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Sample records for male circumcision findings

  1. Male circumcision.

    PubMed

    2012-09-01

    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

  2. Circumcision (Male)

    MedlinePlus

    ... can also be a matter of family tradition, personal hygiene or preventive health care. For others, however, circumcision ... can also be a matter of family tradition, personal hygiene or preventive health care. Sometimes there's a medical ...

  3. Techniques of male circumcision.

    PubMed

    Abdulwahab-Ahmed, Abdullahi; Mungadi, Ismaila A

    2013-01-01

    Male circumcision is a controversial subject in surgical practice. There are, however, clear surgical indications of this procedure. The American Academy of Pediatrics (AAP) recommends newborn male circumcision for its preventive and public health benefits that has been shown to outweigh the risks of newborn male circumcision. Many surgical techniques have been reported. The present review discusses some of these techniques with their merits and drawbacks. This is an attempt to inform the reader on surgical aspects of male circumcision aiding in making appropriate choice of a technique to offer patients. Pubmed search was done with the keywords: Circumcision, technique, complications, and history. Relevant articles on techniques of circumcision were selected for the review. Various methods of circumcision including several devices are in use for male circumcision. These methods can be grouped into three: Shield and clamp, dorsal slit, and excision. The device methods appear favored in the pediatric circumcision while the risk of complications increases with increasing age of the patient at surgery.

  4. Voluntary Medical Male Circumcision: A Cross-Sectional Study Comparing Circumcision Self-Report and Physical Examination Findings in Lesotho

    DTIC Science & Technology

    2011-11-29

    addition, we would like to thank Naomi Bock, Emmanuel Njeuhmeli, Jason Reed, and Carolyn Williams for their support in the design and implementation...1054–1061. 14. Urassa M, Todd J, Boerma JT, Hayes R, Isingo R (1997) Male circumcision and susceptibility to HIV infection among men in Tanzania. AIDS

  5. Newborn male circumcision

    PubMed Central

    Sorokan, S Todd; Finlay, Jane C; Jefferies, Ann L

    2015-01-01

    The circumcision of newborn males in Canada has become a less frequent practice over the past few decades. This change has been significantly influenced by past recommendations from the Canadian Paediatric Society and the American Academy of Pediatrics, who both affirmed that the procedure was not medically indicated. Recent evidence suggesting the potential benefit of circumcision in preventing urinary tract infection and some sexually transmitted infections, including HIV, has prompted the Canadian Paediatric Society to review the current medical literature in this regard. While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male. PMID:26435672

  6. Perspectives of Parents and Health Care Workers on Early Infant Male Circumcision Conducted Using Devices: Qualitative Findings From Harare, Zimbabwe

    PubMed Central

    Mavhu, Webster; Hatzold, Karin; Ncube, Getrude; Fernando, Shamiso; Mangenah, Collin; Chatora, Kumbirai; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M

    2016-01-01

    ABSTRACT Background: The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend early infant male circumcision (EIMC) for prevention of HIV. Here, we present findings from a qualitative study in Zimbabwe that assessed parental and health care workers' perspectives of EIMC conducted using devices. Methods: This qualitative study was nested within a trial of EIMC devices. Between January and May 2013, we held 4 focus group discussions (FGDs) and 12 in-depth interviews with parents and 12 in-depth interviews with clinicians (7 trial clinicians and 5 non-trial clinicians). We also conducted 95 short telephone interviews with parents who had arranged to bring their sons for EIMC but then defaulted. Results: Parents who had adopted EIMC spoke of their initial anxieties about the procedure. Additionally, they commented on both the procedure and outcome. Parents who decided against EIMC cited fear of harm, specifically the infant's death, penile injury, and excessive pain. Misperceptions about male circumcision in general and EIMC specifically were a significant barrier to EIMC adoption and were prevalent among health care workers as well as parents. In particular, the findings suggest strong parental concerns about the fate of the discarded foreskin. Parents who chose EIMC for their newborn sons felt that the procedure was safe and expressed satisfaction with the outcome. For their part, health care workers largely thought that EIMC was safe and that the outcome was aesthetically pleasing. They also felt that it would be feasible to offer wide-scale EIMC for HIV prevention in the public sector; they recommended strategies to increase EIMC uptake, in addition to highlighting a few concerns. Conclusions: The qualitative study enables us to better understand parental and health care workers' perspectives of EIMC conducted using devices, especially their perspectives on EIMC safety, feasibility, acceptability, and barriers. These findings

  7. Non-therapeutic infant male circumcision

    PubMed Central

    Alkhenizan, Abdullah; Elabd, Kossay

    2016-01-01

    Objectives: To review the evidence of the benefits and harms of infant male circumcision, and the legal and ethical perspectives of infant male circumcision. Methods: We conducted a systematic search of the literature using PubMed, EMBASE, and the Cochrane library up to June 2015. We searched the medical law literature using the Westlaw and Lexis Library law literature resources up to June 2015. Results: Male circumcision significantly reduced the risk of urinary tract infections by 87%. It also significantly reduced transmission of human immunodeficiency virus among circumcised men by 70%. Childhood and adolescent circumcision is associated with a 66% reduction in the risk of penile cancer. Circumcision was associated with 43% reduction of human papilloma virus infection, and 58% reduction in the risk of cervical cancer among women with circumcised partners compared with women with uncircumcised partners. Male infant circumcision reduced the risk of foreskin inflammation by 68%. Conclusion: Infant male circumcision should continue to be allowed all over the world, as long as it is approved by both parents, and performed in facilities that can provide appropriate sterilization, wound care, and anesthesia. Under these conditions, the benefits of infant male circumcision outweigh the rare and generally minor potential harms of the procedure. PMID:27570848

  8. Perceptions of voluntary medical male circumcision among circumcising and non-circumcising communities in Malawi

    PubMed Central

    Rennie, Stuart; Perry, Brian; Corneli, Amy; Chilungo, Abdullah; Umar, Eric

    2015-01-01

    Three randomised controlled trials in Africa indicated that voluntary medical male circumcision (VMMC) is an effective method to reduce a man’s risk of becoming infected through sex with an HIV-positive female partner. The success of recent public health initiatives to increase numbers of circumcised men in Malawi has been very limited. We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with men, women, and male adolescents from non-circumcising and circumcising communities in southern Malawi to better understand their beliefs about male circumcision and the promotion of VMMC for HIV prevention. Results revealed that beliefs about male circumcision, in general, are strongly mediated by Malawian culture and history. Participants have attempted to develop a new meaning for circumcision in light of the threat of HIV infection and the publicised risk reduction benefits of VMMC. Several study participants found it difficult to distinguish VMMC from traditional circumcision practices (jando and lupanda), despite awareness that the new form of circumcision was an expression of (western) modern medicine performed largely for public health purposes. Greater recognition of background cultural beliefs and practices could inform future efforts to promote medical male circumcision as an HIV prevention strategy in this context. PMID:25630610

  9. Perceptions of voluntary medical male circumcision among circumcising and non-circumcising communities in Malawi.

    PubMed

    Rennie, Stuart; Perry, Brian; Corneli, Amy; Chilungo, Abdullah; Umar, Eric

    2015-01-01

    Three randomised controlled trials in Africa indicated that voluntary medical male circumcision (VMMC) is an effective method to reduce a man's risk of becoming infected through sex with an HIV-positive female partner. The success of recent public health initiatives to increase numbers of circumcised men in Malawi has been very limited. We conducted in-depth interviews and focus group discussions (FGDs) with men, women and male adolescents from non-circumcising and circumcising communities in southern Malawi to better understand their beliefs about male circumcision and the promotion of VMMC for HIV prevention. Results revealed that beliefs about male circumcision, in general, are strongly mediated by Malawian culture and history. Participants have attempted to develop a new meaning for circumcision in light of the threat of HIV infection and the publicised risk reduction benefits of VMMC. Several study participants found it difficult to distinguish VMMC from traditional circumcision practices (jando and lupanda), despite awareness that the new form of circumcision was an expression of (western) modern medicine performed largely for public health purposes. Greater recognition of background cultural beliefs and practices could inform future efforts to promote medical male circumcision as an HIV prevention strategy in this context.

  10. The influence of male circumcision for HIV prevention on sexual behaviour among traditionally circumcised men in Cape Town, South Africa.

    PubMed

    Eaton, L A; Cain, D N; Agrawal, A; Jooste, S; Udemans, N; Kalichman, S C

    2011-11-01

    We examined the relationship between HIV prevention beliefs related to male circumcision and sexual behaviour/sexually transmitted infection (STI) acquisition among traditionally circumcised men in Cape Town, South Africa. HIV-negative men (n = 304), circumcised for cultural/religious reasons, attending a health clinic in Cape Town, South Africa, completed cross-sectional surveys. Generalized linear models were used to analyse the relationships between unprotected vaginal sex acts, number of female sexual partners, STI diagnoses and male circumcision-related beliefs and risk perceptions. Men who were aware that circumcision offers protection against HIV (relative risk [RR] = 1.19, 95% confidence interval [CI] = 1.06-1.32, P < 0.01), endorsed risk compensation related to male circumcision (RR = 1.15, 95% CI = 1.11-1.12, P < 0.01) and perceived lower risk of HIV infection when circumcised (RR = 1.08, 95% CI = 1.04-1.12, P < 0.01) were more likely to report unprotected vaginal sex acts. Similar patterns were also identified when predicting number of female sexual partners. Men who were more likely to endorse risk compensation related to male circumcision were also more likely to be diagnosed with a chronic STI (odds ratio [OR] = 1.64, 95% CI = 1.06-2.53, P < 0.05). Our findings suggest that we must not overlook the effects of beliefs towards male circumcision for HIV prevention among men traditionally circumcised; doing so may undermine current efforts to reduce HIV transmission through male circumcision.

  11. Informing the scaling up of voluntary medical male circumcision efforts through the use of theory of reasoned action: survey findings among uncircumcised young men in Swaziland.

    PubMed

    Gurman, Tilly A; Dhillon, Preeti; Greene, Jessica L; Makadzange, Panganai; Khumlao, Philisiwe; Shekhar, Navendu

    2015-04-01

    Assessing predictors of intention to circumcise can help to identify effective strategies for increasing uptake of voluntary medical male circumcision (VMMC). Grounded in the theory of reasoned action (TRA), the current study of uncircumcised males ages 13-29 in Swaziland (N = 1,257) employed multivariate logistic regression to determine predictors of VMMC intention. The strongest predictors were strongly disagreeing/disagreeing that sex was more painful for a circumcised man (odds ratio [OR] = 4.37; p = < .007), a Christian man should not get circumcised (OR = 2.47; p < .001), and circumcision makes penetration more painful and difficult (OR = 2.44; p = .007). Several beliefs about enhanced sexual performance, normative beliefs (parents, sexual partner, and friends), and non-TRA-related factors (e.g., importance of plowing season to daily schedule) were also statistically significant predictors. TRA proved a useful theory to explore young men's intention to circumcise and can help inform interventions aimed at increasing uptake of VMMC.

  12. Counseling parents who are considering newborn male circumcision.

    PubMed

    Mielke, Ruth T

    2013-01-01

    The American Academy of Pediatrics recently issued a statement that the health benefits of newborn male circumcision exceed the risks and therefore justify access to the procedure for families who choose it. Further, clinicians are charged with providing factually correct information that communicates the risks and benefits of elective newborn male circumcision in a nonbiased manner. However, many clinicians lack adequate information to discuss the risks and benefits of male circumcision. The purpose of this review is to highlight evidence on the risks and benefits of newborn male circumcision and provide clinicians with counseling points that can be used to guide discussion with parents considering newborn male circumcision.

  13. Ritual male infant circumcision and human rights.

    PubMed

    Jacobs, Allan J; Arora, Kavita Shah

    2015-01-01

    Opponents of male circumcision have increasingly used human rights positions to articulate their viewpoint. We characterize the meaning of the term "human rights." We discuss these human rights arguments with special attention to the claims of rights to an open future and to bodily integrity. We offer a three-part test under which a parental decision might be considered an unacceptable violation of a child's right. The test considers the impact of the practice on society, the impact of the practice on the individual, and the likelihood of adverse impact. Infant circumcision is permissible under this test. We conclude that infant circumcision may be proscribed as violating local norms, even though it does not violate human rights.

  14. Behavior Change Pathways to Voluntary Medical Male Circumcision: Narrative Interviews with Circumcision Clients in Zambia

    PubMed Central

    Price, Jessica E.; Phiri, Lyson; Mulenga, Drosin; Hewett, Paul C.; Topp, Stephanie M.; Shiliya, Nicholas; Hatzold, Karin

    2014-01-01

    As an HIV prevention strategy, the scale-up of voluntary medical male circumcision (VMMC) is underway in 14 countries in Africa. For prevention impact, these countries must perform millions of circumcisions in adolescent and adult men before 2015. Although acceptability of VMMC in the region is well documented and service delivery efforts have proven successful, countries remain behind in meeting circumcision targets. A better understanding of men's VMMC-seeking behaviors and experiences is needed to improve communication and interventions to accelerate uptake. To this end, we conducted semi-structured interviews with 40 clients waiting for surgical circumcision at clinics in Zambia. Based on Stages of Change behavioral theory, men were asked to recount how they learned about adult circumcision, why they decided it was right for them, what they feared most, how they overcame their fears, and the steps they took to make it to the clinic that day. Thematic analysis across all cases allowed us to identify key behavior change triggers while within-case analysis elucidated variants of one predominant behavior change pattern. Major stages included: awareness and critical belief adjustment, norming pressures and personalization of advantages, a period of fear management and finally VMMC-seeking. Qualitative comparative analysis of ever-married and never-married men revealed important similarities and differences between the two groups. Unprompted, 17 of the men described one to four failed prior attempts to become circumcised. Experienced more frequently by older men, failed VMMC attempts were often due to service-side barriers. Findings highlight intervention opportunities to increase VMMC uptake. Reaching uncircumcised men via close male friends and female sex partners and tailoring messages to stage-specific concerns and needs would help accelerate men's movement through the behavior change process. Expanding service access is also needed to meet current demand

  15. Behavior change pathways to voluntary medical male circumcision: narrative interviews with circumcision clients in Zambia.

    PubMed

    Price, Jessica E; Phiri, Lyson; Mulenga, Drosin; Hewett, Paul C; Topp, Stephanie M; Shiliya, Nicholas; Hatzold, Karin

    2014-01-01

    As an HIV prevention strategy, the scale-up of voluntary medical male circumcision (VMMC) is underway in 14 countries in Africa. For prevention impact, these countries must perform millions of circumcisions in adolescent and adult men before 2015. Although acceptability of VMMC in the region is well documented and service delivery efforts have proven successful, countries remain behind in meeting circumcision targets. A better understanding of men's VMMC-seeking behaviors and experiences is needed to improve communication and interventions to accelerate uptake. To this end, we conducted semi-structured interviews with 40 clients waiting for surgical circumcision at clinics in Zambia. Based on Stages of Change behavioral theory, men were asked to recount how they learned about adult circumcision, why they decided it was right for them, what they feared most, how they overcame their fears, and the steps they took to make it to the clinic that day. Thematic analysis across all cases allowed us to identify key behavior change triggers while within-case analysis elucidated variants of one predominant behavior change pattern. Major stages included: awareness and critical belief adjustment, norming pressures and personalization of advantages, a period of fear management and finally VMMC-seeking. Qualitative comparative analysis of ever-married and never-married men revealed important similarities and differences between the two groups. Unprompted, 17 of the men described one to four failed prior attempts to become circumcised. Experienced more frequently by older men, failed VMMC attempts were often due to service-side barriers. Findings highlight intervention opportunities to increase VMMC uptake. Reaching uncircumcised men via close male friends and female sex partners and tailoring messages to stage-specific concerns and needs would help accelerate men's movement through the behavior change process. Expanding service access is also needed to meet current demand

  16. Traditional Male Circumcision: Ways to Prevent Deaths Due to Dehydration.

    PubMed

    Douglas, Mbuyiselo; Maluleke, Thelmah Xavela

    2016-02-01

    Deaths of initiates occurring in the circumcision initiation schools are preventable. Current studies list dehydration as one of the underlying causes of deaths among traditional male circumcision initiates in the Eastern Cape, a province in South Africa, but ways to prevent dehydration in the initiation schools have not been adequately explored. The goals of this study were to (a) explore the underlying determinants of dehydration among initiates aged from 12 to 18 years in the traditional male circumcision initiation schools and (b) determine knowledge of participants on the actions to be taken to prevent dehydration. The study was conducted at Libode, a rural area falling under Nyandeni municipality. A simple random sampling was used to select three focus group discussions with 36 circumcised boys. A purposive sampling was used to select 10 key informants who were matured and experienced people with knowledge of traditional practices and responsible positions in the communities. The research findings indicate that the practice has been neglected to inexperienced, unskillful, and abusive traditional attendants. The overall themes collated included traditional reasons for water restriction, imbalanced food nutrients given to initiates, poor environmental conditions in the initiation hut, and actions that should be taken to prevent dehydration. This article concludes with discussion and recommendation of ways to prevent dehydration of initiates in the form of a comprehensive circumcision health promotion program.

  17. Exploring drivers for safe male circumcision: Experiences with health education and understanding of partial HIV protection among newly circumcised men in Wakiso, Uganda

    PubMed Central

    Daniel, Marguerite; Atuyambe, Lynn Muhimbuura; Makumbi, Fredrick Edward; Sandøy, Ingvild Fossgard

    2017-01-01

    Introduction About 2.5 million men have voluntarily been circumcised since Uganda started implementing the WHO recommendation to scale up safe male circumcision to reduce HIV transmission. This study sought to understand what influences men's circumcision decisions, their experiences with health education at health facilities and their knowledge of partial HIV risk reduction in Wakiso district. Methods Data were collected in May and June 2015 at five public health facilities in Wakiso District. Twenty-five in-depth interviews were held with adult safe male circumcision clients. Data were analysed using thematic network analysis. Findings Safe male circumcision decisions were mainly influenced by sexual partners, a perceived need to reduce the risk of HIV/STIs, community pressure and other benefits like hygiene. Sexual partners directly requested men to circumcise or indirectly influenced them in varied ways. Health education at facilities mainly focused on the surgical procedure, circumcision benefits especially HIV risk reduction, wound care and time to resumption of sex, with less focus on post-circumcision sexual behaviour. Five men reported no health education. All men reported that circumcision only reduces and does not eliminate HIV risk, and could mention ways it protects, although some extended the benefit to direct protection for women and prevention of other STIs. Five men thought social marketing messages were ‘misleading’ and feared risk compensation within the community. Conclusions Participants reported positive community perception about safe male circumcision campaigns, influencing men to seek services and enabling female partners to impact this decision-making process. However, there seemed to be gaps in safe male circumcision health education, although all participants correctly understood that circumcision offers only partial protection from HIV. Standard health education procedures, if followed at health facilities offering safe male

  18. Could Circumcision of HIV-Positive Males Benefit Voluntary Medical Male Circumcision Programs in Africa? Mathematical Modeling Analysis

    PubMed Central

    Awad, Susanne F.; Sgaier, Sema K.; Lau, Fiona K.; Mohamoud, Yousra A.; Tambatamba, Bushimbwa C.; Kripke, Katharine E.; Thomas, Anne G.; Bock, Naomi; Reed, Jason B.; Njeuhmeli, Emmanuel; Abu-Raddad, Laith J.

    2017-01-01

    Background The epidemiological and programmatic implications of inclusivity of HIV-positive males in voluntary medical male circumcision (VMMC) programs are uncertain. We modeled these implications using Zambia as an illustrative example. Methods and Findings We used the Age-Structured Mathematical (ASM) model to evaluate, over an intermediate horizon (2010–2025), the effectiveness (number of VMMCs needed to avert one HIV infection) of VMMC scale-up scenarios with varying proportions of HIV-positive males. The model was calibrated by fitting to HIV prevalence time trend data from 1990 to 2014. We assumed that inclusivity of HIV positive males may benefit VMMC programs by increasing VMMC uptake among higher risk males, or by circumcision reducing HIV male-to-female transmission risk. All analyses were generated assuming no further antiretroviral therapy (ART) scale-up. The number of VMMCs needed to avert one HIV infection was projected to increase from 12.2 VMMCs per HIV infection averted, in a program that circumcises only HIV-negative males, to 14.0, in a program that includes HIV-positive males. The proportion of HIV-positive males was based on their representation in the population (e.g. 12.6% of those circumcised in 2010 would be HIV-positive based on HIV prevalence among males of 12.6% in 2010). However, if a program that only reaches out to HIV-negative males is associated with 20% lower uptake among higher-risk males, the effectiveness would be 13.2 VMMCs per infection averted. If improved inclusivity of HIV-positive males is associated with 20% higher uptake among higher-risk males, the effectiveness would be 12.4. As the assumed VMMC efficacy against male-to-female HIV transmission was increased from 0% to 20% and 46%, the effectiveness of circumcising regardless of HIV status improved from 14.0 to 11.5 and 9.1, respectively. The reduction in the HIV incidence rate among females increased accordingly, from 24.7% to 34.8% and 50.4%, respectively

  19. Reported Male Circumcision Practices in a Muslim-Majority Setting

    PubMed Central

    Iftikhar, Sundus

    2017-01-01

    Introduction. Male circumcision is a recommended practice in Muslim tradition. It is important to ensure that this procedure is performed as safely as possible in these communities. Methods. Five hundred adult men and women with at least one male child less than 18 years were interviewed in Karachi, Pakistan, regarding details of their child's circumcision. The survey focused on actual and perceived delays in circumcision and perceptions about appropriate age and reasons and benefits and complications of the procedure. Circumcisions done after two months of age were defined as delayed. Results. Religious requirement was the primary reason for circumcision in 92.6% of children. However, 89.6% of respondents were of the opinion that circumcision had medical benefits as well. Half of the children (54.1%) had delayed circumcision (range 2.5 months to 13 years), even though 81.2% of parents were of the opinion that circumcisions should be done within 60 days of birth. Facility-delivered babies had less delay in circumcisions (49.1%) as compared to home-delivered babies (60.5%). Conclusion. Understanding the perceptions and practices around male circumcision can help guide national strategies for designing and implementing safe circumcision programs in Muslim-majority settings, with the potential to benefit an annual birth cohort of 20–25 million boys worldwide. PMID:28194416

  20. Reported Male Circumcision Practices in a Muslim-Majority Setting.

    PubMed

    Anwer, Abdul Wahid; Samad, Lubna; Iftikhar, Sundus; Baig-Ansari, Naila

    2017-01-01

    Introduction. Male circumcision is a recommended practice in Muslim tradition. It is important to ensure that this procedure is performed as safely as possible in these communities. Methods. Five hundred adult men and women with at least one male child less than 18 years were interviewed in Karachi, Pakistan, regarding details of their child's circumcision. The survey focused on actual and perceived delays in circumcision and perceptions about appropriate age and reasons and benefits and complications of the procedure. Circumcisions done after two months of age were defined as delayed. Results. Religious requirement was the primary reason for circumcision in 92.6% of children. However, 89.6% of respondents were of the opinion that circumcision had medical benefits as well. Half of the children (54.1%) had delayed circumcision (range 2.5 months to 13 years), even though 81.2% of parents were of the opinion that circumcisions should be done within 60 days of birth. Facility-delivered babies had less delay in circumcisions (49.1%) as compared to home-delivered babies (60.5%). Conclusion. Understanding the perceptions and practices around male circumcision can help guide national strategies for designing and implementing safe circumcision programs in Muslim-majority settings, with the potential to benefit an annual birth cohort of 20-25 million boys worldwide.

