Adult Male Circumcision Outcomes: Experience in a Developing Country Setting

Abstract

Introduction: We examined male circumcision outcomes among young adults in an African setting. Materials and Methods: Participants were healthy, sexually active, uncircumcised, HIV-seronegative males aged 18–24 years. The main outcomes measured included complications, healing, satisfaction and resumption of activities. Results: Of 1,475 procedures, 26 (1.8%) were associated with 27 adverse events, most commonly wound disruption/delayed healing (0.6%), wound infection (0.4%), and bleeding (0.3%). Adverse events per clinician averaged 3.8 and 2.1% for procedures 1–100 and 101–200, respectively, and <1% for procedures 201–300, 301–400 and >400, respectively (p < 0.001). Participants resumed normal general activities after a median of 1 postoperative day and 93% with regular employment resumed working within 1 week. After 30 days, 99% of participants reported being very satisfied. After 90 days, 65% reported having had sex, 45% reported that their partners had expressed an opinion, 92% of whom were very satisfied with the outcome. Conclusions: Safe and acceptable adult male circumcision services can be delivered in developing country settings.

Factors associated with the safety of voluntary medical male circumcision in Nyanza province, Kenya

“…RCTs have shown that more experienced providers perform faster and safer circumcisions, 8,22 and our results confirm these findings. In our study, the providers who had performed only 20 male circumcisions under supervision took an average of 21.0 minutes to perform their first 20 procedures; however, providers who had performed more than 100 circumcisions and those who had performed over 200 procedures took an average of 17.6 and 15.5 minutes, respectively.…”

“…This study lends support to recommendations that providers must perform a minimum of 20 male circumcision procedures to qualify as a VMMC provider, and ideally over 100 procedures to reach and maintain a desired level of clinical expertise. 8,22 In Kenya, legislation was passed in 2009 to allow nurses to provide VMMC services as part of the national VMMC programme. While adjusting for provider experience reduced the magnitude of the protective effect conferred by having a clinician rather than a nurse perform the circumcision, in the clinic system a procedure performed by a clinician was still 40.0% less likely to result in an adverse event than one performed by a nurse.…”

“…The RCTs, which provided services in a clinical trial setting, reported the following adverse event rates: 3.8% in Orange Farm, South Africa; 1.5% in Kisumu, Kenya; and 3.6% in Rakai, Uganda. 1,7,8 Most recently, at the former Orange Farm RCT site, 1.8% of medical male circumcisions offered in one high-volume facility resulted in an adverse event. 9 Historically, intra-and post-operative adverse events have been detected through passive or active surveillance systems.…”

Why circumcision is a biomedical imperative for the 21stcentury

“…This is reduced to <1% after 400 circumcisions. (126) Fictions Various myths abound concerning circumcision. Emotive arguments, such as ones prevalent on anti-circumcision internet sites, are not supported by current scientific evidence.…”

Male Circumcision: An Appraisal of Current Instrumentation

“…Unless combined with other surgery, circumcision later obviously requires a separate (occasionally overnight) visit to hospital. Healing is slower than in newborns and the rate of complications is greater, but still low: 1-4% (Auvert et al, 2005;Cathcart et al, 2006;Bailey et al, 2007;Gray et al, 2007;Krieger et al, 2007). Most common is postoperative bleeding (0.4-0.8%), infection (0.2-0.4%), wound disruptions (0.3%), problems with appearance (0.6%), damage to the penis (0.3%), insufficient skin removed (0.3%), delayed wound healing (0.1%), delayed healing (0.2%), swelling at the incision site or haematoma (0.1-0.6%) or need to return to the theatre (0.5%).…”