.5 months to 13 years), even though 81.2% of parents were of the opinion that circumcisions should be done within 60 days of birth. Facility-delivered babies had less delay in circumcisions (49.1%) as compared to home-delivered babies (60.5%). Conclusion. Understanding the perceptions and practices around male circumcision can help guide national strategies for designing and implementing safe circumcision programs in Muslim-majority settings, with the potential to benefit an annual birth cohort of 20–25 million boys worldwide. PMID:28194416

  17. 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

  18. Ritual male infant circumcision and human rights.

    Science.gov (United States)

    Jacobs, Allan J; Arora, Kavita Shah

    2015-01-01

    Opponents of male circumcision have increasingly used human rights positions to articulate their viewpoint. We characterize the meaning of the term "human rights." We discuss these human rights arguments with special attention to the claims of rights to an open future and to bodily integrity. We offer a three-part test under which a parental decision might be considered an unacceptable violation of a child's right. The test considers the impact of the practice on society, the impact of the practice on the individual, and the likelihood of adverse impact. Infant circumcision is permissible under this test. We conclude that infant circumcision may be proscribed as violating local norms, even though it does not violate human rights.

  19. 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....

  20. 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.

  1. Ketamine-propofol sedation in circumcision

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    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.

  2. Self-assessment of circumcision status by adolescents.

    Science.gov (United States)

    Risser, Jan M H; Risser, William L; Eissa, Mona A; Cromwell, Polly F; Barratt, Michelle S; Bortot, Andrea

    2004-06-01

    In epidemiologic studies of the relation between circumcision and sexually transmitted infections, it is necessary to rely on self-report of circumcision status. The purpose of this 2002 study in Houston, Texas, was to determine whether adolescent males could make correct self-reports. During physical examinations, adolescents were asked whether they were circumcised. The authors then examined the adolescents' genitalia. Circumcision status was recorded as complete (glans penis fully exposed), partial (glans partly covered), or uncircumcised (glans completely covered). The mean age of the 1,508 subjects was 15.0 (standard deviation, 1.63) years; 64% were Black, 29% Hispanic, and 7% White. Forty-nine percent had full, 1% partial, and 50% no circumcision. Of the 738 fully circumcised subjects, 512 (69%) considered themselves circumcised, 54 (7%) considered themselves uncircumcised, and 172 (23%) did not know. Of the 751 uncircumcised youth, 491 (65%) described themselves as uncircumcised, 27 (4%) reported being circumcised, and 233 (31%) did not know. The sensitivity of self-report among those who thought they knew their status was 90.5%, and the specificity was 94.8%; 27% did not know their status. In this population, self-report of circumcision status did not result in accurate information mainly because many adolescents were unsure of their status.

  3. 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

  4. 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…

  5. [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.

  6. 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.

  7. 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.

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

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    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.

  9. 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.

  10. Prepuce health and childhood circumcision: Choices in Canada

    Science.gov (United States)

    Abara, Emmanuel O.

    2017-01-01

    Introduction: Worldwide, almost 100% of boys are born with penises with a “hood” called prepuce or foreskin. In the course of the boy’s life, the prepuce can be circumcised, can become affected by diseased (e.g., phimosis), or a can become infected and hurt the neonate (and his sexual partner) in adulthood. The objectives of this report are to: 1) review the state, function, fate, and care of the prepuce in childhood, with focus on the neonate, in Canada; 2) understand the current practice of childhood male circumcision in terms of age, indications, performers, techniques, outcomes, and education; and 3) consider ways to sustain a good healthcare professional-parental dialogue for safe practices that are accessible, acceptable, and culturally sensitive in the care of the prepuce. Methods: A literature review was carried out in the English language through the major databases: PubMed (MEDLINE), EMBASE, the Cochrane Library, CINAHL, Web of Science (WOS) Core Collection, LILAC, WHO/UNAIDS, Clinical Trials (www.clinicaltrials.gov), Google Scholar, and grey literature. Search words included: prepuce, diseases of prepuce, prepuce in the neonate, prepuce in the neonate in Canada, male circumcision, childhood male circumcision, neonatal circumcision, neonatal circumcision in Canada, complications of neonatal circumcision in Canada, and circumcision adverse events. Results: From 1970–1999, three of 10 Canadian newborn males were circumcised for religious, cultural, and medical reasons. The rest of the neonates, if alive, are living with their prepuce; <4% expected to require treatment for afflictions of the prepuce at some point. There are several providers of circumcision with different levels of training and competencies and using a diversity of devices and techniques. Neonatal and childhood circumcision in Canada is carried out to fulfill parental wishes, as well as for medical, religious, and cultural reasons. Appropriate informed consent and education regarding

  11. 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.

  12. Does circumcision alter the periurethral uropathogenic bacterial flora

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    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.

  13. Why Thailand should consider promoting neonatal circumcision?

    Science.gov (United States)

    Srithanaviboonchai, Kriengkrai; Grimes, Richard M

    2012-09-01

    Male circumcision (MC) has been proven to reduce the risk of HIV transmission. The WHO and UNAIDS jointly recommend the international community consider MC as an HIV prevention measure. MC reduces the risk of acquiring other sexually transmitted infections (STIs) among men, urinary tract infections among children and penile cancer. Lowering the prevalence of STIs in men may reduce the incidence of STIs among women. High levels of adult MC are difficult to achieve in cultures where it has not been customary. Adult MC is associated with a high prevalence of post-operative complications. Neonatal male circumcision (NC) is simpler, safer, and cheaper. Higher coverage with MC can be achieved through NC. Thailand is a good country to promoting NC for the following reasons: most HIV infections are contracted through heterosexual transmission, there is a low MC rate, most newborn deliveries occur in hospitals, there is a relatively strong health care infrastructure and Thailand has well developed HIV care services. Issues of concern regarding promoting NC include length of time before seeing benefits, cost effectiveness of the intervention, the burden to the health care delivery system and concerns about children's rights. NC is an efficacious HIV prevention strategy that should be considered by those involved in HIV/AIDS prevention planning in Thailand. Further studies are needed to determine whether NC should be promoted in Thailand.

  14. Acceptability of neonatal male circumcision in Lusaka, Zambia.

    Science.gov (United States)

    Waters, Emily; Stringer, Elizabeth; Mugisa, Bridget; Temba, Salome; Bowa, Kasonde; Linyama, David

    2012-01-01

    Neonatal male circumcision (NMC) is being scaled up in Zambia and elsewhere in Southern Africa as a long-term HIV prevention strategy. We conducted 12 focus group discussions with 129 parents and grandparents in Lusaka, recruited from two sites providing free NMC services and information about NMC, to explore the acceptability of circumcising newborn boys. Most participants recognized the benefits of circumcision for HIV prevention, and the advantages of circumcising their children and grandchildren at a young age. Fear of negative outcomes, concerns about pain, and issues around cultural identity may challenge NMC uptake. To effectively promote the service, the upper age limit for NMC must be emphasized, and fathers must be targeted by messaging campaigns.

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

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    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.

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

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    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.

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

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    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.

  18. 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.

  19. Male circumcision does not result in inferior perceived male sexual function - a systematic review

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel Mønsted; Düring, Signe; Frimodt-Møller, Cai

    2016-01-01

    INTRODUCTION: The debate on non-medical male circumcision has gaining momentum during the past few years. The objective of this systematic review was to determine if circumcision, medical indication or age at circumcision had an impact on perceived sexual function in males. METHODS: Systematic...... searches were performed in MEDLINE and Embase. The included studies compared long-term sexual function in circumcised and non-circumcised males, before and after circumcision, or compared different ages at circumcision. The quality of the studies was assessed according to the level of evidence (Grade A......-D). RESULTS: Database and hand searches yielded 3,677 records. Inclusion criteria were fulfilled in 38 studies including two randomised trials. Overall, the only identified differences in sexual function in circumcised males were decreased premature ejaculation and increased penile sensitivity (Grade A...

  20. 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.

  1. 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

  2. Female Genital Mutilation - the Importance of Recognition and Management

    OpenAIRE

    Campos, AC

    2010-01-01

    Female genital mutilation, also named female genital cutting or female circumcision, refers to all practices involving total or partial removal of female external genitalia, or causing other lesions without an established health benefit. The World Health Organization estimates that 130 million women have been submitted to genital mutilation and 3 million are annually exposed to such risk in Africa. It has classified the practice of female genital mutation in four types. Portugal is considered...

  3. 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…

  4. The when and how of male circumcision and the risk of HIV

    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 is cru...

  5. Traditional Male Circumcision: Ways to Prevent Deaths Due to Dehydration.

    Science.gov (United States)

    Douglas, Mbuyiselo; Maluleke, Thelmah Xavela

    2016-02-01

    Deaths of initiates occurring in the circumcision initiation schools are preventable. Current studies list dehydration as one of the underlying causes of deaths among traditional male circumcision initiates in the Eastern Cape, a province in South Africa, but ways to prevent dehydration in the initiation schools have not been adequately explored. The goals of this study were to (a) explore the underlying determinants of dehydration among initiates aged from 12 to 18 years in the traditional male circumcision initiation schools and (b) determine knowledge of participants on the actions to be taken to prevent dehydration. The study was conducted at Libode, a rural area falling under Nyandeni municipality. A simple random sampling was used to select three focus group discussions with 36 circumcised boys. A purposive sampling was used to select 10 key informants who were matured and experienced people with knowledge of traditional practices and responsible positions in the communities. The research findings indicate that the practice has been neglected to inexperienced, unskillful, and abusive traditional attendants. The overall themes collated included traditional reasons for water restriction, imbalanced food nutrients given to initiates, poor environmental conditions in the initiation hut, and actions that should be taken to prevent dehydration. This article concludes with discussion and recommendation of ways to prevent dehydration of initiates in the form of a comprehensive circumcision health promotion program.

  6. [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.

  7. Anesthesia methods used by anesthetic specialists for circumcision cases

    Science.gov (United States)

    Altaş, Cafer; Küçükosman, Gamze; Yurtlu, Bülent S.; Okyay, Rahşan D.; Aydın, Bengü G.; Pişkin, Özcan; Çimencan, Murat; Ayoğlu, Hilal; Hancı, Volkan; Özkoçak-Turan, Işıl

    2017-01-01

    Objectives: To examine the anesthesiologist’s choice for anesthesia techniques and drugs in circumcision and determine the preoperative examination, intraoperative monitoring techniques, postoperative analgesia methods, and common complications among anesthesiologists working in Turkey. Methods: This cross-sectional study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between May and July 2012. Survey data were obtained via survey forms through electronic data over the web. The questionnaire consists of 20 questions. These questions included demographic data, methods of anesthesia for circumcision, postoperative analgesia methods, and monitoring methods. Results: The data were obtained from 206 anesthesiologists who agreed to participate in the survey. Circumcision was performed most frequently in the age group of 3-6 years old. It was found that 47% of routine preoperative laboratory tests were coagulation parameters and complete blood count tests. The most common method of anesthesia was laryngeal mask. The frequency of administration of regional anesthesia was 37.4%, and caudal block was more preferable. Bupivacaine as a local anesthetic in regional anesthesia and midazolam and ketamine were the most preferred agents in sedoanalgesia. During regional anesthesia, ultrasound was most often used by anesthesiologists (31.6%). Conclusion: Ambulatory anesthesia protocols, which are also needed in circumcision, can be improved with international recommendation, and these protocols could be conformed as sociocultural structure in societies. This study should be regarded as a preliminary study to attract attention on anesthesia techniques in circumcision. PMID:28042634

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

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    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

  9. Do motives matter in male circumcision? 'Conscientious objection' against the circumcision of a Muslim child with a blood disorder.

    Science.gov (United States)

    Ahmad, Ayesha

    2014-02-01

    Whilst there have been serious attempts to locate the practice of male circumcision for religious motives in the context of the (respective) religion's narrative and community, the debate, when referring to a clinical context, is often more nuanced. This article will contribute further to the debate by contextualising the Islamic practice of male circumcision within the clinical setting typical of a contemporary hospital. It specifically develops an additional complication; namely, the child has a pre-existing blood disorder. As an approach to contributing to the circumcision debate further, the ethics of a conscientious objection for secular motives towards a religiously-motivated clinical intervention will be explored. Overall, the discussion will provide relevance for such debates within the value-systems of a multi-cultural society. This article replicates several approaches to deconstructing a request for conscientious refusal of non-therapeutic circumcision by a Clinical Ethics Committee (CEC), bringing to light certain contradictions that occur in normatively categorizing motives for performing the circumcision.

  10. Complications of Circumcision in Childhood and Preventive Strategies

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    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

  11. 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

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

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    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.

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

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    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.

  14. Voluntary Medical Male Circumcision: A Cross-Sectional Study Comparing Circumcision Self-Report and Physical Examination Findings in Lesotho

    Science.gov (United States)

    2011-11-29

    During the physical examination, with a study nurse present, a medical doctor examined the penis for extent of circumcision, using a four-point scale...However, this does not appear to have biased the study results, as the average MC prevalence in the LDHS is similar across all men aged 20 y and older (57.9...Rakai, Uganda ( size matters). AIDS 23: 2209–2213. 24. Lagarde E, Dirk T, Puren A, Reathe RT, Bertran A (2003) Acceptability of male circumcision as a

  15. 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.

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

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    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.

  17. Female genital mutilation and the unborn female child in southwest Nigeria.

    Science.gov (United States)

    Ogunlola, I O; Orji, E O; Owolabi, A T

    2003-03-01

    Female genital mutilation, despite efforts to abolish it, is still widely practised in Nigeria. The risk of female genital mutilation to a female child in southwest Nigeria was investigated by interviewing 430 consecutive pregnant women attending the antenatal clinic of Wesley Guild Hospital Ilesa, Nigeria between July 2001 to October 2001. The results show that 60% of the pregnant women studied had a type of genital mutilation. The decision to mutilate a female child is taken before she is born. Seventy-four (17.2%) of the women and 146 (34%) of their husbands would circumcise their female child. The decision to circumcise a female child is made between the husband and wife but the final decision comes mainly from the husband. Because the majority of the women (58.4%) were yet to decide whether or not to circumcise their female children, they could sway the decision either way before the husband makes up his mind. Therefore, every effort should be taken to involve men in the struggle to eradicate this unwholesome practice.