  1. Infant Male Circumcision: Healthcare Provider Knowledge and Associated Factors

    PubMed Central

    Starzyk, Erin J.; Kelley, Michele A.; Caskey, Rachel N.; Schwartz, Alan; Kennelly, Joan F.; Bailey, Robert C.

    2015-01-01

    Background and Objectives The emerging science demonstrates various health benefits associated with infant male circumcision and adult male circumcision; yet rates are declining in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend that healthcare providers present evidence-based risk and benefit information for infant male circumcision to parent(s) and guardian(s). The purpose of this study was to assess providers’ level of infant male circumcision knowledge and to identify the associated characteristics. Methods An online survey was administered to healthcare providers in the family medicine, obstetrics, and pediatrics medical specialties at an urban academic health center. To assess infant male circumcision knowledge, a 17 point summary score was constructed to identify level of provider knowledge within the survey. Results Ninety-two providers completed the survey. Providers scored high for the following knowledge items: adverse event rates, protects against phimosis and urinary tract infections, and does not prevent hypospadias. Providers scored lower for items related to more recent research: protection against cervical cancer, genital ulcer disease, bacterial vaginosis, and reduction in HIV acquisition. Two models were constructed looking at (1) overall knowledge about male circumcision, and (2) knowledge about male circumcision reduction in HIV acquisition. Pediatricians demonstrated greater overall infant male circumcision knowledge, while obstetricians exhibited significantly greater knowledge for the HIV acquisition item. Conclusion Providers’ knowledge levels regarding the risks and benefits of infant male circumcision are highly variable, indicating the need for system-based educational interventions. PMID:25635664

  2. Effects of adult male circumcision on premature ejaculation: results from a prospective study in China.

    PubMed

    Gao, Jingjing; Xu, Chuan; Zhang, Jingjing; Liang, Chaozhao; Su, Puyu; Peng, Zhen; Shi, Kai; Tang, Dongdong; Gao, Pan; Lu, Zhaoxiang; Liu, Jishuang; Xia, Lei; Yang, Jiajia; Hao, Zongyao; Zhou, Jun; Zhang, Xiansheng

    2015-01-01

    The purpose of this study is to investigate the effects of adult male circumcision on premature ejaculation (PE). Therefore, between December 2009 and March 2014, a total of 575 circumcised men and 623 uncircumcised men (control group) were evaluated. Detailed evaluations (including circumcision and control groups) on PE were conducted before circumcision and at the 3-, 6-, 9-, and 12-month follow-up visits after circumcision. Self-estimated intravaginal ejaculatory latency time (IELT), Patient-Reported Outcome measures, and 5-item version of the International Index of Erectile Function were used to measure the ejaculatory and erectile function for all subjects. The results showed that, during the one-year follow-up, men after circumcision experienced higher IELT and better scores of control over ejaculation, satisfaction with sexual intercourse, and severity of PE than men before circumcision (P < 0.001 for all). Similarly, when compared with the control group, the circumcised men reported significantly improved IELT, control over ejaculation, and satisfaction with sexual intercourse (P < 0.001 for all). These findings suggested that circumcision might have positive effects on IELT, ejaculatory control, sexual satisfaction, and PE severity. In addition, circumcision was significantly associated with the development of PE.

  3. Medical male circumcision coverage in Rakai, Uganda.

    PubMed

    Kong, Xiangrong; Kigozi, Godfrey; Ssekasanvu, Joseph; Nalugoda, Fred; Nakigozi, Gertrude; Chang, Larry W; Latkin, Carl; Serwadda, David; Wawer, Maria J; Gray, Ronald H

    2017-03-13

    We assessed medical male circumcision (MMC) scale-up in Rakai, Uganda using population-based surveys during 2007-2014. MMC coverage increased from 28.5 to 52.0%. Coverage was initially lower in 15-19-year-olds but increased in 2014, was higher in married men and in trading communities, and lowest in the sexually inactive. Coverage did not vary by self-perceived risk of HIV or HIV serostatus. Increasing generalized coverage suggested that MMC became normative, but coverage falls short of WHO/Joint United Nations Programme on HIV and AIDS (UNAIDS) 80% targets, indicating the need for demand generation.

  4. Adult male circumcision with a circular stapler versus conventional circumcision: A prospective randomized clinical trial.

    PubMed

    Jin, X D; Lu, J J; Liu, W H; Zhou, J; Yu, R K; Yu, B; Zhang, X J; Shen, B H

    2015-06-01

    Male circumcision is the most frequently performed procedure by urologists. Safety and efficacy of the circumcision procedure requires continual improvement. In the present study, we investigated the safety and efficacy of a new male circumcision technique involving the use of a circular stapler. In total, 879 consecutive adult male patients were randomly divided into 2 groups: 441 underwent stapler circumcision, and 438 underwent conventional circumcision. The operative time, pain score, blood loss volume, healing time, treatment costs, and postoperative complications were compared between the two groups. The operative time and blood loss volume were significantly lower in the stapler group than in the conventional group (6.8 ± 3.1 vs 24.2 ± 3.2 min and 1.8 ± 1.8 vs 9.4 ± 1.5 mL, respectively; P<0.01 for both). The intraoperative and postoperative pain scores were significantly lower in the stapler group than in the conventional group (0.8 ± 0.5 vs 2.4 ± 0.8 and 4.0 ±0.9 vs 5.8 ± 1.0, respectively; P<0.01 for both). Additionally, the stapler group had significantly fewer complications than the conventional group (2.7% vs 7.8%, respectively; P<0.01). However, the treatment costs in the stapler group were much higher than those in the conventional group (US$356.60 ± 8.20 vs US$126.50 ± 7.00, respectively; P<0.01). Most patients (388/441, 88.0%) who underwent stapler circumcision required removal of residual staple nails. Overall, the present study has shown that stapler circumcision is a time-efficient and safe male circumcision technique, although it requires further improvement.

  5. Circumcision of male infants as a human rights violation.

    PubMed

    Svoboda, J Steven

    2013-07-01

    Every infant has a right to bodily integrity. Removing healthy tissue from an infant is only permissible if there is an immediate medical indication. In the case of infant male circumcision there is no evidence of an immediate need to perform the procedure. As a German court recently held, any benefit to circumcision can be obtained by delaying the procedure until the male is old enough to give his own fully informed consent. With the option of delaying circumcision providing all of the purported benefits, circumcising an infant is an unnecessary violation of his bodily integrity as well as an ethically invalid form of medical violence. Parental proxy 'consent' for newborn circumcision is invalid. Male circumcision also violates four core human rights documents-the Universal Declaration of Human Rights, the Convention on the Rights of the Child, the International Covenant on Civil and Political Rights, and the Convention Against Torture. Social norm theory predicts that once the circumcision rate falls below a critical value, the social norms that currently distort our perception of the practice will dissolve and rates will quickly fall.

  6. Fatal haemorrhage following male ritual circumcision.

    PubMed

    Hiss, J; Horowitz, A; Kahana, T

    2000-03-01

    Lethal complications following ritual circumcision are extremely rare, the most common being sepsis. We present here a case of fatal haemorrhage from a tiny incision of the glans, following a 'home' circumcision of a 6-week-old baby. The post-mortem examination disclosed idiopathic neonatal hepatitis. It is suggested that the previously undiagnosed hepatic condition was responsible for the fatal haemorrhage.

  7. Circumcision

    MedlinePlus

    ... and discomfort. previous continue Caring for a Circumcised Penis Following circumcision, it is important to keep the ... easily treated. previous continue Caring for an Uncircumcised Penis As with a penis that's circumcised, an uncircumcised ...

  8. [Male circumcision: hope for HIV infection decrease in southern Africa].

    PubMed

    Legeai, Camille; Auvert, Bertran

    2008-05-01

    Given the magnitude of the HIV pandemic, development of new prevention means is necessary. Male circumcision reduces HIV transmission from female to male by 57 % [95 % Confident Interval (CI): 42-68 %]. Its generalization in sub-Saharan Africa could avert, among men and women, from 1 to 4 millions new HIV infections over the next ten years. Acceptability of this new prevention mean is high in countries which could benefit the most from male circumcision, that means located in southern Africa, a region where in majority men are uncircumcised and where HIV prevalence is high. Male circumcision is a cost-effective prevention strategy. Actual prevention means (condoms, sexual abstinence and fidelity) are not used enough to curb the HIV epidemic. Research is ongoing on other prevention means (vaccine, pre- and post-exposition prophylaxis, microbicides, diaphragm) but their efficiency has not been demonstrated yet. Nevertheless, generalization of circumcision in southern Africa is responsible for contestations in part due to the fact that this prevention mean protects only partially from HIV infection. Moreover, for now, only a few countries integrated circumcision in their HIV prevention program in spite of WHO (World Health Organization) recommendations supporting male circumcision acknowledgement as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men. Significant available funding should allow the situation to evolve quickly. At the same time, research goes on in order to know more about the effects and to facilitate the generalization of this prevention mean which is a great hope for southern Africa.

  9. "After my husband's circumcision, I know that I am safe from diseases": women's attitudes and risk perceptions towards male circumcision in Iringa, Tanzania.

    PubMed

    Layer, Erica H; Beckham, Sarah W; Mgeni, Lilian; Shembilu, Catherine; Momburi, Romani B; Kennedy, Caitlin E

    2013-01-01

    While male circumcision reduces the risk of female-to-male HIV transmission and certain sexually transmitted infections (STIs), there is little evidence that circumcision provides women with direct protection against HIV. This study used qualitative methods to assess women's perceptions of male circumcision in Iringa, Tanzania. Women in this study had strong preferences for circumcised men because of the low risk perception of HIV with circumcised men, social norms favoring circumcised men, and perceived increased sexual desirability of circumcised men. The health benefits of male circumcision were generally overstated; many respondents falsely believed that women are also directly protected against HIV and that the risk of all STIs is greatly reduced or eliminated in circumcised men. Efforts to engage women about the risks and limitations of male circumcision, in addition to the benefits, should be expanded so that women can accurately assess their risk of HIV or STIs during sexual intercourse with circumcised men.

  10. Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy.

    PubMed

    Morris, Brian J; Krieger, John N; Klausner, Jeffrey D

    2016-08-08

    We evaluate recent claims opposing infant male circumcision, a procedure now supported by the evidence-based policy of the American Academy of Pediatrics. We find those criticisms depend on speculative claims about the foreskin and obfuscation of the strong scientific evidence supporting pediatric policy development. An argument that circumcision should be delayed to allow a boy to make up his own mind as an adult fails to appreciate the psychological, scheduling and financial burdens later circumcision entails, so reducing the likelihood that it will occur. In contrast, early infant circumcision is convenient, safer, quicker, lower risk, healing is faster, cosmetic outcome is routinely good and the lifetime benefits accrue immediately. Benefits include reduction in urinary tract infections, inflammatory skin conditions, foreskin problems, and, when older, substantial protection against sexually transmitted infections and genital cancers in the male and his female sexual partners. Some authorities regard the failure to offer parents early infant circumcision as unethical, just as it would be unethical to fail to encourage the vaccination of children. In conclusion, the criticisms of evidence-based infant male circumcision policy are seriously flawed and should be dismissed as unhelpful to evidence-based development and implementation of pediatric policy intended to improve public health and individual wellbeing.

  11. Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy

    PubMed Central

    Morris, Brian J; Krieger, John N; Klausner, Jeffrey D

    2016-01-01

    We evaluate recent claims opposing infant male circumcision, a procedure now supported by the evidence-based policy of the American Academy of Pediatrics. We find those criticisms depend on speculative claims about the foreskin and obfuscation of the strong scientific evidence supporting pediatric policy development. An argument that circumcision should be delayed to allow a boy to make up his own mind as an adult fails to appreciate the psychological, scheduling and financial burdens later circumcision entails, so reducing the likelihood that it will occur. In contrast, early infant circumcision is convenient, safer, quicker, lower risk, healing is faster, cosmetic outcome is routinely good and the lifetime benefits accrue immediately. Benefits include reduction in urinary tract infections, inflammatory skin conditions, foreskin problems, and, when older, substantial protection against sexually transmitted infections and genital cancers in the male and his female sexual partners. Some authorities regard the failure to offer parents early infant circumcision as unethical, just as it would be unethical to fail to encourage the vaccination of children. In conclusion, the criticisms of evidence-based infant male circumcision policy are seriously flawed and should be dismissed as unhelpful to evidence-based development and implementation of pediatric policy intended to improve public health and individual wellbeing. PMID:27610340

  12. Why women object to male circumcision to prevent HIV in a moderate-prevalence setting.

    PubMed

    Kelly, Angela; Kupul, Martha; Aeno, Herick; Shih, Patti; Naketrumb, Richard; Neo, James; Fitzgerald, Lisa; Kaldor, John M; Siba, Peter M; Vallely, Andrew

    2013-02-01

    Adult male circumcision has been shown to reduce the transmission of HIV. Women's acceptability of male circumcision is important in Papua New Guinea's preparedness to introduce male circumcision, and in ethical considerations of its use as a biomedical technology for HIV prevention. We conducted 21 focus group discussions and 18 in-depth interviews with women in all four regions of Papua New Guinea. The majority of women objected to the introduction of male circumcision for three main reasons: circumcision would result in sexual risk compensation; circumcision goes against Christian faith; and circumcision is a new practice that is culturally inappropriate. A minority of women accepted male circumcision for the prevention of HIV and other sexually transmitted infections, and for the benefit of penile hygiene and health. Women's objections to circumcision as a biomedical method of preventing HIV reemphasize the importance of sociocultural and behavioral interventions in Papua New Guinea.

  13. Infant male circumcision and the autonomy of the child: two ethical questions.

    PubMed

    McMath, Akim

    2015-08-01

    Routine neonatal circumcision--the non-therapeutic circumcision of infant males--has generated considerable ethical controversy. In this article, I suggest that much of the disagreement results from conflicting ideas about the autonomy of the child. I examine two questions about autonomy. First, I ask whether we should be realists or idealists about the future autonomous choices of the child-that is, whether we should account for the fact that the child may not make the best choices in future, or whether we should assume that his future choices will reflect his best interests. Second, I ask whether the child has a right to autonomy with respect to circumcision, an interest in autonomy or neither--that is, whether respect for autonomy overrides considerations of interests, whether it counts as one interest among many or whether it counts for nothing. In response to the first question, I argue that we should be idealists when evaluating the child's own interests, but realists when evaluating public health justifications for circumcision. In response to the second question, I argue that the child has an interest in deciding whether or not to be circumcised, insofar as the decision is more likely to reflect his actual interests and his own values. Finally, I show how these findings may help to resolve some particular disputes over the ethics of infant male circumcision.

  14. Key considerations in scaling up male circumcision in Tanzania: views of the urban residents in Tanzania.

    PubMed

    Francis, Joel M; Kakoko, Deodatus; Tarimo, Edith A M; Munseri, Patricia; Bakari, Muhammad; Sandstrom, Eric

    2012-01-01

    Male circumcision (MC) reduces the risk of sexually transmitted infections (STI) including HIV. The WHO and UNAIDS recommend male circumcision as an additional intervention to prevent HIV infection. Tanzania is embarking on activities to scale up safe male circumcision for HIV prevention and other related health benefits. In line with this, it is crucial to assess views of the population using specific groups. This paper describes perceptions on male circumcision and strategies of enhancing uptake of male circumcision in urban Tanzania using members of the police force. This cross sectional survey was conducted among members of the police force in Dar es Salaam Tanzania from January 2010 to July 2010. The police officer serves as a source of the clinical trial participants in on-going phase I/II HIV vaccine trials. Three hundred and thirteen (313) police officers responded to a self-administered questionnaire that comprised of socio-demographic characteristics, reasons for not circumcising, perceptions regarding circumcision, methods of enhancing male circumcision, communication means and barriers to promote circumcision. This was followed by a physical examination to determine male circumcision status. The prevalence of circumcision was 96%. Most (69%) reported to have been circumcised in the hospital. The reported barriers to male circumcision among adults and children were: anticipation of pain, cost, fear to lose body parts, and lack of advice for adult's circumcision. Sensitization of parents who take children to the reproductive and child health services was recommended by most respondents as the appropriate strategy to promote male circumcision. The least recommended strategy was for the women to sensitize men. Use of radio programs and including male circumcision issues in school curricula as means of enhancing community sensitization regarding male circumcision were also highly recommended. Other recommendations include use of public media, seminars at

  15. Circumcision

    MedlinePlus

    Circumcision is a surgical procedure to remove the foreskin, the skin that covers the tip of the ... AAP), there are medical benefits and risks to circumcision. Possible benefits include a lower risk of urinary ...

  16. Early Resumption of Sex following Voluntary Medical Male Circumcision amongst School-Going Males

    PubMed Central

    2016-01-01

    Voluntary medical male circumcision is an integral part of the South African government’s response to the HIV and AIDS epidemic. Following circumcision, it is recommended that patients abstain from sexual activity for six weeks, as sex may increase the risk of female-to-male HIV transmission and prolong the healing period. This paper investigates the resumption of sexual activity during the healing period among a cohort of school-going males in the KwaZulu-Natal province of South Africa. The analysis for this paper compares two groups of sexually active school-going males: the first group reported having sex during the healing period (n = 40) and the second group (n = 98) reported no sex during the healing period (mean age: 17.7, SD: 1.7).The results show that 29% (n = 40) of young males (mean age: 17.9, SD: 1.8) who were previously sexually active, resumed sexual activity during the healing period, had on average two partners and used condoms inconsistently. In addition, those males that engage in sexual activity during the healing period were less inclined to practice safe sex in the future (AOR = 0.055, p = 0.002) than the group of males who reported no sex during the healing period. These findings suggest that a significant proportion of young males may currently and in the future, subject themselves to high levels of risk for contracting HIV post circumcision. Education, as part of a VMMC campaign, must emphasize the high risk of HIV transmission for both the males their partners during the healing period. PMID:27930720

  17. The Consideration of Socioeconomic Determinants in Prevention of Traditional Male Circumcision Deaths and Complications.

    PubMed

    Douglas, Mbuyiselo; Hongoro, Charles

    2016-03-18

    The responsiveness to socioeconomic determinants is perceived as highly crucial in preventing the high mortality and morbidity rates of traditional male circumcision initiates in the Eastern Cape, a province in South Africa. The study sought to describe social determinants and explore economic determinants related to traditional circumcision of boys from 12 to 18 years of age in Libode rural communities in Eastern Cape Province. From the results of a descriptive cross-sectional survey (n = 1,036), 956 (92.2%) boys preferred traditional male circumcision because of associated social determinants which included the variables for the attainment of social manhood values and benefits; 403 (38.9%) wanted to attain community respect; 347 (33.5%) wanted the accepted traditional male circumcision for hygienic purposes. The findings from the exploratory focus group discussions were revolving around variables associated with poverty, unemployment, and illegal actions to gain money. The three negative economic determinants were yielded as themes: (a) commercialization and profitmaking, (b) poverty and unemployment, (c) taking health risk for cheaper practices, and the last theme was the (d) actions suggested to prevent the problem. The study concluded with discussion and recommendations based on a developed strategic circumcision health promotion program which is considerate of socioeconomic determinants.

  18. Exposé of misleading claims that male circumcision will increase HIV infections in Africa

    PubMed Central

    Morris, Brian J.; Waskett, Jake H.; Gray, Ronald H.; Halperin, Daniel T.; Wamai, Richard; Auvert, Bertran; Klausner, Jeffrey D.

    2011-01-01

    Despite over two decades of extensive research showing that male circumcision protects against heterosexual acquisition of HIV in men, and that includes findings from large randomized controlled trials leading to acceptance by the WHO/UNAIDS and the Cochrane Committee, opponents of circumcision continue to generate specious arguments to the contrary. In a recent issue of the Journal of Public Health in Africa, Van Howe and Storms claim that male circumcision will increase HIV infections in Africa. Here we review the statements they use in support of their thesis and show that there is no scientific basis to such an assertion. We also evaluate the statistics used and show that when these data are properly analyzed the results lead to a contrary conclusion affirming the major role of male circumcision in protecting against HIV infection in Africa. Researchers, policy makers and the wider community should rely on balanced scholarship when assessing scientific evidence. We trust that our assessment may help refute the claims by Van Howe and Storms, and provide reassurance on the importance of circumcision for HIV prevention. PMID:28299069

  19. Who is taking up voluntary medical male circumcision? Early evidence from Tanzania.

    PubMed

    Gummerson, Elizabeth; Maughan-Brown, Brendan; Venkataramani, Atheendar

    2013-10-23

    We examined the impacts of nationwide voluntary medical male circumcision efforts in Tanzania. Using Demographic and Health Surveys data, we found that circumcision rates increased from 37% to 47% in regions targeted by the program. Those who took up medical male circumcision were younger, more educated, wealthier, and more likely to use condoms. Efforts going forward should focus on stimulating circumcision demand among more vulnerable men.

  20. “If you are circumcised, you are the best”: Understandings and perceptions of voluntary medical male circumcision among men from KwaZulu-Natal, South Africa

    PubMed Central

    Humphries, Hilton; van Rooyen, Heidi; Knight, Lucia; Barnabas, Ruanne; Celum, Connie

    2014-01-01

    While the uptake of voluntary medical male circumcision (VMMC) is increasing, South Africa has only attained 20% of its target to circumcise 80% of adult men by 2015. Understanding the factors influencing uptake is essential to meeting these targets. This qualitative study reports on findings from focus group discussions with men in rural KwaZulu-Natal, South Africa about what factors influence their perceptions of VMMC. The study found that VMMC is linked to perceptions of masculinity and male gender identity including sexual health, sexual performance and pleasure, possible risk compensation and self-identity. Findings highlight the need to understand how these perceptions of sexual health and performance affect men’s decisions to undergo circumcision and the implications for uptake of VMMC. The study also highlights the need for individualised and contextualised information and counselling that can identify, understand and address the perceptions men have of VMMC, and the impacts they believe it will have on them. PMID:25567140

  1. Perceptions and knowledge of voluntary medical male circumcision for HIV prevention in traditionally non-circumcising communities in South Africa.

    PubMed

    Hoffman, Jacob Robin; Arendse, Kirsten D; Larbi, Carl; Johnson, Naomi; Vivian, Lauraine M H

    2015-01-01

    Voluntary medical male circumcision (VMMC) has been recommended for the prevention of HIV transmission, particularly in sub-Saharan Africa. Uptake of the campaign has been relatively poor, particularly in traditionally non-circumcising regions. This study evaluates the knowledge, attitudes and practices of medical male circumcision (MC) of 104 community members exposed to promotional campaigns for VMMC for five years. Results show that 93% of participants have heard of circumcision and 72% have heard of some health benefit from the practice. However, detailed knowledge of the relationship with HIV infection is lacking: 12.2% mistakenly believed you could not get HIV after being circumcised, while 75.5% believe that a circumcised man is still susceptible and another 12.2% do not know of any relationship between HIV and MC. There are significant barriers to the uptake of the practice, including misperceptions and fear of complications commonly attributed to traditional, non-medical circumcision. However, 88.8% of participants believe circumcision is an acceptable practice, and community-specific promotional campaigns may increase uptake of the service.

