For further in-depth information and results about male circumcision based on medical research, see circinfo.net.
Teenage and Adult Circumcision
As discussed in the other sections dealing with infanct circumcision, the best age for circumcision is immediately after birth, as the procedure takes only a few minutes, and local anasthesia can be used.
However, teenage and especiallly adult circumcision plays a vital in the global endeavor to stop the spread of HIV/AIDS. Hence all over the world, and especially in sub-Saharan African countries circumcision drives of adult men have been done in many countries which have been ravaged by the AIDS epidemic. The subject of adult circumcision is therefore very relevant in these situations, and various techniques have been developed - also with the support of the United Nations - to come up with effective and safe methods which can be used in conditions which do not always allow the standard medical conditions used to in developed countries.
Some of the major factors that need to be kept in mind for adult circumcision is that either a local or a complete anasthesia will be required, depending on the wish of the patient. In the US mostly free-hand methods are used for adults, as it is difficult to find clamps with the correct sizes for adults, and also it is not easy to pinpoint where the circumcision band (scar) will be. There are several clinics which provide this service, cf. the Section Medical Websites. The procedure is still only a minor surgical operation, which normally takes about 30 minutes to perform and can be done on an out-patient basis (i.e. no hospital stay is required). Afterwards the patient will normally need to stay at home from a few days to a week in order for the circumcision to heal, and normally the stiches are removed after 2-3 weeks. The cost of the operation will depened on several factors, including local or complete anasthesia used, hostpital stay or out-patient basis etc. The biggest cost factor - like with all medical issues - is the hospital stay. A typical adult circumcision can therefore cost from ca. $200 - $2000.
For adult circumsisions peformed in places like Africa the emphasis is on using methods which ensure hygienic standards under conditions which might not be optimal, e.g. in fields hospitals in the countryside. The use of disposable devices (which are only used once)is therefore the most common means of peforming adult circumsions. Several devices have been developed, e.g. in a recent article a no-needle method tested in multiple center field trials has been discussed. The study concluded "This study has important implications for the scale-up of VMMC services. Using topical anaesthesia, excising the foreskin after applying the the Unicirc instrument for 5 minutes and sealing the wound with cyanoacrylate tissue adhesive in adults is rapid, easy to learn, heals rapidly by primary intention with excellent cosmetic results, and is potentially cheaper and safer than other methods. Use of this new method will greatly facilitate scale-up of mass circumcision programs."
Voluntary medical male circumcision (VMMC) is a priority HIV preventive method, for further information on how circumcision reduces the risk of the transmission of STD's like HIV/AIDS, please see the Section Medical Benefits - HIV/AIDS
Further online information about how adult circumcisions are perforemd can be found here.
Medical Articles and Abstracts
Cost Analysis of Adult Male Circumcision with the PrePex Device versus Surgery in Rwanda.utabazi V, Bitega JP, Muyenzi Ngeruka L, Nyemazi JP, Dain M, Kaplan SA, Karema C, Binagwaho A
Urol Nurs. 2014 Nov-Dec;34(6):303-11.
In this study from Rwanda, voluntary adult male circumcision costs 33% less with trained nurses using the PrePex device compared with physician-nurse teams performing dorsal-slit surgery. These cost savings and the documented safety, speed, and efficacy of the PrePex procedure, serve Rwanda's HIV prevention program.
For the online abstract, see here.
Acceptability of Male Circumcision among College Students in Medical Universities in Western China: A Cross-Sectional Study.Jiang J, Su J1, Yang X1, Huang M et al.,
PLoS One. 2015 Sep 21;10(9):e0135706. doi: 10.1371/journal.pone.0135706.
BACKGROUND: Male circumcision (MC) has been shown to reduce the risk of female to male transmission of HIV. The goal of this survey was to explore MC's acceptability and the factors associated with MC among college students in medical universities in western China.
METHODS: A cross-sectional study was carried out in three provinces in western China (Guangxi, Chongqing and Xinjiang) to assess the acceptability of MC as well as to discover factors associated with the acceptability among college students in medical universities. A total of 1,790 uncircumcised male students from three medical universities were enrolled in this study. In addition, 150 students who had undergone MC were also enrolled in the survey, and they participated in in-depth interviews.
RESULTS: Of all the uncircumcised participants (n = 1,790), 55.2% (n = 988) were willing to accept MC. Among those who accepted MC, 67.3% thought that MC could improve their sexual partners' hygiene, 46.3% believed that HIV and sexually transmitted diseases (STDs) could be partially prevented by MC. The multivariable logistic regression indicates that MC's acceptability was associated with three factors: the redundant foreskin (OR = 10.171, 95% CI = 7.629-13.559), knowing the hazard of having a redundant foreskin (OR = 1.597, 95% CI = 1.097-2.323), and enhancing sexual pleasure (OR = 1.628, 95% CI = 1.312-2.021). The in-depth interviews for subjects who had undergone MC showed that the major reason for having MC was the redundant foreskin (87.3%), followed by the benefits and the fewer complications of having MC done. In addition, most of these participants (65.3%) said that the MC could enhance sexual satisfaction.
CONCLUSIONS: MC's acceptance among college students in medical universities is higher than it is among other populations in western China. An implementation of an MC programme among this population is feasible in the future.
For the online abstract, see here.
"If You Are Not Circumcised, I Cannot Say Yes": The Role of Women in Promoting the Uptake of Voluntary Medical Male Circumcision in Tanzania.Osaki H, Mshana G, Wambura M et al.,
PLoS One. 2015 Sep 24;10(9):e0139009. doi: 10.1371/journal.pone.0139009.
Voluntary Medical Male Circumcision (VMMC) for HIV prevention in Tanzania was introduced by the Ministry of Health and Social Welfare in 2010 as part of the national HIV prevention strategy. A qualitative study was conducted prior to a cluster randomized trial which tested effective strategies to increase VMMC up take among men aged ?20 years. During the formative qualitative study, we conducted in-depth interviews with circumcised males (n = 14), uncircumcised males (n = 16), and participatory group discussions (n = 20) with men and women aged 20-49 years in Njombe and Tabora regions of Tanzania. Participants reported that mothers and female partners have an important influence on men's decisions to seek VMMC both directly by denying sex, and indirectly through discussion, advice and providing information on VMMC to uncircumcised partners and sons. Our findings suggest that in Tanzania and potentially other settings, an expanded role for women in VMMC communication strategies could increase adult male uptake of VMMC services.
For the online abstract, see here.