  18. Complications of circumcision in male neonates, infants and children: a systematic review

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    Halperin Daniel

    2010-02-01

    Full Text Available Abstract Background Approximately one in three men are circumcised globally, but there are relatively few data on the safety of the procedure. The aim of this paper is to summarize the literature on frequency of adverse events following pediatric circumcision, with a focus on developing countries. Methods PubMed and other databasess were searched with keywords and MeSH terms including infant/newborn/pediatric/child, circumcision, complications and adverse events. Searches included all available years and were conducted on November 6th 2007 and updated on February 14th 2009. Additional searches of the Arabic literature included searches of relevant databases and University libraries for research theses on male circumcision. Studies were included if they contained data to estimate frequency of adverse events following neonatal, infant and child circumcision. There was no language restriction. A total of 1349 published papers were identified, of which 52 studies from 21 countries met the inclusion criteria. The Arabic literature searches identified 46 potentially relevant papers, of which six were included. Results Sixteen prospective studies evaluated complications following neonatal and infant circumcision. Most studies reported no severe adverse events (SAE, but two studies reported SAE frequency of 2%. The median frequency of any complication was 1.5% (range 0-16%. Child circumcision by medical providers tended to be associated with more complications (median frequency 6%; range 2-14% than for neonates and infants. Traditional circumcision as a rite of passage is associated with substantially greater risks, more severe complications than medical circumcision or traditional circumcision among neonates. Conclusions Studies report few severe complications following circumcision. However, mild or moderate complications are seen, especially when circumcision is undertaken at older ages, by inexperienced providers or in non-sterile conditions

  19. Acceptability and uptake of neonatal male circumcision in Lusaka, Zambia.

    Science.gov (United States)

    Waters, Emily; Li, Michelle; Mugisa, Bridget; Bowa, Kasonde; Linyama, David; Stringer, Elizabeth; Stringer, Jeffrey

    2013-07-01

    Neonatal male circumcision (NMC) is an uncommon procedure in Southern Africa, but is being scaled up in Zambia for long-term HIV prevention. We conducted a cross-sectional survey on NMC with a convenience sample of mothers of newborn boys at two public clinics in Lusaka. Following the survey, mothers received information on availability of NMC, and uptake of the service was tracked. Predictors of uptake were assessed using bivariate and multivariate logistic regression. Of the 1,249 eligible mothers approached, 1000 (80%) agreed to participate. Although 97% of surveyed mothers said they definitely or probably planned to have their newborn son circumcised, only 11% of participants brought their newborn sons for NMC. Significant predictors of uptake in adjusted models included: Older maternal age (AOR 3.77, 95% CI 1.48-9.63 for age 36 and above compared to mothers age 25 and below), having attended antenatal care at an NMC site (AOR 2.13, 95% CI 1.32-3.44), older paternal age (AOR 4.36, 95% CI 1.28-14.91 for age 26-35 compared to fathers age 25 and below), and the infant's father being circumcised (AOR 2.21, 95% CI 1.35-3.62). While acceptability studies in Southern Africa have suggested strong support for MC among parents for having their sons circumcised, this may not translate to high uptake of newly-introduced NMC services.

  20. Penile shaft sinus: A sequalae of circumcision in urethral duplication

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    Lukman O Abdur-Rahman

    2009-01-01

    Full Text Available Urethral duplication (UD is rare congenital anomalies with varied presentation. Careful clinical evaluation of children by specialist would enhance diagnosis, adequate management and reduce occurrence of complication. We present a 12-year-old boy with chronic post circumcision ventral penile sinus that was successfully managed for urethral duplication.

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

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    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.

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

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    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

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

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    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.

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

    OpenAIRE

    2013-01-01

    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...

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

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    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

  6. 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.

  7. 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…

  8. Community and healthcare providers' perspectives on male circumcision: a multi-centric qualitative study in India.

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    Seema Sahay

    Full Text Available Although male circumcision (MC is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores beliefs, experiences and understanding of the community and healthcare providers (HCPs about adult MC as an HIV prevention option in India.This qualitative study covered 134 in-depth interviews from Belgaum, Kolkata, Meerut and Mumbai cities of India. Of these, 62 respondents were the members of circumcising (CC/non-circumcising communities (NCC; including medically and traditionally circumcised men, parents of circumcised children, spouses of circumcised men, and religious clerics. Additionally, 58 registered healthcare providers (RHCPs such as general and pediatric surgeons, pediatricians, skin and venereal disease specialists, general practitioners, and operation theatre nurses were interviewed. Fourteen traditional circumcisers were also interviewed. The data were coded and analyzed in QSR NUD*IST ver. 6.0. The study has not explored the participants' views about neonatal versus adult circumcision.Members of CC/NCC, traditional circumcisers and RCHPs expressed sharp religious sensitivities around the issue of MC. Six themes emerged: Male circumcision as the religious rite; Multiple meanings of MC: MC for 'religious identity/privilege/sacrifice' or 'hygiene'; MC inflicts pain and cost; Medical indications outweigh faith; Hesitation exists in accepting 'foreign' evidence supporting MC; and communication is the key for acceptance of MCs. Medical indications could make members of NCC accept MC following appropriate counseling. Majority of the RHCPs demanded local in-country evidence.HCPs must educate high-risk groups regarding the preventive and therapeutic role of MC. Communities need to discuss and create new social norms about male circumcision for better societal acceptance especially among the NCC. Feasibility

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

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    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.

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

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    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. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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…

  16. 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…

  17. 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

  18. 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

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. The World Health Organization work and experiences in combating female genital mutilation in Addis Ababa, Ethiopia

    OpenAIRE

    Mladonova, Anna

    2007-01-01

    This thesis is dedicated to a better understanding of World Health Organization contribution to process of combating female genital mutilation in Addis Ababa, Ethiopia. The World Health Organization is well known all over the world for their work in public health. This organization is dealing with many issues concerning health and well being of people, the one of these issues is combating female genital mutilation. The practice of female circumcision/female genital mutilation is practic...

  4. Factors associated with mothers' decisions on male neonatal circumcision in Swaziland.

    Science.gov (United States)

    Mapureti, Phillip; Chola, Lumbwe; Skinner, Donald

    2015-01-01

    Neonatal male circumcision is safer, easier and cheaper than adult male circumcision, but is not widely practised in Swaziland. It has been suggested as one of several ways of controlling the spread of HIV. We conducted research aimed at assessing mothers' knowledge, attitudes and perceptions towards circumcision and reasons why mothers have their newly born male children circumcised. A cross-sectional study was conducted at Hlatikulu Government Hospital, a rural hospital in Shiselweni region, Swaziland. The target population was mothers with children younger than 6 months old who presented at the hospital. Of the 392 participants who were interviewed, 43 (11.2%) had circumcised their children. The participants' ages ranged from 15 to 44 with a mean age of 25.3 years. All the respondents had a mean knowledge score of 7.8 out of a maximum possible of 11, a mean attitudes score of 3.6 out of 6 and a mean perception score of 1.8 out of 3. The main reasons for mothers circumcising their children were to keep the penile organ clean (97.7%), to reduce sexually transmitted infections when one is sexually active (97.7%) and to reduce HIV transmission (97.7%). Participants who did not circumcise their children cited mainly that their spouses did not approve (84.5%), that they were anxious about complications after the operation (44.4%) and fear that their newborns would feel pain (54.4%). The mothers in this study had high knowledge, positive attitudes and perceptions towards male neonatal circumcision, but the circumcision levels are still very low. Interventions need to be directed towards providing accurate information and resources that facilitate mothers, and to a greater extend fathers, in making the decision to circumcise their male children and being able to act on that decision.

  5. 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.

  6. '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 inter......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...... risk of the individual male and the private sphere. The study provides three important lessons for MC programmes: (1) the broad social aspects of MC put forward by the interviewees suggest the potential for a popular intervention and, consequently, a large uptake of MC; (2) findings suggest...

  7. 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.

  8. Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have?

    Science.gov (United States)

    Morris, Brian J; Bailis, Stefan A; Wiswell, Thomas E

    2014-05-01

    The objective of this review was to assess the trend in the US male circumcision rate and the impact that the affirmative 2012 American Academy of Pediatrics policy statement might have on neonatal circumcision practice. We searched PubMed for the term circumcision to retrieve relevant articles. This review was prompted by a recent report by the Centers for Disease Control and Prevention that found a slight increase, from 79% to 81%, in the prevalence of circumcision in males aged 14 to 59 years during the past decade. There were racial and ethnic disparities, with prevalence rising to 91% in white, 76% in black, and 44% in Hispanic males. Because data on neonatal circumcision are equivocal, we undertook a critical analysis of hospital discharge data. After correction for underreporting, we found that the percentage had declined from 83% in the 1960s to 77% by 2010. A risk-benefit analysis of conditions that neonatal circumcision protects against revealed that benefits exceed risks by at least 100 to 1 and that over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin. Other analyses show that neonatal male circumcision is cost-effective for disease prevention. The benefits of circumcision begin in the neonatal period by protection against infections that can damage the pediatric kidney. Given the substantial risk of adverse conditions and disease, some argue that failure to circumcise a baby boy may be unethical because it diminishes his right to good health. There is no long-term adverse effect of neonatal circumcision on sexual function or pleasure. The affirmative 2012 American Academy of Pediatrics policy supports parental education about, access to, and insurance and Medicaid coverage for elective infant circumcision. As with vaccination, circumcision of newborn boys should be part of public health policies. Campaigns should prioritize population subgroups with lower circumcision

  9. 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

  10. 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.

  11. 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.

  12. 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.

  13. Relationship between circumcision and human papillomavirus infection: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Yi-Ping Zhu

    2017-01-01

    Full Text Available Male circumcision (MC is reported to reduce human papillomavirus (HPV prevalence in men. However, the efficacy remains imprecise. The aim of this study was to conduct a systematic review and meta-analysis to assess the relationship between MC and genital HPV infection and genital warts. PUBMED, EMBASE, and Web of Science were searched from inception to March 22, 2015. We identified 30 papers, including a total of 12149 circumcised and 12252 uncircumcised men who were evaluated for the association of circumcision with genital HPV or genital warts. Compared with men who were not circumcised, circumcised men may have had significantly reduced odds of genital HPV prevalence (odds ratio [OR]: 0.68; 95% confidence interval [95% CI]: 0.56-0.82. There was no significant association between MC and genital HPV acquisition of new infections (OR: 0.99; 95% CI: 0.62-1.60, genital HPV clearance (OR: 1.38; 95% CI: 0.96-1.97, and prevalence of genital warts (OR: 1.17; 95% CI: 0.63-2.17. This meta-analysis suggests that circumcision reduces the prevalence of genital HPV infections. However, no clear evidence was found that circumcision was associated with decreased HPV acquisition, increased HPV clearance, or decreased the prevalence of genital warts. More studies are required to evaluate adequately the effect of MC on the acquisition and clearance of HPV infections and prevalence of genital warts.

  14. 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).

  15. 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...

  16. 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

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

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    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.

  18. 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

    2015-03-31

    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.

  19. 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 (Pejaculation 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.

  20. 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

    INTRODUCTION: 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. MATERIAL AND METHODS: Patient file data from...... children who had undergone ritual circumcision in the 1996-2003 period were retrieved. Complications recorded until December 2011 were noted. RESULTS: Circumcision in 315 boys aged from 3 weeks to 16 years (median five years) were evaluated. A total of 16 boys (5.1%) had significant complications......, including three incomplete circumcisions requiring re-surgery, two requiring re-surgery six months and five years postoperatively due to fibrotic phimosis and two requiring meatotomy due to meatal stenosis two and three year postoperatively. Acute complications included two superficial skin infections one...

  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. Use of tubularized incised plate urethroplasty for secondary hypospadias repair or repair in circumcised patients

    OpenAIRE

    2008-01-01

    PURPOSE: To retrospectively review our experience of the tubularized incised plate (TIP) urethroplasty in a series of re-operative hypospadias repairs or circumcised children. MATERIALS AND METHODS: Between September 2001 and September 2007, 17 children (mean 4.6 years, range 7 months to 15 years), were referred for hypospadias re-operation. Some of these patients had previously undergone circumcision and missed hypospadias. In all cases, the TIP urethroplasty was covered with an additional l...

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

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    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

  5. 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.

  6. 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.

  7. 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.

  8. [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.

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

    Science.gov (United States)

    Dini, Catia

    2010-01-01

    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.

  10. 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.

  11. The prevalence and practice of female genital mutilation in Nnewi, Nigeria: the impact of female education.

    Science.gov (United States)

    Igwegbe, A O; Egbuonu, I

    2000-09-01

    Three hundred and twenty-five consecutive live female deliveries at Nnamdi Azikiwe University Teaching Hospital, Nnewi were followed up for 9 months for evidence of any genital mutilation. Their mothers were examined for genital mutilation and a questionnaire based on face-to-face interview of the mothers was also administered. There was no genital mutilation observed among the 200 female babies whose mothers completed the 9 months follow up, The prevalence of genital mutilation among the mothers was 48%. The prevalence of female genital mutilation among the mothers increased with age. The circumcision index C.I. was zero and 3.0 at 16-20 years and 31-35 years age groups, respectively. Also the prevalence decreased with increasing level of education. The circumcision index was 1.0 for mothers at primary level education and least 0.33 at tertiary level of education. There was no relationship with parity. None of the mothers was willing to allow genital mutilation to be performed on her baby but 36% applied local treatment to the clitoris especially powder (28%). Dystocia was the commonest complication in the mothers and the knowledge about female genital mutilation was acquired informally from fellow women. Female education is paramount in the campaign and advocacy against female genital mutilation.

  12. 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.

  13. 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

  14. The emerging trend of self-circumcision and the need to define cause: Case report of a 21 year-old male

    Directory of Open Access Journals (Sweden)

    Ronald Kintu-Luwaga

    2016-01-01

    Conclusion: Cases of self-circumcision continue to emerge. There is need to report all cases, explore and manage the possible causes. The stigma uncircumcised males face among circumcised peers may be an important cause. Public health education and improved access to voluntary medical male circumcision services may help to prevent this practice.

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

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    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.

  16. International efforts on abandoning female genital mutilation

    Directory of Open Access Journals (Sweden)

    E. Edouard

    2013-09-01

    Full Text Available Female genital mutilation (FGM, sometimes referred to as female circumcision or female genital cutting, is a harmful cultural practice without any known health benefit. Its short-term and long-term health risks have led to numerous initiatives toward its eradication at international and local levels, over the last two decades. While major challenges remain and millions of girls and women are still at risk of being subjected to FGM, there is growing evidence that interventions that take into account the social dynamics that perpetuate FGM are yielding positive results toward its reduction. Well-recognized as a human rights violation in international treaties, the elimination of female genital mutilation requires ongoing interventions through cross-sectoral approaches that address attitudinal, cultural and behavioral change.

  17. 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

  18. Penile herpes simplex virus type 1 infection presenting two and a half years after Jewish ritual circumcision of an infant.

    Science.gov (United States)

    Yossepowitch, Orit; Gottesman, Tamar; Schwartz, Orna; Stein, Michal; Serour, Francis; Dan, Michael

    2013-06-01

    The association between Jewish ritual circumcision and genital herpes simplex virus type 1 infection has been well described. We report a case of genital herpes that first presented at the age of 2½ years. We believe that the infection was acquired asymptomatically through direct orogenital suction performed during circumcision in the newborn period.

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

    NARCIS (Netherlands)

    Adams, A.; Moyer, E.

    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

  20. 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.

  1. 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

  2. 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

  3. 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.

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

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    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.

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

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    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.

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

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    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.

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

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    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.

  8. The Consideration of Socioeconomic Determinants in Prevention of Traditional Male Circumcision Deaths and Complications.

    Science.gov (United States)

    Douglas, Mbuyiselo; Hongoro, Charles

    2016-03-18

    The responsiveness to socioeconomic determinants is perceived as highly crucial in preventing the high mortality and morbidity rates of traditional male circumcision initiates in the Eastern Cape, a province in South Africa. The study sought to describe social determinants and explore economic determinants related to traditional circumcision of boys from 12 to 18 years of age in Libode rural communities in Eastern Cape Province. From the results of a descriptive cross-sectional survey (n = 1,036), 956 (92.2%) boys preferred traditional male circumcision because of associated social determinants which included the variables for the attainment of social manhood values and benefits; 403 (38.9%) wanted to attain community respect; 347 (33.5%) wanted the accepted traditional male circumcision for hygienic purposes. The findings from the exploratory focus group discussions were revolving around variables associated with poverty, unemployment, and illegal actions to gain money. The three negative economic determinants were yielded as themes: (a) commercialization and profitmaking, (b) poverty and unemployment, (c) taking health risk for cheaper practices, and the last theme was the (d) actions suggested to prevent the problem. The study concluded with discussion and recommendations based on a developed strategic circumcision health promotion program which is considerate of socioeconomic determinants.

