Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia
Version 3.1 (Dec09)
Urinary tract infections
Urinary tract infections are infrequent in adult men, but more frequent
in children and older men. Usually there is an underlying cause, for
example, kidney or bladder stones. Symptoms include:
• frequent urge to urinate;
• pain and a burning feeling in the area of the bladder or urethra
during urination (dysuria);
• feeling tired, shaky, and weak (malaise);
• feeling pain in the bladder or urethra even when not urinating;
• passing only a small amount of urine, despite an intense urge to
urinate;
• milky or cloudy urine; sometimes urine may be reddish, indicating
that blood is present;
• fever (suggesting that the infection has reached the kidneys);
• pain in the back or side, below the ribs;
• nausea;
• vomiting.
Urinary tract infections in men should be distinguished from urethral
discharge caused by an STI. A patient with a urinary tract infection
should be told to drink plenty of water, starting immediately. He should
also be given an appropriate. Men and boys with recurrent urinary
tract infection, or who do not respond to treatment at the first level of
care, should be referred for further investigations.
Infertility
Between 60 and 80 million couples around the world are infertile, and
most of them live in developing countries. Infertility is defined as
failure to conceive after at least 12 months of unprotected vaginal
intercourse. A large proportion of cases of infertility in developing
countries are attributable to STIs, which can damage the fallopian
tubes in women and obstruct the sperm ducts in men, particularly
when left untreated. Reproductive tract infections in men can affect
the prostate (prostatitis), the epididymis (epididymitis), and the testes
(orchitis). In many societies, childlessness is highly stigmatizing, and
the couple’s emotional response to their infertility is often exacerbated
by family, peer and media pressure. Frequently the female partner is
considered responsible for the failure to conceive, commonly resulting
in marital tension, divorce, polygamy or ostracism. However, a WHO
investigation of 5800 infertile couples found that reduced male
reproductive capacity was a contributory factor in at least 50% of
infertile couples. 7 In order to provide more efficient, systematic and
cost-effective care for infertile couples, and to improve the accuracy of
diagnoses, health care providers managing an infertile couple should
ensure that all essential information is collected. The WHO Manual for
the Standardized Investigation and Diagnosis of the Infertile Couple
provides clear guidelines and a logical sequence of steps for clinicians
to follow in evaluating both partners in an infertile couple. 8
Linking male circumcision and other male SRH services Chapter 2-11