Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) widely performed for religious or cultural reasons, while in others it is performed principally on medical grounds. In order to make an informed decision, every potential client or parent is entitled to full information about the benefits and risks of the procedure. The decision of an adult or young man to be circumcised, and the decision of a parent to have his or her son circumcised, should be based on culture, religion, personal preference, and evidence-based information provided by a health care worker. Benefits If circumcision is being done for reasons other than the treatment of a specific medical problem, the health benefits are primarily preventive, and may only be realized long after the procedure. Circumcision may reduce the risk of acquiring some infections and related complications, but does not guarantee complete protection. Some of these conditions are common, while others are less so, and the degree of risk of the individual is likely to depend on his behaviour and where he lives. Although the strength of the evidence varies by disease, the benefits of circumcision include the following: • It is easier to keep the penis clean. • There is a reduced risk of urinary tract infections in childhood. 1 • Circumcision prevents inflammation of the glans (balanitis) and the foreskin (posthitis). • Circumcision prevents the potential development of scar tissue on the foreskin, which may lead to phimosis (inability to retract the foreskin) and paraphimosis (swelling of the retracted foreskin resulting in inability to return the foreskin to its normal position). • There is a reduced risk of some sexually transmitted infections (STIs), especially ulcerative diseases, such as chancroid and syphilis. 2, 3 • There is a reduced risk of becoming infected with human 4, 5, 6, 7, 8 immunodeficiency virus (HIV). 9, 10 • There is a reduced risk of penile cancer. • There is a reduced risk of cancer of the cervix in female sex partners. 11 Risks As for any surgical procedure, there are risks associated with circumcision. While the benefits of circumcision may be wide-ranging and long-term, any problems generally occur during or soon after the procedure. They include: • pain; • bleeding; • haematoma (formation of a blood clot under the skin); • infection at the site of the circumcision; • increased sensitivity of the glans penis for the first few months after the procedure; • irritation of the glans; • meatitis (inflammation of the opening of the urethra); • injury to the penis; Male circumcision and HIV infection Chapter 1-2
Male circumcision under local anaesthesia Version 3.1 (Dec09) • adverse reaction to the anaesthetic used during the circumcision. These complications are rare when circumcision is performed by well trained, adequately equipped, experienced health care personnel, and are usually easily and rapidly resolved. Data from controlled trials show that fewer than 1 in 50 procedures result in complications. 4, 6 MALE CIRCUMCISION AND HIV INFECTION There is currently great interest in the role of male circumcision in preventing HIV infection. Research studies have shown a lower risk of infection in circumcised compared with uncircumcised men, as well as a lower prevalence of HIV infection in populations where male circumcision is common. These data led WHO and UNAIDS to recommend that male circumcision be promoted as an additional method of HIV prevention and that countries or settings with generalized HIV epidemics and low prevalence of circumcision should urgently scale up circumcision services. 12 The evidence linking male circumcision and HIV A systematic review and meta-analysis of 28 published studies found that uncircumcised men are 2–3 times more likely to be infected with HIV than circumcised men, with the difference being most pronounced in men with high exposure to HIV infection. 5 A sub-analysis of 10 African studies, involving men considered to be at high risk of becoming infected, found a 3.4 times higher incidence of HIV infection among those who had not been circumcised. 5 In a prospective study in Uganda of HIV-negative men whose partners were HIV-positive, none of 50 circumcised men became infected within two years, compared with 40 of 137 uncircumcised men. 13 Male circumcision and regional differences in HIV prevalence The geographical regions in sub-Saharan Africa where men are more commonly circumcised overlap with areas of lower HIV prevalence. An extensive study by the Joint United Nations Programme on HIV/AIDS (UNAIDS) investigated behavioural and other factors that could account for the large disparities in HIV prevalence across different African regions. 14 A low prevalence of male circumcision and a high prevalence of genital herpes (which is more common in uncircumcised men) emerged as the principal determinants of the differences in HIV rates. Table 1.1 shows the prevalence of HIV infection in a number of countries with low or high rates of male circumcision. Countries in sub- Saharan Africa where male circumcision is common (>80%) generally have HIV prevalence levels well below those of countries where circumcision is less common (
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Manual for Male Circumcision under Local Anaesthesia

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