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

    Science.gov (United States)

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

    2015-04-01

    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.

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

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    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. 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.

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    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.

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

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    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.

  13. Epidermal inclusion cyst as a rare complication of neonatal male circumcision: a case report

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    Okeke Linus Ikechukwu

    2009-07-01

    Full Text Available Abstract Introduction Ibadan, Nigeria, has a very high rate of complications of male circumcision. In a previous survey, redundant or excessive loss of foreskin, skin bridges and injury to the glans penis were the major types of complications identified. Epidermal inclusion cyst complicating neonatal male circumcision appears to be extremely rare, and an extensive search of all databases revealed no reports in the recent literature. Case presentation In 1992, a 10-year-old boy was seen at the urology outpatients clinic presenting with a globular swelling in the penile skin located at the ventral surface proximal to the coronal sulcus. The histology of the excised mass revealed an epidermal inclusion cyst. Since then, he has remained healthy. Conclusions Epidermal inclusion cyst complicating male neonatal circumcision is extremely rare. The diagnosis is easy and a simple total excision is curative.

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

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    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.

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

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    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.

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

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    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

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

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    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

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

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    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

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

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    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.

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

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    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.

  1. Reconstruction of the penile skin loss due to 'radical' circumcision with a full thickness skin graft

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    Ignjatović Ivan

    2010-01-01

    Full Text Available Background. Excessive resection of penile skin is a rare but important complication of circumcision. Penis 'trapping' under the skin and consequent sexual dysfunction occur as a result. Case report. Excessive circumcision with complete resection of the penile skin is shown. Penis, trapped under the skin, was deliberated and skin defect was substituted with the full thickness skin graft. One year after the surgery penis has a good cosmetic appearance, adequate size and sexual function. Conclusion. Full thickness skin graft is a good option for augmentation of the penile skin loss in cases with intact hypodermal tissue and extensive skin loss, for the reconstruction in a single act.

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

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    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.

  3. 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.

  4. Evaluation of a safer male circumcision training programme for traditional surgeons and nurses in the Eastern Cape, South Africa.

    Science.gov (United States)

    Peltzer, Karl; Nqeketo, Ayanda; Petros, George; Kanta, Xola

    2008-06-18

    Training designed to improve circumcision knowledge, attitude and practice was delivered over 5 days to 34 traditional surgeons and 49 traditional nurses in the Eastern Cape, South Africa. Training included the following topics: initiation rites; statutory regulation of traditional male circumcision and initiation into Manhood (TCIM); structure and function of the male sex organs; procedure of safe circumcision, infection control; sexually transmitted infections (STIs); HIV/AIDS; infection control measures; aftercare of the initiate including after care of the circumcision wound and initiate as a whole; detection and early management of common complications of circumcision; nutrition and fluid management; code of conduct and ethics; and sexual health education. The evaluation of the training consisted of a prospective assessment of knowledge and attitude immediately prior to and after training. Significant improvement in knowledge and/or attitudes was observed in legal aspects, STI, HIV and environmental aspects, attitudes in terms of improved collaboration with biomedical health care providers, normal and abnormal anatomy and physiology, sexually transmitted infections and including HIV, circumcision practice and aftercare of initiates. We concluded that safer circumcision training can be successfully delivered to traditional surgeons and nurses.

  5. 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…

  6. Reasons for Female Circumcision among Some Ethnic Groups in Bendel State, Nigeria

    OpenAIRE

    OMORODION, Francisca Isi; MYERS, Robert A

    1989-01-01

    This paper is concerned with aspects of the history of Abuja in the Central Nigerian region -- an area designated as the new Federal capital of Nigeria. We examine some aspects of inter-group relations and then reflect on technological and economic development in the area. In the course of discussion, we reflect on aspects of iron technology, textile, leather processing and pottery and comment on issues related to trade in the region.

  7. Use of tubularized incised plate urethroplasty for secondary hypospadias repair or repair in circumcised patients

    Directory of Open Access Journals (Sweden)

    Seyed A. Mousavi

    2008-10-01

    Full Text Available PURPOSE: To retrospectively review our experience of the tubularized incised plate (TIP urethroplasty in a series of re-operative hypospadias repairs or circumcised children. MATERIALS AND METHODS: Between September 2001 and September 2007, 17 children (mean 4.6 years, range 7 months to 15 years, were referred for hypospadias re-operation. Some of these patients had previously undergone circumcision and missed hypospadias. In all cases, the TIP urethroplasty was covered with an additional layer of subcutaneous tissue or dartos flap. The original location, associated complications and results were recorded. RESULTS: There were 4 (30.7%, incidences of complications of TIP re-operation, 2 meatal stenosis, one stenosis with small fistula and one dehiscence. Re-operation was necessary in only one patient of our series (7.6% and the others were cured by dilatation. No complications occurred in the circumcised patents. CONCLUSION: Using TIP urethroplasty as described by Snodgrass, is a suitable method for treating primary and re-operative cases. It can also be used successfully in patients, who do not have a healthy skin flap and in circumcised patients when there is a lack of foreskin.

  8. 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…

  9. 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.

  10. 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...

  11. 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

  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. After Cologne: male circumcision and the law. Parental right, religious liberty or criminal assault?

    Science.gov (United States)

    Merkel, Reinhard; Putzke, Holm

    2013-07-01

    Non-therapeutic circumcision violates boys' right to bodily integrity as well as to self-determination. There is neither any verifiable medical advantage connected with the intervention nor is it painless nor without significant risks. Possible negative consequences for the psychosexual development of circumcised boys (due to substantial loss of highly erogenous tissue) have not yet been sufficiently explored, but appear to ensue in a significant number of cases. According to standard legal criteria, these considerations would normally entail that the operation be deemed an 'impermissible risk'-neither justifiable on grounds of parental rights nor of religious liberty: as with any other freedom right, these end where another person's body begins. Nevertheless, after a resounding decision by a Cologne district court that non-therapeutic circumcision constitutes bodily assault, the German legislature responded by enacting a new statute expressly designed to permit male circumcision even outside of medical settings. We first criticise the normative foundations upon which such a legal concession seems to rest, and then analyse two major flaws in the new German law which we consider emblematic of the difficulty that any legal attempt to protect medically irrelevant genital cutting is bound to face.

  15. Case of a congenital urethral duplication being unmasked following circumcision for balanitis xerotica obliterans.

    Science.gov (United States)

    Boyd, Matthew; Woodward, Mark; Lambert, Anthony

    2010-07-01

    We present the case of an 11-year-old boy diagnosed with an Effmann Type II A1 urethral duplication after routine circumcision for balanitis xerotica obliterans (BXO). We discuss the pathophysiology, investigation and management both of BXO and urethral duplication.

  16. 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

  17. The cost and impact of male circumcision on HIV/AIDS in Botswana

    Directory of Open Access Journals (Sweden)

    Bollinger Lori A

    2009-05-01

    Full Text Available Abstract The HIV/AIDS epidemic continues to be a major issue facing Botswana, with overall adult HIV prevalence estimated to be 25.7 percent in 2007. This paper estimates the cost and impact of the draft Ministry of Health male circumcision strategy using the UNAIDS/WHO Decision-Makers' Programme Planning Tool (DMPPT. Demographic data and HIV prevalence estimates from the recent National AIDS Coordinating Agency estimations are used as input to the DMPPT to estimate the impact of scaling-up male circumcision on the HIV/AIDS epidemic. These data are supplemented by programmatic information from the draft Botswana National Strategy for Safe Male Circumcision, including information on unit cost and program goals. Alternative scenarios were developed in consultation with stakeholders. Results suggest that scaling-up adult and neonatal circumcision to reach 80% coverage by 2012 would result in averting almost 70,000 new HIV infections through 2025, at a total net cost of US$47 million across that same period. This results in an average cost per HIV infection averted of US$689. Changing the target year to 2015 and the scale-up pattern to a linear pattern results in a more evenly-distributed number of MCs required, and averts approximately 60,000 new HIV infections through 2025. Other scenarios explored include the effect of risk compensation and the impact of increasing coverage of general prevention interventions. Scaling-up safe male circumcision has the potential to reduce the impact of HIV/AIDS in Botswana significantly; program design elements such as feasible patterns of scale-up and inclusion of counselling are important in evaluating the overall success of the program.

  18. 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.

  19. 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.

  20. 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.

  1. Neonatal Herpes Simplex Virus Type 1 Infection and Jewish Ritual Circumcision With Oral Suction: A Systematic Review.

    Science.gov (United States)

    Leas, Brian F; Umscheid, Craig A

    2015-06-01

    Jewish ritual circumcision rarely but occasionally includes a procedure involving direct oral suction of the wound, which can expose an infant to infection with herpes simplex virus type 1 (HSV-1). This practice has provoked international controversy in recent years, but no systematic review of the clinical literature has previously been published. We designed this review to identify and synthesize all published studies examining the association between circumcision with direct oral suction and HSV-1 infection. Our search strategy identified 6 published case series or case reports, documenting 30 cases between 1988 and 2012. Clinical findings were consistent with transmission of infection during circumcision, although the evidence base is limited by the small number of infections and incomplete case data. Published evidence suggests that circumcision with direct oral suction has resulted in severe neonatal illness and death from HSV-1 transmission, but further research is necessary to clarify the risk of infection.

  2. Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease

    DEFF Research Database (Denmark)

    Frisch, Morten; Simonsen, Jacob

    2017-01-01

    attributable fraction (AFp) associated with non-therapeutic circumcision. METHODS: In two nationwide cohort studies (comprising 4.0 million males of all ages and 810 719 non-Muslim males aged 0-36 years, respectively), we compared hospital contact rates for USD during 1977-2013 between circumcised and intact...... Danish males. Hazard ratios (HRs) were obtained using Cox proportional hazards regression, and the AFp estimated the proportion of USD cases in

  3. Evaluation of epidemiology, safety, and complications of male circumcision using conventional dissection surgery: experience at one center

    Directory of Open Access Journals (Sweden)

    Moslemi MK

    2011-05-01

    Full Text Available Mohammad Kazem Moslemi1, Mehdi Abedinzadeh2, Mohammad Aghaali11Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran; 2Department of Urology, Moradi Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, IranBackground: Circumcision can be performed for a variety of techniques, including conventional dissection surgery or a Plastibell device, and has religious, ritual, or medical roots. In countries like Iran, circumcision is done purely on religious grounds. In this study, we outline 390 cases in our practice and describe the epidemiology, indications, surgical technique used, and the early complications.Materials and methods: In this retrospective study, the charts for 390 circumcision cases were analyzed for the period March 2005 to August 2010. We reviewed all cases, noting age, indication, type of anesthesia used, technique, cosmetic appearance, and any potential early complications. All cases were followed up 1–4 weeks postoperatively and their notes were evaluated.Results: The age of children who underwent circumcision ranged from 3 weeks to 14 years, with a mean age of 4.25 years. The most common age for circumcision was 4–5 years (14.6%, and the least common age was 11–12 years (1.5%. In 372 cases (95%, the parents had opted for the procedure for religious reasons, and in 18 cases (5%, there was a medical indication, including phimosis (11 cases, 3%, urinary tract infection (5 cases, 1.2%, and balanoposthitis (2 cases, 0.8%. No major early complications were found in our series. Cosmetic appearance was satisfactory in all cases by 4 weeks after the operation.Conclusion: Circumcision was performed for religious reasons in our cases, although medical indications sometimes modified the timing of the procedure. Conventional dissection surgery for circumcision was safe, effective, and without any major complications.Keywords: male circumcision, conventional

  4. 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.

  5. 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.

  6. Neonatal herpes simplex virus infection following Jewish ritual circumcisions that included direct orogenital suction - New York City, 2000-2011.

    Science.gov (United States)

    2012-06-08

    Herpes simplex virus (HSV) infection commonly causes "cold sores" (HSV type 1 [HSV-1]) and genital herpes (HSV-1 or HSV type 2 [HSV-2]); HSV infection in newborns can result in death or permanent disability. During November 2000-December 2011, a total of 11 newborn males had laboratory-confirmed HSV infection in the weeks following out-of-hospital Jewish ritual circumcision, investigators from the New York City Department of Health and Mental Hygiene (DOHMH) learned. Ten of the 11 newborns were hospitalized; two died. In six of the 11 cases, health-care providers confirmed parental reports that the ritual circumcision included an ultra-Orthodox Jewish practice known as metzitzah b'peh, in which the circumciser (mohel, plural: mohelim) places his mouth directly on the newly circumcised penis and sucks blood away from the circumcision wound (direct orogenital suction). In the remaining cases, other evidence suggested that genital infection was introduced by direct orogenital suction (probable direct orogenital suction). Based on cases reported to DOHMH during April 2006-December 2011, the risk for neonatal herpes caused by HSV-1 and untyped HSV following Jewish ritual circumcision with confirmed or probable direct orogenital suction in New York City was estimated at 1 in 4,098 or 3.4 times greater than the risk among male infants considered unlikely to have had direct orogenital suction. Oral contact with a newborn's open wound risks transmission of HSV and other pathogens. Circumcision is a surgical procedure that should be performed under sterile conditions. Health-care professionals advising parents and parents choosing Jewish ritual circumcision should inquire in advance whether direct orogenital suction will be performed, and orogenital suction should be avoided.

  7. 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...

  8. Attitudes, Perceptions and Potential Uptake of Male Circumcision among Older Men in Turkana County, Kenya Using Qualitative Methods

    Science.gov (United States)

    Macintyre, Kate; Andrinopoulos, Katherine; Moses, Natome; Bornstein, Marta; Ochieng, Athanasius; Peacock, Erin; Bertrand, Jane

    2014-01-01

    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. PMID:24802112

  9. 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.

  10. Acceptability of infant male circumcision as part of HIV prevention and male reproductive health efforts in Gaborone, Botswana, and surrounding areas.

    Science.gov (United States)

    Plank, Rebeca M; Makhema, Joseph; Kebaabetswe, Poloko; Hussein, Fatima; Lesetedi, Chiapo; Halperin, Daniel; Bassil, Barbara; Shapiro, Roger; Lockman, Shahin

    2010-10-01

    Adult male circumcision reduces a man's risk for heterosexual HIV acquisition. Infant circumcision is safer, easier and less costly but not widespread in southern Africa. Questionnaires were administered to sixty mothers of newborn boys in Botswana: 92% responded they would circumcise if the procedure were available in a clinical setting, primarily to prevent future HIV infection, and 85% stated the infant's father must participate in the decision. Neonatal male circumcision appears to be acceptable in Botswana and deserves urgent attention in resource-limited regions with high HIV prevalence, with the aim to expand services in safe, culturally acceptable and sustainable ways.

  11. 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.

  12. 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.

  13. 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.

  14. 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

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

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    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

  16. 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...