  2. Geographic coverage of male circumcision in western Kenya

    PubMed Central

    Akullian, Adam; Onyango, Mathews; Klein, Daniel; Odhiambo, Jacob; Bershteyn, Anna

    2017-01-01

    Abstract Voluntary Medical Male Circumcision (VMMC) for human immunodeficiency virus (HIV) prevention has scaled up rapidly among young men in western Kenya since 2008. Whether the program has successfully reached uncircumcised men evenly across the region is largely unknown. Using data from two cluster randomized surveys from the 2008 and 2014 Kenyan Demographic Health Survey (KDHS), we mapped the continuous spatial distribution of circumcised men by age group across former Nyanza Province to identify geographic areas where local circumcision prevalence is lower than the overall, regional prevalence. The prevalence of self-reported circumcision among men 15 to 49 across six counties in former Nyanza Province increased from 45.6% (95% CI = 33.2–58.0%) in 2008 to 71.4% (95% CI = 67.4–75.0%) in 2014, with the greatest increase in men 15 to 24 years of age, from 40.4% (95% CI = 27.7–55.0%) in 2008 to 81.6% (95% CI = 77.2–85.0%) in 2014. Despite the dramatic scale-up of VMMC in western Kenya, circumcision coverage in parts of Kisumu, Siaya, and Homa Bay counties was lower than expected (P < 0.05), with up to 50% of men aged 15 to 24 still uncircumcised by 2014 in some areas. The VMMC program has proven successful in reaching a large population of uncircumcised men in western Kenya, but as of 2014, pockets of low circumcision coverage still existed. Closing regional gaps in VMMC prevalence to reach 80% coverage may require targeting specific areas where VMMC prevalence is lower than expected. PMID:28079830

  3. Geographic coverage of male circumcision in western Kenya.

    PubMed

    Akullian, Adam; Onyango, Mathews; Klein, Daniel; Odhiambo, Jacob; Bershteyn, Anna

    2017-01-01

    Voluntary Medical Male Circumcision (VMMC) for human immunodeficiency virus (HIV) prevention has scaled up rapidly among young men in western Kenya since 2008. Whether the program has successfully reached uncircumcised men evenly across the region is largely unknown. Using data from two cluster randomized surveys from the 2008 and 2014 Kenyan Demographic Health Survey (KDHS), we mapped the continuous spatial distribution of circumcised men by age group across former Nyanza Province to identify geographic areas where local circumcision prevalence is lower than the overall, regional prevalence. The prevalence of self-reported circumcision among men 15 to 49 across six counties in former Nyanza Province increased from 45.6% (95% CI = 33.2-58.0%) in 2008 to 71.4% (95% CI = 67.4-75.0%) in 2014, with the greatest increase in men 15 to 24 years of age, from 40.4% (95% CI = 27.7-55.0%) in 2008 to 81.6% (95% CI = 77.2-85.0%) in 2014. Despite the dramatic scale-up of VMMC in western Kenya, circumcision coverage in parts of Kisumu, Siaya, and Homa Bay counties was lower than expected (P < 0.05), with up to 50% of men aged 15 to 24 still uncircumcised by 2014 in some areas. The VMMC program has proven successful in reaching a large population of uncircumcised men in western Kenya, but as of 2014, pockets of low circumcision coverage still existed. Closing regional gaps in VMMC prevalence to reach 80% coverage may require targeting specific areas where VMMC prevalence is lower than expected.

  4. Ability and willingness to pay for voluntary medical male circumcision: a cross-sectional survey in Kisumu County, Kenya.

    PubMed

    Wandei, Stephen; Nangami, Mabel; Egesa, Omar

    2016-01-01

    Voluntary medical male circumcision is one of the most effective measures in preventing male acquisition of HIV during heterosexual intercourse. In Kenya, the voluntary medical male circumcision programme was launched in the year 2008 as part of a comprehensive national HIV prevention strategy. With the global challenge of funding HIV intervention programs, the sustainability of the programme beyond the donor periods need to be assessed. The purpose of this study was to determine the household ability and willingness to pay for voluntary medical male circumcision as an alternative method of funding the programme. The findings show that 62.2% of the households were "able" to pay for medical circumcision. However, 60.4% of them were not "willing" to pay for the service regardless of the cost. The findings indicate that ability to pay is not a significant predictor of willingness to pay for voluntary medical male circumcision within Kisumu County. Knowledge on the role of medical circumcision is a more important factor in determining willingness to pay for the service.

  5. The when and how of male circumcision and the risk of HIV: a retrospective cross-sectional analysis of two HIV surveys from Guinea-Bissau

    PubMed Central

    Rasmussen, Dlama Nggida; Wejse, Christian; Larsen, Olav; Da Silva, Zacarias; Aaby, Peter; Sodemann, Morten

    2016-01-01

    Introduction Male circumcision (MC) reduces the risk of HIV, and this risk reduction may be modified by socio-cultural factors such as the timing and method (medical and traditional) of circumcision. Understanding regional variations in circumcision practices and their relationship to HIV is crucial and can increase insight into the HIV epidemic in Africa. Methods We used data from two retrospective HIV surveys conducted in Guinea-Bissau from 1993 to 1996 (1996 cohort) and from 2004 to 2007 (2006 cohort). Multivariate logistical models were used to investigate the relationships between HIV risk and circumcision status, timing, method of circumcision, and socio-demographic factors. Results MC was protective against HIV infection in both cohorts, with adjusted odds ratios (AORs) of 0.28 (95% CI 0.12-0.66) and 0.30 (95% CI 0.09-0.93), respectively. We observed that post-pubertal (≥13 years) circumcision provided the highest level of HIV risk reduction in both cohorts compared to non-circumcised. However, the difference between pre-pubertal (≤12 years) and post-pubertal (≥13 years) circumcision was not significant in the multivariate analysis. Seventy-six percent (678/888) of circumcised males in the 2006 cohort were circumcised traditionally, and 7.7% of those males were HIV-infected compared to 1.9% of males circumcised medically, with AOR of 2.7 (95% CI 0.91-8.12). Conclusion MC is highly prevalent in Guinea-Bissau, but ethnic variations in method and timing may affect its protection against HIV. Our findings suggest that sexual risk behaviour and traditional circumcision may increases HIV risk. The relationship between circumcision age, sexual behaviour and HIV status remains unclear and warrants further research. PMID:27200126

  6. Triggering the decision to undergo medical male circumcision: a qualitative study of adult men in Botswana.

    PubMed

    Wirth, Kathleen E; Semo, Bazghina-Werq; Ntsuape, Conrad; Ramabu, Nankie M; Otlhomile, Boyce; Plank, Rebeca M; Barnhart, Scott; Ledikwe, Jenny H

    2016-08-01

    In 2007, the World Health Organization endorsed voluntary medical male circumcision (VMMC) as part of comprehensive HIV-prevention strategies. A major challenge facing VMMC programs in sub-Saharan Africa remains demand creation; there is urgent need for data on key elements needed to trigger the decision among eligible men to seek VMMC. Using qualitative methods, we sought to better understand the circumcision decision-making process in Botswana related to VMMC. From July to November 2013, we conducted 27 focus group discussions in four purposively selected communities in Botswana with men (stratified by circumcision status and age), women (stratified by age) and community leaders. All discussions were facilitated by a trained same-sex interviewer, audio recorded, transcribed and translated to English, and analyzed for key themes using an inductive content analytic approach. Improved hygiene was frequently cited as a major benefit of circumcision and many participants believed that cleanliness was directly responsible for the protective effect of VMMC on HIV infection. While protection against HIV was frequently noted as a benefit of VMMC, the data indicate that increased sexual pleasure and perceived attractiveness, not fear of HIV infection, was an underlying reason why men sought VMMC. Data from this qualitative study suggest that more immediate benefits of VMMC, such as improved hygiene and sexual pleasure, play a larger role in the circumcision decision compared with protection from potential HIV infection. These findings have immediate implications for targeted demand creation and mobilization activities for increasing uptake of VMMC among adult men in Botswana.

  7. Achieving the HIV prevention impact of voluntary medical male circumcision: lessons and challenges for managing programs.

    PubMed

    Sgaier, Sema K; Reed, Jason B; Thomas, Anne; Njeuhmeli, Emmanuel

    2014-05-01

    Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009-2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection "Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up." The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform.

  8. Traditional Male Circumcision in Uganda: A Qualitative Focus Group Discussion Analysis

    PubMed Central

    Sabet Sarvestani, Amir; Bufumbo, Leonard; Geiger, James D.; Sienko, Kathleen H.

    2012-01-01

    Background The growing body of evidence attesting to the effectiveness of clinical male circumcision in the prevention of HIV/AIDS transmission is prompting the majority of sub-Saharan African governments to move towards the adoption of voluntary medical male circumcision (VMMC). Even though it is recommended to consider collaboration with traditional male circumcision (TMC) providers when planning for VMMC, there is limited knowledge available about the TMC landscape and traditional beliefs. Methodology and Main Findings During 2010–11 over 25 focus group discussions (FGDs) were held with clan leaders, traditional cutters, and their assistants to understand the practice of TMC in four ethnic groups in Uganda. Cultural significance and cost were among the primary reasons cited for preferring TMC over VMMC. Ethnic groups in western Uganda circumcised boys at younger ages and encountered lower rates of TMC related adverse events compared to ethnic groups in eastern Uganda. Cutting styles and post-cut care also differed among the four groups. The use of a single razor blade per candidate instead of the traditional knife was identified as an important and recent change. Participants in the focus groups expressed interest in learning about methods to reduce adverse events. Conclusion This work reaffirmed the strong cultural significance of TMC within Ugandan ethnic groups. Outcomes suggest that there is an opportunity to evaluate the involvement of local communities that still perform TMC in the national VMMC roll-out plan by devising safer, more effective procedures through innovative approaches. PMID:23082112

  9. Bodily Integrity and Male Circumcision: An Islamic Perspective

    PubMed Central

    Alahmad, Ghiath; Dekkers, Wim

    2012-01-01

    The notion of bodily integrity forms an important part of the value-structure of many religions and cultures. In this paper, we explore the notion of bodily integrity in Islam using male circumcision as the focus of the discussion. Our aim is to contribute to a better understanding of the Muslim perspective and of the differences and similarities between Western and Islamic ethical structures, in particular, regarding the concept of bodily integrity. PMID:23610746

  10. Need for Physician Education on the Benefits and Risks of Male Circumcision in the United States

    ERIC Educational Resources Information Center

    Carbery, Baevin; Zhu, Julia; Gust, Deborah A.; Chen, Robert T.; Kretsinger, Katrina; Kilmarx, Peter H.

    2012-01-01

    Physicians may be called upon to counsel male patients or parents of newborn males regarding their decision to circumcise their newborn sons. The purpose of the present study was to describe physicians who do not understand the benefits and risks associated with male circumcision well enough to counsel parents of newborn male infants and adult…

  11. Circumcision

    MedlinePlus

    ... benefits alone may not outweigh those other considerations. Risks Risks related to circumcision: Bleeding Infection Redness around ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...

  12. The Cost of Voluntary Medical Male Circumcision in South Africa

    PubMed Central

    Tchuenche, Michel; Palmer, Eurica; Haté, Vibhuti; Thambinayagam, Ananthy; Loykissoonlal, Dayanund; Forsythe, Steven

    2016-01-01

    Given compelling evidence associating voluntary medical male circumcision (VMMC) with men’s reduced HIV acquisition through heterosexual intercourse, South Africa in 2010 began scaling up VMMC. To project the resources needed to complete 4.3 million circumcisions between 2010 and 2016, we (1) estimated the unit cost to provide VMMC; (2) assessed cost drivers and cost variances across eight provinces and VMMC service delivery modes; and (3) evaluated the costs associated with mobilize and motivate men and boys to access VMMC services. Cost data were systematically collected and analyzed using a provider’s perspective from 33 Government and PEPFAR-supported (U.S. President's Emergency Plan for AIDS Relief) urban, rural, and peri-urban VMMC facilities. The cost per circumcision performed in 2014 was US$132 (R1,431): higher in public hospitals (US$158 [R1,710]) than in health centers and clinics (US$121 [R1,309]). There was no substantial difference between the cost at fixed circumcision sites and fixed sites that also offer outreach services. Direct labor costs could be reduced by 17% with task shifting from doctors to professional nurses; this could have saved as much as $15 million (R163.20 million) in 2015, when the goal was 1.6 million circumcisions. About $14.2 million (R154 million) was spent on medical male circumcision demand creation in South Africa in 2014—primarily on personnel, including community mobilizers (36%), and on small and mass media promotions (35%). Calculating the unit cost of VMMC demand creation was daunting, because data on the denominator (number of people reached with demand creation messages or number of people seeking VMMC as a result of demand creation) were not available. Because there are no “dose-response” data on demand creation ($X in demand creation will result in an additional Z% increase in VMMC clients), research is needed to determine the appropriate amount and allocation of demand creation resources. PMID:27783612

  13. Understanding the partial protection of male circumcision for HIV prevention among women in Iringa Region, Tanzania: an ethnomedical model.

    PubMed

    Layer, Erica H; Beckham, Sarah W; Momburi, Romani B; Kennedy, Caitlin E

    2013-08-01

    Communicating the partial efficacy of male circumcision for HIV prevention is challenging. Understanding how people conceptualize risk can help programs communicate messages in a way that is understandable to local communities. This article explores women's ethnomedical model of disease transmission related to male circumcision in Iringa Region, Tanzania. We conducted in-depth interviews (IDIs) with 32 female partners of male circumcision clients and focus group discussions (FGDs) with married (n=3) and unmarried (n=3) women from November 2011 to February 2012. Interviews were digitally recorded, transcribed, and translated into English, and codes were developed based on emerging themes. While women understand that circumcised men are still at risk of HIV, risk is perceived to be low as long as both partners avoid abrasions during sexual intercourse and the man's penis is kept clean. Women said that HIV transmission only occurs when both partners have abrasions on their genitalia and mixing of blood occurs. Abrasions are thought to be the result of friction from fast or dry sex and are more likely to occur with uncircumcised men; thus, HIV can be prevented if a man is circumcised and couples have gentle, lubricated sex. In addition, women reported that the foreskin traps particles of sexually transmitted infections (STIs) including HIV, which can easily be passed on to female partners. In contrast, circumcised men are viewed as being able to clean themselves of disease particles and, therefore, do not easily acquire diseases or transmit them to female partners. These findings align with the scientific understanding of increased HIV risk associated with abrasions or microflora in the foreskin; however, the ethnomedical model differs from scientific understanding in that disease transmission can in fact occur without either of these conditions. Programs can build upon these findings to better convey risks along with the benefits of male circumcision.

  14. Attitudes, Perceptions and Potential Uptake of Male Circumcision among Older Men in Turkana County, Kenya Using Qualitative Methods

    PubMed Central

    Macintyre, Kate; Andrinopoulos, Katherine; Moses, Natome; Bornstein, Marta; Ochieng, Athanasius; Peacock, Erin; Bertrand, Jane

    2014-01-01

    Background In many communities, older men (i.e., over 25 years of age) have not come forward for Voluntary Medical Male Circumcision (VMMC) services. Reasons for low demand among this group of men are not well understood, and may vary across geographic and cultural contexts. This paper examines the facilitators and barriers to VMMC demand in Turkana County, Kenya, with a focus on older men. This is one of the regions targeted by the VMMC program in Kenya because the Turkana ethnic group does not traditionally circumcise, and the rates of HIV and STD transmission are high. Methods and Findings Twenty focus group discussions and 69 in-depth interviews were conducted with circumcised and uncircumcised men and their partners to elicit their attitudes and perceptions toward male circumcision. The interviews were conducted in urban, peri-urban, and rural communities across Turkana. Our results show that barriers to circumcision include stigma associated with VMMC, the perception of low risk for HIV for older men and their “protection by marriage,” cultural norms, and a lack of health infrastructure. Facilitators include stigma against not being circumcised (since circumcision is associated with modernity), protection against disease including HIV, and cleanliness. It was also noted that older men should adopt the practice to serve as role models to younger men. Conclusions Both men and women were generally supportive of VMMC, but overcoming barriers with appropriate communication messages and high quality services will be challenging. The justification of circumcision being a biomedical procedure for protection against HIV will be the most important message for any communication strategy. PMID:24802112

  15. Voluntary Medical Male Circumcision: Logistics, Commodities, and Waste Management Requirements for Scale-Up of Services

    PubMed Central

    Edgil, Dianna; Stankard, Petra; Forsythe, Steven; Rech, Dino; Chrouser, Kristin; Adamu, Tigistu; Sakallah, Sameer; Thomas, Anne Goldzier; Albertini, Jennifer; Stanton, David; Dickson, Kim Eva; Njeuhmeli, Emmanuel

    2011-01-01

    Background The global HIV prevention community is implementing voluntary medical male circumcision (VMMC) programs across eastern and southern Africa, with a goal of reaching 80% coverage in adult males by 2015. Successful implementation will depend on the accessibility of commodities essential for VMMC programming and the appropriate allocation of resources to support the VMMC supply chain. For this, the United States President’s Emergency Plan for AIDS Relief, in collaboration with the World Health Organization and the Joint United Nations Programme on HIV/AIDS, has developed a standard list of commodities for VMMC programs. Methods and Findings This list of commodities was used to inform program planning for a 1-y program to circumcise 152,000 adult men in Swaziland. During this process, additional key commodities were identified, expanding the standard list to include commodities for waste management, HIV counseling and testing, and the treatment of sexually transmitted infections. The approximate costs for the procurement of commodities, management of a supply chain, and waste disposal, were determined for the VMMC program in Swaziland using current market prices of goods and services. Previous costing studies of VMMC programs did not capture supply chain costs, nor the full range of commodities needed for VMMC program implementation or waste management. Our calculations indicate that depending upon the volume of services provided, supply chain and waste management, including commodities and associated labor, contribute between US$58.92 and US$73.57 to the cost of performing one adult male circumcision in Swaziland. Conclusions Experience with the VMMC program in Swaziland indicates that supply chain and waste management add approximately US$60 per circumcision, nearly doubling the total per procedure cost estimated previously; these additional costs are used to inform the estimate of per procedure costs modeled by Njeuhmeli et al. in “Voluntary Medical

  16. Male circumcision for HIV prevention in Papua New Guinea: a summary of research evidence and recommendations for public health following a national policy forum.

    PubMed

    Vallely, A; MacLaren, D J; Kaleva, W; Millan, J; Tommbe, R; Marape, W; Manineng, C; Buchanan, H; Amos, A; Frank, R; Kelly, A; Kupul, M; Aeno, H; Trowalle, E; John, L N; Redman-Maclaren, M L; Ryan, C; Browne, K; Tynan, A; Hill, P S; Gray, R T; Murray, J; Wilson, D P; Law, G; Siba, P; McBride, W J H; Farley, T; Kaldor, J M

    2011-01-01

    In 2005, a clinical trial in South Africa found that circumcision of young men could reduce their risk of acquiring HIV (human immunodeficiency virus) infection by over 60%. In the following year, two more trials in Africa confirmed this finding, leading the World Health Organization to recommend male circumcision as a public health strategy for HIV prevention in high-incidence countries. In order to inform public health policy in Papua New Guinea (PNG), two major research projects were initiated with the goals of investigating the status of penile cutting practices and assessing understandings, acceptability, feasibility and cost-effectiveness of male circumcision for HIV prevention. In addition, behavioural surveillance surveys systematically asked questions on penile cutting practices and an ethnographic literature review informed historical perspectives of penile cutting in PNG. Key findings from these research activities were presented at a National Policy Forum on Male Circumcision for HIV Prevention held in Port Moresby in November 2011. The Forum made three key recommendations: (1) the formation of a joint National Department of HealthlNational AIDS Council Secretariat Policy Committee on male circumcision; (2) the establishment of an integrated harm reduction program; and (3) that future policy on wide-scale roll-out of male circumcision for HIV prevention in PNG be informed by a combination of data from (a) male circumcision intervention pilot programs and (b) research on the potential protective effect of other forms of penile cutting.

  17. Circumcision

    MedlinePlus

    ... español Circuncisión Whether you're expecting a baby boy or have just welcomed your new little guy ... and consider some of the issues. About Circumcision Boys are born with a hood of skin, called ...

  18. Age Targeting of Voluntary Medical Male Circumcision Programs Using the Decision Makers’ Program Planning Toolkit (DMPPT) 2.0

    PubMed Central

    Kripke, Katharine; Opuni, Marjorie; Schnure, Melissa; Sgaier, Sema; Castor, Delivette; Reed, Jason; Stover, John

    2016-01-01

    Background Despite considerable efforts to scale up voluntary medical male circumcision (VMMC) for HIV prevention in priority countries over the last five years, implementation has faced important challenges. Seeking to enhance the effect of VMMC programs for greatest and most immediate impact, the U. S. President’s Plan for AIDS Relief (PEPFAR) supported the development and application of a model to inform national planning in five countries from 2013–2014. Methods and Findings The Decision Makers’ Program Planning Toolkit (DMPPT) 2.0 is a simple compartmental model designed to analyze the effects of client age and geography on program impact and cost. The DMPPT 2.0 model was applied in Malawi, South Africa, Swaziland, Tanzania, and Uganda to assess the impact and cost of scaling up age-targeted VMMC coverage. The lowest number of VMMCs per HIV infection averted would be produced by circumcising males ages 20–34 in Malawi, South Africa, Tanzania, and Uganda and males ages 15–34 in Swaziland. The most immediate impact on HIV incidence would be generated by circumcising males ages 20–34 in Malawi, South Africa, Tanzania, and Uganda and males ages 20–29 in Swaziland. The greatest reductions in HIV incidence over a 15-year period would be achieved by strategies focused on males ages 10–19 in Uganda, 15–24 in Malawi and South Africa, 10–24 in Tanzania, and 15–29 in Swaziland. In all countries, the lowest cost per HIV infection averted would be achieved by circumcising males ages 15–34, although in Uganda this cost is the same as that attained by circumcising 15- to 49-year-olds. Conclusions The efficiency, immediacy of impact, magnitude of impact, and cost-effectiveness of VMMC scale-up are not uniform; there is important variation by age group of the males circumcised and countries should plan accordingly. PMID:27410966

  19. Feasibility and Effectiveness of a Peer Referral Incentive Intervention to Promote Male Circumcision Uptake in Zambia

    PubMed Central

    Bolton, Carolyn; Lyabola, Lane-Lee; Phiri, Gabriel; Samona, Alick; Kaonga, Albert; Thirumurthy, Harsha

    2016-01-01

    Background: Medical male circumcision is a promising HIV prevention tool in countries with generalized HIV epidemics, but demand creation interventions are needed to support scale-up. We piloted a peer referral intervention in which circumcision clients were offered incentives for referring their peers for circumcision. Methods: The intervention was implemented between June 2014 and February 2015 in 6 randomly selected health facilities in Southern Province, Zambia. For the first 5 months, circumcision clients ≥18 years of age were given referral vouchers that allowed them to refer up to 5 peers for circumcision within a 3-month period. An incentive of US$2 was offered for each referral. The primary outcome was the number of circumcisions performed per month in each facility. To assess the effect of the intervention, a difference-in-difference analysis was performed using longitudinal data from the intervention facilities and 22 nonintervention facilities. A questionnaire was also implemented to understand men's perceptions of the intervention. Results: During the 8-month intervention period, 1222 men over 18 years of age were circumcised in intervention facilities. In the first 5 months, 699 circumcision clients were enrolled and 385 clients brought a referral voucher given to them by an enrolled client. Difference-in-difference analyses did not show a significant increase in circumcisions performed in intervention facilities. However, circumcision clients reported that the referral incentive motivated them to encourage their friends to seek male circumcision. Peer referrals were also reported to be an important factor in men's decisions because 78% of clients who were referred reported that talking with a circumcised friend was important for their decision to get circumcised. Conclusions: The peer referral incentive intervention for male circumcision was feasible and acceptable. However, the intervention did not have a significant effect on demand for male

  20. The acceptability of male circumcision as an HIV intervention among a rural Zulu population, Kwazulu-Natal, South Africa.

