Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1 (Dec09) to make independent decisions. In some situations, health care workers may need to judge whether an adolescent has the maturity to request, and consent to, circumcision, independent of his parent or guardian. Circumcision is an opportunity to make contact with adolescent boys, and provide them with information and counselling about their own sexual and reproductive health and that of their current or future partners. Adequate time should be allowed for counselling before and after the operation. Adolescents should be advised that it is important to return after the procedure for a check-up and further counselling and information on condom use and other aspects of sexual and reproductive health. Documenting informed consent for surgery The circumcision team should ensure that the client has been informed about the risks and benefits of male circumcision, that the information has been given in an understandable way, using everyday local language. The oral information should be backed up by written information sheets in the local language (see the sample information sheet for adult and adolescent clients in Appendix 3.2). After receiving the information the client should be allowed to ask questions. He should then be given time to reflect before being asked to sign the consent document (see the sample certificate of consent for adults and adolescents in Appendix 3.3). INFANT CIRCUMCISION Circumcision can be performed with the least physical risk on infants. When counselling parents who have been offered, or have requested, circumcision for their infant, health care providers have a responsibility to explain all the associated benefits and risks. Any benefits with regard to preventing HIV infection will be realized only many years in the future when the child becomes sexually active. Parents or guardians should use the information they are given to evaluate what is in the best interests of the child. They may also wish to consider cultural and religious factors in reaching a fully informed decision. More information on counselling parents who wish to have their baby circumcised is given in Chapter 6. INTEGRATION OF TRADITIONAL CIRCUMCISION EVENTS WITH CLINICAL CIRCUMCISION In some communities, groups of boys are circumcised at the same time, by a traditional circumciser who uses a traditional technique without anaesthesia. This group activity coincides with the “rites of passage” from adolescence to adulthood, and often takes place in circumcision “camps” or ceremonies. The event is usually both festive and educational for the participants and the community. The goals are Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-12
Male circumcision under local anaesthesia Version 3.1 (Dec09) to acknowledge the boy’s physical and emotional maturity and readiness to face the challenges of adulthood, as well as to support him during the painful circumcision procedure. In the camps, young boys attend various civic education classes, facilitated by the traditional circumciser, community leaders or event organizer. Essentially, they are taught how to behave as men. Some parents prefer to have their sons circumcised individually. They may take the boy to a hospital or clinic, and have a health care provider perform a medical circumcision under local anaesthesia. If they choose to have the boy circumcised at home, they may engage either a nurse or a traditional circumciser. They may also specify which technique they prefer. The increasing interest in medical circumcision in communities with a culture of traditional circumcision provides an opportunity to integrate the traditional event with safer clinical procedures including appropriate follow-up. There are many reports of high complication rates following traditional circumcision ceremonies and circumcisions performed by traditional providers. Safety can be improved by introducing medical circumcision into traditional ceremonies, or by performing the circumcision under local anaesthesia in a clinic separate from, but linked to, the traditional ceremony. Educational topics during a circumcision event may include the following: • the physical and psychological changes that occur in boys and girls during adolescence; • sexuality and gender issues; • male and female sexual and reproductive health and rights; • sexually transmitted infections; • HIV infection; • safer sex practices (correct and consistent use of condoms, reducing the number of sexual partners, delaying the start of sexual relations, and avoiding penetrative sex); • family planning; • substance use (drugs, alcohol, tobacco); • violence, including gender-based violence; • community expectations of men; • goal-setting and decision-making. Health institutions that want to organize group circumcision events should do so in partnership with traditional circumcisers and the community. A joint educational programme can be drawn up, under shared responsibility. The decision to circumcise boys in camps will depend on resources, customs and traditions in the community. A mobile outreach service during the holidays is a convenient way to reach many boys and their parents. Whichever approach is adopted, the quality of the clinical circumcision should be ensured, in order to build and maintain confidence in the community regarding the safety and advisability of medical circumcision. Educating and Counselling Clients and Obtaining Informed Consent Chapter 3-13
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Manual for Male Circumcision under Local Anaesthesia

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