  17. Identifying and addressing barriers to uptake of voluntary medical male circumcision in Nyanza, Kenya among men 18-35: a qualitative study.

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    Emily Evens

    Full Text Available BACKGROUND: Uptake of VMMC among adult men has been lower than desired in Nyanza, Kenya. Previous research has identified several barriers to uptake but qualitative exploration of barriers is limited and evidence-informed interventions have not been fully developed. This study was conducted in 2012 to 1 increase understanding of barriers to VMMC and 2 to inform VMMC rollout through the identification of evidence-informed interventions among adult men at high risk of HIV in Nyanza Province, Kenya. METHODS: Focus groups (n = 8 and interviews were conducted with circumcised (n = 8 and uncircumcised men (n = 14 from the two districts in Nyanza, Kenya. Additional interviews were conducted with female partners (n = 20, health providers (n = 12, community leaders (n = 12 and employers (n = 12. Interview and focus group guides included questions about individual, interpersonal and societal barriers to VMMC uptake and ways to overcome them. Inductive thematic coding and analysis were conducted through a standard iterative process. RESULTS: Two primary concerns with VMMC emerged 1 financial issues including missing work, losing income during the procedure and healing and family survival during the recovery period and 2 fear of pain during and after the procedure. Key interventions to address financial concerns included: a food or cash transfer, education on saving and employer-based benefits. Interventions to address concerns about pain included refining the content of demand creation and counseling messages about pain and improving the ways these messages are delivered. CONCLUSIONS: Men need accurate and detailed information on what to expect during and after VMMC regarding both pain and time away from work. This information should be incorporated into demand creation activities for men considering circumcision. Media content should frankly and correctly address these concerns. Study findings support scale up and/or further improvement of these ongoing

  18. 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.

  19. Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision.

    Science.gov (United States)

    Svoboda, J Steven; Van Howe, Robert S

    2013-07-01

    The American Academy of Pediatrics recently released a policy statement and technical report on circumcision, in both of which the organisation suggests that the health benefits conferred by the surgical removal of the foreskin in infancy definitively outweigh the risks and complications associated with the procedure. While these new documents do not positively recommend neonatal circumcision, they do paradoxically conclude that its purported benefits 'justify access to this procedure for families who choose it,' claiming that whenever and for whatever reason it is performed, it should be covered by government health insurance. The policy statement and technical report suffer from several troubling deficiencies, ultimately undermining their credibility. These deficiencies include the exclusion of important topics and discussions, an incomplete and apparently partisan excursion through the medical literature, improper analysis of the available information, poorly documented and often inaccurate presentation of relevant findings, and conclusions that are not supported by the evidence given.

  20. Methemoglobinemia presenting in a circumcised baby following application of prilocaine: a case report

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    Ozgun Gulten

    2010-02-01

    Full Text Available Abstract Introduction Local anesthesia with prilocaine has become a routine part of ambulatory circumcision procedures. Methemoglobinemia is a rare but potentially lethal complication of local anesthetics. Case presentation We report the case of a 40-day-old Turkish boy who presented with cyanosis after receiving local anesthesia with prilocaine. His methemoglobin level revealed severe methemoglobinemia (methemoglobin = 44%. His cyanosis resolved after intravenous administration of methylene blue. Conclusion Although the association between prilocaine use and methemoglobinemia has generally restricted the use of prilocaine in babies, it is still widely used in ambulatory procedures, especially during circumcision in the neonatal period. Prilocaine should not be used in babies who are less than 3 months old because of the risk of methemoglobinemia; other local anesthetics may be used for this age group. Furthermore, general anesthesia by mask ventilation may be favored for babies less than 3 months of age instead of local anesthetics.

  1. 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

    in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non-US-based physicians and representatives of general medical......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...... urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance...

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

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    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.

  3. Prevalence of complications of male circumcision in Anglophone Africa: a systematic review

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    Mataya Ronald H

    2007-03-01

    Full Text Available Abstract Background There is growing evidence that male circumcision (MC prevents heterosexual acquisition of HIV by males in sub-Saharan Africa, the region of the world heavily affected by the HIV pandemic. While there is growing support for wide-spread availability and accessibility of MC in Africa, there is limited discussion about the prevalence of physical complications of male circumcision on the continent. Methods A systematic literature search and review of articles in indexed journals and conference abstracts was conducted to collect and analyze prevalence of complications of MC in Anglophone sub-Saharan Africa. Information extracted included: indications for MC, complications reported, age of patients and category of circumcisers. Results There were 8 articles and 2 abstracts that were suitable for the analysis. The studies were not strictly comparable as some reported on a wide range of complications while others reported just a limited list of possible complications. Prevalence of reported complications of MC ranged from 0% to 50.1%. Excluding the study with 50.1%, which was on a series of haemophilia patients, the next highest prevalence of complications was 24.1%. Most of the complications were minor. There was no firm evidence to suggest that MCs performed by physician surgeons were associated with lower prevalence of complications when compared with non-physician health professionals. Conclusion The available data are inadequate to obtain a reasonable assessment of the prevalence of complications of MC in sub-Saharan Africa. Some of the available studies however report potentially significant prevalence of complications, though of minor clinical significance. This should be considered as public health policy makers consider whether to scale-up MC as an HIV preventative measure. Decision for the scale-up will depend on a careful cost-benefit assessment of which physical complications are certainly an important aspect. There is

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

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    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.

  5. Skin phototype and local trauma in the onset of balanitis xerotica obliterans (BXO) in circumcised patients.

    Science.gov (United States)

    Villa, Massimo; Dragonetti, Emanuele; Grande, Michele; Bove, Pierluigi; Sansalone, Salvatore; Rulli, Francesco; Tambucci, Roberto; Tucci, Gianfranco; Baldi, Alfonso

    2012-01-01

    The association between balanitis xerotica obliterans (BXO) and skin disorders is long established, however, the role of skin phototype and local trauma in its onset has never been investigated in detail. Medical records of all Caucasian children circumcised over a 6-year period were reviewed. The excised skin underwent histological examination for BXO. Children with histological diagnosis of BXO were classified as group A, whereas children without histological diagnosis of BXO were classified as group B. The Fitzpatrick phototype (FT) was obtained in all children performing a personal or family interview with regards to their sunburn and suntan experience. According to their FT, both group A and B patients were divided into two subgroups: FT 1-2, with a higher tendency to sunburn due to their low skin melanin content; and FT 3-4 with a higher tendency to tan due to their higher skin melanin content. Maneuvers of mechanical reduction of the foreskin (MRF) performed at least 5-10 times per month during the year preceding circumcision was also considered. Statistical analysis was performed using univariate and multivariate analysis. A total of 297 patients met the inclusion criteria of our study: 78 patients were classified as group A and 219 as group B. The risk of developing BXO was significantly greater in FT 1-2 patients (n=76) (odd ratio=0.232, 95% confidence interval=0.124-0.435, pBXO (odds ratio= 5.344, 95% confidence interval=2.860-9.987, pBXO in circumcised individuals. Moreover, the data produced suggest should the advantages of repeated MRF be weighed against the increased risk of developing BXO, which in turn may increase complication rate of circumcision surgery.

  6. Comprehensive description of newborn distress behavior in response to acute pain (newborn male circumcision).

    Science.gov (United States)

    Warnock, Fay; Sandrin, Dilma

    2004-02-01

    One of the most difficult challenges still facing researchers and clinicians is assessing pain in the newborn. Behaviors provide one of the most promising avenues for deepening our fundamental understanding of complex phenomenon like newborn pain, and are key to developing descriptive-level knowledge to further newborn pain assessment efforts. In this ethologically based research, we report on the duration and frequency of neonatal distress behavior to seven distinct noxious and non-noxious but distress-provoking events including baseline (diaper change, post-diaper change, application of arm and leg restraints, post-application of arm and leg restraints, circumcision, post-circumcision) associated with newborn surgical pain. Approximately 67 min of videotaped data, involving four neonates who had undergone newborn male circumcision, were coded at 1-s intervals (4010 s in total). A reliably established coding scheme was used to code behaviors as they were observed on videotape for the duration of the seven designated events. This led to the identification of (1) 40 distress behaviors as they occurred along the continuum of distress, (2) eight distress behaviors specific to surgery, (3) 11 classes of behaviors occurring within the five sub-phases of circumcision, and (4) a description of 25 distinct post-distress behaviors. Findings support the ability to distinguish distress behaviors specific to pain and the ability to detect prolonged distress as well as individual differences in distress-related pain expression. Findings also justify ongoing use of ethological approaches to further newborn pain assessment and to investigate poorly understood topics such as infant self-regulation within the context of pain (pain recovery).

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

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    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

  8. Mandatory neonatal male circumcision in Sub-Saharan Africa: medical and ethical analysis.

    Science.gov (United States)

    Clark, Peter A; Eisenman, Justin; Szapor, Stephen

    2007-12-01

    The majority of those infected with HIV in sub-Saharan Africa do not have access to antiretroviral therapy, which is known to prolong the lives of HIV-positive persons in industrialized countries. Although the availability of antiretroviral therapy for those infected with HIV has increased worldwide, the infection rate out surpasses those started on such treatment. Without an AIDS vaccine or curative treatment, and given the difficulty in getting persons at risk to adopt healthy sexual behaviors, alternative approaches to decrease the spread of HIV infection are urgently needed. Three recent randomized controlled trials undertaken in Kisumu, Kenya, Raki District, Uganda and Orange Farm, South Africa have confirmed that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 51% to 60%. These three studies provide a solid evidence-base for future health policy. The procedure for adolescents and adults is expensive compared to abstinence, condoms or other methods; and the surgery is not without serious risks if performed by traditional healers using unsterilized blades as often happens in rural Africa. However, neonatally, the procedure is relatively inexpensive and the risks diminish considerably. Mandating neonatal male circumcision is an effective therapy that has minimal risks, is cost efficient and will save human lives. To deny individuals access to this effective therapy is to deny them the dignity and respect all persons deserve. Neonatal male circumcision is medically necessary and ethically imperative.

  9. Risks from circumcision during the first month of life compared with those for uncircumcised boys.

    Science.gov (United States)

    Wiswell, T E; Geschke, D W

    1989-06-01

    The records of 136,086 boys born in US Army hospitals from 1980 to 1985 were reviewed for indexed complications related to circumcision status during the first month of life. For 100,157 circumcised boys, there were 193 complications (0.19%). These included 62 local infections, eight cases of bacteremia, 83 incidences of hemorrhage (31 requiring ligature and three requiring transfusion), 25 instances of surgical trauma, and 20 urinary tract infections. There were no deaths or reported losses of the glans or entire penis. By contrast, the complications in the 35,929 uncircumcised infants were all related to urinary tract infections. Of the 88 boys with such infections (0.24%), 32 had concomitant bacteremia, three had meningitis, two had renal failure, and two died. The frequencies of urinary tract infection (P less than .0001) and bacteremia (P less than .0002) were significantly higher in the uncircumcised boys. Serious complications from routine prepuce removal are rare and relatively minor. Circumcision may be beneficial in reducing the occurrence of urinary tract infections and their associated sequelae.

  10. 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.

  11. Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries

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    Klausner Jeffrey D

    2006-11-01

    Full Text Available Abstract Background Both religious practices and male circumcision (MC have been associated with HIV and other sexually-transmitted infectious diseases. Most studies have been limited in size and have not adequately controlled for religion, so these relationships remain unclear. Methods We evaluated relationships between MC prevalence, Muslim and Christian religion, and 7 infectious diseases using country-specific data among 118 developing countries. We used multivariate linear regression to describe associations between MC and cervical cancer incidence, and between MC and HIV prevalence among countries with primarily sexual HIV transmission. Results Fifty-three, 14, and 51 developing countries had a high (>80%, intermediate (20–80%, and low ( Conclusion Male circumcision was significantly associated with lower cervical cancer incidence and lower HIV prevalence in sub-Saharan Africa, independent of Muslim and Christian religion. As predicted, male circumcision was also strongly associated with lower HIV prevalence among countries with primarily heterosexual HIV transmission, but not among countries with primarily homosexual or injection drug use HIV transmission. These findings strengthen the reported biological link between MC and some sexually transmitted infectious diseases, including HIV and cervical cancer.

  12. 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

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    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

  13. A study of circumcision prevalence and complications in under 5 year old boys in Galleno village-Shahre Ray, Jan 1997

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    Tootoonchi P

    1998-06-01

    Full Text Available To determine circumcision prevalence and complications in under 5 year old boys. We assessed 181 boys in a cross sectional study at a rutal area in Tehran suburbs, in Jan 1997. Data were collected by an interview about age, circumcision age and method, type of complications, nationality and parent literacy. 126 boys (69% were circumcised, (mean 12 months. Only 27 of them (21.4% were circumcised in neonatal period. 62 boys (49.2% were circumcised with ring methods (plastibell or clamp, 54 boys (42.9% with surgical methods and the others (7.9% with nonmendical methods (traditional. Complications were 9.5% (16 and the higher circumcision age was related significantly with higher complications (P<0.04. In our study was no complication in the boys who circumcised under six months. Complications prevalence were high (9.5%. In neonatal period 34% (9 and in postneonatal period 53% (52 of boys were circumcised with inappropriate methods with age. The most common complications were local infection (43%

  14. 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

  15. 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

  16. 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

  17. 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.

  18. Anal sex role, circumcision status, and HIV infection among men who have sex with men in Chongqing, China.

    Science.gov (United States)

    Zhou, Chao; Raymond, H Fisher; Ding, Xianbin; Lu, Rongrong; Xu, Jing; Wu, Guohui; Feng, Liangui; Fan, Song; Li, Xuefeng; McFarland, Willi; Xiao, Yan; Ruan, Yuhua; Shao, Yiming

    2013-10-01

    Men who have sex with men (MSM) in China face a rapidly expanding HIV epidemic. Anal sex role plays a significant role in HIV infection. Research has already begun in China investigating the potential for circumcision-based interventions to slow the rise of HIV among Chinese MSM. Using peer referral recruitment, we sampled 491 men who reported anal sex role preference. We analyzed preferred anal sex role, enacted sex role during recent sexual behavior, and circumcision status and HIV infection among MSM in one Chinese city. Men reported on their anal sex role preference and reported on up to three male sexual partners. Men were asked to report on whether they were "top" or "bottom" with each of the partners. Those that preferred being bottom and versatile were significantly younger than those who preferred being top. Men who preferred bottoming and those that preferred the versatile role were significantly more likely to be HIV-infected than those who preferred to be tops. There was no significant association between circumcision and HIV infection among men who maintained their preferred top role. In terms of anal sex role behavior, prevalence was not statistically different across anal sex roles. Circumcision conferred no additional protection to men who preferred and who engaged the top role during anal sex. HIV interventions will need to address anal sex roles in more sophisticated ways than perhaps originally thought. Simplistic assumptions that anal sex role is a fixed behavior undermines interventions such as circumcision among MSM.

  19. Medicalization of female genital mutilation/cutting

    Directory of Open Access Journals (Sweden)

    G.I. Serour

    2013-09-01

    In some Muslim countries where FGM/C is prevalent it is often wrongly quoted that the basis for performing FGM/C is religious instruction. FGM/C has no religious basis what so ever and has been condemned by Al-Azhar based on several verses in the Holy Quraan that relates explicitly or implicitly to female circumcision. The use of the gender term “Sunna circumcision” is nothing but a form of deceit used to misguide people and give the impression that this act is one of the Islamic practices. As for the traditions attributed to Prophet Mohamed (PBUH, scholars of the past and present have agreed that none of these traditions are authentic and therefore should not be attributed to the Prophet (PBUH.