    PubMed

    Scott, B E; Weiss, H A; Viljoen, J I

    2005-04-01

    Epidemiological and biological studies provide compelling evidence for the protective effect of male circumcision against the acquisition of HIV. Three randomized controlled trials are currently underway to assess the impact of male circumcision as an HIV intervention in traditionally non-circumcising areas with high levels of heterosexually-transmitted infection. This study explores the acceptability of male circumcision among the rural Zulu around Hlabisa and Mtubatuba, KwaZulu-Natal, South Africa. A cross-sectional convenience sample of 100 men and 44 women was surveyed, and two male focus groups held, to ascertain circumcision preferences within the population. Four in-depth interviews with service providers assessed the feasibility of promoting male circumcision. Fifty-one per cent of uncircumcised men and 68% of women favoured male circumcision of themselves or their partners; while 50% of men and 73% of women would circumcise their sons. For men, the main predictors of circumcision preference pertained to beliefs surrounding sexual pain and pleasure; for women, knowledge about the relationship between male circumcision status and STI acquisition was the key indicator for circumcision preference. Among both sexes the main barrier to circumcision was fear of pain and death. The greatest logistical barrier was that circumcision can presently only be carried out by trained hospital doctors.

  1. Do motives matter in male circumcision? 'Conscientious objection' against the circumcision of a Muslim child with a blood disorder.

    PubMed

    Ahmad, Ayesha

    2014-02-01

    Whilst there have been serious attempts to locate the practice of male circumcision for religious motives in the context of the (respective) religion's narrative and community, the debate, when referring to a clinical context, is often more nuanced. This article will contribute further to the debate by contextualising the Islamic practice of male circumcision within the clinical setting typical of a contemporary hospital. It specifically develops an additional complication; namely, the child has a pre-existing blood disorder. As an approach to contributing to the circumcision debate further, the ethics of a conscientious objection for secular motives towards a religiously-motivated clinical intervention will be explored. Overall, the discussion will provide relevance for such debates within the value-systems of a multi-cultural society. This article replicates several approaches to deconstructing a request for conscientious refusal of non-therapeutic circumcision by a Clinical Ethics Committee (CEC), bringing to light certain contradictions that occur in normatively categorizing motives for performing the circumcision.

  2. The male circumcision: the oldest ancient procedure, its past, present and future roles.

    PubMed

    Mwashambwa, Masumbuko Y; Mwampagatwa, Ipyana H; Rastegaev, Alexander; Gesase, Ainory P

    2013-07-01

    Circumcision, a surgical removal of male prepuce has existed throughout human history, and it appears it shall exist until humanity ends. During its entire existence, there have been changing reasons or indications from cultural, traditional, religious and currently medical, and it has vehemently been criticized by some individuals for different reasons and in different countries. Emergency of new diseases particularly Human Immunodeficient virus (HIV) has brought the ancient procedure back on spot light, this has come as a result of recent studies which have demonstrated that it does not only reduces significantly the rate of HIV infection, as well as penile cancer and cervical cancer. This has lead to massive male circumcision campaigns in areas with low prevalence of circumcision. On the other hand the socio-cultural and sexual aspects of male circumcision have been studied but often ignored. This article will therefore increase awareness of male circumcision and the increasing roles with time, recommend up scaling of medical male circumcision and possible safe circumcision training to tradition circumcisers.

  3. Male and female viewpoints on female circumcision in Ekpeye, Rivers State, Nigeria.

    PubMed

    Briggs, L A

    2002-12-01

    One hundred and ninety five male and female volunteers across the social strata were interviewed using structured questionnaire. Data were analysed using frequency tables. The study revealed that 74.7% of female respondents were circumcised. They believe that the practice would help prevent sexual promiscuity, curb sexual desires and that it is a custom they cannot do without. Most of the men would not marry an uncircumcised female, while a substantial number of the respondents would like to circumcise their daughters. Community effort to eradicate the practice is very minimal. Based on the findings, it is suggested that communities where female genital mutilation (FGM) is practiced as a social norm should be involved in eradication campaigns with support from national and international organisations.

  4. Acceptability of Voluntary Medical Male Circumcision (VMMC) among Male Sexually Transmitted Diseases Patients (MSTDP) in China

    PubMed Central

    Lau, Joseph T. F.; Kim, Yoona

    2016-01-01

    Voluntary Medical Male circumcision (VMMC) is an evidence-based, yet under-utilized biomedical HIV intervention in China. No study has investigated acceptability of VMMC among male sexually transmitted diseases patients (MSTDP) who are at high risk of HIV transmission. A cross-sectional survey interviewed 350 HIV negative heterosexual MSTDP in Shenzhen, China; 12.0% (n = 42) of them were circumcised at the time of survey. When the uncircumcised participants (n = 308) were informed that VMMC could reduce the risk of HIV infection via heterosexual intercourse by 50%, the prevalence of acceptability of VMMC in the next six months was 46.1%. Adjusted for significant background variables, significant factors of acceptability of VMMC included: 1) emotional variables: the Emotional Representation Subscale (adjusted odds ratios, AOR = 1.13, 95%CI: 1.06–1.18), 2) cognitive variables derived from Health Belief Model (HBM): perceived some chance of having sex with HIV positive women in the next 12 months (AOR = 2.48, 95%CI: 1.15–5.33) (perceived susceptibility), perceived severity of STD infection (AOR = 1.06, 95%CI: 1.02–1.10), perceived benefit of VMMC in risk reduction (AOR = 1.29, 95%CI: 1.16–1.42) and sexual performance (AOR = 1.45, 95%CI: 1.26–1.71), perceived barriers against taking up VMMC (AOR = 0.88, 95%CI: 0.81–0.95), and perceived cue to action (AOR = 1.41, 95%CI: 1.23–1.61) and self-efficacy (AOR = 1.38, 95%CI: 1.26–1.35) related to taking up VMMC. The association between perceived severity of STD infection and acceptability was fully mediated by emotional representation of STD infection. The relatively low prevalence of circumcision and high acceptability suggested that the situation was favorable for implementing VMMC as a means of HIV intervention among MSTDP in China. HBM is a potential suitable framework to guide the design of future VMMC promotion. Future implementation programs should be conducted in STD clinic settings, taking the

  5. Community and Healthcare Providers' Perspectives on Male Circumcision: A Multi-Centric Qualitative Study in India

    PubMed Central

    Sahay, Seema; Nagarajan, Karikalan; Mehendale, Sanjay; Deb, Sibnath; Gupta, Abhilasha; Bharat, Shalini; Bhatt, Shripad; Kumar, Athokpam Bijesh; Kanthe, Vidisha; Sinha, Anju; Chandhiok, Nomita

    2014-01-01

    Background Although male circumcision (MC) is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores beliefs, experiences and understanding of the community and healthcare providers (HCPs) about adult MC as an HIV prevention option in India. Methods This qualitative study covered 134 in-depth interviews from Belgaum, Kolkata, Meerut and Mumbai cities of India. Of these, 62 respondents were the members of circumcising (CC)/non-circumcising communities (NCC); including medically and traditionally circumcised men, parents of circumcised children, spouses of circumcised men, and religious clerics. Additionally, 58 registered healthcare providers (RHCPs) such as general and pediatric surgeons, pediatricians, skin and venereal disease specialists, general practitioners, and operation theatre nurses were interviewed. Fourteen traditional circumcisers were also interviewed. The data were coded and analyzed in QSR NUD*IST ver. 6.0. The study has not explored the participants' views about neonatal versus adult circumcision. Results Members of CC/NCC, traditional circumcisers and RCHPs expressed sharp religious sensitivities around the issue of MC. Six themes emerged: Male circumcision as the religious rite; Multiple meanings of MC: MC for ‘religious identity/privilege/sacrifice’ or ‘hygiene’; MC inflicts pain and cost; Medical indications outweigh faith; Hesitation exists in accepting ‘foreign’ evidence supporting MC; and communication is the key for acceptance of MCs. Medical indications could make members of NCC accept MC following appropriate counseling. Majority of the RHCPs demanded local in-country evidence. Conclusion HCPs must educate high-risk groups regarding the preventive and therapeutic role of MC. Communities need to discuss and create new social norms about male circumcision for better societal acceptance

  6. Voluntary Medical Male Circumcision: An HIV Prevention Priority for PEPFAR

    PubMed Central

    Reed, Jason Bailey; Njeuhmeli, Emmanuel; Thomas, Anne Goldzier; Bacon, Melanie C.; Bailey, Robert; Cherutich, Peter; Curran, Kelly; Dickson, Kim; Farley, Tim; Hankins, Catherine; Hatzold, Karin; Justman, Jessica; Mwandi, Zebedee; Nkinsi, Luke; Ridzon, Renee; Ryan, Caroline; Bock, Naomi

    2013-01-01

    As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President’s Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya’s Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods—such as medical devices that remove the foreskin without injected anesthesia and/or sutures—are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all. PMID:22797745

  7. Voluntary medical male circumcision: an HIV prevention priority for PEPFAR.

    PubMed

    Reed, Jason Bailey; Njeuhmeli, Emmanuel; Thomas, Anne Goldzier; Bacon, Melanie C; Bailey, Robert; Cherutich, Peter; Curran, Kelly; Dickson, Kim; Farley, Tim; Hankins, Catherine; Hatzold, Karin; Justman, Jessica; Mwandi, Zebedee; Nkinsi, Luke; Ridzon, Renee; Ryan, Caroline; Bock, Naomi

    2012-08-15

    As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President's Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen populations may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya's Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success. Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods-such as medical devices that remove the foreskin without injected anesthesia and/or sutures-are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all.

  8. [Adult male circumcision for military men: history and future].

    PubMed

    Li, Philip Shihua; Lü, Nian-Qing; Masson, Puneet; Huang, Yu-Feng; Sun, Ying-Hao

    2010-06-01

    Adult male circumcision (MC) has been shown to reduce the transmission of HPV, HSV, and HIV significantly during vaginal intercourse. However, the benefits of adult MC for men in military service have been poorly documented. Soldiers in war time have additional challenges in maintaining good penile hygiene, rendering uncircumcised men vulnerable to inflammation and infection; these maladies not only negatively impact these individuals, but also undermine the overall military strength. Adult MC can provide some long-term benefits for these military service men. Many African countries have already taken a special interest in adult MC for their military forces, resulting in increased numbers of these surgeries among this special population of men. In this review, we discuss the history of adult MC in the military along with the current trends and economic significance.

  9. Use of Economic Compensation to Increase Demand for Voluntary Medical Male Circumcision in Kenya: Qualitative Interviews With Male Participants in a Randomized Controlled Trial and Their Partners

    PubMed Central

    Lanham, Michele; Murray, Kate; Rao, Samwel; Agot, Kawango; Omanga, Eunice; Thirumurthy, Harsha

    2016-01-01

    Background: Interventions to increase demand for medical male circumcision are urgently needed in eastern and southern Africa. Following promising evidence that providing economic compensation can increase male circumcision uptake in Kenya, there is a need to understand the role of this intervention in individuals' decision-making regarding circumcision and explore perceptions of the intervention and concerns such as coercion. Methods: As part of a randomized controlled trial in Kenya that found compensation in the form of food vouchers worth US $8.75–US $15.00 to be effective in increasing male circumcision uptake, we conducted qualitative in-depth interviews with 45 circumcised and uncircumcised male participants and 19 female partners to explore how compensation provision influenced the decision to get circumcised. Interview transcripts were coded and an inductive thematic analysis was conducted to identify patterns in decision-making. Results: Interviews revealed that compensation promoted circumcision uptake by addressing a major barrier to male circumcision uptake: lost wages during and after the circumcision procedure. Participants who did not get circumcised perceived the compensation amounts to be insufficient for offsetting their costs associated with getting circumcised or reported having nonfinancial barriers that were not addressed by the intervention, such as fear of pain. Participants also reported that they did not feel compelled to get circumcised for financial gain. Female partners of circumcised participants felt that the intervention helped to motivate their partners to get circumcised. Conclusions: The results suggest that the provision of economic compensation is an acceptable intervention that can address an important barrier to male circumcision uptake. Providing compensation to circumcision clients in the form of food vouchers warrants further consideration in voluntary medical male circumcision demand creation efforts. PMID:27404013

  10. The Effects of Providing Fixed Compensation and Lottery-Based Rewards on Uptake of Medical Male Circumcision in Kenya: A Randomized Trial

    PubMed Central

    Masters, Samuel H.; Rao, Samwel; Murray, Kate; Prasad, Ram; Zivin, Joshua G.; Omanga, Eunice; Agot, Kawango

    2016-01-01

    Background: Effective demand creation strategies are needed to increase uptake of medical male circumcision and reduce new HIV infections in eastern and southern Africa. Building on insights from behavioral economics, we assessed whether providing compensation for opportunity costs of time or lottery-based rewards can increase male circumcision uptake in Kenya. Methods: Uncircumcised men aged 21–39 years were randomized in 1:1:1 ratio to 2 intervention groups or a control group. One intervention group was offered compensation of US $12.50 conditional on circumcision uptake. Compensation was provided in the form of food vouchers. A second intervention group was offered the opportunity to participate in a lottery with high-value prizes on undergoing circumcision. The primary outcome was circumcision uptake within 3 months. Results: Among 903 participants enrolled, the group that received compensation of US $12.50 had the highest circumcision uptake (8.4%, 26/308), followed by the lottery-based rewards group (3.3%, 10/302), and the control group (1.3%, 4/299). Logistic regression analysis showed that compared with the control group, the fixed compensation group had significantly higher circumcision uptake [adjusted odds ratio 7.1; 95% CI: 2.4 to 20.8]. The lottery-based rewards group did not have significantly higher circumcision uptake than the control group (adjusted odds ratio 2.5; 95% CI: 0.8 to 8.1). Conclusions: Providing compensation was effective in increasing circumcision uptake among men over a short period. The results are consistent with studies showing that such interventions can modify health behaviors by addressing economic barriers and behavioral biases in decision making. Contrary to findings from studies of other health behaviors, lottery-based rewards did not significantly increase circumcision uptake. Trial Registration: Registry for International Development Impact Evaluations: RIDIE-STUDY-ID-530e60df56107. PMID:27404012

  11. Effects of household shocks and poverty on the timing of traditional male circumcision and HIV risk in South Africa.

    PubMed

    Venkataramani, Atheendar S; Maughan-Brown, Brendan

    2013-06-01

    Poverty may influence HIV risk by increasing vulnerability to economic shocks and thereby preventing key health investments. We explored this possibility by examining the relationship between household shocks and the timing of traditional male circumcision, a practice associated with considerable expense and whose HIV-prevention benefits are larger when done earlier, even within young adulthood. Using unique data on a sample of Xhosa men, a group that almost universally practices traditional circumcision, we found that respondents in the poorest households delayed circumcision by 2 years if a household member experienced loss of income or death and/or illness. The impact of these shocks declined with increasing household income. Our findings suggest that interventions that work to mitigate the impact of shocks among the poor may be useful in HIV prevention efforts. More generally, they illustrate that the relationship between HIV and wealth may be more nuanced than assumed in previous work.

  12. Modeling Costs and Impacts of Introducing Early Infant Male Circumcision for Long-Term Sustainability of the Voluntary Medical Male Circumcision Program.

    PubMed

    Njeuhmeli, Emmanuel; Stegman, Peter; Kripke, Katharine; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Hatzold, Karin; Christensen, Alice; Stover, John

    2016-01-01

    Voluntary medical male circumcision (VMMC) has been shown to be an effective prevention strategy against HIV infection in males [1-3]. Since 2007, the President's Emergency Plan for AIDS Relief (PEPFAR) has supported VMMC programs in 14 priority countries in Africa. Today several of these countries are preparing to transition their VMMC programs from a scale-up and expansion phase to a maintenance phase. As they do so, they must consider the best approaches to sustain high levels of male circumcision in the population. The two alternatives under consideration are circumcising adolescents 10-14 years old over the long term or integrating early infant male circumcision (EIMC) into maternal and child health programs. The paper presents an analysis, using the Decision Makers Program Planning Tool, Version 2.0 (DMPPT 2.0), of the estimated cost and impact of introducing EIMC into existing VMMC programs in several countries in eastern and southern Africa. Limited cost data exist for the implementation of EIMC, but preliminary studies, such as the one detailed in Mangenah, et al. [4-5], suggest that the cost of EIMC may be less than that of adolescent and adult male circumcision. If this is the case, then adding EIMC to the VMMC program will increase the number of circumcisions that need to be performed but will not increase the total cost of the program over the long term. In addition, we found that a delayed or slow start-up of EIMC would not substantially reduce the impact of adding it to the program or increase cumulative long-term costs, which should make introduction of EIMC more feasible and attractive to countries contemplating such a program innovation.

  13. Modeling Costs and Impacts of Introducing Early Infant Male Circumcision for Long-Term Sustainability of the Voluntary Medical Male Circumcision Program

    PubMed Central

    Stegman, Peter; Kripke, Katharine; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Hatzold, Karin; Christensen, Alice; Stover, John

    2016-01-01

    Voluntary medical male circumcision (VMMC) has been shown to be an effective prevention strategy against HIV infection in males [1–3]. Since 2007, the President’s Emergency Plan for AIDS Relief (PEPFAR) has supported VMMC programs in 14 priority countries in Africa. Today several of these countries are preparing to transition their VMMC programs from a scale-up and expansion phase to a maintenance phase. As they do so, they must consider the best approaches to sustain high levels of male circumcision in the population. The two alternatives under consideration are circumcising adolescents 10–14 years old over the long term or integrating early infant male circumcision (EIMC) into maternal and child health programs. The paper presents an analysis, using the Decision Makers Program Planning Tool, Version 2.0 (DMPPT 2.0), of the estimated cost and impact of introducing EIMC into existing VMMC programs in several countries in eastern and southern Africa. Limited cost data exist for the implementation of EIMC, but preliminary studies, such as the one detailed in Mangenah, et al. [4–5], suggest that the cost of EIMC may be less than that of adolescent and adult male circumcision. If this is the case, then adding EIMC to the VMMC program will increase the number of circumcisions that need to be performed but will not increase the total cost of the program over the long term. In addition, we found that a delayed or slow start-up of EIMC would not substantially reduce the impact of adding it to the program or increase cumulative long-term costs, which should make introduction of EIMC more feasible and attractive to countries contemplating such a program innovation. PMID:27410233

  14. Obtaining a male circumcision prevalence rate of 80% among adults in a short time

    PubMed Central

    Marshall, Esaie; Rain-Taljaard, Reathe; Tsepe, Motlalepule; Monkwe, Cornelius; Taljaard, Dirk; Hlatswayo, Florence; Xaba, Dumazile; Molomo, Tebogo; Lissouba, Pascale; Puren, Adrian; Auvert, Bertran

    2017-01-01

    Abstract World Health Organization recommends a target for the male circumcision prevalence rate of 80%. This rate will have a substantial impact on the human immunodeficiency virus-acquired immunodeficiency syndrome epidemic in Eastern and Southern Africa. The objective of the study was to assess whether an innovative intervention can lead to an increased voluntary male medical circumcision (VMMC) uptake among adults in a short time. This prospective observational study of a demand generation intervention was conducted in the township of Orange Farm (South Africa) in August to November 2015. In this community male circumcision prevalence rate among adults was stable between 2010 and 2015 at 55% and 57%, despite regular VMMC campaigns at community level and the presence of a VMMC clinic that offered free VMMC. The intervention took place in a random sample of 981 households where 522 men aged 18 to 49 years accepted to participate in the study. Among the 226 uncircumcised men, 212 accepted to be enrolled in the intervention study. A personal male circumcision adviser trained in interpersonal communication skills was assigned to each uncircumcised participant. The male circumcision advisers were trained to explain the risks and benefits of VMMC, and to discuss 24 possible reasons given by men for not being circumcised. Participants were then followed for 9 weeks. Each participant had a maximum of 3 motivational interviews at home. Participants who decided to be circumcised received financial compensation for their time equivalent to 2.5 days of work at the minimum South African salary rate. Among the 212 uncircumcised men enrolled in the intervention, 69.8% (148/212; 95% confidence interval [CI]; 63.4%–75.7%) agreed to be circumcised, which defines the uptake of the intervention. The male circumcision prevalence rate of the sample increased from 56.7% (296/522) to 81.4% (425/522; 77.9%–84.6%), P < 0.001, corresponding to a relative increase of 43.6% (95% CI

  15. Christians' cut: popular religion and the global health campaign for medical male circumcision in Swaziland.

    PubMed

    Golomski, Casey; Nyawo, Sonene

    2017-01-11

    Swaziland faces one of the worst HIV epidemics in the world and is a site for the current global health campaign in sub-Saharan Africa to medically circumcise the majority of the male population. Given that Swaziland is also majority Christian, how does the most popular religion influence acceptance, rejection or understandings of medical male circumcision? This article considers interpretive differences by Christians across the Kingdom's three ecumenical organisations, showing how a diverse group people singly glossed as 'Christian' in most public health acceptability studies critically rejected the procedure in unity, but not uniformly. Participants saw medical male circumcision's promotion and messaging as offensive and circumspect, and medical male circumcision as confounding gendered expectations and sexualised ideas of the body in Swazi Culture. Pentecostal-charismatic churches were seen as more likely to accept medical male circumcision, while traditionalist African Independent Churches rejected the operation. The procedure was widely understood to be a personal choice, in line with New Testament-inspired commitments to metaphorical circumcision as a way of receiving God's grace.

  16. [Clinical studies of shang ring male circumcision in China and Africa].

    PubMed

    Cheng, Feng; Lü, Nian-Qing; Xu, Hao-Qin; Barone, Mark A; Lee, Richard; Goldstein, Marc; Li, Philip S

    2014-04-01

    HIV/STIs remain a major global public health problem. One of the global strategies for the prevention and control of HIV/STIs is to interrupt their transmission, which requires the public health methods based on scientific evidence and cost-effectiveness. The scale-up of male circumcision services in the priority countries of the HIV-prevention project in sub-Saharan Africa has been hampered by the scarcity of trained providers and relative technical difficulty of male circumcision techniques recommended by WHO and UNAIDS. Shang Ring is an innovative and disposable device for male circumcision, which has been safely used for over 600 000 males in China since 2006. Clinical studies of more than 3 000 cases of Shang Ring circumcision in China, Kenya, Zambia, and Uganda have demonstrated its safety, effectiveness, acceptability and ease of use. The most obvious advantages of Shang Ring include short procedure time (3-6 min), excellent postoperative cosmesis, low rate of complications, high acceptance by clients and providers, ease of use, and standardization for reliable performance. As an innovative technique, Shang Ring has a great potential for facilitating the safe and effective scale-up of circumcision services. This article comprehensively reviews the clinical studies of Shang Ring male circumcision in China and Africa.

  17. Innovative Methods of Male Circumcision for HIV Prevention-Getting the Right Evidence.

    PubMed

    Samuelson, Julia; Hargreave, Timothy; Ridzon, Renee; Farley, Tim

    2016-06-01

    World Health Organization recommends that countries with hyperendemic and generalized HIV epidemics implement voluntary medical male circumcision programs for HIV prevention. Innovative methods of male circumcision including devices have the potential to simplify the procedure, reduce time and cost, increase client acceptability, enhance safety, and expand the numbers of providers who may perform circumcision. We describe work led by World Health Organization and supported by global partners to define a pathway for the evaluation of efficacy and safety of male circumcision devices, to set priority criteria, and to establish a process to guide the use of devices in publicly funded voluntary medical male circumcision programs for HIV prevention. A device classification scheme, an expert Technical Advisory Group on Innovations in Male Circumcision, and a formal prequalification program have also guided considerations on safe use of devices. A rigorous approach was deemed appropriate given the intervention is for use among healthy men for public health purposes. The pathway and processes led to coordinated research, better standardization in research outcomes, and guidance that informed the research, introduction and implementation phases. The lessons learnt from this case study can inform evaluation and use of future public health innovations.

