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Young MR, Odoyo-June E, Nordstrom SK, Irwin TE, Ongong'a DO, Ochomo B, Agot K, Bailey RC. Factors associated with uptake of infant male circumcision for HIV prevention in western Kenya. Pediatrics 2012; 130:e175-82. [PMID: 22711723 DOI: 10.1542/peds.2011-2290] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Three randomized trials demonstrated male circumcision decreases female-to-male HIV incidence by 60%. Male circumcision research in sub-Saharan Africa has focused on adolescents and adults. Modeling suggests infant male circumcision (IMC) will be cost saving for HIV prevention in high to moderate seroprevalent regions. This study examined parental decision-making and differences in characteristics of parents accepting and declining IMC services in western Kenya. METHODS This case-control study was conducted in 2010 at 5 government hospitals in Nyanza Province, Kenya. Cases were mothers and fathers accepting circumcision for their son. Controls were parents who declined IMC services. A questionnaire comprising 41 questions was administered. RESULTS A total of 627 mothers and 493 fathers enrolled. In multivariable logistic regression modeling, factors associated with accepting IMC among mothers were the following: father circumcised (odds ratio [OR] = 2.30, P < .001) and agreeing with the father about the IMC decision (OR = 4.38, P < .001). Among fathers, factors associated with accepting IMC were the following: being circumcised (OR = 1.77, P = .016) and agreeing with the mother about IMC (OR = 11.0, P < .001). Fathers were the primary decision makers in most instances (66%). Few parents (3%) reported they would prefer a future son to remain uncircumcised. CONCLUSIONS Fathers are important in the IMC decision-making process. Fathers, as well as mothers, should be targeted for optimal scale-up of IMC services. Circumcision programs should offer services for males of all ages, as male circumcision at some age is highly acceptable to both men and women.
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Affiliation(s)
- Marisa R Young
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Illinois, USA.
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52
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Vasan S, Michael NL. Improved outlook on HIV-1 prevention and vaccine development. Expert Opin Biol Ther 2012; 12:983-94. [DOI: 10.1517/14712598.2012.688020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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53
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Paix BR, Peterson SE. Circumcision of neonates and children without appropriate anaesthesia is unacceptable practice. Anaesth Intensive Care 2012; 40:511-6. [DOI: 10.1177/0310057x1204000318] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Circumcision is painful surgery and appropriate intraoperative anaesthesia and postoperative analgesia is required. This is recognised in the policies of the Royal Australasian College of Physicians and the majority of Australian State Health Departments. Nevertheless, anecdotal evidence exists that neonatal circumcision continues to be performed in Australia with either no anaesthesia or with inadequate anaesthesia. This paper presents the evidence that neonatal circumcision is painful and reviews the available anaesthetic techniques. The authors conclude that general anaesthesia is arguably the most reliable way of ensuring adequate anaesthesia, although this may mean deferment of the procedure until the child is older. Local or regional anaesthesia for neonatal circumcision ideally requires a separate skilled anaesthetist (other than the proceduralist) to monitor the patient and intervene if the anaesthesia is inadequate. Topical anaesthesia with lignocaine-prilocaine (EMLA) cream is insufficient.
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Affiliation(s)
- B. R. Paix
- Department of Anaesthesia, Flinders Medical Centre, Adelaide, South Australia
| | - S. E. Peterson
- School of Veterinary and Biomedical Sciences, Murdoch University, Perth, Western Australia
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Abstract
The aim of this article is to describe the circumcision procedure during history, its therapeutic and preventive goals, with focus on bioethical, economic and law issues. The origins of this practice are lost in antiquity. It was performed since 3000 BC by the Egyptians for hygienic and religious reasons. Moreover, male circumcision is a religious commandment in Judaism and Islam, and it is customary in some Oriental Orthodox and other Christian churches of Africa. Nowadays, circumcision is performed as a routine procedure by the Jews and the Muslims for religious reasons. The world prevalence of men with circumcision is 12.5-33%, especially in USA, Canada, Islamic people and Africa; in Europe the prevalence rate is low (in Great Britain it is 1.5%). Currently, male circumcision is being highly debated because of ethical, law and scientific issues and the different roles of this procedure: therapeutic, prophylactic (but there is no universal consensus) and ritualistic role. Nowadays, in Italy there is a strong debate about the consensus for this practice and its indications. The Italian law does not allow performing ritualistic circumcision, as a free of charge procedure in public hospitals, at the government's expenses, because the Italian law must protect different religious cultures, in name of the laity of the State. Thus, national bioethical committee (CNB) has established that ritualistic circumcision may only be performed on a paying basis in public hospitals. As a protective practice, circumcision has decreased in the entire world because of the improvement of hygienical conditions and, above all, the lack of unanimous consent on the real usefulness of protective circumcision, even if several studies have recently demonstrated the protecting role of male circumcision against HIV infection.