  20. 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...

  1. Male Circumcision at Different Ages in Rwanda: A Cost-Effectiveness Study

    Science.gov (United States)

    Binagwaho, Agnes; Pegurri, Elisabetta; Muita, Jane; Bertozzi, Stefano

    2010-01-01

    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-saving (the cost

  2. 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

  3. 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.

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

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    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.

  5. 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.

  6. 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.

  7. Female genital mutilation - postcircumcision vulval complications in Nigerians.

    Science.gov (United States)

    Adekunle, A O; Fakokunde, F A; Odukogbe, A A; Fawole, A O

    1999-11-01

    Female genital mutilation is a cultural practice that can adversely affect the health of women. Vulval complications of female circumcision in 39 patients managed at the University College Hospital, Ibadan, Nigeria over a period of 10 years were reviewed. The complications were: labial adhesions of varying degrees (51.3%) and clitoral retention cysts (48.7%). However, both types of complications occurred concurrently in two (5.1%) patients. All patients were treated surgically with good outcome. The only immediate complication of treatment was secondary haemorrhage in one patient with clitoral cyst. Regrettably, one patient with labial adhesion required a repeat surgical procedure 2 months later. The histological examination of all the retention cysts revealed epidermal inclusion cysts. Emphasising the reproductive health implications of female genital mutilation may prove an effective strategy towards eradication of the practice.

  8. Effects of household shocks and poverty on the timing of traditional male circumcision and HIV risk in South Africa.

    Science.gov (United States)

    Venkataramani, Atheendar S; Maughan-Brown, Brendan

    2013-06-01

    Poverty may influence HIV risk by increasing vulnerability to economic shocks and thereby preventing key health investments. We explored this possibility by examining the relationship between household shocks and the timing of traditional male circumcision, a practice associated with considerable expense and whose HIV-prevention benefits are larger when done earlier, even within young adulthood. Using unique data on a sample of Xhosa men, a group that almost universally practices traditional circumcision, we found that respondents in the poorest households delayed circumcision by 2 years if a household member experienced loss of income or death and/or illness. The impact of these shocks declined with increasing household income. Our findings suggest that interventions that work to mitigate the impact of shocks among the poor may be useful in HIV prevention efforts. More generally, they illustrate that the relationship between HIV and wealth may be more nuanced than assumed in previous work.

  9. 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.

  10. 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.

  11. 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

  12. Rationalising circumcision: from tradition to fashion, from public health to individual freedom--critical notes on cultural persistence of the practice of genital mutilation.

    Science.gov (United States)

    Hellsten, S K

    2004-06-01

    Despite global and local attempts to end genital mutilation, in their various forms, whether of males or females, the practice has persisted throughout human history in most parts of the world. Various medical, scientific, hygienic, aesthetic, religious, and cultural reasons have been used to justify it. In this symposium on circumcision, against the background of the other articles by Hutson, Short, and Viens, the practice is set by the author within a wider, global context by discussing a range of rationalisations used to support different types of genital mutilation throughout time and across the globe. It is argued that in most cases the rationalisations invented to provide support for continuing the practice of genital mutilation--whether male or female--within various cultural and religious settings have very little to do with finding a critical and reflective moral justification for these practices. In order to question the ethical acceptability of the practice in its non-therapeutic forms, we need to focus on child rights protection.

  13. 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.

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

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    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.

  15. Women's roles in voluntary medical male circumcision in Nyanza Province, Kenya.

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    Michele Lanham

    Full Text Available Women are an important audience for voluntary medical male circumcision (VMMC communication messages so that they know that VMMC provides only partial protection against HIV. They may also be able to influence their male partners to get circumcised and practice other HIV protective measures after VMMC. This study was conducted in two phases of qualitative data collection. Phase 1 used in-depth interviews to explore women's understanding of partial protection and their role in VMMC. Phase 2 built on the findings from the Phase 1, using focus groups to test VMMC communication messages currently used in Nyanza Province and to further explore women's roles in VMMC. Sixty-four sexually active women between the ages of 18 and 35 participated. In Phase 1, all women said they had heard of partial protection, though some were not able to elaborate on what the concept means. When women in Phase 2 were exposed to messages about partial protection, however, participants understood the messages well and were able to identify the main points. In Phases 1 and 2, many participants said that they had discussed VMMC with their partner, and for several, it was a joint decision for the man to go for VMMC. These findings suggest that current VMMC messaging is reaching women, though communications could more effectively target women to increase their ability to communicate about partial HIV protection from VMMC. Also, women seem to be playing an important role in encouraging men to get circumcised, so reaching out to women could be a valuable intervention strategy for increasing VMMC uptake and promoting use of other HIV protective measures after VMMC.

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

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    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.

  17. Loss of anatomical landmarks with eutectic mixture of local anesthetic cream for neonatal male circumcision.

    Science.gov (United States)

    Plank, Rebeca M; Kubiak, David W; Abdullahi, Rasak Bamidele; Ndubuka, Nnamdi; Nkgau, Maggie M; Dapaah-Siakwan, Fredrick; Powis, Kathleen M; Lockman, Shahin

    2013-02-01

    We report two cases of newborns who developed marked local edema after application of a eutectic mixture of local anesthetic (EMLA) topical anesthetic cream for neonatal male circumcision (NMC). Although local edema and erythema are known potential side effects of EMLA cream, a common anesthetic used for NMC, the loss of landmarks precluding safe NMC has not previously been reported, and is described here. Although we cannot recommend an alternate local anesthetic for neonates with this reaction to EMLA, based on a review of the published data we think that serious systemic adverse events related to EMLA are extremely rare.

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

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    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

  19. Complete penile amputation during ritual neonatal circumcision and successful replantation using postoperative leech therapy.

    Science.gov (United States)

    Banihani, Omaya I; Fox, Janelle A; Gander, Brian H; Grunwaldt, Lorelei J; Cannon, Glenn M

    2014-08-01

    Circumcision is the most common surgical procedure in males in the United States, and minor complications are not uncommon. Major complications like partial penile amputations have been reported with successful replantation. Complete penile amputations in adult males have been described, and successful replantation has been reported with increasing success. We report a case of complete penile amputation at the penopubic junction using a Mogen clamp in a 7-day-old neonate with replantation using postoperative leech therapy. To our knowledge this is the first time leech therapy has been used postoperatively for neonatal penile amputation.

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

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    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

  1. The potential impact of male circumcision on HIV in Sub-Saharan Africa.

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    Brian G Williams

    2006-07-01

    Full Text Available BACKGROUND: A randomized controlled trial (RCT has shown that male circumcision (MC reduces sexual transmission of HIV from women to men by 60% (32%-76%; 95% CI offering an intervention of proven efficacy for reducing the sexual spread of HIV. We explore the implications of this finding for the promotion of MC as a public health intervention to control HIV in sub-Saharan Africa. METHODS AND FINDINGS: Using dynamical simulation models we consider the impact of MC on the relative prevalence of HIV in men and women and in circumcised and uncircumcised men. Using country level data on HIV prevalence and MC, we estimate the impact of increasing MC coverage on HIV incidence, HIV prevalence, and HIV-related deaths over the next ten, twenty, and thirty years in sub-Saharan Africa. Assuming that full coverage of MC is achieved over the next ten years, we consider three scenarios in which the reduction in transmission is given by the best estimate and the upper and lower 95% confidence limits of the reduction in transmission observed in the RCT. MC could avert 2.0 (1.1-3.8 million new HIV infections and 0.3 (0.1-0.5 million deaths over the next ten years in sub-Saharan Africa. In the ten years after that, it could avert a further 3.7 (1.9-7.5 million new HIV infections and 2.7 (1.5-5.3 million deaths, with about one quarter of all the incident cases prevented and the deaths averted occurring in South Africa. We show that a MC will increase the proportion of infected people who are women from about 52% to 58%; b where there is homogenous mixing but not all men are circumcised, the prevalence of infection in circumcised men is likely to be about 80% of that in uncircumcised men; c MC is equivalent to an intervention, such as a vaccine or increased condom use, that reduces transmission in both directions by 37%. CONCLUSIONS: This analysis is based on the result of just one RCT, but if the results of that trial are confirmed we suggest that MC could

  2. 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。

  3. 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

  4. 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.

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

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    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.

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

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    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.

  7. 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。

  8. 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

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

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    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.

  10. Can male circumcision have an impact on the HIV epidemic in men who have sex with men?

    Directory of Open Access Journals (Sweden)

    Steven M Goodreau

    Full Text Available Three trials have demonstrated the prophylactic effect of male circumcision (MC for HIV acquisition among heterosexuals, and MC interventions are underway throughout sub-Saharan Africa. Similar efforts for men who have sex with men (MSM are stymied by the potential for circumcised MSM to acquire HIV easily through receptive sex and transmit easily through insertive sex. Existing work suggests that MC for MSM should reach its maximum potential in settings where sexual role segregation is historically high and relatively stable across the lifecourse; HIV incidence among MSM is high; reported willingness for prophylactic circumcision is high; and pre-existing circumcision rates are low. We aim to identify the likely public health impact that MC interventions among MSM would have in one setting that fulfills these conditions-Peru-as a theoretical upper bound for their effectiveness among MSM generally.We use a dynamic, stochastic sexual network model based in exponential-family random graph modeling and parameterized from multiple behavioral surveys of Peruvian MSM. We consider three enrollment criteria (insertive during 100%, >80% or >60% of UAI and two levels of uptake (25% and 50% of eligible men; we explore sexual role proportions from two studies and different frequencies of switching among role categories. Each scenario is simulated 10 times. We estimate that efficiency could reach one case averted per 6 circumcisions. However, the population-level impact of an optimistic MSM-MC intervention in this setting would likely be at most ∼5-10% incidence and prevalence reductions over 25 years.Roll-out of MC for MSM in Peru would not result in a substantial reduction in new HIV infections, despite characteristics in this population that could maximize such effects. Additional studies are needed to confirm these results for other MSM populations, and providers may consider the individual health benefits of offering MC to their MSM patients.

  11. 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.

  12. 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

  13. 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

  14. 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.

  15. Is the mass circumcision drive in KwaZulu-Natal involving neonates and children less than 16 years of age legal? What should doctors do?

    Science.gov (United States)

    McQuoid-Mason, D J

    2013-05-01

    As a result of the revival of male circumcision among Zulu males as a cultural practice and an attempt to reduce the incidence of HIV infection, the KwaZulu-Natal government has implemented a programme of mass circumcision of Zulu males. The question arises whether the implementation of such a programme on neonates and children under 16 years of age is legal in terms of the Constitution and the Children's Act. The answer hinges on whether the circumcision is done as a cultural practice or for medical reasons. Doctors are provided with guidance as to what they should do when faced with neonates or males under 16 years of age being presented for circumcision.

  16. Knowledge, beliefs, and attitudes to female genital mutilation (FGM) in Shao community of Kwara State, Nigeria.

    Science.gov (United States)

    Amusan, O A; Asekun-Olarinmoye, E O

    To determine the level of knowledge, belief, and assess the attitude to female genital mutilation (FGM) and its complications in Shao community, Nigeria, a cross-sectional descriptive study with a health education intervention was used. A majority of respondents (99.5%) understood female circumcision to mean cutting off parts of the female genitals. There was a high level of knowledge regarding most of the complications of FGM as more than 50% of respondents knew at least four complications of FGM. Awareness of the global anti-FGM campaign was also high (78.8%). The most common reasons proffered for the practice of FGM were based on tradition or religion. Paternal grandfathers (50.0%) and fathers (21.0%) were cited as decision makers in the family most often responsible for requesting FGM. Post-intervention results showed that there was a statistically significant increase in the proportion of respondents who know more complications of FGM and who have no intention of circumcising future female children. Despite a high level of knowledge regarding the complications of FGM and a high level of awareness of the global campaign against it, there still exists a high prevalence of practice of FGM in this community. FGM remains a pressing human rights and public health issue. It is our recommendation that this health education intervention strategy be replicated nationwide especially using mass media.

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. Female genital mutilation in Iraqi Kurdistan: description and associated factors.

    Science.gov (United States)

    Saleem, Rozhgar A; Othman, Nasih; Fattah, Fattah H; Hazim, Luma; Adnan, Berivan

    2013-01-01

    The high prevalence of female genital mutilation has been a concern in Iraqi Kurdistan. This study was undertaken to estimate its prevalence and describe factors associated with its occurrence. A cross-sectional survey was undertaken from March to April 2011 of females aged up to 20 years using interviews and clinical examination. The survey included 1,508 participants with mean age of 13.5 years (SD 5.6). Overall female genital mutilation prevalence was 23%, and the mean age at which it had been performed was 4.6 years (SD 2.4). Type I (partial or total removal of the clitoris) comprised 76% of those who had had female genital mutilation; in 79% of cases the decision to perform it was made by the mother; and in 54% of cases it was performed by traditional birth attendants/midwives. Women aged 16 years and over were more likely to have had female genital mutilation compared to children aged below 6 years (OR 11.9, p Kurdistan region were more likely to have been circumcised. The study results show that female genital mutilation is a frequent practice in Iraqi Kurdistan. Attention and intervention is needed to address this aspect of the well-being of girls and women.

  2. 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

  3. 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.

  4. 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.

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

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    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.

  6. 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

  7. 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.

  8. 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.

  9. 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。

  10. 包皮环切术围手术期护理体会%Perioperative nursing experience of circumcision

    Institute of Scientific and Technical Information of China (English)

    王琦; 洪云; 沈玉美

    2016-01-01

    Circumcision is one of the most common clinical surgery.It has significant effect on the treatment of patients with redundant prepuce,and nursing intervention has a significant impact on the treatment of patients.In this paper,the author gives a brief introduction of perioperative nursing experience of circumcision,to provide discuss for clinic.%包皮环切术是目前临床中最为常见的一种手术,对包皮过长患者的治疗效果显著,而护理干预对患者的治疗效果有显著影响。本文简要介绍包皮环切术围手术期护理体会,为临床提供探讨。

  11. 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

  12. Comparison of clinical effects of two modified circumcision%两种改良包皮环切术临床疗效对比

    Institute of Scientific and Technical Information of China (English)

    孙崇全; 房波; 周伯珍

    2016-01-01

    Objective:To investigate the clinical efficacy of improved disposable circumcision device circumcision and traditional circumcision.Methods:280 patients of circumcision were selected.They were divided into the improved disposable circumcision device circumcision group with 150 cases and the traditional circumcision group with 130 cases.Results:The differences of operation time,cost of treatment,incision healing time,and postoperative edema between groups were statistically significant (P0.05). Conclusion:According to the patients' different conditions, choose the appropriate method to achieve the best results.%目的:探讨改良后的一次性包皮环切器包皮环切术与传统包皮环切术的临床疗效比较。方法:收治280例患者包皮环切术患者,分为改良包皮环切器组(n=150)与改良传统组(n=130)。结果:两组手术时间、治疗费用、切口愈合时间、术后水肿情况差异具有统计学意义(P<0.05);出血量、术后切口裂开、切口感染率、切口出血情况及术后满意度比较,差异无统计学意义(P>0.05)。结论:应根据患者的不同情况,选择合适的方法,达到最佳效果。

  13. 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.