  18. Male circumcision as strategy for HIV prevention and sexually transmitted diseases. The potential role of traditional birth attendants in neonatal male circumcision.

    PubMed

    Dini, Catia

    2010-01-01

    In developing countries, it would be advisable to give priority to human immunodeficiency virus (HIV) prevention strategies, because of the high mortality caused by the rapid spread of the pandemic. Furthermore, HIV prevention could contribute to the mitigation of tuberculosis (TB) propagation, which is tightly correlated to acquired immune deficiency syndrome (AIDS). As demonstrated, male circumcision (MC) confers protection against HIV and sexually transmitted diseases (STD). The suggested strategy considers the neonatal MC advantageous, since it is safer, feasible, culturally more acceptable and less costly than adult MC. This approach is based on the assumption that, if newborn males are circumcised, within the next 15-20 years the sexually active population will be almost entirely circumcised and, consequently, the HIV transmission will be reduced. The employment of retrained traditional birth attendants is considered in order to implement the MC after the child birth and to facilitate its acceptance in those contexts where it is not traditionally performed.

  19. Advertising for Demand Creation for Voluntary Medical Male Circumcision

    PubMed Central

    Wilson, Nicholas; Frade, Sasha; Rech, Dino

    2016-01-01

    Objective: To measure the effects of information, a challenge, and a conditional cash transfer on take-up of voluntary medical male circumcision (VMMC). Design: A randomized, controlled experiment with 4000 postcard recipients in Soweto (Johannesburg), South Africa. Methods: We examined differences in take-up of several decisions in the VMMC cascade between the control arm and each of several intervention arms using logistic regression. Results: Logistic regression analysis indicated that the group offered US $10 as compensation and the group challenged with “Are you tough enough?” had significantly higher take-up of the VMMC procedure than did the control group [odds ratios, respectively, 5.30 (CI: 2.20 to 12.76) and 2.70 (CI: 1.05 to 6.91)]. Similarly, the compensation group had significantly higher take-up of the VMMC counseling session than did the control group [odds ratio 3.76 (CI: 1.79 to 7.89)]. The analysis did not reveal significantly different take-up of either the VMMC counseling session or the procedure in the partner preference information group compared with the control group [odds ratios, respectively, 1.23 (CI: 0.51 to 2.97) and 1.67 (CI: 0.61 to 4.62)]. The analysis did not reveal significantly higher take-up of the VMMC nurse hotline in any intervention group compared with the control group [odds ratios for US $10, information, and challenge, respectively, 1.17 (CI: 0.67 to 2.07), 0.69 (CI: 0.36 to 1.32), and 0.60 (0.31 to 1.18)]. Conclusions: Among adult males in Soweto, South Africa, compensation of US $10 provided conditional on completing the VMMC counseling session compared with no compensation offer and a postcard with a challenge, “Are you tough enough?” compared with no challenge, resulted in moderate increases in take-up of circumcision. PMID:27404010

  20. Do the Benefits of Male Circumcision Outweigh the Risks? A Critique of the Proposed CDC Guidelines

    PubMed Central

    Earp, Brian D.

    2015-01-01

    The Centers for Disease Control and Prevention (CDC) have announced a set of provisional guidelines concerning male circumcision, in which they suggest that the benefits of the surgery outweigh the risks. I offer a critique of the CDC position. Among other concerns, I suggest that the CDC relies more heavily than is warranted on studies from Sub-Saharan Africa that neither translate well to North American populations nor to circumcisions performed before an age of sexual debut; that it employs an inadequate conception of risk in its benefit vs. risk analysis; that it fails to consider the anatomy and functions of the penile prepuce (i.e., the part of the penis that is removed by circumcision); that it underestimates the adverse consequences associated with circumcision by focusing on short-term surgical complications rather than long-term harms; that it portrays both the risks and benefits of circumcision in a misleading manner, thereby undermining the possibility of obtaining informed consent; that it evinces a superficial and selective analysis of the literature on sexual outcomes associated with circumcision; and that it gives less attention than is desirable to ethical issues surrounding autonomy and bodily integrity. I conclude that circumcision before an age of consent is not an appropriate health-promotion strategy. PMID:25853108

  1. Do the Benefits of Male Circumcision Outweigh the Risks? A Critique of the Proposed CDC Guidelines.

    PubMed

    Earp, Brian D

    2015-01-01

    The Centers for Disease Control and Prevention (CDC) have announced a set of provisional guidelines concerning male circumcision, in which they suggest that the benefits of the surgery outweigh the risks. I offer a critique of the CDC position. Among other concerns, I suggest that the CDC relies more heavily than is warranted on studies from Sub-Saharan Africa that neither translate well to North American populations nor to circumcisions performed before an age of sexual debut; that it employs an inadequate conception of risk in its benefit vs. risk analysis; that it fails to consider the anatomy and functions of the penile prepuce (i.e., the part of the penis that is removed by circumcision); that it underestimates the adverse consequences associated with circumcision by focusing on short-term surgical complications rather than long-term harms; that it portrays both the risks and benefits of circumcision in a misleading manner, thereby undermining the possibility of obtaining informed consent; that it evinces a superficial and selective analysis of the literature on sexual outcomes associated with circumcision; and that it gives less attention than is desirable to ethical issues surrounding autonomy and bodily integrity. I conclude that circumcision before an age of consent is not an appropriate health-promotion strategy.

  2. Psychological and sexual effects of circumcision in adult males

    PubMed Central

    Aydogmus, Yasin; Semiz, Murat; Er, Okan; Bas, Okan; Atay, Irfan; Kilinc, Muhammet Fatih

    2016-01-01

    Introduction: Our aim was to investigate the psychological and sexual effects of circumcision in adult men, and analyze these changes following circumcision. Methods: We included 37 adults who applied to our clinic for circumcision and who did not have any psychiatric or urologic disorders and age-matched 30 controls in our study. Body Cathexis Scale (BCS), Liebowitz Social Anxiety Scale (LSAS), and Premature Ejaculation Diagnostic Tool (PEDT) were applied to the study group twice, once before and once three months after circumcision, and only once in the control group. Also, intravaginal ejaculation latency time (IELT) was noted and premature ejaculation (PE) evaluation was done. Intra- and intergroup comparisons were performed. Results: The two groups were similar with regard to demographic data. Comparison of preoperative BCS and LSAS scores with the scores of the control group showed significant differences (p=0.003, p<0.001, and p<0.001, respectively). However, postoperative scores were similar to the scores obtained in the control group (p=0.768, p>0.05, and p>0.05, respectively). Scores of all scales showed significant improvements postoperatively. Also, PEDT scores and IELT changes before and after circumcision were significant in the study group, but not when compared to the control group. Conclusions: Our results indicated that social anxiety and anxiety levels decreased after circumcision in adult Turkish men, and their body gratification increased. We found that not being circumcised might negatively affect individuals in adulthood when it comes to body image and sexual satisfaction, however, both improve after circumcision. PMID:27790295

  3. Voluntary medical male circumcision in resource-constrained settings.

    PubMed

    Tobian, Aaron A R; Adamu, Tigistu; Reed, Jason B; Kiggundu, Valerian; Yazdi, Youseph; Njeuhmeli, Emmanuel

    2015-12-01

    Throughout East and Southern Africa, the WHO recommends voluntary medical male circumcision (VMMC) to reduce heterosexual HIV acquisition. Evidence has informed policy and the implementation of VMMC programmes in these countries. VMMC has been incorporated into the HIV prevention portfolio and more than 9 million VMMCs have been performed. Conventional surgical procedures consist of forceps-guided, dorsal slit or sleeve resection techniques. Devices are also becoming available that might help to accelerate the scale-up of adult VMMC. The ideal device should make VMMC easier, safer, faster, sutureless, inexpensive, less painful, require less infrastructure, be more acceptable to patients and should not require follow-up visits. Elastic collar compression devices cause vascular obstruction and necrosis of foreskin tissue and do not require sutures or injectable anaesthesia. Collar clamp devices compress the proximal part of the foreskin to reach haemostasis; the distal foreskin is removed, but the device remains and therefore no sutures are required. Newer techniques and designs, such as tissue adhesives and a circular cutter with stapled anastomosis, are improvements, but none of these methods have achieved all desirable characteristics. Further research, design and development are needed to address this gap to enable the expansion of the already successful VMMC programmes for HIV prevention.

  4. Modeling the Impact of Uganda’s Safe Male Circumcision Program: Implications for Age and Regional Targeting

    PubMed Central

    Kripke, Katharine; Vazzano, Andrea; Kirungi, William; Musinguzi, Joshua; Opio, Alex; Ssempebwa, Rhobbinah; Nakawunde, Susan; Kyobutungi, Sheila; Akao, Juliet N.; Magala, Fred; Mwidu, George; Castor, Delivette

    2016-01-01

    Background Uganda aims to provide safe male circumcision (SMC) to 80% of men ages 15–49 by 2016. To date, only 2 million men have received SMC of the 4.2 million men required. In response to age and regional trends in SMC uptake, the country sought to re-examine its targets with respect to age and subnational region, to assess the program’s progress, and to refine the implementation approach. Methods and Findings The Decision Makers’ Program Planning Tool, Version 2.0 (DMPPT 2.0), was used in conjunction with incidence projections from the Spectrum/AIDS Impact Module (AIM) to conduct this analysis. Population, births, deaths, and HIV incidence and prevalence were used to populate the model. Baseline male circumcision prevalence was derived from the 2011 AIDS Indicator Survey. Uganda can achieve the most immediate impact on HIV incidence by circumcising men ages 20–34. This group will also require the fewest circumcisions for each HIV infection averted. Focusing on men ages 10–19 will offer the greatest impact over a 15-year period, while focusing on men ages 15–34 offers the most cost-effective strategy over the same period. A regional analysis showed little variation in cost-effectiveness of scaling up SMC across eight regions. Scale-up is cost-saving in all regions. There is geographic variability in program progress, highlighting two regions with low baseline rates of circumcision where additional efforts will be needed. Conclusion Focusing SMC efforts on specific age groups and regions may help to accelerate Uganda’s SMC program progress. Policy makers in Uganda have already used model outputs in planning efforts, proposing males ages 10–34 as a priority group for SMC in the 2014 application to the Global Fund’s new funding model. As scale-up continues, the country should also consider a greater effort to expand SMC in regions with low MC prevalence. PMID:27410234

  5. The role of the foreskin in male circumcision: an evidence-based review.

    PubMed

    Dinh, Minh H; Fahrbach, Kelly M; Hope, Thomas J

    2011-03-01

    HIV sexual transmission via the male genital tract remains poorly defined. Male circumcision was shown to reduce female-to-male transmission in Africa, providing a clue that the foreskin plays a role in the route of transmission. Scientific data in four categories relating to how the foreskin might affect HIV transmission is summarized: (i) surface area, (ii) microbiologic environment, (iii) HIV-1-susceptible cells, and (iv) tissue structure. The relative contribution of each of these areas is yet unknown, and further studies will be crucial in understanding how male circumcision affects HIV transmission in men.

  6. “If You Are Not Circumcised, I Cannot Say Yes”: The Role of Women in Promoting the Uptake of Voluntary Medical Male Circumcision in Tanzania

    PubMed Central

    Osaki, Haika; Mshana, Gerry; Wambura, Mwita; Grund, Jonathan; Neke, Nyasule; Kuringe, Evodius; Plotkin, Marya; Mahler, Hally; Terris-Prestholt, Fern; Weiss, Helen; Changalucha, John

    2015-01-01

    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. PMID:26402231

  7. Male Circumcision Significantly Reduces Prevalence and Load of Genital Anaerobic Bacteria

    PubMed Central

    Liu, Cindy M.; Hungate, Bruce A.; Tobian, Aaron A. R.; Serwadda, David; Ravel, Jacques; Lester, Richard; Kigozi, Godfrey; Aziz, Maliha; Galiwango, Ronald M.; Nalugoda, Fred; Contente-Cuomo, Tania L.; Wawer, Maria J.; Keim, Paul; Gray, Ronald H.; Price, Lance B.

    2013-01-01

    ABSTRACT Male circumcision reduces female-to-male HIV transmission. Hypothesized mechanisms for this protective effect include decreased HIV target cell recruitment and activation due to changes in the penis microbiome. We compared the coronal sulcus microbiota of men from a group of uncircumcised controls (n = 77) and from a circumcised intervention group (n = 79) at enrollment and year 1 follow-up in a randomized circumcision trial in Rakai, Uganda. We characterized microbiota using16S rRNA gene-based quantitative PCR (qPCR) and pyrosequencing, log response ratio (LRR), Bayesian classification, nonmetric multidimensional scaling (nMDS), and permutational multivariate analysis of variance (PerMANOVA). At baseline, men in both study arms had comparable coronal sulcus microbiota; however, by year 1, circumcision decreased the total bacterial load and reduced microbiota biodiversity. Specifically, the prevalence and absolute abundance of 12 anaerobic bacterial taxa decreased significantly in the circumcised men. While aerobic bacterial taxa also increased postcircumcision, these gains were minor. The reduction in anaerobes may partly account for the effects of circumcision on reduced HIV acquisition. PMID:23592260

  8. Process Evaluation of a Sport-Based Voluntary Medical Male Circumcision Demand-Creation Intervention in Bulawayo, Zimbabwe

    PubMed Central

    Hershow, Rebecca B.; Kaufman, Zachary A.; Gannett, Katherine R.; Kombandeya, Thandanani; Chaibva, Cynthia; Ross, David A.; Harrison, Abigail

    2016-01-01

    Introduction: Grassroot Soccer (GRS) developed 2 brief and scalable voluntary medical male circumcision (VMMC) promotion interventions for males in Bulawayo, Zimbabwe, consisting of a 60-minute interactive, soccer-themed educational session with follow-up behavioral and logistical reinforcement. Both interventions were led by circumcised male community leaders (“coaches”) ages 18–30. “Make The Cut” (MTC) targeted adult males on soccer teams and “Make The Cut+” targeted boys in secondary schools. We conducted a process evaluation of MTC and Make The Cut+ to investigate perceptions of program impact, intervention components, and program delivery; participants' understandings of intervention content; and factors related to uptake. Methods: We conducted 17 interviews and 2 focus group discussions with coaches and 29 interviews with circumcised (n = 13) and uncircumcised participants (n = 16). Results: Findings demonstrate high program acceptability, highlighting the coach–participant relationship as a key factor associated with uptake. Specifically, participants valued the coaches' openness to discuss their personal experiences with VMMC and the accompaniment by their coaches to the VMMC clinic. Conclusions: Should the coach quality remain consistent at scale, MTC offers an effective approach toward generating VMMC demand among males. PMID:27749598

  9. HIV prevention: Making male circumcision the 'right' tool for the job.

    PubMed

    Bell, Kirsten

    2015-01-01

    In recent years, HIV/AIDS programming has been transformed by an ostensibly 'new' procedure: male circumcision. This article examines the rise of male circumcision as the 'right' HIV prevention tool. Treating this controversial topic as a 'matter of concern' rather than a 'matter of fact', I examine the reasons why male circumcision came to be seen as a partial solution to the problem of HIV transmission in the twenty-first century and to what effect. Grounded in a close reading of the primary literature, I suggest that the embrace of male circumcision in HIV prevention must be understood in relation to three factors: (1) the rise of evidence-based medicine as the dominant paradigm for conceptualising medical knowledge, (2) the fraught politics of HIV/AIDS research and funding, which made the possibility of a biomedical intervention attractive and (3) underlying assumptions about the nature of African 'culture' and 'sexuality'. I conclude by stressing the need to expand the parameters of the debate beyond the current polarised landscape, which presents us with a problematic either/or scenario regarding the efficacy of male circumcision.

  10. Impediments for the Uptake of the Botswana Government's Male Circumcision Initiative for HIV Prevention

    PubMed Central

    Sabone, Motshedisi; Magowe, Mabel; Busang, Lesego; Moalosi, Jonathan; Binagwa, Benjamin; Mwambona, Janet

    2013-01-01

    Botswana remains one of the countries with high prevalence of HIV infection with a population prevalence rate of 17.6 in 2008. In 2009, the Ministry of Health launched male circumcision as an additional strategy to the already existing HIV preventive efforts. The purpose of this paper is to share what the participants of a survey to evaluate a short-term male circumcision communication strategy in seven health districts of Botswana reported as impediments for the program's uptake. Qualitative data were obtained from 32 key informants and 36 focus group discussions in 2011. Content analysis method was used to analyze data and to derive themes and subthemes. Although male circumcision was generally acceptable to communities in Botswana, the uptake of the program was slow, and participants attributed that to a number of challenges or impediments that were frustrating the initiative. The impediments were organized into sociocultural factors, knowledge/informational factors, and infrastructural and system factors. PMID:24228001

  11. Programme science research on medical male circumcision scale-up in sub-Saharan Africa.

    PubMed

    Gray, Ronald H; Wawer, Maria J; Kigozi, Godfrey

    2013-08-01

    Three randomised trials demonstrate that voluntary medical male circumcision (MMC) reduces male HIV acquisition by 50-60%, and post-trial surveillance has shown that the effects are long lasting. Scale-up of services has been initiated in 14 high-priority sub-Saharan African countries with high rates of HIV and low prevalence of MMC. However, circumcision coverage in the region remains low. Challenges to MMC rollout include suboptimal demand among higher-risk men, the need to expand access and reduce costs of MMC through personnel task shifting and task sharing, assuring and maintaining a high quality of service provision, and the testing and introduction of non-surgical devices. In addition, early infant male circumcision has not been adequately evaluated in Africa. Here, we describe challenges to implementation and discuss the ongoing and future role of implementation and programme science in addressing such challenges.

  12. Need for physician education on the benefits and risks of male circumcision in the United States.

    PubMed

    Carbery, Baevin; Zhu, Julia; Gust, Deborah A; Chen, Robert T; Kretsinger, Katrina; Kilmarx, Peter H

    2012-08-01

    Physicians may be called upon to counsel male patients or parents of newborn males regarding their decision to circumcise their newborn sons. The purpose of the present study was to describe physicians who do not understand the benefits and risks associated with male circumcision well enough to counsel parents of newborn male infants and adult men. A self-administered, cross-sectional electronic survey of physicians was conducted in 2008. We analyzed responses from 1,500 physicians (510 family practitioners, 490 internists, 250 pediatricians, and 250 obstetricians/gynecologists). Nearly 22% (n = 327/1500) reported they did not understand the risks and benefits of newborn male circumcision well enough to counsel parents and 40.3% (n = 504/1250) reported not understanding the risks and benefits well enough to counsel adult men. A substantial minority of physicians may need additional training and/or information about current male circumcision research to feel comfortable counseling parents of newborn male infants or adult men.

  13. Can Male Circumcision Have an Impact on the HIV Epidemic in Men Who Have Sex with Men?

    PubMed Central

    Goodreau, Steven M.; Carnegie, Nicole B.; Vittinghoff, Eric; Lama, Javier R.; Fuchs, Jonathan D.; Sanchez, Jorge; Buchbinder, Susan P.

    2014-01-01

    Background Three trials have demonstrated the prophylactic effect of male circumcision (MC) for HIV acquisition among heterosexuals, and MC interventions are underway throughout sub-Saharan Africa. Similar efforts for men who have sex with men (MSM) are stymied by the potential for circumcised MSM to acquire HIV easily through receptive sex and transmit easily through insertive sex. Existing work suggests that MC for MSM should reach its maximum potential in settings where sexual role segregation is historically high and relatively stable across the lifecourse; HIV incidence among MSM is high; reported willingness for prophylactic circumcision is high; and pre-existing circumcision rates are low. We aim to identify the likely public health impact that MC interventions among MSM would have in one setting that fulfills these conditions—Peru—as a theoretical upper bound for their effectiveness among MSM generally. Methods and Findings We use a dynamic, stochastic sexual network model based in exponential-family random graph modeling and parameterized from multiple behavioral surveys of Peruvian MSM. We consider three enrollment criteria (insertive during 100%, >80% or >60% of UAI) and two levels of uptake (25% and 50% of eligible men); we explore sexual role proportions from two studies and different frequencies of switching among role categories. Each scenario is simulated 10 times. We estimate that efficiency could reach one case averted per 6 circumcisions. However, the population-level impact of an optimistic MSM-MC intervention in this setting would likely be at most ∼5–10% incidence and prevalence reductions over 25 years. Conclusions Roll-out of MC for MSM in Peru would not result in a substantial reduction in new HIV infections, despite characteristics in this population that could maximize such effects. Additional studies are needed to confirm these results for other MSM populations, and providers may consider the individual health benefits of

  14. Cost and Impact of Voluntary Medical Male Circumcision in South Africa: Focusing the Program on Specific Age Groups and Provinces

    PubMed Central

    Kripke, Katharine; Thambinayagam, Ananthy; Pillay, Yogan; Loykissoonlal, Dayanund; Bonnecwe, Collen; Barron, Peter; Kiwango, Eva; Castor, Delivette

    2016-01-01

    Background In 2012, South Africa set a goal of circumcising 4.3 million men ages 15–49 by 2016. By the end of March 2014, 1.9 million men had received voluntary medical male circumcision (VMMC). In an effort to accelerate progress, South Africa undertook a modeling exercise to determine whether circumcising specific client age groups or geographic locations would be particularly impactful or cost-effective. Results will inform South Africa’s efforts to develop a national strategy and operational plan for VMMC. Methods and Findings The study team populated the Decision Makers’ Program Planning Tool, Version 2.0 (DMPPT 2.0) with HIV incidence projections from the Spectrum/AIDS Impact Module (AIM), as well as national and provincial population and HIV prevalence estimates. We derived baseline circumcision rates from the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey. The model showed that circumcising men ages 20–34 offers the most immediate impact on HIV incidence and requires the fewest circumcisions per HIV infection averted. The greatest impact over a 15-year period is achieved by circumcising men ages 15–24. When the model assumes a unit cost increase with client age, men ages 15–29 emerge as the most cost-effective group. When we assume a constant cost for all ages, the most cost-effective age range is 15–34 years. Geographically, the program is cost saving in all provinces; differences in the VMMC program’s cost-effectiveness across provinces were obscured by uncertainty in HIV incidence projections. Conclusion The VMMC program’s impact and cost-effectiveness vary by age-targeting strategy. A strategy focusing on men ages 15–34 will maximize program benefits. However, because clients older than 25 access VMMC services at low rates, South Africa could consider promoting demand among men ages 25–34, without denying services to those in other age groups. Uncertainty in the provincial estimates makes them

  15. Safety and Acceptability of the PrePex Device When Used in Routine Male Circumcision Service Delivery During Active Surveillance in Zimbabwe

    PubMed Central

    Mavhu, Webster; Ncube, Getrude; Xaba, Sinokuthemba; Madidi, Ngonidzashe; Keatinge, Jo; Dhodho, Efison; Samkange, Christopher A.; Tshimanga, Mufuta; Mangwiro, Tonderayi; Mugurungi, Owen; Njeuhmeli, Emmanuel; Cowan, Frances M.