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55
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Naja Z, Al-Tannir MA, Faysal W, Daoud N, Ziade F, El-Rajab M. A comparison of pudendal block vs dorsal penile nerve block for circumcision in children: a randomised controlled trial. Anaesthesia 2011; 66:802-7. [DOI: 10.1111/j.1365-2044.2011.06753.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zaroo MI, Sheikh BA, Wani AH, Darzi MA, Mir M, Dar H, Baba Peerzada UF, Zargar HR. Use of preputial skin for coverage of post-burn contractures of fingers in children. Indian J Plast Surg 2011; 44:68-71. [PMID: 21713163 PMCID: PMC3111128 DOI: 10.4103/0970-0358.81436] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Hand burns are common injuries. Children frequently sustain burn injuries, especially to their hands. Contractures are a common sequel of severe burns around joints. The prepuce, or foreskin, has been used as a skin graft for a number of indications. We conducted this study to evaluate the feasibility of utilising the preputial skin for the management of post-burn contractures of fingers in uncircumcised male children. MATERIALS AND METHODS Preputial skin was used for the coverage of released contractures of fingers in 12 patients aged 2-6 years. The aetiology of burns was "Kangri" burn in eight patients and scalding in four patients. Six patients had contracture in two fingers, four patients in one finger, and two patients had contractures in three fingers. RESULTS None of the patients had graft loss, and all the wounds healed within 2 weeks. All patients had complete release of contractures without any recurrence. Hyperpigmentation of the grafts was observed over a period of time, which was well accepted by the parents. CONCLUSIONS Preputial skin can be used successfully for male children with mild-to-moderate contractures of 2-3 fingers for restoration of the hand function, minimal donor site morbidity.
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Affiliation(s)
- Mohammed I Zaroo
- Department of Plastic and Reconstructive Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Mavundla TR, Netswera FG, Toth F, Bottoman B, Tenge S. How boys become dogs: stigmatization and marginalization of uninitiated xhosa males in East London, South Africa. QUALITATIVE HEALTH RESEARCH 2010; 20:931-941. [PMID: 20363954 DOI: 10.1177/1049732310363804] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Male circumcision is practiced in South Africa among the Xhosa people as a rite of passage from boyhood to manhood. The manhood status achieved after the ritual accords men power and authority in the community over women and uncircumcised men. Therefore, uninitiated men experience great pressures to get circumcised. We describe the experience of newly initiated Xhosa men in East London, South Africa. Interpretive phenomenology was used as the inquiry of choice. Data were collected through focus group discussions in which 14 men participated. The theme of marginalization of uninitiated Xhosa males emerged with two categories: (a) rejection, and (b) lack of respect. The participants revealed that uninitiated men are rejected by the community, their own families, friends, and women. We frame the discussion around the concept of stigma. Acknowledging that uninitiated males are stigmatized can help mitigate stigma, and in turn, the incidence of medical complications from botched circumcisions.
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Castro JG, Jones DL, Lopez M, Barradas I, Weiss SM. Making the case for circumcision as a public health strategy: opening the dialogue. AIDS Patient Care STDS 2010; 24:367-72. [PMID: 20565321 DOI: 10.1089/apc.2009.0353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Hispanics in the United States have lower rates of male circumcision and higher rates of HIV. Although MC has been demonstrated to reduce the risk of acquisition of several sexual transmitted diseases such as HIV, human papilloma virus infection, and herpes simplex virus type 2, MC is only medically reimbursable by insurance for adults or children following recurrent infection, injury, or malformation of the penis. We conducted two studies of attitudes regarding MC among health care providers to Hispanic clients at Miami, Florida STD and Prenatal Clinics. This study presents qualitative data drawn from intensive interviews with 21 providers, including a mohel. Qualitative data was analyzed for dominant themes and collapsed into overarching themes. Thirteen themes emerged; acceptability, appearance, circumcision and children, circumcision and HIV, cost, cultural differences, health benefits, knowledge and personal experiences, pain and injury to the penis, perceived HIV risk, religion, sexual performance, and sexual pleasure. Except for the mohel, Hispanic male providers related MC acceptability to American Pediatric Association guidelines, personal circumcision status, and were skeptical regarding health benefits for sexually transmitted disease (STD)/HIV risk reduction. Female providers focused on the financial burden to parents, lack of information, and low acceptability among Hispanic men. This study illustrates the differing attitudes on circumcision held by providers, and suggests that gender, culture, cost, and providers themselves may limit MC acceptability among Hispanic clients. Results suggest that promotion of MC as an HIV risk reduction strategy must begin with the support of medical practitioners to promote the endorsement of MC as a prevention strategy.