  14. 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.

  15. 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..

  16. 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.

  17. 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.

  18. 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, ...

  19. Circumcision and sexual behavior: factors independently associated with human papillomavirus detection among men in the HIM study.

    Science.gov (United States)

    Giuliano, Anna R; Lazcano, Eduardo; Villa, Luisa Lina; Flores, Roberto; Salmeron, Jorge; Lee, Ji-Hyun; Papenfuss, Mary; Abrahamsen, Martha; Baggio, Maria Luiza; Silva, Roberto; Quiterio, Manuel

    2009-03-15

    There is growing interest in understanding human papillomavirus (HPV) infection and related disease among men. To date there have been numerous studies reporting HPV DNA prevalence among men from several different countries, however, few have incorporated multivariable analyses to determine factors independently associated with male HPV detection. The purpose of this study was to assess the factors independently associated with HPV detection in men ages 18-70 years residing in Brazil (n = 343), Mexico (n = 312), and the United States (US) (n = 333). In samples combined from the coronal sulcus, glans penis, shaft, and scrotum, we evaluated factors associated with any, oncogenic, and nononcogenic HPV infections. In multivariable analyses, detection of any HPV infection was significantly associated with reported race of Asian/Pacific Islander, lifetime and recent number of sexual partners, and having sex in the past 3 months. Oncogenic HPV detection was independently associated with lifetime and recent number of sexual partners, and having sex in the past 3 months. NonOncogenic HPV infection was independently associated with lifetime number of sexual partners. Circumcision, assessed by clinical examination, was associated with reduced risk of HPV detection across all categories of HPV evaluated. HPV detection in men in the current study was strongly related to sexual behavior and circumcision status. Interventions such as circumcision may provide a low-cost method to reduce HPV infection.

  20. Spatial distribution of female genital mutilation in Nigeria.

    Science.gov (United States)

    Kandala, Ngianga-Bakwin; Nwakeze, Ngozi; Kandala, Shadrack Ngianga I I

    2009-11-01

    The harmful effects of female genital mutilation (FGM) on women are recognized worldwide. Although it is practiced by persons of all socioeconomic backgrounds, there are differences within countries and between communities. The aim of this study was to use the 2003 Nigeria Demographic and Health Survey data to determine the spatial distribution of the prevalence of FGM and associated risk factors. Data were available for 7,620 women; 1,673 (22.0%) interviewed had had FGM and 2,168 women had living children, of whom 485 (22.4%) daughters had undergone FGM. Unmarried women were more likely to report a lower prevalence of FGM. Modernization (education and high socioeconomic status) had minimal impact on the likelihood of FGM, but education plays an important role in the mother's decision not to circumcise her daughter. It follows from these findings that community factors have a large effect on FGM, with individual factors having little effect on the distribution of FGM.

  1. 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.

  2. 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。

  3. 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.

  4. Risk Factors for HIV/Syphilis Infection and Male Circumcision Practices and Preferences among Men Who Have Sex with Men in China

    Directory of Open Access Journals (Sweden)

    Yali Zeng

    2014-01-01

    Full Text Available Objective. To investigate factors associated with HIV infection and the frequency and willingness of male circumcision among men who have sex with men (MSM in Chengdu city, China. Methods. A cross-sectional survey provided information on participants' demographics, risk behaviors, circumcision, and uptake of HIV prevention services. Results. Of 570 participants, 13.3% were infected with HIV and 15.9% with syphilis. An estimated 43.0% of respondents reported having unprotected receptive anal intercourse, and 58.9% reported having ≥2 male sexual partners in the past 6 months. Multivariable logistic regression revealed that syphilis, more male sex partners, predominantly receptive anal intercourse, and exclusively receptive male sex were associated with HIV infection. Higher level of education and peer education service were inversely associated with HIV infection. Nearly a fifth (18.0% of participants were circumcised. More than half of uncircumcised participants expressed willingness to be circumcised. Conclusion. This study reveals a high prevalence of HIV and syphilis among MSM in Chengdu province of China. The frequency of unprotected receptive anal intercourse and multiple male sexual partnerships highlight the urgency for an effective comprehensive HIV prevention strategy. Although the willingness to accept male circumcision (MC is high, further research is needed to assess the protective effective of MC among MSM.

  5. 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.

  6. 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.

  7. Early infant male circumcision: Systematic review, risk-benefit analysis, and progress in policy

    Science.gov (United States)

    Morris, Brian J; Kennedy, Sean E; Wodak, Alex D; Mindel, Adrian; Golovsky, David; Schrieber, Leslie; Lumbers, Eugenie R; Handelsman, David J; Ziegler, John B

    2017-01-01

    AIM To determine whether recent evidence-based United States policies on male circumcision (MC) apply to comparable Anglophone countries, Australia and New Zealand. METHODS Articles in 2005 through 2015 were retrieved from PubMed using the keyword “circumcision” together with 36 relevant subtopics. A further PubMed search was performed for articles published in 2016. Searches of the EMBASE and Cochrane databases did not yield additional citable articles. Articles were assessed for quality and those rated 2+ and above according to the Scottish Intercollegiate Grading System were studied further. The most relevant and representative of the topic were included. Bibliographies were examined to retrieve further key references. Randomized controlled trials, recent high quality systematic reviews or meta-analyses (level 1++ or 1+ evidence) were prioritized for inclusion. A risk-benefit analysis of articles rated for quality was performed. For efficiency and reliability, recent randomized controlled trials, meta-analyses, high quality systematic reviews and large well-designed studies were used if available. Internet searches were conducted for other relevant information, including policies and Australian data on claims under Medicare for MC. RESULTS Evidence-based policy statements by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) support infant and later age male circumcision (MC) as a desirable public health measure. Our systematic review of relevant literature over the past decade yielded 140 journal articles that met our inclusion criteria. Together, these showed that early infant MC confers immediate and lifelong benefits by protecting against urinary tract infections having potential adverse long-term renal effects, phimosis that causes difficult and painful erections and “ballooning” during urination, inflammatory skin conditions, inferior penile hygiene, candidiasis, various sexually transmissible

  8. Male Circumcision and the Epidemic Emergence of HIV-2 in West Africa

    Science.gov (United States)

    Hewlett, Barry Stephen; Camacho, Ricardo Jorge

    2016-01-01

    Background Epidemic HIV-2 (groups A and B) emerged in humans circa 1930–40. Its closest ancestors are SIVsmm infecting sooty mangabeys from southwestern Côte d'Ivoire. The earliest large-scale serological surveys of HIV-2 in West Africa (1985–91) show a patchy spread. Côte d'Ivoire and Guinea-Bissau had the highest prevalence rates by then, and phylogeographical analysis suggests they were the earliest epicenters. Wars and parenteral transmission have been hypothesized to have promoted HIV-2 spread. Male circumcision (MC) is known to correlate negatively with HIV-1 prevalence in Africa, but studies examining this issue for HIV-2 are lacking. Methods We reviewed published HIV-2 serosurveys for 30 cities of all West African countries and obtained credible estimates of real prevalence through Bayesian estimation. We estimated past MC rates of 218 West African ethnic groups, based on ethnographic literature and fieldwork. We collected demographic tables specifying the ethnic partition in cities. Uncertainty was incorporated by defining plausible ranges of parameters (e.g. timing of introduction, proportion circumcised). We generated 1,000 sets of past MC rates per city using Latin Hypercube Sampling with different parameter combinations, and explored the correlation between HIV-2 prevalence and estimated MC rate (both logit-transformed) in the 1,000 replicates. Results and Conclusions Our survey reveals that, in the early 20th century, MC was far less common and geographically more variable than nowadays. HIV-2 prevalence in 1985–91 and MC rates in 1950 were negatively correlated (Spearman rho = -0.546, IQR: -0.553–-0.546, p≤0.0021). Guinea-Bissau and Côte d'Ivoire cities had markedly lower MC rates. In addition, MC was uncommon in rural southwestern Côte d'Ivoire in 1930.The differential HIV-2 spread in West Africa correlates with different historical MC rates. We suggest HIV-2 only formed early substantial foci in cities with substantial uncircumcised

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

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    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.

  10. 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

  11. 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

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    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

  12. Effects of genital ulcer disease and herpes simplex virus type 2 on the efficacy of male circumcision for HIV prevention: Analyses from the Rakai trials.

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    Ronald H Gray

    2009-11-01

    Full Text Available BACKGROUND: Randomized trials show that male circumcision (MC reduces the incidence of HIV and herpes simplex virus type 2 (HSV-2 infections, and symptomatic genital ulcer disease (GUD. We assessed the role of GUD and HSV-2 in the protection against HIV afforded by MC. METHODS AND FINDINGS: HIV-uninfected men were randomized to immediate (n = 2,756 or delayed MC (n = 2,775 in two randomized trials in Rakai, Uganda. GUD symptoms, HSV-2 status, and HIV acquisition were determined at enrollment and at 6, 12, and 24 mo of follow up. Ulcer etiology was assessed by PCR. We estimated the prevalence and prevalence risk ratios (PRRs of GUD in circumcised versus uncircumcised men and assessed the effects of HSV-2 serostatus as a risk-modifying factor for GUD. We estimated the proportion of the effect of MC on HIV acquisition that was mediated by symptomatic GUD, and by HSV-2 infection. Circumcision significantly reduced symptomatic GUD in HSV-2-seronegative men (PRR = 0.51, 95% [confidence interval] CI 0.43-0.74, HSV-2-seropositive men (PRR = 0.66, 95% CI 0.51-0.69, and in HSV-2 seroconverters (PRR = 0.48, 95% CI 0.30-0.79. The proportion of acute ulcers due to HSV-2 detected by PCR was 48.0% in circumcised men and 39.3% in uncircumcised men (chi(2p = 0.62. Circumcision reduced the risk of HIV acquisition in HSV-2 seronegative men (incidence rate ratio [IRR] = 0.34, 95% CI 0.15-0.81, and potentially in HSV-2 seroconverters (IRR = 0.56, 95% CI 0.19-1.57; not significant, but not in men with prevalent HSV-2 at enrollment (IRR = 0.89, 95% CI 0.49-1.60. The proportion of reduced HIV acquisition in circumcised men mediated by reductions in symptomatic GUD was 11.2% (95% CI 5.0-38.0, and the proportion mediated by reduced HSV-2 incidence was 8.6% (95% CI -1.2 to 77.1. CONCLUSIONS: Circumcision reduced GUD irrespective of HSV-2 status, but this reduction played only a modest role in the protective effect of circumcision on HIV acquisition.

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

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    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.

  14. Hesitance towards voluntary medical male circumcision in Lesotho: reconfiguring global health governance.

    Science.gov (United States)

    Bulled, Nicola L

    2015-01-01

    Drawing on work examining HIV prevention initiatives in Lesotho, this paper considers the hesitation of national state actors towards the new strategy for HIV prevention - voluntary medical male circumcision (VMMC). Lesotho offers a representative case study on global health governance, given the country's high HIV burden and heavy dependence on foreign donor nations to implement local HIV prevention initiatives. In this paper, I use the case of VMMC opposition in Lesotho to examine how the new era of 'partnerships' has shifted the architecture of contemporary global health, specifically considering how global agreements are translated or negotiated into local practice. I argue that Lesotho's domestic policy-makers, in employing national statistics to assess if VMMC is an effective approach to addressing the local epidemic, are asserting a claim of expertise. In doing so, they challenge the traditional structures of global health politics, which have largely been managed by experts and funders from and in the global North. I explore the development of global VMMC policy, what drives Lesotho's resistance to comply, and consider the impact renegotiation efforts may have on future global health architecture.

  15. 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.

  16. Female sexuality

    Science.gov (United States)

    Rao, T.S. Sathyanarana; Nagaraj, Anil Kumar M.

    2015-01-01

    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

  17. 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.

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

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    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

  19. FEMALE PSEUDOHERMAPHRODITISM

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    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.

  20. 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"

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    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).

  1. Stopping female genital mutilation. An update.

    Science.gov (United States)

    Gamble, A

    1995-01-01

    There is widespread consensus among many individuals, countries, and organizations that female genital mutilation (FGM) is a human rights abuse. France, Britain, Sweden, and Switzerland have passed legislation forbidding medical personnel from performing FGM, eighteen African countries have made official statements against FGM, and FGM was an issue in the 1993 World Health Assembly, the 1993 World Human Rights Conference, and the 1994 International Conference on Population and Development. True change, however, depends upon a transformation in the informal economic, social, and political structures which perpetuate women's dependency upon marriage and men. The Research Action Information Network for the Bodily Integrity of Women (RAINBOW) and the Development Law and Policy Unit of the Columbia University School of Public Health introduced the Global Action Against FGM (GAAFGM) Project in June 1994. The project is designed to integrate action against FGM into existing health and human rights programs and to pool available resources against FGM. GAAFGM has also coordinated an interagency working group comprised of international agencies, in-country grassroots organizations, and women's groups, which met for the first time in November 1994. The project should provide considerable information and leadership on the issue. On another front, participants in the most recent preparatory meeting for the upcoming Beijing Conference noted the existence of a strong recognition that FGM is a problem upon which the international community should act. The author notes recent litigation brought by the Egyptian Organization for Human Rights against the grand sheik of Al-Azhar University for issuing a fatwa declaring female circumcision an Islamic duty. In addition, a Ghanaian may be granted refugee status in Canada on the basis of her efforts to avoid mutilation if deported to her country of origin.

  2. Health complications of female genital mutilation in Sierra Leone

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    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

  3. 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.

  4. [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.

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

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    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.

  6. Male circumcision and prevalence of genital human papillomavirus infection in men: a multinational study

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    Albero Ginesa

    2013-01-01

    Full Text Available Abstract Background Accumulated evidence from epidemiological studies and more recently from randomized controlled trials suggests that male circumcision (MC may substantially protect against genital HPV infection in men. The purpose of this study was to assess the association between MC and genital HPV infection in men in a large multinational study. Methods A total of 4072 healthy men ages 18–70 years were enrolled in a study conducted in Brazil, Mexico, and the United States. Enrollment samples combining exfoliated cells from the coronal sulcus, glans penis, shaft, and scrotum were analyzed for the presence and genotyping of HPV DNA by PCR and linear array methods. Prevalence ratios (PR were used to estimate associations between MC and HPV detection adjusting for potential confounders. Results MC was not associated with overall prevalence of any HPV, oncogenic HPV types or unclassified HPV types. However, MC was negatively associated with non-oncogenic HPV infections (PR 0.85, 95% confident interval: 0.76-0.95, in particular for HPV types 11, 40, 61, 71, and 81. HPV 16, 51, 62, and 84 were the most frequently identified genotypes regardless of MC status. Conclusions This study shows no overall association between MC and genital HPV infections in men, except for certain non-oncogenic HPV types for which a weak association was found. However, the lack of association with MC might be due to the lack of anatomic site specific HPV data, for example the glans penis, the area expected to be most likely protected by MC.

