Download Dr. Gordon Ambayo

VOLUNTARY
MEDICAL MALE
CIRCUMCISION
(VMMC)
PRESENTER : DR GORDON AMBAYO
UNIVERSITY HEALTH SERVICES
DATE:
16.6.2016
Objectives
— Definition
— Reasons attributed to circumcision
— Research Based Evidence
— Benefits
— Procedure
— Possible Risks
— Conclusion and take home message
DEFINITION
— Circumcision is the surgical removal of the foreskin
(prepuse), Which is the fold of skin that covers the head
of the penis (glans).
The word circumcision (comes from
Latin word circumcidere, meaning
"to cut around") which is the
surgical removal of the foreskin
(prepuce) from the human penis.
The foreskin is the fold of skin
covering the head of the penis.
The penis before circumcision
WHY CIRCUMCISION?
Religious reasons for male
circumcision
Practiced as a religious rite predominantly among the
Islamic and Judaic religions
Biblical origin of circumcision is traced in Genesis
17:12-14 New International Version (NIV)
12 For
the generations to come every male among you who
is eight days old must be circumcised, including those
born in your household or bought with money from a
foreigner—those who are not your offspring. 13 Whether
born in your household or bought with your money, they
must be circumcised. My covenant in your flesh is to be an
everlasting covenant. 14 Any uncircumcised male, who has
not been circumcised in the flesh, will be cut off from my
people; he has broken my covenant. ”
Cultural reasons for male
circumcision
Circumcision was and is still
practiced during Initiation mainly
as a rite of passage marking the
transition stage from childhood to
adulthood.
SOCIAL REASONS
— Personal Hygiene
Circumcision makes it simpler to wash the
penis. Washing beneath the foreskin of an
uncircumcised penis is generally not easy
and often forgotten since the foreskin has
to be retracted and washed.
— Peer pressure, socialization,
Inability to freely socialize, ridicule, and
considered as a social outcast.
Surgical reasons
Male circumcision done as a surgical
therapeutic intervention to alleviate certain
symptoms. For example:
Ø Phimosis
Is a condition in men where the foreskin
cannot be fully retracted over the glans
penis and this requires surgery due to
retention of urine and recurrent penile
infections. It affects 1 out of 10 boys and
men.
Phimosis
ØParaphimosis
Occurs when the foreskin of an
uncircumcised male cannot be pulled
back over the head of the penis.
Untreated paraphimosis, causes
swelling of the glans, severe pain and
can disrupt blood flow to the tip of
the penis leading to strangulation of
penile head.
Paraphimosis
Note the tightness of the foreskin
strangulating the penis
Medical reasons for male
circumcision
Since early 1980s scientists have observed
that circumcised men are less likely to get
infected with HIV than uncircumcised men,
and HIV is less common among
populations that traditionally practice male
circumcision than in communities where
the procedure is rare.
— In March 2007 following release of compelling evidence
from three randomized, controlled clinical trials, WHO
issued recommendations that male circumcision be
considered as part of a comprehensive HIV prevention
package.
— The clinical trials, conducted in Kenya, South Africa and
Uganda, showed that male circumcision reduced the risk
of heterosexually acquired HIV infection in men by
about 60%.
— The clinical trial data were consistent with results from
observational studies, which found, both at the
population and individual levels, lower incidence and
prevalence of HIV in circumcised men compared with
those not circumcised.
How does circumcision prevent
HIV?
ØLarge surface area of exposure,
The inner surface of the foreskin acts as HIV’s main ‘entry
point’ during penetrative sex between an uninfected man
and a HIV-infected person due a large surface area of
exposure
ØHigher proportion of T-lymphocytes cells in the foreskin
Studies of human foreskin tissue demonstrated that the
foreskin is highly susceptible to uptake of HIV. The inner
surface contains a higher concentration of T-lymphocytes
cells which HIV targets, Then uses this cells to facilitate its
entry and survival in the human body.
Cont…
Ø Reduced foreskin keratin concentration,
A protein found in the skin, which has a protective BARRIER
effect against the virus and other micro organisms.
Ø Genital ulcers
Circumcision reduces the likelihood of genital ulcers and
microscopic ulcerations during sex. Presence of open wounds
or genital ulcer increases risk of HIV
Ø Anaerobic bacteria in the foreskin
Presence of anaerobic bacteria(bacteria that thrives well in
areas with reduced oxygen) plays an important role in
increasing the risk of HIV acquisition since this bacteria
tempers with the integrity of the inner part of the foreskin.
Ø Microscopic tears in the foreskin
Since the foreskin is fragile, small tears during “rough” sex acts
as entry points for the virus to enter the body.
Benefits of circumcision
ØEnhanced personal hygiene
ØReduced chance of contracting HIV up to 60%
through penetrative sex with an infected person
ØReduced incidences of some ulcerative STIs,
including chancroid, balanitis, “Candida(thrush)”
and syphilis
ØCircumcision has also been associated with a
reduction in penile human papillomavirus (HPV)
genital herpes simplex virus-2 (HSV-2)
Benefits of circumcision
ØReduced incidences of urinary tract
infections over 10 fold.
ØReduction in penile cancer. 1 out of
100,000 uncircumcised men gets penile
cancer which requires penile amputation or
radical surgery that can disfigure the penis.
ØUncircumcised men have 1.5 to 2 times
higher risk of getting prostate cancer due to
higher incidences of HPV .
Benefits cont….
ØWomen tend to prefer the circumcised penis for
appearance, hygiene, increased penile-vaginal
contact, stimulation and marginally greater staying
power during sex.( feminine opinion and
socialization)
ØReduction in cervical cancer in female partners, this
is due to reduced human papilloma virus (HPV)
incidences in their male counterparts
ØReduced incidences of acquiring Candida and other
STIs which easily thrive in the inner foreskin
NB:
Male circumcision does not
provide complete protection
from HIV infection and is
therefore promoted as an
Additional (and not an
alternative) strategy for the
prevention of HIV
Transmission by up to 60%.
Surgical procedure
vThe adult procedure takes 20-30 minutes
under local anaesthesia.
vThe wound is usually stitched, and the
stitches takes 2weeks to dissolve, but if any is
left after 2 weeks, it normally removed.
vSexual Intercourse can resume after 6 weeks
Risks
ØMinor bleeding
ØLocal wound infections can occur
ØCircumcision is not advised for men with
bleeding disorders such as Haemophilia.
If it has to be done, it requires a
specialized team of physicians.
Risks are extremely rare under
qualified hands.
At UON ITS ABSOLUTELY FREE
Think about it
THE TRUTH IS…
— BEFORE
AFTER
Hey Come lets reason together!