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Affiliation(s)
- José G. Castro
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Deborah Lynne Jones
- Department: Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Maria Lopez
- Department: Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Isabel Barradas
- Department of Psychiatry, University of Miami, Miami, Florida
| | - Stephen M. Weiss
- Department: Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
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59
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Samad A, Khanzada TW, Kumar B. Plastibell circumcision: a minor surgical procedure of major importance. J Pediatr Urol 2010; 6:28-31. [PMID: 19525148 DOI: 10.1016/j.jpurol.2009.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Accepted: 05/19/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the number of days taken by the Plastibell to fall off after circumcision and the Plastibell impaction rate in various age groups. METHODS This was a prospective cohort study of male babies who underwent circumcision using the Plastibell technique. Patients were followed up 1 week postoperatively as well as soon after the Plastibell had fallen off. RESULTS Mean age was 14.3 months and mean weight 8.2kg at time of surgery. The average time taken for the Plastibell to fall off after circumcision for babies under 3 months was 8.7 days; this period gradually increased to 16.8 days for children over 5 years of age. The overall complication rate was 7.4%. Plastibell impaction was the commonest complication, encountered after 6.1% of procedures, and was managed by cutting the Plastibell. The impaction rate was only 2.3% for babies under 3 months, but gradually increased to 26.9% for children over 5 years. CONCLUSION The time taken by the Plastibell to fall off spontaneously as well as the Plastibell impaction rate increases gradually with age. In view of the overall safety, comfort and absence of any long-term complication, this procedure justifies recommendation in all children aged under 1 year, but its use is debatable in older children.
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Affiliation(s)
- Abdul Samad
- Department of Surgery, Isra University, Hyderabad, Pakistan.
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60
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Sansom SL, Prabhu VS, Hutchinson AB, An Q, Hall HI, Shrestha RK, Lasry A, Taylor AW. Cost-effectiveness of newborn circumcision in reducing lifetime HIV risk among U.S. males. PLoS One 2010; 5:e8723. [PMID: 20090910 PMCID: PMC2807456 DOI: 10.1371/journal.pone.0008723] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 12/15/2009] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Stephanie L. Sansom
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vimalanand S. Prabhu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Angela B. Hutchinson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Qian An
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - H. Irene Hall
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ram K. Shrestha
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Arielle Lasry
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Allan W. Taylor
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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61
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Perera CL, Bridgewater FHG, Thavaneswaran P, Maddern GJ. Safety and efficacy of nontherapeutic male circumcision: a systematic review. Ann Fam Med 2010; 8:64-72. [PMID: 20065281 PMCID: PMC2807391 DOI: 10.1370/afm.1073] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE We wanted to assess the safety and efficacy of nontherapeutic male circumcision through a systematic review of the literature. METHODS We systematically searched The York Centre for Reviews and Disseminations, Cochrane Library, PubMed, and EMBASE databases for randomized controlled trials published between January 1997 and August 2008. Studies reporting on circumcision in an operative setting in males of any age with no contraindications to or medical indications for circumcision were eligible for inclusion. The main comparator was intact genitalia. From 73 retrieved studies, 8 randomized controlled trials were ultimately included for analysis. RESULTS Severe complications were uncommon. Analgesia/anesthesia during circumcision was promoted. The prevalence of self-reported genital ulcers was significantly lower in circumcised men than uncircumcised men (3.1% vs 5.8%; prevalence risk ratio 0.53; 95% confidence interval [CI], 0.43-0.64; P<.001). Circumcised sub-Saharan African men were at significantly lower risk of acquiring human immunodeficiency virus/acquired immune deficiency syndrome than were uncircumcised men (random effects odds ratio = 0.44, 95% CI, 0.32-0.59; P <.001). The evidence suggests that adult circumcision does not affect sexual satisfaction and function. CONCLUSIONS Strong evidence suggests circumcision can prevent human immunodeficiency virus/acquired immune deficiency syndrome acquisition in sub-Saharan African men. These findings remain uncertain in men residing in other countries. The role of adult nontherapeutic male circumcision in preventing sexually transmitted infections, urinary tract infections, and penile cancer remains unclear. Current evidence fails to recommend widespread neonatal circumcision for these purposes.
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Affiliation(s)
- Caryn L Perera
- ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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62
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Tobian AAR, Gray RH, Quinn TC. Male circumcision for the prevention of acquisition and transmission of sexually transmitted infections: the case for neonatal circumcision. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2010; 164:78-84. [PMID: 20048246 PMCID: PMC2907642 DOI: 10.1001/archpediatrics.2009.232] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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63
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Smith DK, Taylor A, Kilmarx PH, Sullivan P, Warner L, Kamb M, Bock N, Kohmescher B, Mastro TD. Male circumcision in the United States for the prevention of HIV infection and other adverse health outcomes: report from a CDC consultation. Public Health Rep 2010; 125 Suppl 1:72-82. [PMID: 20408390 PMCID: PMC2788411 DOI: 10.1177/00333549101250s110] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In April 2007, the Centers for Disease Control and Prevention (CDC) held a two-day consultation with a broad spectrum of stakeholders to obtain input on the potential role of male circumcision (MC) in preventing transmission of human immunodeficiency virus (HIV) in the U.S. Working groups summarized data and discussed issues about the use of MC for prevention of HIV and other sexually transmitted infections among men who have sex with women, men who have sex with men (MSM), and newborn males. Consultants suggested that (1) sufficient evidence exists to propose that heterosexually active males be informed about the significant but partial efficacy of MC in reducing risk for HIV acquisition and be provided with affordable access to voluntary, high-quality surgical and risk-reduction counseling services; (2) information about the potential health benefits and risks of MC should be presented to parents considering infant circumcision, and financial barriers to accessing MC should be removed; and (3) insufficient data exist about the impact (if any) of MC on HIV acquisition by MSM, and additional research is warranted. If MC is recommended as a public health method, information will be required on its acceptability and uptake. Especially critical will be efforts to understand how to develop effective, culturally appropriate public health messages to mitigate increases in sexual risk behavior among men, both those already circumcised and those who may elect MC to reduce their risk of acquiring HIV.