  7. Safety of over twelve hundred infant male circumcisions using the Mogen clamp in Kenya.

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    Marisa R Young

    Full Text Available BACKGROUND: Several sub-Saharan African countries plan to scale-up infant male circumcision (IMC for cost-efficient HIV prevention. Little data exist about the safety of IMC in East and southern Africa. We calculated adverse event (AE rate and risks for AEs associated with introduction of IMC services at five government health facilities in western Kenya. METHODS: AE data were analyzed for IMC procedures performed between September, 2009 and November, 2011. Healthy infants aged ≤ 2 months and weighing ≥ 2.5 kg were eligible for IMC. Following parental consent, trained clinicians provided IMC services free of charge under local anesthesia using the Mogen clamp. Odds ratios and 95% confidence intervals were used to explore AE risk factors. FINDINGS: A total of 1,239 IMC procedures were performed. Median age of infants was 4 days (IQR=1, 16. The overall AE rate among infants reviewed post-operatively was 2.7% (18/678; 95%CI: 1.4, 3.9. There was one severe AE involving excision of a small piece of the lateral aspect of the glans penis. Other AEs were mild or moderate and were treated conservatively. Babies one month of age or older were more likely to have an AE (OR 3.20; 95%CI: 1.23, 8.36. AE rate did not differ by nurse versus clinical officer or number of previous procedures performed. CONCLUSION: IMC services provided in Kenyan Government hospitals in the context of routine IMC programming have AE rates comparable to those in developed countries. The optimal time for IMC is within the first month of life.

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

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    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

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

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    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

  10. 'Secrets' that kill: crisis, custodianship and responsibility in ritual male circumcision in the Eastern Cape Province, South Africa.

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    Kepe, Thembela

    2010-03-01

    This paper analyses a tension between traditional leaders and the post-apartheid government in South Africa, concerning the crisis in ritual male circumcision. Over the last two decades, following ritual male circumcision, thousands of youth have been admitted to hospitals, hundreds have undergone penile amputations and hundreds have died. Following the government's intervention through legislation and other health measures, traditional leaders allege that this is a violation of cultural rights enshrined in the Constitution. Drawing on newspaper and journal articles, books, policy documents, and legislation, as well as informal interviews with initiates and their parents and field observations in the Eastern Cape Province (2002-2009), this paper explores the validity of the traditional leaders' challenge, arguing that the crisis in the ritual should be seen in a broader context than the tension between traditional leaders and the state. Finally, the paper argues the tension between traditional leaders and government, and the sensational reporting of this by the media, unfortunately takes away focus from the health crisis in the ritual.

  11. No difference in keratin thickness between inner and outer foreskins from elective male circumcisions in Rakai, Uganda.

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    Minh H Dinh

    Full Text Available It has been hypothesized that increased HIV acquisition in uncircumcised men may relate to a more thinly keratinized inner foreskin. However, published data are contradictory and potentially confounded by medical indications for circumcision. We tested the hypothesis that the inner foreskin was more thinly keratinized than the outer foreskin using tissues from 19 healthy, HIV-uninfected men undergoing routine prophylactic circumcision in Rakai, Uganda. Sections from 3 foreskin anatomic sites (inner, outer, and frenar band were snap-frozen separately. Two independent laboratories each separately stained, imaged, and measured keratin thicknesses in a blinded fashion. There was no significant difference in keratin thickness between the inner (mean = 14.67±7.48 µm and outer (mean = 13.30±8.49 µm foreskin, or between the inner foreskin and the frenar band (mean = 16.91±12.42 µm. While the frenar band showed the greatest intra-individual heterogeneity in keratin thickness, there was substantial inter-individual variation seen in all regions. Measurements made by the two laboratories showed high correlation (r = 0.741, 95% CI, 0.533-0.864. We conclude that, despite inter- and intra-individual variability, keratin thickness was similar in the inner and outer foreskin of healthy Ugandan men, and that reduced keratin thickness is not likely to make the inner foreskin more susceptible to HIV acquisition.

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

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    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.

  13. 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

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    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.

  14. 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

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    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

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

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    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.

  16. Male circumcision and sexual risk behaviors may contribute to considerable ethnic disparities in HIV prevalence in Kenya: an ecological analysis.

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    Chris Richard Kenyon

    Full Text Available HIV prevalence varies between 0.8 and 20.2% in Kenya's various ethnic groups. The reasons underlying these variations have not been evaluated before.We used data from seven national surveys spanning the period 1989 to 2008 to compare the prevalence of a range of risk factors in Kenya's ethnic groups. Spearman's and linear regression were used to assess the relationship between HIV prevalence and each variable by ethnic group.The ethnic groups exhibited significant differences in a number of HIV related risk factors. Although the highest HIV prevalence group (the Luo had the highest rates of HIV testing (Men 2008 survey: 56.8%, 95% CI 51.0-62.5% and condom usage at last sex (Men 2008∶28.6%, 95% CI 19.6-37.6%, they had the lowest prevalence of circumcision (20.9%, 95% CI 15.9-26.0 the highest prevalence of sex with a non-married, non-cohabiting partner (Men: 40.2%, 95% CI 33.2-47.1% and pre-marital sex (Men 2008∶73.9%, 95% CI 67.5-80.3% and the youngest mean age of debut for women (1989 SURVEY: 15.7 years old, 95% CI 15.2-16.2. At a provincial level there was an association between the prevalence of HIV and male concurrency (Spearman's rho = 0.79, P = 0.04. Ethnic groups with higher HIV prevalence were more likely to report condom use (Men 2008 survey: R2 = 0.62, P = 0.01 and having been for HIV testing (Men 2008 survey: R2 = 0.47, P = 0.04.In addition to differences in male circumcision prevalence, variation in sexual behavior may contribute to the large variations in HIV prevalence in Kenya's ethnic groups. To complement the prevention benefits of the medical male circumcision roll-out in several parts of Kenya, interventions to reduce risky sexual behavior should continue to be promoted.

  17. 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

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    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.

  18. 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

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    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、

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

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    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

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

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    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.

  1. The Relationship Between Distance and Post-operative Visit Attendance Following Medical Male Circumcision in Nyanza Province, Kenya.

    Science.gov (United States)

    Golub, Ginger; Herman-Roloff, Amy; Hoffman, Susie; Jaoko, Walter; Bailey, Robert C

    2016-11-01

    To date, there is no research on voluntary medical male circumcision (VMMC) catchment areas or the relationship between distance to a VMMC facility and attendance at a post-operative follow-up visit. We analyzed data from a randomly selected subset of males self-seeking circumcision at one of 16 participating facilities in Nyanza Province, Kenya between 2008 and 2010. Among 1437 participants, 46.7 % attended follow-up. The median distance from residence to utilized facility was 2.98 km (IQR 1.31-5.38). Nearly all participants (98.8 %) lived within 5 km from a facility, however, 26.3 % visited a facility more than 5 km away. Stratified results demonstrated that among those utilizing fixed facilities, greater distance was associated with higher odds of follow-up non-attendance (OR5.01-10km vs. 0-1km = 1.71, 95 % CI 1.08, 2.70, p = 0.02; OR>10km vs. 0-1 km = 2.80, 95 % CI 1.26, 6.21, p = 0.01), adjusting for age and district of residence. We found 5 km marked the threshold distance beyond which follow-up attendance significantly dropped. These results demonstrate distance is an important predictor of attending follow-up, and this relationship appears to be modified by facility type.

  2. 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

  3. New publication on female genital mutilation. Interviews with Nahid Toubia and Anika Rahman, co-authors of Female Genital Mutilation: a Guide to Laws and Policies Worldwide.

    Science.gov (United States)

    Grossman, S

    2000-09-01

    Female circumcision/female genital mutilation (FC/FGM) is the collective name given to several different traditional practices that involve the cutting of female genitals. The WHO has grouped them in four categories: type 1: Clitoridectomy; type 2: Excision; type 3: Infibulation; and type 4: Unclassified. Reports indicate that an estimated 130 million girls and women have undergone FC/FGM and that it is practiced in 28 countries in the sub-Saharan and northeastern regions of Africa. As part of the growing movement to stop this human rights violation, numerous UN bodies and nongovernmental organizations such as the Center for Reproductive Law and Policy (CRLP) and RAINBO work together to monitor government responses. Presented in a questionnaire form, two authors Anika Rahman, CRLP's International Program Director, and Nahid Toubia, Director of RAINBO, discuss their recent book collaboration, "Female Genital Mutilation: A Guide to Laws and Policies Worldwide". The issues covered in the interview include the purpose of the book, reasons why FC/FGM is considered a human rights violation rather than a threat to women's health, role of international agencies in the eradication of the practice, and the effects of formal laws and policies in eliminating FC/FGM.

  4. 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。

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. Hui Muslims’Circumcision Ceremony in Xingjing Town%宁夏兴泾镇回族的割礼仪式解读

    Institute of Scientific and Technical Information of China (English)

    周晶; 陶瑞

    2016-01-01

    Male circumcision,which is commonly found in human society,is a rite of passage. On the basis of main-taining the traditional Islamic religious tradition,by the influence of historical and social factors,the Muslim circumcision ceremony had local circumstances and ethnic characteristics. Circumcision is a Muslim rite with specific the symbolism of cleanness. Circumcision is not only a beneficial to health of hygiene practices,but also a cultural phenomenon of the flow-ing through the gift. It maintains in everyday life of the relatives and friends to the indivisible relationship.%普遍存在于人类社会中的男性割礼是对男性生殖器包皮进行切割的成人仪式。在维系伊斯兰教宗教传统的基础上,受历史和社会因素的影响,回族穆斯林的割礼仪式有了地方性情节和民族性特征。割礼是穆斯林的一项圣行,具有干净与洁净的象征意义。同时,割礼不仅是一种有益于男性身体健康的卫生习俗,也是人们通过礼物流动而采借的文化现象,它维系着日常生活中亲友之间难以割舍的亲密关系。

  10. 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.

  11. 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.

  12. 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

  13. 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.

  14. 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 ...

  15. 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

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

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    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.

  17. 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

  18. 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

  19. 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.

  20. 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.

  1. An overview of female genital mutilation in Nigeria.

    Science.gov (United States)

    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, Biomedcentral and African Journal Online (AJOL) (FGM)] and textbooks, journals, and selected references for proper understanding of the topic was included in this review. The national prevalence rate of FGM is 41% among adult women. Evidence abound that the prevalence of FGM is declining. The ongoing drive to eradicate FGM is tackled by World Health Organization, United Nations International Children Emergency Fund, Federation of International Obstetrics and Gynecology (FIGO), African Union, The economic commission for Africa, and many women organizations. However, there is no federal law banning FGM in Nigeria. There is need to eradicate FGM in Nigeria. Education of the general public at all levels with emphasis on the dangers and undesirability of FGM is paramount.

  2. 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 

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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.

  8. 商环包皮环切与传统袖套式包皮环切术后患者生活质量比较%Comparison of the quality of life after Shang-ring circumcision and Sleeve circumcision

    Institute of Scientific and Technical Information of China (English)

    王肖; 钱永; 杜永强

    2016-01-01

    Objective:To compare the effects between Shang-ring circumcision and Sleeve circumcision on the quality of life. Methods:One hundred and thirty adult patients with redundant prepuce and phimosis were treated with Shang-ring circumcision ( Shang-ring group,78 cases) and Sleeve circumcision( Sleeve group,52 cases) . The quality of life between two groups after operation were compared. Results:The pain in Shang-ring group was more than that in Sleeve group in postoperative 2 weeks(P0. 05). The physical composite scores after 1 to 2 weeks of operation and mental composite scores after 3 to 14 days of operation in Shang-ring group were significantly higher than those in Sleeve group(P 0.05)。商环组患者术后1~2周体能综合评分和术后3 d至2周思想综合评分均显著高于袖套组(P<0.01)。术后6周包皮环切手术后患者自慰相对困难,自慰快感减低,但对性生活质量无明显影响。结论:2种手术方式对患者术后生活质量影响各有侧重,包皮环切手术对性生活质量无明显的提高,对自慰有影响。

  9. 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...

  10. 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...

  11. Female genital cutting.

    Science.gov (United States)

    Perron, Liette; Senikas, Vyta; Burnett, Margaret; Davis, Victoria

    2013-11-01

    Objectif : Renforcer le cadre national des soins offerts aux adolescentes et aux femmes affectées par l’excision génitale féminine (EGF) au Canada en fournissant aux professionnels de la santé : (1) des renseignements ayant pour but d’approfondir leur compréhension de cette pratique et leurs connaissances à ce sujet; (2) des consignes quant aux aspects légaux liés à cette pratique; (3) des directives cliniques pour la gestion des soins obstétricaux et gynécologiques, y compris la prise en charge des complications liées à l’EGF; et (4) des conseils quant à l’offre de soins compétents au plan culturel aux adolescentes et aux femmes ayant subi une EGF. Résultats : La littérature publiée a été récupérée par l’intermédiaire de recherches menées dans PubMed, CINAHL et The Cochrane Library en septembre 2010 au moyen d’un vocabulaire contrôlé (p. ex. « Circumcision », « Female ») et de mots clés (p. ex. « female genital mutilation », « clitoridectomy », « infibulation ») appropriés. Nous avons également mené des recherches dans Social Science Abstracts, Sociological Abstracts, Gender Studies Database et ProQuest Dissertations and Theses en 2010 et en 2011. Aucune restriction n’a été appliquée en matière de date ou de langue. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu’en décembre 2011. La littérature grise (non publiée) a été identifiée par l’intermédiaire de recherches menées dans les sites Web d’organismes s’intéressant à l’évaluation des technologies dans le domaine de la santé et d’organismes connexes, dans des collections de directives cliniques, dans des registres d’essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. Valeurs : La qualité des résultats a été évaluée au moyen des critères décrits dans le rapport du Groupe d’étude canadien sur les soins

  12. 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.

  13. 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。

  14. 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

  15. 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

  16. 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。

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. Voluntary medical male circumcision: a qualitative study exploring the challenges of costing demand creation in eastern and southern Africa.

    Directory of Open Access Journals (Sweden)

    Jane T Bertrand

    Full Text Available BACKGROUND: This paper proposes an approach to estimating the costs of demand creation for voluntary medical male circumcision (VMMC scale-up in 13 countries of eastern and southern Africa. It addresses two key questions: (1 what are the elements of a standardized package for demand creation? And (2 what challenges exist and must be taken into account in estimating the costs of demand creation? METHODS AND FINDINGS: We conducted a key informant study on VMMC demand creation using purposive sampling to recruit seven people who provide technical assistance to government programs and manage budgets for VMMC demand creation. Key informants provided their views on the important elements of VMMC demand creation and the most effective funding allocations across different types of communication approaches (e.g., mass media, small media, outreach/mobilization. The key finding was the wide range of views, suggesting that a standard package of core demand creation elements would not be universally applicable. This underscored the importance of tailoring demand creation strategies and estimates to specific country contexts before estimating costs. The key informant interviews, supplemented by the researchers' field experience, identified these issues to be addressed in future costing exercises: variations in the cost of VMMC demand creation activities by country and program, decisions about the quality and comprehensiveness of programming, and lack of data on critical elements needed to "trigger the decision" among eligible men. CONCLUSIONS: Based on this study's findings, we propose a seven-step methodological approach to estimate the cost of VMMC scale-up in a priority country, based on our key assumptions. However, further work is needed to better understand core components of a demand creation package and how to cost them. Notwithstanding the methodological challenges, estimating the cost of demand creation remains an essential element in deriving

  2. Needs Assessment and Theory-Based Promotion 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

    2016-11-01

    Voluntary medical male circumcision (VMMC) is an evidence-based biomedical HIV prevention method. It is under-utilized in countries outside Africa, including China. The present single-arm, non-blinded test-of-concept trial was designed to promote VMMC among 179 male sexually transmitted diseases patients (MSTDP) in Shenzhen, China. It was based on behavioral health theories and results of a formative survey. At month 4, 45.5 % of the MSTDP responded positively to the intervention (19.9 % had taken up VMMC and 25.6 % intended to do so in the next 6 months). Adjusted analysis showed that cognitive variables measured at baseline (perceived self-efficacy, subjective norm and behavioral intention) significantly predicted adoption of VMMC during the 4-month follow-up period. Process evaluation involving clinicians of the STD clinics was positive. At month 6, 36.0 % of the circumcised participants used condom less frequently with their regular sex partner. We recommend scaling up the intervention, taking prevention of risk compensation into account.

