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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!