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Affiliation(s)
- Dawn K Smith
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS E-45, Atlanta, GA 30333, USA.
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Ahaghotu C, Okafor H, Igiehon E, Gray E. Psychosocial factors influence parental decision for circumcision in pediatric males of African American descent. J Natl Med Assoc 2009; 101:325-30. [PMID: 19397222 DOI: 10.1016/s0027-9684(15)30879-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The most recent policy statement by the American Academy of Pediatrics suggests there are insufficient data to recommend routine newborn circumcision. Nevertheless, circumcision rates have not declined in the United States. Some studies suggest that African Americans are less likely to be circumcised. In blacks that choose to circumcise their males, we sought to examine the factors that drive parents to favor circumcision. METHODS The Parental Attitudes on Circumcision questionnaire was utilized to obtain demographic information and attitudinal responses to circumcision during urology clinic sessions at Howard University Hospital, a major teaching hospital located in an urban setting. Parents and caregivers of male children aged 3 months to 7 years participated. Valid responses from 146 participants were collected. RESULTS Ninety-six percent of our respondents believe that circumcision is healthy. Forty-one percent indicated health reasons as the most important influencing factor for choosing to circumcise their child, while 25% selected maternal preference. Eighty-one percent of all respondents indicated that 1 or more health care providers asked about their decision to circumcise their child. The mother was 12 times more likely than the father to make the final decision for circumcision, especially when her personal preference played a role. Eighty-eight percent of respondents felt that circumcision is painful, but 87% considered the procedure safe, and another 72% believe that it is a necessary procedure. CONCLUSION African American parents strongly believe that circumcision is essential for a healthy state and are willing to opt for the procedure despite the belief that it may be painful for the child. The mother primarily made the final decision to circumcise her child, largely based on the perceived health and hygiene benefits. In blacks, the mother yields considerable influence in the decision to circumcise the child, with maternal preference as the main reason for seeking circumcision in as much as a quarter of cases.
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Affiliation(s)
- Chiledum Ahaghotu
- Division of Urology, Howard University Hospital Washington, DC 20001, USA.
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65
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Kilmarx PH, Kretsinger K, Millett GA. Considerations in the role of male circumcision in the prevention of HIV transmission in the USA. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/hiv.09.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Male circumcision (MC) has been associated with a reduced risk for female–male HIV transmission in observational and ecological studies, as well as clinical trials. Three recent randomized, controlled trials in sub-Saharan Africa demonstrated a 50–60% reduction in HIV incidence among men randomized to circumcision compared with uncircumcised men. In 2007, WHO/UNAIDS recommended that MC be recognized as an additional efficacious intervention to prevent sexual transmission of HIV from women to men. This article reviews information on the potential role of MC for HIV prevention in the USA where, compared with the African clinical trial countries, the prevalence of HIV infection is lower, the main route of HIV transmission is male–male sex rather than heterosexual sex and the prevalence of MC is higher.
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Affiliation(s)
- Peter H Kilmarx
- Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, 1600 Clifton Road, MS E-45, Atlanta, GA 30333, USA
| | - Katrina Kretsinger
- Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, 1600 Clifton Road, MS E-45, Atlanta, GA 30333, USA
| | - Gregorio A Millett
- Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, 1600 Clifton Road, MS E-45, Atlanta, GA 30333, USA
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66
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Marberger M. Should we be concerned about losing urology territory to other specialties? Indian J Urol 2009; 25:221-4. [PMID: 19672352 PMCID: PMC2710070 DOI: 10.4103/0970-1591.52925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael Marberger
- Department of Urology, Waehringer Guertel 18–20, A-1090 Vienna, Austria
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67
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Halperin DT, Wamai RG, Weiss HA, Hankins C, Agot K, Karim QA, Shisana O, Bailey RC, Betukumesu B, Bongaarts J, Bowa K, Cash R, Cates W, Diallo MO, Dludlu S, Geffen N, Heywood M, Jackson H, Kayembe PK, Kapiga S, Kebaabetswe P, Kintaudi L, Klausner JD, Leclerc-Madlala S, Mabuza K, Makhubele MB, Micheni K, Morris BJ, de Moya A, Ncala J, Ntaganira I, Nyamucherera OF, Otolorin EO, Pape JW, Phiri M, Rees H, Ruiz M, Sanchez J, Sawires S, Seloilwe ES, Serwadda DM, Setswe G, Sewankambo N, Simelane D, Venter F, Wilson D, Woelk G, Zungu N. Male circumcision is an efficacious, lasting and cost-effective strategy for combating HIV in high-prevalence AIDS epidemics. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17469600.2.5.399] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | | | - Helen A Weiss
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Kawango Agot
- Universities of Nairobi, Illinois & Manitoba (UNIM) Project, Lumumba Health Center, University of Nairobi, Kenya
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Saidi Kapiga
- Harvard School of Public Health, MA, USA and,University of Tanzania, Tanzania
| | | | | | | | | | - Khanya Mabuza
- National Emergency Response Council on HIV/AIDS (NERCHA), Swaziland
| | | | | | | | - Antonio de Moya