  3. Female Labor Supply

    NARCIS (Netherlands)

    Maassen-van den Brink, te Henriet

    1994-01-01

    To gain insight on factors that impede economic independence of women, this book concentrates on female labor supply in relation to child care, male-female wage differentials, the division of unpaid labor, and marital conflicts between women and men. It may very well be that restrictions on the opti

  4. 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,…

  5. Female Sexuality: An Enigma.

    Science.gov (United States)

    Daniluk, Judith

    1991-01-01

    Describes constructions of sexuality that have occurred within social context in which language, culture, and behavior interact to reinforce male power. Against backdrop of these patriarchal examples of female sexual expression and experience, discusses difficulties of female clients. Addresses critical counseling concerns in terms of contextual…

  6. Female Reproductive System

    Science.gov (United States)

    ... Reproductive System en español Sistema reproductor femenino About Human Reproduction All living things reproduce. Reproduction — the process by ... male and female reproductive systems are essential for reproduction. The female needs a ... like other organisms, pass certain characteristics of themselves ...

  7. Female urethral syndrome. A female prostatitis?

    OpenAIRE

    1996-01-01

    The cause of the female urethral syndrome has previously been obscure, as it has been associated by definition with a lack of objective findings but a plethora of subjective complaints of retropubic pressure, dyspareunia, urinary frequency, and dysuria. There is now strong evidence that the microscopic paraurethral glands connected to the distal third of the urethra in the prevaginal space are homologous to the prostate. They stain histologically for prostate-specific antigen and, like the pr...

  8. 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.

  9. “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

  10. 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,

  11. 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

  12. 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.

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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。

  19. 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。

  20. Female Athlete Triad

    Science.gov (United States)

    ... habits, their periods may stop. Triad Factor #3: Osteoporosis Estrogen is lower in girls with female athlete triad. Low estrogen levels and poor nutrition, especially low calcium intake, can lead to osteoporosis, the third aspect of the triad. Osteoporosis is ...

  1. Female pattern baldness

    Science.gov (United States)

    Alopecia in women; Baldness - female; Hair loss in women; Androgenetic alopecia in women; Hereditary balding or thinning in women ... in the skin called a follicle. In general, baldness occurs when the hair follicle shrinks over time, ...

  2. 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.

  3. Female Pattern Hair Loss

    Science.gov (United States)

    ... are signs of hormone imbalance, such as excess facial or body hair, a hormone evaluation should be done. Hormonal changes are a common cause of female hair loss. Many women do not realize that hair loss can occur ...

  4. Male sexual harassment alters female social behaviour towards other females.

    Science.gov (United States)

    Darden, Safi K; Watts, Lauren

    2012-04-23

    Male harassment of females to gain mating opportunities is a consequence of an evolutionary conflict of interest between the sexes over reproduction and is common among sexually reproducing species. Male Trinidadian guppies Poecilia reticulata spend a large proportion of their time harassing females for copulations and their presence in female social groups has been shown to disrupt female-female social networks and the propensity for females to develop social recognition based on familiarity. In this study, we investigate the behavioural mechanisms that may lead to this disruption of female sociality. Using two experiments, we test the hypothesis that male presence will directly affect social behaviours expressed by females towards other females in the population. In experiment one, we tested for an effect of male presence on female shoaling behaviour and found that, in the presence of a free-swimming male guppy, females spent shorter amounts of time with other females than when in the presence of a free-swimming female guppy. In experiment two, we tested for an effect of male presence on the incidence of aggressive behaviour among female guppies. When males were present in a shoal, females exhibited increased levels of overall aggression towards other females compared with female only shoals. Our work provides direct evidence that the presence of sexually harassing males alters female-female social behaviour, an effect that we expect will be recurrent across taxonomic groups.

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. Text messaging to improve attendance at post-operative clinic visits after adult male circumcision for HIV prevention: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Thomas A Odeny

    Full Text Available BACKGROUND: Following male circumcision for HIV prevention, a high proportion of men fail to return for their scheduled seven-day post-operative visit. We evaluated the effect of short message service (SMS text messages on attendance at this important visit. METHODOLOGY: We enrolled 1200 participants >18 years old in a two-arm, parallel, randomized controlled trial at 12 sites in Nyanza province, Kenya. Participants received daily SMS text messages for seven days (n = 600 or usual care (n = 600. The primary outcome was attendance at the scheduled seven-day post-operative visit. The primary analysis was by intention-to-treat. PRINCIPAL FINDINGS: Of participants receiving SMS, 387/592 (65.4% returned, compared to 356/596 (59.7% in the control group (relative risk [RR] = 1.09, 95% confidence interval [CI] 1.00-1.20; p = 0.04. Men who paid more than US$1.25 to travel to clinic were at higher risk for failure to return compared to those who spent ≤ US$1.25 (adjusted relative risk [aRR] 1.35, 95% CI 1.15-1.58; p<0.001. Men with secondary or higher education had a lower risk of failure to return compared to those with primary or less education (aRR 0.87, 95% CI 0.74-1.01; p = 0.07. CONCLUSIONS: Text messaging resulted in a modest improvement in attendance at the 7-day post-operative clinic visit following adult male circumcision. Factors associated with failure to return were mainly structural, and included transportation costs and low educational level. TRIAL REGISTRATION: ClinicalTrials.govNCT01186575.

  10. Violent female offenders

    Directory of Open Access Journals (Sweden)

    Ismael Loinaz

    2014-12-01

    Full Text Available Female violent offending is an understudied topic in Spanish-speaking countries. This review explores themajor research findings accumulated internationally over the last decade (2003-2013 about women'sviolence and crimes. The focus of the review is the intimate partner violence (IPV and sexual violencecommitted by females, the psychopathy and violence risk assessment, and the treatment and recidivism ofthese female offenders. Although the female offender topic is too wide to review all crime typologies (childphysical abuse is not included, for example the review indicates that: there are legal and police biases inthe treatment of women offenders; women can commit the same IPV and share the motivations of maleoffenders; sexual violence has a low prevalence, but there are many limitations in this research topic;predicting the risk of non-specific violence is feasible with the available tools; psychopathy is less prevalentamong adult female offenders, although there are fewer differences with male offenders among adolescentsamples; research about treatments is very limited and there are not effectiveness evidences; and last,recidivism rates for violent crimes are very low (in cases where information is available. Main implicationsand research lines are discussed.

  11. 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.

  12. 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.

  13. 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.

  14. 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 findings....... Such a review is indtended to provide some insight into how scholars in different social contexts, who study apparently the same phenomenon, direct their focus. It should also enrich research into female entrepreneurship in both regions of the world and provide directions for further research in the field....

  15. 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.

  16. 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.

  17. 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.

  18. 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

  19. 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

  20. On Female Consumption Formulae

    Institute of Scientific and Technical Information of China (English)

    李建平

    2012-01-01

    This is an observation by the daily deliberation of China major consuming force-female,which should be a great master piece.Because of the not-in-depth study and analysis,I can only put it in the air as a clue for further research by experts.

  1. Female sexual dysfunction

    DEFF Research Database (Denmark)

    Giraldi, Annamaria; Wåhlin-Jacobsen, Sarah

    2016-01-01

    Female sexual dysfunction (FSD) is a controversial condition, which has prompted much debate regarding its aetiology, components, and even its existence. Our inability to work together as clinicians, psychologists, patients, and advocates hinders our understanding of FSD, and we will only improve...

  2. 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.

  3. 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.

  4. 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

  5. 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

  6. 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。

  7. 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.

  8. Female athletes and health

    Directory of Open Access Journals (Sweden)

    Malara Marzena

    2016-06-01

    Full Text Available It is well documented that regular physical activity has a beneficial effect on human health by affecting the metabolic processes that are of fundamental importance in the body’s functions, such as insulin sensitivity and glucose disposal, as well as lipid and lipoprotein turnover. On the other hand, there is a wealth of studies which indicate that strenuous, regular physical activity, such as that performed by high performance athletes, may be detrimental for the athletes’ health especially in women. This review focuses on the factors that contribute to health problems in female athletes, named the female athlete triad, which includes excessive dieting, menstrual dysfunctions (anovulatory menstrual cycles, oligomenorrhea, amenorrhea and a low bone mineral density (BMD. As a result of these factors, women who participate in sports, especially those focused on leanness, need special attention and education from health professionals, coaches and the athletes themselves to prevent the detrimental effects of an inadequate energy supply against high energy demands.

  9. 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.

  10. Hormones and female sexuality

    OpenAIRE

    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...

  11. Acceptability of male circumcision among men who have sex with men in Guiyang city%贵阳市男男性行为者包皮环切术接受意愿调查

    Institute of Scientific and Technical Information of China (English)

    郑敏; 刘民; 姚永明; 申莉梅

    2012-01-01

    Objective To investigate the acceptability of male circumcision (MC) and its influencing factors among men who have sex with men( MSM) in Guiyang municipality to promote the acceptability of male circumcision for the prevention of sexually transmitted diseases. Methods Questionnaire interviews were administered to 357 MSM recruited and the results of 302 MSM without MC experience were analyszed. Results Among the MSM, 57. 3 % (173/302) had the first sex at the average age of 21. 7 years and 61. 6% (186/302)had the first sex with men. For the MSM the average number of male partners in the latest 6 months was 4.2 and 94. 4% (285/302) of MSM had anal sex with men but only 31.4% (89/302) used a condom everytime. There were 17. 9% (54/302) of MSM having anal sex with female, of which only 35. 1 % (19/54) used a condom everytime. Totally 48. 01 % (145/302) of the MSM accepted MC. Multivariate logistic regression analyses showed the influencing factors included knowing the effect of MC on prevention of sexually transmitted diseases(P=0. 016) ,with self-diagnosed prepuce or phimosis(P= 0.006) .awareness of effect of MC on quality of sex (P = 0.000), and believing in good quality of MC (P = 0.000). Conclusion The knowledge about effects of MC on sexual function and prevention of sexually transmitted diseases are related to the acceptability on MC among MSM in Guiyang city.%目的 探索包皮环切术作为艾滋病预防干预措施在贵州省贵阳市男男性行为人群(MSM)中的可接受性及影响因素.方法 对贵阳市招募的符合条件的302名男男性行为行者进行包皮环切术(MC)接受意愿及其影响因素问卷调查.结果 本次调查的MSM性取向为同性恋的占57.3% (173/302),发生首次性行为的平均年龄是21.7岁,首次性行为的性伴61.6% (186/302)是男性;最近6个月男性性伴数平均是4.2人,94.4%( 285/302)的MSM与男性有过肛交性行为,且与男性发生性行为时只有31.4% (89/302)

  12. 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

  13. 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.

  14. 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.

  15. INGUINAL HERNIA IN FEMALES

    OpenAIRE

    2001-01-01

    9 patients of inguinal hernia in females were diagnosed in a total of 50 patients who presented with congenital groin problems, 8 of these were managed surgically. There were 6 small children, 1 young girl and 2 elderly ladies. All children were managed by herniotomy and herniorrhaphy was done in women. 2 patients under one year presented with irreducible hernia, one of them on exploration was found to be having sliding hernia with incarcerated ovary and tube as contents while other one had i...

  16. 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

  17. Female entrepreneurial activity in Romania

    OpenAIRE

    Annamária DÉZSI-BENYOVSZKI; Tünde Petra SZABÓ; Ágnes NAGY

    2016-01-01

    The aim of this study is to analyse the female entrepreneurial activity in Romania. We will compare the socio-demographic characteristics, the entrepreneurial attitudes and perceptions of female early-stage entrepreneurs and the female employees in order to highlight the main differences. Using a logistic regression we will identify the main influencing factors of the probability of becoming a female early-stage entrepreneur.

  18. 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.

  19. [Female sexual dysfunction].

    Science.gov (United States)

    Luria, Mijal

    2009-09-01

    Female sexual problems are common, frequently overlooked and have a significant impact on the lives of women. Research in the last decade has brought to the understanding and recognition of a number of standpoints, mainly the broad range of normative function. In 2003, the American Urological Association Foundation convened an international committee of experts in the field of women's sexuality, to reconsider the existing definitions of women's sexual dysfunction. Based on the circular response cycle developed by Basson, the group emphasized motivations that might move a woman from being sexually "neutral" to making a decision to be sexual with her partner, as a normative alternative to the need for spontaneous sexual desire as the trigger for sexual behavior. Etiology may stem from medical as well as psychological factors, thus assessment must include a complete evaluation. Treatment includes psycho-education, improvement of interpersonal communication, cognitive behavioral treatment and elucidation and treatment of medical problems, if necessary. Several pharmacological treatments are under investigation, with modest results and uncertainties about their long term safety. This review presents the female sexual response as it is understood today and the current diagnostic and therapeutic understandings and directions.

  20. Mothers' factors associated with female genital mutilation in daughters in the Iraqi Kurdistan Region.

    Science.gov (United States)

    Shabila, Nazar P

    2017-03-01

    An important proactive factor for the continuation of female genital mutilation (FGM) is tradition and customs inherited in the family from mothers to daughters. Therefore, the aim of this study was to determine mothers' factors associated with the occurrence of FGM among their daughters. The datasets from the Iraq Multiple Indicator Cluster Survey 2011, on 5,184 women aged 15 to 49 years having at least one daughter, was used. Multivariate analysis based on a binary logistic regression model was applied. Mothers' age (adjusted odds ratio [aOR] = 8.18 at ages 25-34 years, aOR = 22.64 at ages 35-44 years, and aOR = 29.78 at ages 45-49 years, compared to the age group 15-24 years), educational level (aOR = 0.52 for primary education, aOR = 0.26 for secondary education, and aOR = 0.03 for higher education compared to uneducated), employment status (aOR = 0.55 for women having office work compared with unemployed), FGM status (aOR = 27.44 for circumcised mothers compared to uncircumcised), the governorate of residence (aOR = 18.73 for Suleimaniya and aOR = 33.23 for Erbil compared with Dohuk), and the wealth index of the household (aOR = 0.55 for richest group compared to the poorest) were significantly associated with the occurrence of FGM in daughters. Strategies aimed at preventing this harmful practice in the Iraqi Kurdistan Region should include female education and empowerment.

  1. 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.

  2. Circumcision Complications Associated with the Plastibell Device and Conventional Dissection Surgery: A Trial of 586 Infants of Ages up to 12 Months

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    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.

  3. 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.

  4. 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