    2016-01-01

    Background: Male circumcision devices have the potential to accelerate voluntary medical male circumcision roll-out, with PrePex being one promising device. Here, we present findings on safety and acceptability from active surveillance of the implementation of PrePex among 1000 males circumcised in Zimbabwe. Methods: The first 1000 men consecutively circumcised using PrePex during routine service delivery were actively followed up. Outcome measures included PrePex uptake, attendance for postcircumcision visits, and adverse events (AEs). A survey was conducted among 500 consecutive active surveillance clients to assess acceptability and satisfaction with PrePex. Results: A total of 2156 men aged 18 years or older were circumcised across the 6 PrePex active surveillance sites. Of these, 1000 (46.4%) were circumcised using PrePex. Among them, 4 (0.4%) self-removals that required surgery (severe AEs) were observed. Six (0.6%) removals by providers (moderate AEs) did not require surgery. A further 280 (28%) AEs were mild or moderate pain during device removal. There were also 12 (1.2%) moderate AEs unrelated to pain. All AEs resolved without sequelae. There was high adherence to follow-up appointments, with 97.7% of clients attending the scheduled day 7 visit. Acceptability of PrePex was high among survey participants, 93% indicated willingness to recommend the device to peers. Of note, 95.8% of respondents reported experiencing pain when the device was being removed. Additionally, 85.2% reported experiencing odor while wearing the device or during removal. Conclusions: Active surveillance of the first 1000 men circumcised using PrePex suggests that the device is both safe and acceptable when used in routine service delivery. PMID:27331593

  16. Early Infant Male Circumcision in Cameroon and Senegal: Demand, Service Provision, and Cultural Context

    PubMed Central

    Kenu, Ernest; Sint, Tin Tin; Kamenga, Claude; Ekpini, Rene

    2016-01-01

    ABSTRACT Background: Male circumcision is almost universal in North and West Africa, and practiced for various reasons. Yet there is little documentation on service delivery, clinical procedures, policies, and programmatic strategies. The United Nations Children’s Fund (UNICEF) commissioned country program reviews in 2014 to shed light on the delivery of male circumcision services for infants in Cameroon and Senegal. Methods: We conducted a policy desk review, key informant interviews, and focus group discussions at health centers and in communities. Between December 2014 and January 2015, we conducted 21 key informant interviews (13 with regional and district officers, 5 with national officers, and 3 with UNICEF officials) and 36 focus group discussions (6 with men, 6 with women, 12 with adolescent boys, and 12 with service providers). Some of the men and women were parents of the adolescents who participated in the focus group discussions. In the French-speaking areas, the focus group discussions were conducted in French through an accredited translator, audio recorded, and transcribed into English. Results: All of the facilities we visited in Cameroon and Senegal offer medical male circumcision, with 10 out of 12 performing early infant male circumcision (EIMC) routinely. Neither country has policies, guidelines, or strategies for EIMC. The procedure is done mainly by untrained service providers, with some providers using modern circumcision devices. There are no key messages on EIMC for families; the increasing demand for EIMC is led by the community. Conclusion: Despite the absence of national policies and strategies, EIMC is routinely offered at all levels of the health care system in Cameroon and Senegal, mainly by untrained service providers. Improving circumcision services will require guidelines for EIMC and improvements in training, equipment, supply chains, recordkeeping, and demand creation. PMID:27413080

  17. Investigating Voluntary Medical Male Circumcision Program Efficiency Gains through Subpopulation Prioritization: Insights from Application to Zambia

    PubMed Central

    Awad, Susanne F.; Sgaier, Sema K.; Tambatamba, Bushimbwa C.; Mohamoud, Yousra A.; Lau, Fiona K.; Reed, Jason B.; Njeuhmeli, Emmanuel; Abu-Raddad, Laith J.

    2015-01-01

    Background Countries in sub-Saharan Africa are scaling-up voluntary male medical circumcision (VMMC) as an HIV intervention. Emerging challenges in these programs call for increased focus on program efficiency (optimizing program impact while minimizing cost). A novel analytic approach was developed to determine how subpopulation prioritization can increase program efficiency using an illustrative application for Zambia. Methods and Findings A population-level mathematical model was constructed describing the heterosexual HIV epidemic and impact of VMMC programs (age-structured mathematical (ASM) model). The model stratified the population according to sex, circumcision status, age group, sexual-risk behavior, HIV status, and stage of infection. A three-level conceptual framework was also developed to determine maximum epidemic impact and program efficiency through subpopulation prioritization, based on age, geography, and risk profile. In the baseline scenario, achieving 80% VMMC coverage by 2017 among males 15–49 year old, 12 VMMCs were needed per HIV infection averted (effectiveness). The cost per infection averted (cost-effectiveness) was USD $1,089 and 306,000 infections were averted. Through age-group prioritization, effectiveness ranged from 11 (20–24 age-group) to 36 (45–49 age-group); cost-effectiveness ranged from $888 (20–24 age-group) to $3,300 (45–49 age-group). Circumcising 10–14, 15–19, or 20–24 year old achieved the largest incidence rate reduction; prioritizing 15–24, 15–29, or 15–34 year old achieved the greatest program efficiency. Through geographic prioritization, effectiveness ranged from 9–12. Prioritizing Lusaka achieved the highest effectiveness. Through risk-group prioritization, prioritizing the highest risk group achieved the highest effectiveness, with only one VMMC needed per infection averted; the lowest risk group required 80 times more VMMCs. Conclusion Epidemic impact and efficiency of VMMC programs can be

  18. Safe male circumcision in Botswana: Tension between traditional practices and biomedical marketing

    PubMed Central

    Katisi, Masego; Daniel, Marguerite

    2015-01-01

    Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance. PMID:25866013

  19. Safe male circumcision in Botswana: tension between traditional practices and biomedical marketing.

    PubMed

    Katisi, Masego; Daniel, Marguerite

    2015-01-01

    Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance.

  20. Cultural bias in the AAP's 2012 Technical Report and Policy Statement on male circumcision.

    PubMed

    Frisch, Morten; Aigrain, Yves; Barauskas, Vidmantas; Bjarnason, Ragnar; Boddy, Su-Anna; Czauderna, Piotr; de Gier, Robert P E; de Jong, Tom P V M; Fasching, Günter; Fetter, Willem; Gahr, Manfred; Graugaard, Christian; Greisen, Gorm; Gunnarsdottir, Anna; Hartmann, Wolfram; Havranek, Petr; Hitchcock, Rowena; Huddart, Simon; Janson, Staffan; Jaszczak, Poul; Kupferschmid, Christoph; Lahdes-Vasama, Tuija; Lindahl, Harry; MacDonald, Noni; Markestad, Trond; Märtson, Matis; Nordhov, Solveig Marianne; Pälve, Heikki; Petersons, Aigars; Quinn, Feargal; Qvist, Niels; Rosmundsson, Thrainn; Saxen, Harri; Söder, Olle; Stehr, Maximilian; von Loewenich, Volker C H; Wallander, Johan; Wijnen, Rene

    2013-04-01

    The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non-US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.

  1. Coverage of newborn and adult male circumcision varies among public and private US payers despite health benefits.

    PubMed

    Clark, Sarah J; Kilmarx, Peter H; Kretsinger, Katrina

    2011-12-01

    Studies have shown that male circumcision greatly reduces the risk for heterosexual transmission of HIV, other sexually transmitted infections, infant urinary tract infections, penile cancer, and other adverse health outcomes. Given recent data regarding these health benefits and the cost-effectiveness of newborn male circumcision, national policy makers are developing new recommendations regarding circumcision for newborn, adolescent, and adult males. To investigate the implications, this study assessed insurance coverage and reimbursement for routine newborn and adult male circumcision in private and public health plans in 2009. We found that coverage varies across private and public payers. Private insurance provides far broader coverage than state Medicaid programs for routine newborn male circumcision. Specifically, Medicaid programs in seventeen states do not cover it, even though low-income populations have a higher risk of HIV and other sexually transmitted diseases compared to higher-income groups. For adult male circumcision, coverage is generally sparse across public and private plans. Presentation of evidence-based recommendations--for example, from the Centers for Disease Control and Prevention--may be necessary if coverage for newborn and adult male circumcision is to be expanded.

  2. Perceptions about medical male circumcision and sexual behaviours of adults in rural Uganda: a cross sectional study

    PubMed Central

    Mukama, Trasias; Ndejjo, Rawlance; Musinguzi, Geofrey; Musoke, David

    2015-01-01

    Introduction Medical male circumcision is currently recognized as an additional important HIV preventive intervention to reduce the risk of heterosexually acquired HIV infection in men. However, sexual behaviours after medical circumcision can potentially reduce the expected benefits of the practice. This study explored the perceptions about medical male circumcision and sexual behaviours of adults in Kayunga district, Uganda. Methods A cross-sectional study was carried out among 393 respondents using a semi structured questionnaire. In addition, four focus group discussions were conducted. Quantitative data was analysed using STATA 12. Univariate, bivariate and multivariate analyses were carried out. Qualitative data was analysed thematically. Results The study established various perceptions about medical male circumcision and sexual behaviours. Majority 247 (64.5%) did not perceive circumcision as a practice that can lead men to have multiple sexual partners. Males were 3 times more likely to think that circumcision would lead to having multiple sexual partners than females (AOR=2.99, CI: 1.93-4.61). Only 89 (23.2%) believed that circumcision would lead to complacency and compromise the use of condoms to prevent against infection with HIV. Respondents who had education above primary were less likely to think that circumcision would compromise the use of condoms (AOR=0.49, CI: 0.31- 0.79). The perception that circumcised youths were less likely to abstain from sexual intercourse was less held among those with education above primary (AOR=0.58, CI: 0.37-0.91) and those older than 30 years (AOR=0.59, CI: 0.38-0.92). Conclusion There were gaps in knowledge and negative perceptions about MMC in the study community. Measures are needed to avert the negative perceptions by equipping communities with sufficient, accurate and consistent information about medical male circumcision and sexual behaviour. PMID:26985272

  3. Factors contributing to the low uptake of medical male circumcision in Mutare Rural District, Zimbabwe

    PubMed Central

    Chiringa, Irene O.; Mashau, Ntsieni S.

    2016-01-01

    Background Medical male circumcision (MMC) has become a significant dimension of HIV prevention interventions, after the results of three randomised controlled trials in Uganda, South Africa and Kenya demonstrated that circumcision has a protective effect against contracting HIV of up to 60%. Following recommendations by the World Health Organization, Zimbabwe in 2009 adopted voluntary MMC as an additional HIV prevention strategy to the existing ABC behaviour change model. Purpose The purpose of this study is thus to investigate the factors contributing to the low uptake of MMC. Methods The study was a quantitative cross-sectional survey conducted in Mutare rural district, Zimbabwe. Questionnaires with open- and closed-ended questions were administered to the eligible respondents. The target population were male participants aged 15–29 who met the inclusion criteria. The households were systematically selected with a sample size of 234. Statistical Package for the Social Sciences was used to analyse the data. Results Socioculturally, circumcised men are viewed as worthless (37%), shameful (30%) and are tainted as promiscuous (20%), psychological factors reported were infection and delayed healing (39%), being ashamed and dehumanised (58%), stigmatised and discriminated (40.2%) and fear of having an erection during treatment period (89.7%) whilst socio-economic factors were not having time, as it will take their time from work (58%) and complications may arise leading to spending money on treatment (84%). Conclusion Knowledge deficits regarding male medical circumcision lead to low uptake, education on male medical circumcision and its benefits. Comprehensive sexual health education should target men and dispel negative attitudes related to the use of health services. PMID:27380850

  4. Prospective investigation of penile length with newborn male circumcision and second to fourth digit ratio

    PubMed Central

    Park, Jong Kwan; Doo, A. Ram; Kim, Joo Heung; Park, Hyung Sub; Do, Jung Mo; Choi, Hwang; Park, Seung Chol; Kim, Myung Ki; Jeong, Young Beom; Kim, Hyung Jim; Kim, Young Gon; Shin, Yu Seob

    2016-01-01

    Introduction: We prospectively investigated the relationship between newborn male circumcision (NMC) and second to fourth digit ratio with penile length. Methods: As participants for our study, we identified already circumcised young patients who visited our hospital for urological treatment. The age at which the circumcision had been done was assessed. The patients’ height and weight were measured. Second to fourth digit ratio was calculated by measuring the second and fourth digit lengths. The flaccid and erectile penile lengths were measured from the base of the penis to the tip of the glans in standing position. Results: A total of 248 patients were included in our study. In univariate analysis, height, second to fourth digit ratio, flaccid penile length, and age of circumcision were associated with erectile penile length. Among these variables, second to fourth digit ratio, flaccid penile length, and age of circumcision were significant predictive factors for erectile penile length in multivariate analysis. The subjects were divided into two groups, including 72 patients in the NMC group and 176 patients in the non-NMC group. No significant difference was found in height, weight, and second to fourth digit ratio between both groups. However, flaccid (p<0.001) and erectile (p=0.001) penile lengths were shorter in the NMC group than in the non-NMC group. Conclusions: Despite the small number of subjects, this study shows that NMC was associated with shorter penile length. Second to fourth digit ratio, flaccid penile length, and age of circumcision were also significant predictive factors for erectile penile length. Further multicentre studies with larger number of subjects and biochemical analyses are needed for potential clinical applicability. PMID:27695583

  5. Doubt, defiance, and identity: Understanding resistance to male circumcision for HIV prevention in Malawi.

    PubMed

    Parkhurst, Justin O; Chilongozi, David; Hutchinson, Eleanor

    2015-06-01

    Global policy recommendations to scale up of male circumcision (MC) for HIV prevention tend to frame the procedure as a simple and efficacious public health intervention. However, there has been variable uptake of MC in countries with significant HIV epidemics. Kenya, for example, has embraced MC and has been dubbed a 'leader' by the global health community, while Malawi has been branded a 'laggard' in its slow adoption of a national programme, with a strong political discourse of resistance forming around MC. Regardless of any epidemiological or technical evidence, the uptake of international recommendations will be shaped by how a policy, and the specific artefacts that constitute that policy, intersect with local concerns. MC holds particular significance within many ethnic and religious groups, serving as an important rite of passage, but also designating otherness or enabling the identification of the social and political self. Understanding how the artefact of MC intersects with local social, economic, and political contexts, is therefore essential to understand the acceptance or resistance of global policy recommendations. In this paper we present an in-depth analysis of Malawi's political resistance to MC, finding that ethnic and religious divisions dominating recent political movements aligned well with differing circumcision practices. Political resistance was further found to manifest through two key narratives: a 'narrative of defiance' around the need to resist donor manipulation, and a 'narrative of doubt' which seized on a piece of epidemiological evidence to refute global claims of efficacy. Further, we found that discussions over MC served as an additional arena through which ethnic identities and claims to power could themselves be negotiated, and therefore used to support claims of political legitimacy.

  6. Increasing voluntary medical male circumcision uptake among adult men in Tanzania

    PubMed Central

    Wambura, Mwita; Mahler, Hally; Grund, Jonathan M.; Larke, Natasha; Mshana, Gerry; Kuringe, Evodius; Plotkin, Marya; Lija, Gissenge; Makokha, Maende; Terris-Prestholt, Fern; Hayes, Richard J.; Changalucha, John; Weiss, Helen A.

    2017-01-01

    Objective: We evaluated a demand-creation intervention to increase voluntary medical male circumcision (VMMC) uptake among men aged 20–34 years in Tanzania, to maximise short-term impact on HIV incidence. Methods: A cluster randomized controlled trial stratified by region was conducted in 20 outreach sites in Njombe and Tabora regions. The sites were randomized 1 : 1 to receive either a demand-creation intervention package in addition to standard VMMC outreach, or standard VMMC outreach alone. The intervention package included enhanced public address messages, peer promotion by recently circumcised men, facility setup to increase privacy, and engagement of female partners in demand creation. The primary outcome was the proportion of VMMC clients aged 20–34 years. Findings: Overall, 6251 and 3968 VMMC clients were enrolled in intervention and control clusters, respectively. The proportion of clients aged 20–34 years was slightly greater in the intervention than control arm [17.7 vs. 13.0%; prevalence ratio = 1.36; 95% confidence intervals (CI):0.9–2.0]. In Njombe region, the proportion of clients aged 20–34 years was similar between arms but a significant two-fold difference was seen in Tabora region (P value for effect modification = 0.006). The mean number of men aged 20–34 years (mean difference per cluster = 97; 95% CI:40–154), and of all ages (mean difference per cluster = 227, 95% CI:33–420) were greater in the intervention than control arm. Conclusion: The intervention was associated with a significant increase in the proportion of clients aged 20–34 years in Tabora but not in Njombe. The intervention may be sensitive to regional factors in VMMC programme scale-up, including saturation. PMID:28350578

  7. Mass safe male circumcision: early lessons from a Ugandan urban site - a case study

    PubMed Central

    Galukande, Moses; Sekavuga, Denis Bbaale; Duffy, Kevin; Wooding, Nicholas; Rackara, Sam; Nakaggwa, Florence; Nagaddya, Teddy; Elobu, Alex Emmanuel; Coutinho, Alex

    2012-01-01

    Introduction It has been proven in several randomized clinical trials that HIV transmission from female to male is reduced by 60% and more among circumcised males. The national target for Uganda by 2015 is to circumcise 4.2 million adult males, an unprecedented number requiring a pragmatic approach and effective model(s) to deliver this target. The objective of the study was to describe early lessons learnt at a start up of a mass safe male circumcision (SMC) program in an urban Ugandan site, implemented through task shifting and a private public partnership approach. Methods A case study of an urban SMC site in Uganda's capital, Kampala with a catchment population of approximately 0.8 million adult males aged between 15 and 49 years. Client enrollment was voluntary; mobilization was by word of mouth and through the media. Non Physician clinicians (NPC) carried out the majority of the SMCs. The SMC and voluntary counseling and testing (VCT), adverse events (AE) management and follow up were done as per set national guidelines. The supervision was by a public and private service provider. All clients were consented. Results A total of 3000 males were circumcised in 27 days spread over four months. The AE rate was 2.1% all AEs were mild and reversible. No deaths occurred. The work rate was 111 SMCs per day. There was sufficient demand for SMC despite minimal mobilization effort. The bulk of the SMC work was successfully carried out by the NPCs. Conclusion Private Public Partnership and task shifting approaches were successful at the start up phase and we anticipate will be feasible for the scale up. PMID:23396906

  8. Factors Associated with the Acceptability of Male Circumcision among Men in Jamaica

    PubMed Central

    Walcott, Melonie M.; Jolly, Pauline E.; Ehiri, John E.; Funkhouser, Ellen; Kempf, Mirjam C.; Hickman, Deborah; Aung, Maung; Zhang, Kui

    2013-01-01

    Objectives To determine the prevalence of male circumcision (MC) among men in the western region of Jamaica, and to identify factors associated with acceptability of MC for self, infants (<1 year) and older sons (1-17 years). Methods A cross-sectional, interviewer-administered questionnaire survey of 549 men aged 19-54 years was conducted in the western region of Jamaica. The survey included questions about the acceptance of MC for self, infants, and sons before and after an information session about the benefits of MC in preventing HIV/STI transmission. Logistic regression models were used to identify factors that were associated with acceptability of MC. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated from the models. Results Fourteen percent of the men reported that they were circumcised. In the multivariable model, which adjusted for age, education, religion and income, there were increased odds of accepting MC for infants/sons among uncircumcised men who accepted MC for self (AOR=8.1; 95% CI = 4.1-15.9), believed they would experience more pleasure during sex if circumcised (AOR=4.0; 95% CI = 2.0-8.2), and reported having no concerns regarding MC (AOR=3.0; 95% CI = 1.8-4.8). Similarly, uncircumcised men who reported no concerns about MC or who believed that they would experience more pleasure during sex if circumcised were more likely to accept MC for self. Conclusion Providing men with information about MC increased acceptance of MC for self, infants (<17 years) and sons (1-17 years). Since targeted education on the benefits of male circumcision for prevention of HIV/STI can be effective in increasing acceptability of MC, health professionals should be trained, and willing to discuss MC with men in healthcare facilities and in the community. PMID:24066164

  9. After Cologne: male circumcision and the law. Parental right, religious liberty or criminal assault?

    PubMed

    Merkel, Reinhard; Putzke, Holm

    2013-07-01

    Non-therapeutic circumcision violates boys' right to bodily integrity as well as to self-determination. There is neither any verifiable medical advantage connected with the intervention nor is it painless nor without significant risks. Possible negative consequences for the psychosexual development of circumcised boys (due to substantial loss of highly erogenous tissue) have not yet been sufficiently explored, but appear to ensue in a significant number of cases. According to standard legal criteria, these considerations would normally entail that the operation be deemed an 'impermissible risk'-neither justifiable on grounds of parental rights nor of religious liberty: as with any other freedom right, these end where another person's body begins. Nevertheless, after a resounding decision by a Cologne district court that non-therapeutic circumcision constitutes bodily assault, the German legislature responded by enacting a new statute expressly designed to permit male circumcision even outside of medical settings. We first criticise the normative foundations upon which such a legal concession seems to rest, and then analyse two major flaws in the new German law which we consider emblematic of the difficulty that any legal attempt to protect medically irrelevant genital cutting is bound to face.

  10. Factors Associated with Knowledge of and Willingness for Adult Male Circumcision in Changsha, China

    PubMed Central

    Zeng, Mingqiang; Wang, Ling; Chen, Caifang; Zeng, Fanchang; Huang, Liang; Xue, Ruizhi; Chen, Junjie; Gao, Benmin; Tang, Zhengyan

    2016-01-01

    Background Male circumcision (MC) has been shown to reduce the risk of male genital diseases. MC is not commonly practiced among Chinese males and little is known about the factors associated with their knowledge of and willingness for MC. This study was to explore the knowledge regarding the foreskin among Chinese males and to identify factors associated with their willingness to undergo circumcision. Methods A total of 237 patients with redundant prepuce/phimosis were interviewed through face-to-face interviews. The items on the questionnaire included: demographics, an objective scale assessing knowledge about the foreskin, willingness to have MC, the attitudes of sexual partners and doctors toward redundant prepuce/phimosis, and the approaches that patients used to acquire knowledge regarding the prepuce. Univariate analysis and multiple logistic regression analysis were performed to identify factors that are associated with willingness to be circumcised (WTC). Results A total of 212 patients completed the interview. Multivariable logistic regression showed that three factors were significantly associated with WTC: being married (OR = 0.43), perceiving redundant prepuce/phimosis as a disease (OR = 1.93), and if a patient’s partner supported MC (OR = 1.39). 58% (n = 122) had received information about the foreskin from another party: 18% (n = 37) from school, 8% (n = 17) from family, 17% (n = 36) from friends, 27% (n = 57) from health care providers. About 4% (n = 8) believed that their partners disliked their redundant prepuce/phimosis. 20% (n = 42) had received doctors’ advice to undergo circumcision. Conclusion Knowledge about the foreskin was low among Chinese males. Our study elucidates the factors associated with WTC and suggests that more education of the population about the foreskin can help improve the recognition of a correctible abnormality and help patients assess the potential role of MC in their health. PMID:26859292

  11. Evaluation of a safer male circumcision training programme for traditional surgeons and nurses in the Eastern Cape, South Africa.