- Consejo Presidencial Del Sida (COPRESIDA), Dominican Republic
| | | | | | | | | | - Jean William Pape
- Haitian Group for the Study of Kaposi’s Sarcoma & Opportunistic Infections (GHESKIO), Haiti
| | | | - Helen Rees
- Reproductive Health & Research Unit, Witwatersrand University, South Africa
| | | | | | | | | | | | | | | | - Dudu Simelane
- Family Life Association of Swaziland (FLAS), Swaziland
| | - François Venter
- Reproductive Health & Research Unit, Witwatersrand University, South Africa
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68
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Begley EB, Jafa K, Voetsch AC, Heffelfinger JD, Borkowf CB, Sullivan PS. 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. PLoS One 2008; 3:e2731. [PMID: 18628946 PMCID: PMC2443289 DOI: 10.1371/journal.pone.0002731] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 06/20/2008] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Elin B Begley
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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69
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70
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Dickson NP, van Roode T, Herbison P, Paul C. Circumcision and risk of sexually transmitted infections in a birth cohort. J Pediatr 2008; 152:383-7. [PMID: 18280846 DOI: 10.1016/j.jpeds.2007.07.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 06/20/2007] [Accepted: 07/26/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the impact of early childhood circumcision on sexually transmitted infection (STI) acquisition to age 32 years. STUDY DESIGN The circumcision status of a cohort of children born in 1972 and 1973 in Dunedin, New Zealand was sought at age 3 years. Information about STIs was obtained at ages 21, 26, and 32 years. The incidence rates of STI acquisition were calculated, taking into account timing of first sex, and comparisons were made between the circumcised men and uncircumcised men. Adjustments were made for potential socioeconomic and sexual behavior confounding factors where appropriate. RESULTS Of the 499 men studied, 201 (40.3%) had been circumcised by age 3 years. The circumcised and uncircumcised groups differed little in socioeconomic characteristics and sexual behavior. Overall, up to age 32 years, the incidence rates for all STIs were not statistically significantly different-23.4 and 24.4 per 1000 person-years for the uncircumcised and circumcised men, respectively. This was not affected by adjusting for any of the socioeconomic or sexual behavior characteristics. CONCLUSIONS These findings are consistent with recent population-based cross-sectional studies in developed countries, which found that early childhood circumcision does not markedly reduce the risk of the common STIs in the general population in such countries.
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Affiliation(s)
- Nigel P Dickson
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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71
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Abstract
Circumcision of males represents a surgical "vaccine" against a wide variety of infections, adverse medical conditions and potentially fatal diseases over their lifetime, and also protects their sexual partners. In experienced hands, this common, inexpensive procedure is very safe, can be pain-free and can be performed at any age. The benefits vastly outweigh risks. The enormous public health benefits include protection from urinary tract infections, sexually transmitted HIV, HPV, syphilis and chancroid, penile and prostate cancer, phimosis, thrush, and inflammatory dermatoses. In women circumcision of the male partner provides substantial protection from cervical cancer and chlamydia. Circumcision has socio-sexual benefits and reduces sexual problems with age. It has no adverse effect on penile sensitivity, function, or sensation during sexual arousal. Most women prefer the circumcised penis for appearance, hygiene and sex. Given the convincing epidemiological evidence and biological support, routine circumcision should be highly recommended by all health professionals.
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Affiliation(s)
- Brian J Morris
- School of Medical Sciences and Bosch Institute, Building F13, The University of Sydney, Sydney, New South Wales 2006, Australia.
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72
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Morris BJ, Bailis SA, Castellsague X, Wiswell TE, Halperin DT. RACP's policy statement on infant male circumcision is ill-conceived. Aust N Z J Public Health 2007; 30:16-22; discussion 22-5. [PMID: 16502947 DOI: 10.1111/j.1467-842x.2006.tb00079.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To conduct a critical peer-review of the 2004 Policy Statement on routine male circumcision produced by the Royal Australasian College of Physicians (RACP). METHOD Comprehensive evaluation in the context of the research field. RESULTS We find that the current Statement downplays the wide-ranging life-long benefits of circumcision in prevention of urinary tract infections (UTIs), penile and cervical cancer, genital herpes and chlamydia in women, HIV infection, phimosis, and various penile dermatoses, and at the same time overstates the complication rate. We highlight the many errors in the RACP Statement and note that it sidesteps making a conclusion based on circumcision's well-documented prophylactic health benefits by instead referring to the status of the foreskin at birth. In the era of preventative medicine we view this as irresponsible. CONCLUSION The RACP's Statement on routine male circumcision is not evidence-based and should be retracted. IMPLICATIONS In the interests of public health and individual well-being an extensive, comprehensive, evidence-based revision should be conducted so as to provide scientifically accurate, balanced information on the advantages, and also the low rate of mostly minor complications, associated with this simple procedure, which for maximum benefits and minimal risk should ideally be performed in the neonatal period.
