The effects of male circumcision on female partners' genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda

Gray, Ronald H.; Kigozi, Godfrey; Serwadda, David; Makumbi, Frederick; Nalugoda, Fred; Watya, Stephen; Moulton, Lawrence H.; Chen, Michael Z.; Sewankambo, Nelson; Kiwanuka, Noah; Sempijja, Victor; Lutalo, Tom; Kagayii, Joseph; Wâbwire-Mângen, Fred; Ridzon, Renée; Bacon, Melanie C.; Wawer, Maria J.

doi:10.1016/j.ajog.2008.07.069

Cited by 204 publications

(199 citation statements)

References 17 publications

Supporting

Mentioning

186

Contrasting

Unclassified

Order By: Relevance

“…81 A small prospective cohort study with good evidence also found that male circumcision, among other factors, was protective against BV in female partners. 82 A cross-sectional study with fair evidence found no effect but may have lacked the power to detect an effect.…”

Section: Bvmentioning

confidence: 99%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

279

143

View full text Add to dashboard Cite

Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. In the United States, the procedure is commonly performed during the newborn period. In 2007, the American Academy of Pediatrics (AAP) convened a multidisciplinary workgroup of AAP members and other stakeholders to evaluate the evidence regarding male circumcision and update the AAP’s 1999 recommendations in this area. The Task Force included AAP representatives from specialty areas as well as members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention. The Task Force members identified selected topics relevant to male circumcision and conducted a critical review of peer-reviewed literature by using the American Heart Association’s template for evidence evaluation. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction. It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers. Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions. Parents should determine what is in the best interest of their child. Physicians who counsel families about this decision should provide assistance by explaining the potential benefits and risks and ensuring that parents understand that circumcision is an elective procedure. The Task Force strongly recommends the creation, revision, and enhancement of educational materials to assist parents of male infants with the care of circumcised and uncircumcised penises. The Task Force also strongly recommends the development of educational materials for providers to enhance practitioners’ competency in discussing circumcision’s benefits and risks with parents. The Task Force made the following recommendations:Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it.Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child.Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks and by ensuring that they understand the elective nature of the procedure.Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not.Elective circumcision should be performed only if the infant’s condition is stable and healthy.Male circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management.Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed.Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision.If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns.Key professional organizations (AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American College of Nurse Midwives, and other midlevel clinicians such as nurse practitioners) should work collaboratively to:Develop standards of trainee proficiency in the performance of anesthetic and procedure techniques, including suturing;Teach the procedure and analgesic techniques during postgraduate training programs;Develop educational materials for clinicians to enhance their own competency in discussing the benefits and risks of circumcision with parents;Offer educational materials to assist parents of male infants with the care of both circumcised and uncircumcised penises.The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure. The American College of Obstetricians and Gynecologists has endorsed this technical report.

show abstract

Section: Bvmentioning

confidence: 99%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

279

143

View full text Add to dashboard Cite

show abstract

“…269 Male circumcision has been prospectively associated with a 966 significant reduction in BV-associated genera, 263,264 and a striking 40-60% reduction in BV 967 incidence in female partners over 12 months. 270 Although there are few studies, BV-968 associated biofilm has been detected in male urine and semen, and more commonly found in 969 male partners of women with BV than healthy controls. 225,271,272 Collectively, these data The concept of a "symptomatic male disease counterpart" has not received much attention.…”

mentioning

confidence: 99%

Sexually transmitted infections: challenges ahead

Unemo

Bradshaw

Hocking

et al. 2017

The Lancet Infectious Diseases

536

445

View full text Add to dashboard Cite

“…There is also evidence for reduced partner genital infections cancer, for example, reduced partner bacterial vaginosis [20,21] HPV and reduced cervical cancer risk [6,[20][21][22][23][24]. MC however does not offer any protection against Neisseria gonorrhoeae, Chlamydia Trachomatis or Trichomomonas vaginalis [25].…”

Section: The Known Risks and Benefits Of MC Is A Public Health Mc Prmentioning

confidence: 99%

Male circumcision: towards a World Health Organisation normative practice in resource limited settings

Hargreave¹

2010

Asian J Androl

View full text Add to dashboard Cite

There is now grade 1 evidence that male circumcision (MC) reduces the risk of a man acquiring HIV. Modelling studies indicate MC could in the next 10 years save up to 2 million lives in those African countries with high HIV prevalence. Several African countries are now scaling up public health MC programmes. The most effective immediate public health MC programmes in Africa will need to target 18-20 years old men. In the longer term there is a need for infant circumcision programmes. In order to implement more widespread MC there is a need to make the surgical procedures as simple as possible so that safe operations can be performed by paramedical staff. The WHO Manual of Male Circumcision under local anaesthetic was written with these objectives in mind. Included in the manual are three adult techniques and four paediatric procedures. The adult procedures are the dorsal slit, the forceps guided and the sleeve resection methods. Paediatric methods included are the plastibell technique, the Mogen and Gomco shield method and a standard surgical dorsal slit procedure. Each method is described in a step by step manner with photographic and line drawing illustrations. In addition to the WHO manual of surgical technique a teaching course has been developed and using this course it has been possible in one week to train a circumcision surgeon who has had no or minimal previous surgical experience. Further scaling will require training of circumcision surgeons, monitoring performance, training the trainer workshops as well as advocacy at national, international and government meetings. In addition to proceeding with standardised methods work is in progress to assess novel techniques in adults such as stay on ring devices and policies are being formulated as to how to assess new devices. Also work is in progress to explore efficiencies in surgical processing by task sharing. Proper informed consent and safety remain paramount and great care has to be taken as programmes in Africa scale up. In continental China where the HIV epidemic is at a much earlier stage there may be a case for considering infant circumcision but great care will be needed to ensure that there is no harm.

show abstract

The effects of male circumcision on female partners' genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda

Cited by 204 publications

References 17 publications

Male Circumcision

Male Circumcision

Sexually transmitted infections: challenges ahead

Male circumcision: towards a World Health Organisation normative practice in resource limited settings

Contact Info

Product

Resources

About