    PubMed

    Peltzer, Karl; Nqeketo, Ayanda; Petros, George; Kanta, Xola

    2008-06-18

    Training designed to improve circumcision knowledge, attitude and practice was delivered over 5 days to 34 traditional surgeons and 49 traditional nurses in the Eastern Cape, South Africa. Training included the following topics: initiation rites; statutory regulation of traditional male circumcision and initiation into Manhood (TCIM); structure and function of the male sex organs; procedure of safe circumcision, infection control; sexually transmitted infections (STIs); HIV/AIDS; infection control measures; aftercare of the initiate including after care of the circumcision wound and initiate as a whole; detection and early management of common complications of circumcision; nutrition and fluid management; code of conduct and ethics; and sexual health education. The evaluation of the training consisted of a prospective assessment of knowledge and attitude immediately prior to and after training. Significant improvement in knowledge and/or attitudes was observed in legal aspects, STI, HIV and environmental aspects, attitudes in terms of improved collaboration with biomedical health care providers, normal and abnormal anatomy and physiology, sexually transmitted infections and including HIV, circumcision practice and aftercare of initiates. We concluded that safer circumcision training can be successfully delivered to traditional surgeons and nurses.

  12. Scaling-up voluntary medical male circumcision – what have we learned?

    PubMed Central

    Ledikwe, Jenny H; Nyanga, Robert O; Hagon, Jaclyn; Grignon, Jessica S; Mpofu, Mulamuli; Semo, Bazghina-werq

    2014-01-01

    In 2007, the World Health Organization (WHO) and the joint United Nations agency program on HIV/AIDS (UNAIDS) recommended voluntary medical male circumcision (VMMC) as an add-on strategy for HIV prevention. Fourteen priority countries were tasked with scaling-up VMMC services to 80% of HIV-negative men aged 15–49 years by 2016, representing a combined target of 20 million circumcisions. By December 2012, approximately 3 million procedures had been conducted. Within the following year, there was marked improvement in the pace of the scale-up. During 2013, the total number of circumcisions performed nearly doubled, with approximately 6 million total circumcisions conducted by the end of the year, reaching 30% of the initial target. The purpose of this review article was to apply a systems thinking approach, using the WHO health systems building blocks as a framework to examine the factors influencing the scale-up of the VMMC programs from 2008–2013. Facilitators that accelerated the VMMC program scale-up included: country ownership; sustained political will; service delivery efficiencies, such as task shifting and task sharing; use of outreach and mobile services; disposable, prepackaged VMMC kits; external funding; and a standardized set of indicators for VMMC. A low demand for the procedure has been a major barrier to achieving circumcision targets, while weak supply chain management systems and the lack of adequate financial resources with a heavy reliance on donor support have also adversely affected scale-up. Health systems strengthening initiatives and innovations have progressively improved VMMC service delivery, but an understanding of the contextual barriers and the facilitators of demand for the procedure is critical in reaching targets. There is a need for countries implementing VMMC programs to share their experiences more frequently to identify and to enhance best practices by other programs. PMID:25336991

  13. Scaling-up voluntary medical male circumcision - what have we learned?

    PubMed

    Ledikwe, Jenny H; Nyanga, Robert O; Hagon, Jaclyn; Grignon, Jessica S; Mpofu, Mulamuli; Semo, Bazghina-Werq

    2014-01-01

    In 2007, the World Health Organization (WHO) and the joint United Nations agency program on HIV/AIDS (UNAIDS) recommended voluntary medical male circumcision (VMMC) as an add-on strategy for HIV prevention. Fourteen priority countries were tasked with scaling-up VMMC services to 80% of HIV-negative men aged 15-49 years by 2016, representing a combined target of 20 million circumcisions. By December 2012, approximately 3 million procedures had been conducted. Within the following year, there was marked improvement in the pace of the scale-up. During 2013, the total number of circumcisions performed nearly doubled, with approximately 6 million total circumcisions conducted by the end of the year, reaching 30% of the initial target. The purpose of this review article was to apply a systems thinking approach, using the WHO health systems building blocks as a framework to examine the factors influencing the scale-up of the VMMC programs from 2008-2013. Facilitators that accelerated the VMMC program scale-up included: country ownership; sustained political will; service delivery efficiencies, such as task shifting and task sharing; use of outreach and mobile services; disposable, prepackaged VMMC kits; external funding; and a standardized set of indicators for VMMC. A low demand for the procedure has been a major barrier to achieving circumcision targets, while weak supply chain management systems and the lack of adequate financial resources with a heavy reliance on donor support have also adversely affected scale-up. Health systems strengthening initiatives and innovations have progressively improved VMMC service delivery, but an understanding of the contextual barriers and the facilitators of demand for the procedure is critical in reaching targets. There is a need for countries implementing VMMC programs to share their experiences more frequently to identify and to enhance best practices by other programs.

  14. Factors associated with uptake of voluntary medical male circumcision, Mazowe District, Zimbabwe, 2014

    PubMed Central

    Rupfutse, Maxwell; Tshuma, Cremence; Tshimanga, Mufuta; Gombe, Notion; Bangure, Donewell; Wellington, Maureen

    2014-01-01

    Introduction Voluntary Medical Male Circumcision (VMMC) is the surgical removal of the foreskin by a trained health worker. VMMC was introduced in Zimbabwe in 2009. It is of concern that the programme performance has been below expectations nationally and in Mazowe district. Zimbabwe is unlikely to meet its 2015 target of circumcising 1 200 000 men aged between 15 and 29 years and unlikely to enjoy maximum benefits of VMMC which include prevention of HIV, sexually transmitted infections and cervical cancer. We therefore broadly aimed at identifying factors influencing the level of VMMC uptake in Mazowe district. Methods An analytic cross-sectional study was carried out in Mazowe district. A multi-stage probability sampling strategy was used to select 300 men aged between 18 and 49 years. Pretested interviewer administered questionnaires, key informant interviews and focus group discussions were used to collect data. Quantitative data was analysed using Epi info where odds ratios and p-values were calculated. Qualitative data was analysed thematically. Results Being of Shona origin (AOR= 7.69 (95%CI 1.78-33.20)), fear of pain (AOR= 7.09 (95%CI 2.58-19.47)) and fear of poor wound healing (AOR= 2.68 (95%CI 1.01-7.08)) were independently associated with being uncircumcised while having a circumcised friend and encouragement by a friend or relative were independently associated with being circumcised. Conclusion Fear of pain, fear of poor wound healing and encouragement by a friend or relative were associated with circumcision status. Widening use of surgical devices and third part referrals may assist in scaling up the programme. PMID:25918577

  15. A Randomized Trial of Mogen Clamp versus Plastibell for Neonatal Male Circumcision in Botswana

    PubMed Central

    Plank, Rebeca M; Ndubuka, Nnamdi O; Wirth, Kathleen E; Mwambona, Janet T; Kebaabetswe, Poloko; Bassil, Barbara; Lesetedi, Chiapo; Hussein, Fatma M; Magetse, Jane; Nkgau, Maggie; Makhema, Joseph; Mmalane, Mompati; Creek, Tracy; Powis, Kathleen M; Shapiro, Roger; Lockman, Shahin

    2013-01-01

    Background Male circumcision can reduce the risk of heterosexually-acquired HIV-1 infection in men. Neonatal male circumcision (NMC) has many potential advantages over circumcision at older ages but little is known about its feasibility and safety in resource-limited settings. Methods We performed a randomized trial in southeastern Botswana of Mogen clamp and Plastibell, two commonly used devices for NMC. Follow-up visits occurred at six weeks and four months postpartum. Adverse events, parental satisfaction and staff impressions were recorded. Results Of 302 male neonates randomized, 300 (99%) underwent circumcision, 153 (51%) with Mogen clamp and 147 (49%) with Plastibell. There were no major adverse events in the Mogen clamp arm but there were two major adverse events in the Plastibell arm (both were a proximally migrated ring that had to be removed by study staff). Minor adverse events were more common with the Mogen clamp compared with the Plastibell, specifically removal of too little skin and formation of skin bridges or adhesions (12 vs. 1 and 11 vs. 3, respectively, all P<0.05). Five (3%) infants in the Mogen clamp arm and none in the Plastibell arm had minor bleeding (P=0.03). More than 94% of mothers reported being highly or completely satisfied with the procedure. Conclusions NMC can be performed in Botswana with a low rate of adverse events and high parental satisfaction. Although the risk of migration and retention of the Plastibell is small, the Mogen clamp may be safer for NMC in regions where immediate emergent medical attention is not available. PMID:23314413

  16. Early infant male circumcision for human immunodeficiency virus prevention: knowledge and attitudes of women attending a rural hospital in Swaziland, Southern Africa.

    PubMed

    Jarrett, Prudence; Kliner, Merav; Walley, John

    2014-01-01

    Swaziland has the highest prevalence of human immunodeficiency virus (HIV) in the world at 26% of the adult population. Medical male circumcision (MMC) has been shown to reduce the risk of acquiring HIV from heterosexual sex by up to 60% and the Government of Swaziland has been promoting adult male circumcision. Infant circumcision commenced in 2013 so it is important to understand the knowledge and views of women as potential mothers, around infant circumcision for medical purposes to inform the development of the service. This study interviewed 14 women of reproductive age attending the outpatient department of Good Shepherd Mission Hospital (GSMH), a rural district hospital, on their knowledge of and attitudes to early infant male circumcision (EIMC). Participants were highly knowledgeable about the health benefits of medical circumcision, although knowledge of the comparative risks and benefits of EIMC to adult circumcision was poor. All participants would have a son circumcised; the preferred age varied from early infancy to adolescence. Complications and pain were the main barriers whilst religious and cultural reasons were mentioned both for and against circumcision. A variety of family members are important in the decision to circumcise a young boy. Acceptability of medical circumcision was high in this study, but concerns about safety, pain, autonomy and cultural factors reduce the acceptability of infant circumcision more specifically. It will be important to provide accurate, culturally sensitive information about infant circumcision to mothers, fathers and grandparents using existing hospital and community services provided at GSMH and throughout Swaziland. Where possible services for MMC should be available to males of all ages so that families and young men may choose the most favourable age for circumcision.

  17. Women’s Perceptions and Misperceptions of Male Circumcision: A Mixed Methods Study in Zambia

    PubMed Central

    Haberland, Nicole A.; Kelly, Christine A.; Mulenga, Drosin M.; Mensch, Barbara S.; Hewett, Paul C.

    2016-01-01

    Women’s perceptions of male circumcision (MC) have implications for behavioral risk compensation, demand, and the impact of MC programs on women’s health. This mixed methods study combines data from the first two rounds of a longitudinal study (n = 934) and in-depth interviews with a subsample of respondents (n = 45) between rounds. Most women correctly reported that MC reduces men’s risk of HIV (64% R1, 82% R2). However, 30% of women at R1, and significantly more (41%) at R2, incorrectly believed MC is fully protective for men against HIV. Women also greatly overestimated the protection MC offers against STIs. The proportion of women who believed MC reduces a woman’s HIV risk if she has sex with a man who is circumcised increased significantly (50% to 70%). Qualitative data elaborate women’s misperception regarding MC. Programs should address women’s informational needs and continue to emphasize that condoms remain critical, regardless of male partner’s circumcision status. PMID:26937971

  18. Scaling Up Early Infant Male Circumcision: Lessons From the Kingdom of Swaziland

    PubMed Central

    Fitzgerald, Laura; Benzerga, Wendy; Mirira, Munamato; Adamu, Tigistu; Shissler, Tracey; Bitchong, Raymond; Malaza, Mandla; Mamba, Makhosini; Mangara, Paul; Curran, Kelly; Khumalo, Thembisile; Mlambo, Phumzile; Njeuhmeli, Emmanuel; Maziya, Vusi

    2016-01-01

    ABSTRACT Background: The government of the Kingdom of Swaziland recognizes that it must urgently scale up HIV prevention interventions, such as voluntary medical male circumcision (VMMC). Swaziland has adopted a 2-phase approach to male circumcision scale-up. The catch-up phase prioritizes VMMC services for adolescents and adults, while the sustainability phase involves the establishment of early infant male circumcision (EIMC). Swaziland does not have a modern-day tradition of circumcision, and the VMMC program has met with client demand challenges. However, since the launch of the EIMC program in 2010, Swaziland now leads the Eastern and Southern Africa region in the scale-up of EIMC. Here we review Swaziland’s program and its successes and challenges. Methods: From February to May 2014, we collected data while preparing Swaziland’s “Male Circumcision Strategic and Operational Plan for HIV Prevention 2014–2018.” We conducted structured stakeholder focus group discussions and in-depth interviews, and we collected EIMC service delivery data from an implementing partner responsible for VMMC and EIMC service delivery. Data were summarized in consolidated narratives. Results: Between 2010 and 2014, trained providers performed more than 5,000 EIMCs in 11 health care facilities in Swaziland, and they reported no moderate or severe adverse events. According to a broad group of EIMC program stakeholders, an EIMC program needs robust support from facility, regional, and national leadership, both within and outside of HIV prevention coordination bodies, to promote institutionalization and ownership. Providers and health care managers in 3 of Swaziland’s 4 regional hospitals suggest that when EIMC is introduced into reproductive, maternal, newborn, and child health platforms, dedicated staff attention can help ensure that EIMC is performed amid competing priorities. Creating informed demand from communities also supports EIMC as a service delivery priority

  19. Barriers and Motivators to Voluntary Medical Male Circumcision Uptake among Different Age Groups of Men in Zimbabwe: Results from a Mixed Methods Study

    PubMed Central

    Hatzold, Karin; Mavhu, Webster; Jasi, Phineas; Chatora, Kumbirai; Cowan, Frances M.; Taruberekera, Noah; Mugurungi, Owen; Ahanda, Kim; Njeuhmeli, Emmanuel

    2014-01-01

    Background We conducted quantitative and qualitative studies to explore barriers and motivating factors to VMMC for HIV prevention, and to assess utilization of existing VMMC communication channels. Methods and Findings A population-based survey was conducted with 2350 respondents aged 15–49. Analysis consisted of descriptive statistics and bivariate analysis between circumcision and selected demographics. Logistic regression was used to determine predictors of male circumcision uptake compared to intention to circumcise. Focus group discussions (FGDs) were held with men purposively selected to represent a range of ethnicities. 68% and 53% of female/male respondents, respectively, had heard about VMMC for HIV prevention, mostly through the radio (71%). Among male respondents, 11.3% reported being circumcised and 49% reported willingness to undergo VMMC. Factors which men reported motivated them to undergo VMMC included HIV/STI prevention (44%), improved hygiene (26%), enhanced sexual performance (6%) and cervical cancer prevention for partner (6%). Factors that deterred men from undergoing VMMC included fear of pain (40%), not believing that they were at risk of HIV (18%), lack of partner support (6%). Additionally, there were differences in motivators and barriers by age. FGDs suggested additional barriers including fear of HIV testing, partner refusal, reluctance to abstain from sex and myths and misconceptions. Conclusions VMMC demand-creation messages need to be specifically tailored for different ages and should emphasize non-HIV prevention benefits, such as improved hygiene and sexual appeal, and need to address men's fear of pain. Promoting VMMC among women is crucial as they appear to have considerable influence over men's decision to get circumcised. PMID:24802746

  20. Does Male Circumcision Protect against Sexually Transmitted Infections? Arguments and Meta-Analyses to the Contrary Fail to Withstand Scrutiny

    PubMed Central

    Morris, Brian J.; Hankins, Catherine A.; Tobian, Aaron A. R.; Krieger, John N.; Klausner, Jeffrey D.

    2014-01-01

    We critically evaluate a recent article by Van Howe involving 12 meta-analyses that concludes, contrary to current evidence, that male circumcision increases the risk of various common sexually transmitted infections (STIs). Our detailed scrutiny reveals that these meta-analyses (1) failed to include results of all relevant studies, especially data from randomized controlled trials, (2) introduced bias through use of inappropriate control groups, (3) altered original data, in the case of human papillomavirus (HPV), by questionable adjustments for “sampling bias,” (4) failed to control for confounders through use of crude odds ratios, and (5) used unnecessarily complicated methods without adequate explanation, so impeding replication by others. Interventions that can reduce the prevalence of STIs are important to international health. Of major concern is the global epidemic of oncogenic types of HPV that contribute to the burden of genital cancers. Meta-analyses, when well conducted, can better inform public health policy and medical practice, but when seriously flawed can have detrimental consequences. Our critical evaluation leads us to reject the findings and conclusions of Van Howe on multiple grounds. Our timely analysis thus reaffirms the medical evidence supporting male circumcision as a desirable intervention for STI prevention. PMID:24944836

  1. Benefits and risks of circumcision.

    PubMed Central

    Warner, E.; Strashin, E.

    1981-01-01

    Circumcisions are performed either prophylactically in the neonatal period or therapeutically at a later age. About 10% of males not circumcised at birth will eventually require circumcision. The present neonatal circumcision rate is about 80% in the United States and 40% in Canada. The single most important determinant of whether a newborn male will be circumcised is the attitude of the attending physician. The literature was reviewed to determine the proven benefits of circumcision and to compare these with the known risks. Circumcising the newborn facilitates penile hygiene, prevents cancer of the penis and decreases the incidence of genital herpes in later life. Whether it decreases the incidence of cancer of the cervix is still uncertain. More important, neonatal circumcision is associated with much lower morbidity and mortality and with lower costs than therapeutic circumcision. Thus, prophylactic circumcision is recommended for the male population as a whole. PMID:7037142

  2. Assessment of changes in risk behaviors during 3 years of posttrial follow-up of male circumcision trial participants uncircumcised at trial closure in Rakai, Uganda.

    PubMed

    Kong, Xiangrong; Kigozi, Godfrey; Nalugoda, Fred; Musoke, Richard; Kagaayi, Joseph; Latkin, Carl; Ssekubugu, Robert; Lutalo, Tom; Nantume, Betty; Boaz, Iga; Wawer, Maria; Serwadda, David; Gray, Ronald

    2012-11-15

    Risk compensation associated with male circumcision has been a concern for male circumcision scale-up programs. Using posttrial data collected during 2007-2011 on 2,137 male circumcision trial participants who were uncircumcised at trial closure in Rakai, Uganda, the authors evaluated their sexual behavioral changes during approximately 3 years' follow-up after trial closure. Eighty-one percent of the men self-selected for male circumcision during the period, and their sociodemographic and risk profiles were comparable to those of men remaining uncircumcised. Linear models for marginal probabilities of repeated outcomes estimate that 3.3% (P < 0.0001) of the male circumcision acceptors reduced their engagement in nonmarital relations, whereas there was no significant change among men remaining uncircumcised. Significant decreases in condom use occurred in both male circumcision acceptors (-9.2% with all partners and -7.0% with nonmarital partners) and nonacceptors (-12.4% and -13.5%, respectively), and these were predominantly among younger men. However, the magnitudes of decrease in condom use were not significantly different between the 2 groups. Additionally, significant decreases in sex-related alcohol consumption were observed in both groups (-7.8% in male circumcision acceptors and -6.1% in nonacceptors), mainly among older men. In summary, there was no evidence of risk compensation associated with male circumcision among this cohort of men during 3 years of posttrial follow-up.

  3. To mutilate in the name of Jehovah or Allah: legitimization of male and female circumcision.

    PubMed

    Abu-Sahlieh, S A

    1994-01-01

    Female circumcison is practised in Sudan, Somalia, Egypt and a few other Arab and Muslim countries. It has triggered a passionate public debate in the West. This debate has found somewhat of an echo in the Arab and Muslim world, but some Muslim religious circles such as Al-Azhar (Egypt), the most important Islamic centre in the world, try to justify it on the basis of sunnah (that is, to conform with the tradition of the prophet Mohammed). Male circumcision is practised by all Muslims and Jews and also by some Christians in Egypt, in the United States and Canada). For different reasons, the debate on this topic is still taboo in Western and in Arab and Muslim countries. The object of this study is to define the role of Islamic law and Muslim religious leaders in female and male circumcision. On purpose, it avoids any use of the word 'Islam', and concentrates on the written sources of Islamic law and the opinions of contemporary Arab authors, mostly of Egyptian origin. Juridical logic cannot acknowledge the distinction between female and male circumcision, both being the mutilation of healthy organs which is damaging to the physical integrity of the child, whatever the underlying religious motivations. Furthermore, both practices violate the Koran: 'Our Lord, You did not create all this in vain' (3:191), and '[He] perfected everything He created' (32:7). In our opinion, a god who demands that his believers be mutilated and branded on their genitals the same as cattle, is a god of questionable ethics. To mutilate children, boys or girls, under the pretext that it is for their own good, shows the influence of cynicism and fanaticism.

  4. Loss of anatomical landmarks with eutectic mixture of local anesthetic cream for neonatal male circumcision.

    PubMed

    Plank, Rebeca M; Kubiak, David W; Abdullahi, Rasak Bamidele; Ndubuka, Nnamdi; Nkgau, Maggie M; Dapaah-Siakwan, Fredrick; Powis, Kathleen M; Lockman, Shahin

    2013-02-01

    We report two cases of newborns who developed marked local edema after application of a eutectic mixture of local anesthetic (EMLA) topical anesthetic cream for neonatal male circumcision (NMC). Although local edema and erythema are known potential side effects of EMLA cream, a common anesthetic used for NMC, the loss of landmarks precluding safe NMC has not previously been reported, and is described here. Although we cannot recommend an alternate local anesthetic for neonates with this reaction to EMLA, based on a review of the published data we think that serious systemic adverse events related to EMLA are extremely rare.

  5. Recommendation by a law body to ban infant male circumcision has serious worldwide implications for pediatric practice and human rights

    PubMed Central

    2013-01-01

    Background Recent attempts in the USA and Europe to ban the circumcision of male children have been unsuccessful. Of current concern is a report by the Tasmanian Law Reform Institute (TLRI) recommending that non-therapeutic circumcision be prohibited, with parents and doctors risking criminal sanctions except where the parents have strong religious and ethnic ties to circumcision. The acceptance of this recommendation would create a precedent for legislation elsewhere in the world, thereby posing a threat to pediatric practice, parental responsibilities and freedoms, and public health. Discussion The TLRI report ignores the scientific consensus within medical literature about circumcision. It contains legal and ethical arguments that are seriously flawed. Dispassionate ethical arguments and the United Nations Convention on the Rights of the Child are consistent with parents being permitted to authorize circumcision for their male child. Uncritical acceptance of the TLRI report’s recommendations would strengthen and legitimize efforts to ban childhood male circumcision not just in Australia, but in other countries as well. The medical profession should be concerned about any attempt to criminalize a well-accepted and evidence-based medical procedure. The recommendations are illogical, pose potential dangers and seem unworkable in practice. There is no explanation of how the State could impose criminal charges against doctors and parents, nor of how such a punitive apparatus could be structured, nor how strength of ethnic or religious ties could be determined. The proposal could easily be used inappropriately, and discriminates against parents not tied to the religions specified. With time, religious exemptions could subsequently be overturned. The law, governments and the medical profession should reject the TLRI recommendations, especially since the recent affirmative infant male circumcision policy statement by the American Academy of Pediatrics attests to the

  6. Knowledge, Attitudes, Practices and Beliefs about Medical Male Circumcision (MMC) among a Sample of Health Care Providers in Haiti

    PubMed Central

    Dévieux, Jessy G.; Saxena, Anshul; Rosenberg, Rhonda; Klausner, Jeffrey D.; Jean-Gilles, Michèle; Madhivanan, Purnima; Gaston, Stéphanie; Rubens, Muni; Theodore, Harry; Deschamps, Marie-Marcelle; Koenig, Serena P.; Pape, Jean William

    2015-01-01

    Background Haiti has the highest number of people living with HIV infection in the Caribbean/Latin America region. Medical male circumcision (MMC) has been recommended to help prevent the spread of HIV. We sought to assess knowledge, attitudes, practices and beliefs about MMC among a sample of health care providers in Haiti. Methods A convenience sample of 153 health care providers at the GHESKIO Centers in Haiti responded to an exploratory survey that collected information on several topics relevant to health providers about MMC. Descriptive statistics were calculated for the responses and multivariable logistic regression was conducted to determine opinions of health care providers about the best age to perform MMC on males. Bayesian network analysis and sensitivity analysis were done to identify the minimum level of change required to increase the acceptability of performing MMC at age less than 1 year. Results The sample consisted of medical doctors (31.0%), nurses (49.0%), and other health care professionals (20.0%). Approximately 76% showed willingness to offer MMC services if they received training. Seventy-six percent believed that their male patients would accept circumcision, and 59% believed infancy was the best age for MMC. More than 90% of participants said that MMC would reduce STIs. Physicians and nurses who were willing to offer MMC if provided with adequate training were 2.5 (1.15–5.71) times as likely to choose the best age to perform MMC as less than one year. Finally, if the joint probability of choosing “the best age to perform MMC” as one year or older and having the mistaken belief that "MMC prevents HIV entirely" is reduced by 63% then the probability of finding that performing MMC at less than one year acceptable to health care providers is increased by 35%. Conclusion Participants demonstrated high levels of knowledge and positive attitudes towards MMC. Although this study suggests that circumcision is acceptable among certain health

  7. Voluntary medical male circumcision for HIV prevention in fishing communities in Uganda: the influence of local beliefs and practice.