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Affiliation(s)
- Brian J Morris
- School of Medical Sciences and Institute for Biomedical Research, University of Sydney, New South Wales.
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73
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Turner AN, Morrison CS, Padian NS, Kaufman JS, Salata RA, Chipato T, Mmiro FA, Mugerwa RD, Behets FM, Miller WC. Men's circumcision status and women's risk of HIV acquisition in Zimbabwe and Uganda. AIDS 2007; 21:1779-89. [PMID: 17690577 PMCID: PMC2978032 DOI: 10.1097/qad.0b013e32827b144c] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether male circumcision of the primary sex partner is associated with women's risk of HIV. DESIGN Data were analyzed from 4417 Ugandan and Zimbabwean women participating in a prospective study of hormonal contraception and HIV acquisition. Most were recruited from family planning clinics; some in Uganda were referred from higher-risk settings such as sexually transmitted disease clinics. METHODS Using Cox proportional hazards models, time to HIV acquisition was compared for women with circumcised or uncircumcised primary partners. Possible misclassification of male circumcision was assessed using sensitivity analysis. RESULTS At baseline, 74% reported uncircumcised primary partners, 22% had circumcised partners and 4% had partners of unknown circumcision status. Median follow-up was 23 months, during which 210 women acquired HIV (167, 34, and 9 women whose primary partners were uncircumcised, circumcised, or of unknown circumcision status, respectively). Although unadjusted analyses indicated that women with circumcised partners had lower HIV risk than those with uncircumcised partners, the protective effect disappeared after adjustment for other risk factors [hazard ratio (HR), 1.03; 95% confidence interval (CI), 0.69-1.53]. Subgroup analyses suggested a non-significant protective effect of male circumcision on HIV acquisition among Ugandan women referred from higher-risk settings: adjusted HR 0.16 (95% CI, 0.02-1.25) but little effect in Ugandans (HR, 1.33; 95% CI, 0.72-2.47) or Zimbabweans (HR, 1.12; 95% CI, 0.65-1.91) from family planning clinics. CONCLUSIONS After adjustment, male circumcision was not significantly associated with women's HIV risk. The potential protection offered by male circumcision for women recruited from high-risk settings warrants further investigation.
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Affiliation(s)
- Abigail Norris Turner
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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74
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Sullivan PS, Kilmarx PH, Peterman TA, Taylor AW, Nakashima AK, Kamb ML, Warner L, Mastro TD. Male circumcision for prevention of HIV transmission: what the new data mean for HIV prevention in the United States. PLoS Med 2007; 4:e223. [PMID: 17676944 PMCID: PMC1925125 DOI: 10.1371/journal.pmed.0040223] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Recent clinical trials in Africa found that male circumcision reduces the risk of acquiring HIV from heterosexual sex--what are the implications of these studies for the United States?
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Affiliation(s)
- Patrick S Sullivan
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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75
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Xu F, Markowitz LE, Sternberg MR, Aral SO. Prevalence of Circumcision and Herpes Simplex Virus Type 2 Infection in Men in the United States: The National Health and Nutrition Examination Survey (NHANES), 1999–2004. Sex Transm Dis 2007; 34:479-84. [PMID: 17413536 DOI: 10.1097/01.olq.0000253335.41841.04] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To study the prevalence of circumcision in the United States and to examine the association between circumcision and herpes simplex virus Type 2 (HSV-2) infection. METHODS As part of National Health and Nutrition Examination Surveys from 1999 to 2004, 6174 men were interviewed about circumcision status and sexual behaviors, and were tested for HSV-2 antibodies. Medical artwork was used to aid the reporting of circumcision status. RESULTS The overall prevalence of circumcision was 79% and varied by race/ethnicity (88% in non-Hispanic whites, 73% in non-Hispanic blacks, 42% in Mexican Americans, and 50% in others). For men born in the United States from 1940 through 1979, the prevalence of circumcision increased, with larger increases in non-Hispanic blacks and Mexican Americans than in non-Hispanic whites; the prevalence of circumcision decreased significantly in those born in the 1980s (84%) compared to those born in 1970s (91%) (P <0.001). Circumcision status was not associated with sexual behaviors we assessed. In multivariate analyses, circumcision was not associated with HSV-2 infection (P = 0.47). CONCLUSIONS The prevalence of circumcision apparently peaked in those born in the 1970s and declined in those born in the 1980s. Circumcision was not associated with HSV-2 infection.
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Affiliation(s)
- Fujie Xu
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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76
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Abstract
PURPOSE OF REVIEW To review the recent literature on male circumcision and its effect on HIV acquisition. RECENT FINDINGS The report from the randomized clinical trial of male circumcision in South Africa demonstrating a 60% protective effect in preventing HIV acquisition provided the first clinical trial evidence of efficacy of male circumcision in protecting men against HIV infection. This protective effect was consistent with both ecological and epidemiologic studies which also show a protective effect of 50-70% in men at high risk for HIV infection. Biological studies also demonstrate an increased number of HIV receptor cells in the mucosa of foreskin providing additional evidence of HIV susceptibility in the uncircumcised male. Male circumcision may also have a beneficial effect in preventing HIV acquisition in women and lowering selected sexually transmitted infections in both sexes. SUMMARY The results of two ongoing randomized clinical trials of male circumcision in Kenya and Uganda are awaited with interest, however male circumcision should be carefully considered as a potential public health tool in preventing HIV acquisition. If other trials confirm the results of the South African trial, implementation of this surgical procedure will need to be carefully scaled up and integrated into other prevention programs with emphasis on surgical training, aseptic techniques, acceptability, availability and cultural considerations.
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Affiliation(s)
- Thomas C Quinn
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA.
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77
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Muula AS. Male circumcision to prevent HIV transmission and acquisition: what else do we need to know? AIDS Behav 2007; 11:357-63. [PMID: 17345145 DOI: 10.1007/s10461-007-9211-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is growing interest and controversy regarding the promotion of male circumcision (MC) for the prevention of HIV transmission in Africa. Three randomized controlled studies has so far been stopped prematurely as evidence accumulated that showed that circumcision was superior to no circumcision in preventing HIV acquisition among sexually active men in Africa. To some people, the evidence is overwhelming and MC should be promoted aggressively. Others suggest cautious decision making. This paper attempts to review a continuum of perceptions and suggest that the decision to scale-up male circumcision cannot just bebased on randomized controlled trial results.
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Affiliation(s)
- Adamson Sinjani Muula
- Department of Community Health, University of Malawi, College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi.
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78
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Dickerman JD. Circumcision in the time of HIV: when is there enough evidence to revise the American Academy of Pediatrics' policy on circumcision? Pediatrics 2007; 119:1006-7. [PMID: 17473102 DOI: 10.1542/peds.2007-0739] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joseph D Dickerman
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont 05405, USA.
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79
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Abstract
This article provides primary care providers, including pediatric nurse practitioners, with a framework for completing a genitourinary assessment. Many primary care providers are reluctant to examine the genitalia of their patients. Routine genital examinations increase diagnostic skills, provide a baseline for future examinations, may improve parent and child compliance with the examination, and may reveal previously undiscovered anomalies or trauma. An assessment of the reproductive and urologic systems should begin with obtaining a focused history from the parent from birth to present. Techniques for performing a focused genitourinary examination will be discussed.
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Affiliation(s)
- Gail Hornor
- Children's Hospital, Center for Child and Family Advocacy, Columbus, OH 43205, USA.
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80
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Aydur E, Gungor S, Ceyhan ST, Taiimaz L, Baser I. Effects of childhood circumcision age on adult male sexual functions. Int J Impot Res 2007; 19:424-31. [PMID: 17314981 DOI: 10.1038/sj.ijir.3901545] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The effects of childhood circumcision on male sexual function have been debated. However, there are no studies, to our knowledge, that assess the possible effects of childhood circumcision age on male sexual function. In an attempt to answer this question, we performed a prospective study to determine the possible relationship between circumcision age and male sexual function, using a validated questionnaire, the Golombok-Rust Inventory of Sexual Satisfaction. We found no relationship between childhood circumcision age and overall sexual function; however some specific domains of sexual function (i.e. avoidance and communication) seemed to be affected by the age at circumcision procedure in this cohort of sexually active males. In addition, prevalence of sexual dysfunction was higher, with premature ejaculation being the most common dysfunction in the survey. We concluded that childhood circumcision age might affect some domains of male sexual function in adulthood, but not the overall function.
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Affiliation(s)
- E Aydur
- Department of Urology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey.
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81
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Fergusson DM, Boden JM, Horwood LJ. Circumcision status and risk of sexually transmitted infection in young adult males: an analysis of a longitudinal birth cohort. Pediatrics 2006; 118:1971-7. [PMID: 17079568 DOI: 10.1542/peds.2006-1175] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Previous research suggests that male circumcision may be a protective factor against the acquisition of sexually transmitted infections; however, studies examining this question have produced mixed results. The aim of this study was to examine the association between circumcision status and sexually transmitted infection risk using a longitudinal birth cohort study. METHODS Data were gathered as part of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children. Information was obtained on: (1) the circumcision status of males in the cohort before 15 years old, (2) measures of self-reported sexually transmitted infection from ages 18 to 25 years, and (3) childhood, family, and related covariate factors. RESULTS Being uncircumcised had a statistically significant bivariate association with self-reported sexually transmitted infection. Adjustment for potentially confounding factors, including number of sexual partners and unprotected sex, as well as background and family factors related to circumcision, did not reduce the association between circumcision status and reports of sexually transmitted infection. Estimates of the population-attributable risk suggested that universal neonatal circumcision would have reduced rates of sexually transmitted infection in this cohort by 48.2%. CONCLUSIONS These findings suggest that uncircumcised males are at greater risk of acquiring sexually transmitted infection than circumcised males. Male circumcision may reduce the risk of sexually transmitted infection acquisition and transmission by up to one half, suggesting substantial benefits accruing from routine neonatal circumcision.
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Affiliation(s)
- David M Fergusson
- Christchurch Health and Development Study, Christchurch School of Medicine and Health Sciences, PO Box 4345, Christchurch, New Zealand.
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Cathcart P, Nuttall M, van der Meulen J, Emberton M, Kenny SE. Trends in paediatric circumcision and its complications in England between 1997 and 2003. Br J Surg 2006; 93:885-90. [PMID: 16673355 DOI: 10.1002/bjs.5369] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND It has been suggested that too many English boys undergo circumcision. This report describes how circumcision rates have changed in England between 1997 and 2003, including data on complication rates and on how age, medical indication and surgical specialty affect postoperative haemorrhage rates. METHODS Data were extracted from the Hospital Episode Statistics database of admissions to National Health Service hospitals in England. Patients were included in the study if an Office of Population Censuses and Surveys version 4 code for circumcision was present in any of the operative procedure fields of the database; 75 868 boys below 15 years of age were included in the study. RESULTS Circumcision rates declined by about 20 per cent, from 2.6 per 1000 boys per year in 1997 to 2.1 in 2003. Between 2000 and 2003, circumcision rates remained static at 2.1 per 1000 boys per year. Circumcision rates fell by 31.2 per cent for boys aged 0-4 years, 9.3 per cent for boys aged 5-9 years and increased by 7.7 per cent in boys aged 10-14 years; 90.2 per cent of circumcisions were done for phimosis and 1.2 per cent of boys experienced a complication. CONCLUSION Circumcision rates in England continued to fall up until 2000, particularly in those aged under 5 years, in whom pathological phimosis is rare. The circumcision rate remains five times higher than the reported incidence of Phimosis.
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Affiliation(s)
- P Cathcart
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
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83
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Short RV. New ways of preventing HIV infection: thinking simply, simply thinking. Philos Trans R Soc Lond B Biol Sci 2006; 361:811-20. [PMID: 16627296 PMCID: PMC1609406 DOI: 10.1098/rstb.2005.1781] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Accepted: 08/23/2005] [Indexed: 11/12/2022] Open
Abstract
HIV infection is the greatest health crisis in human history. It continues to spread unchecked among the poor in the developing world because we have failed to design simple preventative methods that are available and affordable to those living on under Dollars 2 a day. Five new methods are discussed. (i) A natural microbicide. Intravaginal lime or lemon juice has been used for centuries as a traditional contraceptive. The juice can also kill HIV in the laboratory, but clinical trials are needed to see if vaginal application is acceptable, safe and effective. (ii) Intravaginal oestrogen. Monkeys can be protected from Simian immunodeficiency virus (SIV) infection by keratinizing the vagina with topical oestrogen. If women take the oral contraceptive pill vaginally it retains its contraceptive efficacy, and the oestrogen it contains should thicken the vagina and protect against HIV infection. Clinical trials are needed. (iii) Male circumcision. Removal of the inner foreskin removes the main site of HIV entry into the penis, resulting in a sevenfold reduction in susceptibility to infection. The practice needs to be promoted. (iv) Post-coital penile hygiene. Wiping the penis immediately after intercourse with lime or lemon juice or vinegar should kill the virus before it has had a chance to infect. A clinical trial of efficacy is needed. (v) PhotoVoice. Asking schoolchildren in developing countries to photograph their impressions of HIV/AIDS is a powerful way of getting them to discuss the subject openly, and develop their own preventative strategies.
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Affiliation(s)
- R V Short
- University of Melbourne Department of Obstetrics and Gynaecology 132 Grattan Street, Carlton Vic. 3053, Australia.
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Affiliation(s)
| | - O. A Kehinde
- 1University College Hospital IbadanIbadanNigeria
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85
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Affiliation(s)
- Jeong Seon Lee
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Kang Won Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Bang Ryu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Schäfer T, Kukies S, Stokes TH, Levin LS, Donatucci CF, Erdmann D. The Prepuce as a Donor Site for Reconstruction of an Extravasation Injury to the Foot in a Newborn. Ann Plast Surg 2005; 54:664-6. [PMID: 15900157 DOI: 10.1097/01.sap.0000162507.02807.81] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Extravasation injury is a common event in pediatric intensive-care units. This is the first report of successful utilization of the prepuce as a skin graft to reconstruct a full thickness skin necrosis due to a phenobarbital extravasation to the forefoot of a newborn.
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Affiliation(s)
- Tobias Schäfer
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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87
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Gray DT. Neonatal circumcision: cost-effective preventive measure or "the unkindest cut of all"? Med Decis Making 2005; 24:688-92. [PMID: 15534350 DOI: 10.1177/0272989x04271535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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