    PubMed

    Mbonye, Martin; Kuteesa, Monica; Seeley, Janet; Levin, Jonathan; Weiss, Helen; Kamali, Anatoli

    2016-09-01

    Local beliefs and practices about voluntary medical male circumcision (VMMC) may influence uptake and effectiveness. Data were gathered through interviews with 40 people from four ethnically mixed fishing communities in Uganda. Some men believed that wound healing could be promoted by contact with vaginal fluids while sex with non-regular partners could chase away spirits - practices which encouraged unsafe sexual practices. Information given by providers stressed that VMMC did not afford complete protection from sexually-transmitted infections, however, a number of male community members held the view that they were fully protected once circumcised. Both men and women said that VMMC was good not just for HIV prevention but also as a way of maintaining hygiene among the men. The implementation of VMMC in high-HIV prevalence settings needs to take account of local beliefs about circumcision, working with local religious/social group leaders, women and peers in the roll-out of the intervention.

  8. The Economic and Epidemiological Impact of Focusing Voluntary Medical Male Circumcision for HIV Prevention on Specific Age Groups and Regions in Tanzania

    PubMed Central

    2016-01-01

    Background Since its launch in 2010, the Tanzania National Voluntary Medical Male Circumcision (VMMC) Program has focused efforts on males ages 10–34 in 11 priority regions. Implementers have noted that over 70% of VMMC clients are between the ages of 10 and 19, raising questions about whether additional efforts would be required to recruit men age 20 and above. This analysis uses mathematical modeling to examine the economic and epidemiological consequences of scaling up VMMC among specific age groups and priority regions in Tanzania. Methods and Findings Analyses were conducted using the Decision Makers’ Program Planning Tool Version 2.0 (DMPPT 2.0), a compartmental model implemented in Microsoft Excel 2010. The model was populated with population, mortality, and HIV incidence and prevalence projections from external sources, including outputs from Spectrum/AIDS Impact Module (AIM). A separate DMPPT 2.0 model was created for each of the 11 priority regions. Tanzania can achieve the most immediate impact on HIV incidence by circumcising males ages 20–34. This strategy would also require the fewest VMMCs for each HIV infection averted. Circumcising men ages 10–24 will have the greatest impact on HIV incidence over a 15-year period. The most cost-effective approach (lowest cost per HIV infection averted) targets men ages 15–34. The model shows the VMMC program is cost saving in all 11 priority regions. VMMC program cost-effectiveness varies across regions due to differences in projected HIV incidence, with the most cost-effective programs in Njombe and Iringa. Conclusions The DMPPT 2.0 results reinforce Tanzania’s current VMMC strategy, providing newfound confidence in investing in circumcising adolescents. Tanzanian policy makers and program implementers will continue to focus scale-up of VMMC on men ages 10–34 years, seeking to maximize program impact and cost-effectiveness while acknowledging trends in demand among the younger and older age groups

  9. What Do People Actually Learn from Public Health Campaigns? Incorrect Inferences About Male Circumcision and Female HIV Infection Risk Among Men and Women in Malawi.

    PubMed

    Maughan-Brown, Brendan; Godlonton, Susan; Thornton, Rebecca; Venkataramani, Atheendar S

    2015-07-01

    Qualitative studies and polling data from sub-Saharan Africa indicate that many individuals may mistakenly believe that male circumcision directly protects women from contracting HIV. This study examines whether individuals who learn that male circumcision reduces female-to-male HIV transmission also erroneously infer a reduction in direct male-to-female transmission risk (i.e. from an HIV-positive man to an uninfected woman). We used data on Malawian men (n = 917) randomized to receive information about voluntary medical male circumcision (VMMC) and HIV risk in 2008 and a random sample of their wives (n = 418). We found that 72 % of men and 82 % of women who believed that male circumcision reduces HIV risk for men also believed that it reduces HIV risk for women. Regression analyses indicated that men randomly assigned to receive information about the protective benefits of circumcision were more likely to adopt the erroneous beliefs, and that the underlying mechanism was the formation of the belief that male circumcision reduces HIV risk for men. The results suggest the need for VMMC campaigns to make explicit that male circumcision does not directly protect women from HIV-infection.

  10. Notes from the Field: Tetanus Cases After Voluntary Medical Male Circumcision for HIV Prevention--Eastern and Southern Africa, 2012-2015.

    PubMed

    Grund, Jonathan M; Toledo, Carlos; Davis, Stephanie M; Ridzon, Renee; Moturi, Edna; Scobie, Heather; Naouri, Boubker; Reed, Jason B; Njeuhmeli, Emmanuel; Thomas, Anne G; Benson, Francis Ndwiga; Sirengo, Martin W; Muyenzi, Leon Ngeruka; Lija, Gissenge J I; Rogers, John H; Mwanasalli, Salli; Odoyo-June, Elijah; Wamai, Nafuna; Kabuye, Geoffrey; Zulu, James Exnobert; Aceng, Jane Ruth; Bock, Naomi

    2016-01-22

    Voluntary medical male circumcision (VMMC) decreases the risk for female-to-male HIV transmission by approximately 60%, and the President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the scale-up of VMMC for adolescent and adult males in countries with high prevalence of human immunodeficiency virus (HIV) and low coverage of male circumcision. As of September 2015, PEPFAR has supported approximately 8.9 million VMMCs.

  11. Voluntary medical male circumcision for HIV prevention and early resumption of sexual activity: a literature review.

    PubMed

    Kamath, Veena; Limaye, Rupali J

    2015-01-01

    A number of programs have focused on scale-up and implementation research regarding voluntary medical male circumcision; however, there is limited research with regard to factors and strategies related to abstinence compliance and the effects of resuming sex during the wound healing period (42-day post-circumcision). We searched the literature for peer-reviewed articles examining early resumption of sex during this period. This review identifies factors that may predispose a client to engage in sex during the 42-day postoperative period, examines how early resumption of sex can inhibit wound healing and increase seroconversion, and reviews strategies that may increase adherence to abstinence during the wound healing period. We found that the most common factor that may predispose a client to engage in sex before the end of the postoperative period is marriage or cohabitation with a sexual partner. With regard to the effect of sex during the postoperative period on wound healing and seroconversion, we found that adverse events incurred were mild, and there was an increased risk of seroconversion. The only strategy studied to increase compliance to abstinence during the postoperative period utilized text messaging, and the trial results indicate that text messaging did not increase abstinence compliance.

  12. Male circumcision, alcohol use and unprotected sex among patrons of bars and taverns in rural areas of North-West province, South Africa.

    PubMed

    Nkosi, Sebenzile; Sikweyiya, Yandisa; Kekwaletswe, Connie T; Morojele, Neo K

    2015-01-01

    Strong research evidence has shown that medical male circumcision significantly reduces heterosexual HIV acquisition among men. However, its effectiveness is enhanced by behavioural factors such as condom use. Currently, little is known of unprotected sex associated with male circumcision (MC) among alcohol-drinking tavern-going men, or whether engagement in unprotected sex may differ between men who have been traditionally circumcised and those who have been medically circumcised. The study sought to determine the relative importance of alcohol consumption and MC as correlates of unprotected sex and to compare the risk of engaging in unprotected sex between traditionally circumcised and medically circumcised tavern-going men from two rural villages in North-West province, South Africa. Data from 314 adult men (≥18 years) were analysed. The men were recruited from four bars/taverns using systematic sampling. They responded to questions regarding their demographic characteristics, alcohol consumption, circumcision status and method (where applicable), and engagement in unprotected sex. Descriptive analyses and bivariate and multivariate logistic regression analyses were conducted. Age, education, relationship status, alcohol consumption and traditional male circumcision (TMC) were independently and significantly associated with unprotected sex. Specifically, probable alcohol dependence and traditional circumcision were independent risk factors for engaging in unprotected sex among tavern-going men. Traditionally circumcised men had a higher risk of engaging in unprotected sex than medically circumcised men. Interventions aimed at reducing alcohol consumption, encouraging protective behaviour among men who have undergone TMC, and increasing condom use are needed in bar/tavern settings. HIV prevention education must be urgently incorporated into TMC programmes.

  13. [Legal aspects of ritual circumcision].

    PubMed

    Schreiber, M; Schott, G E; Rascher, W; Bender, A W

    2009-12-01

    Female circumcision (genital mutilation) is a criminal violation of human rights under German law. Even with consent of the person to be circumcised and/or her legal representative this procedure must not be carried out since a consent to female circumcision is unethical and therefore void. As much consent as there is on female circumcision the legal situation with ritual male circumcision is very unclear. In practice and unnoticed by the public male circumcision is carried out - be it for medical or ritual reasons - without deeper-going reflexions on the clearness of the medical indication or the legal situation with ritual circumcision. From the medical aspect there are big differences between female and male circumcision but also certain parallels. Various reasons, partly founded in prejudice and misinformation, make people refrain from regarding circumcision of boys also as illegal. Contrary to the prevailing opinion male circumcision also represents a bodily harm which a doctor can only carry out after a preoperative interview and with the consent of the affected person. Since ritual male circumcision does not serve the wellbeing of a child it is not possible for the parents to give their consent to the circumcision in lieu of the child. Male circumcision is only permitted if the child has given his consent and is thus only legally permitted if the child has reached an age at which he is mature enough to understand the meaning and extent of such an action which is hardly the case before he has completed his 16 (th) year.

  14. Comparative Cost of Early Infant Male Circumcision by Nurse-Midwives and Doctors in Zimbabwe

    PubMed Central

    Mangenah, Collin; Mavhu, Webster; Hatzold, Karin; Biddle, Andrea K; Ncube, Getrude; Mugurungi, Owen; Ticklay, Ismail; Cowan, Frances M; Thirumurthy, Harsha

    2016-01-01

    ABSTRACT Background: The 14 countries that are scaling up voluntary male medical circumcision (VMMC) for HIV prevention are also considering early infant male circumcision (EIMC) to ensure longer-term reductions in HIV incidence. The cost of implementing EIMC is an important factor in scale-up decisions. We conducted a comparative cost analysis of EIMC performed by nurse-midwives and doctors using the AccuCirc device in Zimbabwe. Methods: Between August 2013 and July 2014, nurse-midwives performed EIMC on 500 male infants using AccuCirc in a field trial. We analyzed the overall unit cost and identified key cost drivers of EIMC performed by nurse-midwives and compared these with costing data previously collected during a randomized noninferiority comparison trial of 2 devices (AccuCirc and the Mogen clamp) in which doctors performed EIMC. We assessed direct costs (consumable and nonconsumable supplies, device, personnel, associated staff training, and waste management costs) and indirect costs (capital and support personnel costs). We performed one-way sensitivity analyses to assess cost changes when we varied key component costs. Results: The unit costs of EIMC performed by nurse-midwives and doctors in vertical programs were US$38.87 and US$49.77, respectively. Key cost drivers of EIMC were consumable supplies, personnel costs, and the device price. In this cost analysis, major cost drivers that explained the differences between EIMC performed by nurse-midwives and doctors were personnel and training costs, both of which were lower for nurse-midwives. Conclusions: EIMC unit costs were lower when performed by nurse-midwives compared with doctors. To minimize costs, countries planning to scale up EIMC should consider using nurse-midwives, who are in greater supply than doctors and are the main providers at the primary health care level, where most infants are born. PMID:27413085

  15. Bringing Early Infant Male Circumcision Information Home to the Family: Demographic Characteristics and Perspectives of Clients in a Pilot Project in Tanzania.

    PubMed

    Amuri, Mbaraka; Msemo, Georgina; Plotkin, Marya; Christensen, Alice; Boyee, Dorica; Mahler, Hally; Phafoli, Semakaleng; Njozi, Mustafa; Hellar, Augustino; Mlanga, Erick; Yansaneh, Aisha; Njeuhmeli, Emmanuel; Lija, Jackson

    2016-07-01

    Iringa region of Tanzania has had great success reaching targets for voluntary medical male circumcision (VMMC). Looking to sustain high coverage of male circumcision, the government introduced a pilot project to offer early infant male circumcision (EIMC) in Iringa in 2013. From April 2013 to December 2014, a total of 2,084 male infants were circumcised in 8 health facilities in the region, representing 16.4% of all male infants born in those facilities. Most circumcisions took place 7 days or more after birth. The procedure proved safe, with only 3 mild and 3 moderate adverse events (0.4% overall adverse event rate). Overall, 93% of infants were brought back for a second-day visit and 71% for a seventh-day visit. These percentages varied significantly by urban and rural residence (97.4% urban versus 84.6% rural for day 2 visit; 82.2% urban versus 49.9% rural for day 7 visit). Mothers were more likely than fathers to have received information about EIMC. However, fathers tended to be key decision makers regarding circumcision of their sons. This suggests the importance of addressing fathers with behavioral change communication about EIMC. Successes in scaling up VMMC services in Iringa did not translate into immediate acceptability of EIMC. EIMC programs will require targeted investments in demand creation to expand and thrive in traditionally non-circumcising settings such as Iringa.

  16. Bringing Early Infant Male Circumcision Information Home to the Family: Demographic Characteristics and Perspectives of Clients in a Pilot Project in Tanzania

    PubMed Central

    Amuri, Mbaraka; Msemo, Georgina; Plotkin, Marya; Christensen, Alice; Boyee, Dorica; Mahler, Hally; Phafoli, Semakaleng; Njozi, Mustafa; Hellar, Augustino; Mlanga, Erick; Yansaneh, Aisha; Njeuhmeli, Emmanuel; Lija, Jackson

    2016-01-01

    ABSTRACT Iringa region of Tanzania has had great success reaching targets for voluntary medical male circumcision (VMMC). Looking to sustain high coverage of male circumcision, the government introduced a pilot project to offer early infant male circumcision (EIMC) in Iringa in 2013. From April 2013 to December 2014, a total of 2,084 male infants were circumcised in 8 health facilities in the region, representing 16.4% of all male infants born in those facilities. Most circumcisions took place 7 days or more after birth. The procedure proved safe, with only 3 mild and 3 moderate adverse events (0.4% overall adverse event rate). Overall, 93% of infants were brought back for a second-day visit and 71% for a seventh-day visit. These percentages varied significantly by urban and rural residence (97.4% urban versus 84.6% rural for day 2 visit; 82.2% urban versus 49.9% rural for day 7 visit). Mothers were more likely than fathers to have received information about EIMC. However, fathers tended to be key decision makers regarding circumcision of their sons. This suggests the importance of addressing fathers with behavioral change communication about EIMC. Successes in scaling up VMMC services in Iringa did not translate into immediate acceptability of EIMC. EIMC programs will require targeted investments in demand creation to expand and thrive in traditionally non-circumcising settings such as Iringa. PMID:27413081

  17. Influencing health debates through letters to the editor: the case of male circumcision.

    PubMed

    Carpenter, Laura M

    2009-04-01

    In this article I use the case of male circumcision (MC) to examine how grassroots activists, medical professionals, other stakeholders, and ordinary people employ letters to the editor (LTEs) to influence public health debates. I also show how journalistic practices affect the use of LTEs. Seventy LTEs about MC from U.S. newspapers between 1985 and 2006 are analyzed using qualitative methods. Pro-MC, anti-MC, and neutral LTE writers supported their stances on similar grounds, described adversaries as biased, and stressed medical and scientific authority. Yet only MC advocates and neutralists trivialized MC and declined to justify their stances, suggesting distinctive dynamics for LTEs about widely accepted practices. The prevalence of debated practices and activists' efforts to piggyback on related issues also affect LTE content. Editors chose LTEs to address readers' critiques, enact news values like balance and controversy, and showcase writers with strong claims to legitimacy, thereby mediating public health debates.

  18. [Circumcision from a historical perspective].

    PubMed

    Meijer, B; Butzelaar, R M

    2000-12-23

    Male circumcision has been practiced by many tribes in different continents. The oldest image of a circumcision dates from 2300 BC and was found in Egypt. In the Jewish religion circumcision symbolizes the covenant between God and Abraham. Despite the fact that Jesus of Nazareth was circumcised, circumcision has never been part of Christianity. Circumcision is not mentioned in the Koran; the practice of circumcision in Islam is attributed to Abraham, who is considered by muslims to be one of the prophets. From the middle of the nineteenth century circumcision was performed for medical reasons. Throughout the centuries, from the time of the Bible, many methods for performing circumcision have been described, and a few to undo it by restoring the prepuce.

  19. Safety, Effectiveness and Acceptability of the PrePex Device for Adult Male Circumcision in Kenya

    PubMed Central

    Feldblum, Paul J.; Odoyo-June, Elijah; Obiero, Walter; Bailey, Robert C.; Combes, Stephanie; Hart, Catherine; Jou Lai, Jaim; Fischer, Shelly; Cherutich, Peter

    2014-01-01

    Objective To assess the safety, effectiveness and acceptability of the PrePex device for adult medical male circumcision (MMC) in routine service delivery in Kenya. Methods We enrolled 427 men ages 18–49 at one fixed and two outreach clinics. Procedures were performed by trained clinical officers and nurses. The first 50 enrollees were scheduled for six follow-up visits, and remaining men were followed at Days 7 and 42. We recorded adverse events (AEs) and time to complete healing, and interviewed men about acceptability and pain. Results Placement and removal procedures each averaged between 3 and 4 minutes. Self-reported pain was minimal during placement but was fleetingly intense during removal. The rate of moderate/severe AEs was 5.9% overall (95% confidence interval [CI] 3.8%–8.5%), all of which resolved without sequelae. AEs included 5 device displacements, 2 spontaneous foreskin detachments, and 9 cases of insufficient foreskin removal. Surgical completion of MMC was required for 9 men (2.1%). Among the closely monitored first 50 participants, the probability of complete healing by Day 42 was 0.44 (95% CI 0.30–0.58), and 0.90 by Day 56. A large majority of men was favorable about their MMC procedure and would recommend PrePex to friends and family. Conclusions The PrePex device was effective for MMC in Kenya, and well-accepted. The AE rate was higher than reported for surgical procedures there, or in previous PrePex studies. Healing time is longer than following surgical circumcision. Provider experience and clearer counseling on post-placement and post-removal care should lead to lower AE rates. Trial Registration ClinicalTrials.gov NCT01711411 PMID:24788898

  20. Estimating Client Out-of-Pocket Costs for Accessing Voluntary Medical Male Circumcision in South Africa

    PubMed Central

    Tchuenche, Michel; Haté, Vibhuti; McPherson, Dacia; Palmer, Eurica; Thambinayagam, Ananthy; Loykissoonlal, Dayanund; Forsythe, Steven

    2016-01-01

    In 2010, South Africa launched a countrywide effort to scale up its voluntary medical male circumcision (VMMC) program on the basis of compelling evidence that circumcision reduces men’s risk of acquiring HIV through heterosexual intercourse. Even though VMMC is free there, clients can incur indirect out-of-pocket costs (for example transportation cost or foregone income). Because these costs can be barriers to increasing the uptake of VMMC services, we assessed them from a client perspective, to inform VMMC demand creation policies. Costs (calculated using a bottom-up approach) and demographic data were systematically collected through 190 interviews conducted in 2015 with VMMC clients or (for minors) their caregivers at 25 VMMC facilities supported by the government and the President’s Emergency Plan for AIDS Relief in eight of South Africa’s nine provinces. The average age of VMMC clients was 22 years and nearly 92% were under 35 years of age. The largest reported out-of-pocket expenditure was transportation, at an average of US$9.20 (R 100). Only eight clients (4%) reported lost days of work. Indirect expenditures were childcare costs (one client) and miscellaneous items such as food or medicine (20 clients). Given competing household expense priorities, spending US$9.20 (R100) per person on transportation to access VMMC services could be a significant burden on clients and households, and a barrier to South Africa’s efforts to create demand for VMMC. Thus, we recommend a more focused analysis of clients’ transportation costs to access VMMC services. PMID:27783635

  1. Innovative Demand Creation for Voluntary Medical Male Circumcision Targeting a High Impact Male Population: A Pilot Study Engaging Pregnant Women at Antenatal Clinics in Kampala, Uganda

    PubMed Central

    Semeere, Aggrey S.; Castelnuovo, Barbara; Bbaale, Denis S.; Kiragga, Agnes N.; Kigozi, Joanita; Muganzi, Alex M.; Coutinho, Alex G.

    2016-01-01

    Background: Circumcision has been shown to be an effective method of HIV prevention; however, only 28% of Ugandan men aged 15–49 years are circumcised. There is a paucity of data on the role of intimate partners in generating demand for voluntary medical male circumcision (VMMC). We conducted a pilot study to assess the feasibility of a partner-focused intervention targeting males >25 years. Methods: Among pregnant women in their third trimester attending antenatal care we evaluated the impact of a pilot behavior change intervention on VMMC through a quasi-experimental approach. We observed VMMC numbers among spouses of women as per standard practice (comparison phase), and after introducing a behavioral change communication package (intervention phase). Logistic regression was used to compare the odds of VMMC uptake between comparison and intervention phases. We used qualitative methods to evaluate the casual chain using a thematic approach. Results: Of the 601 women studied, 90% articulated the health benefits of VMMC and 99% expressed interest in their spouse getting circumcised. Women's knowledge was not increased by the intervention. Four men were circumcised in the comparison and 7 in the intervention phase. The intervention was not associated with higher odds of circumcision (odds ratio 1.5, 95% CI: 0.3 to 6.0, P = 0.65). We interviewed 117 individuals overall with the main enablers for VMMC being: free VMMC, transport reimbursement, and health benefits. Deterrents included misconceptions, lost wages and fear of pain. Most of the uncircumcised men interviewed reported interest in VMMC. Conclusions: Our pilot intervention had no significant impact on increasing VMMC demand. The study demonstrated the feasibility of pregnant women engaging their spouses to discuss VMMC. PMID:27404008

  2. A Cross Sectional Study of the Prevalence of Preputial and Penile Scrotal Abnormalities among Clients Undergoing Voluntary Medical Male Circumcision in Soweto, South Africa

    PubMed Central

    Mukudu, Hillary; Otwombe, Kennedy; Laher, Fatima; Lazarus, Erica; Manentsa, Mmatsie; Lebina, Limakatso; Mapulanga, Victor; Bowa, Kasonde; Martinson, Neil

    2016-01-01

    Objective Medical device use is currently approved for males without preputial or major penile scrotal abnormalities for voluntary medical male circumcision (VMMC). We determined the prevalence of preputial abnormalities at a busy VMMC centre in Soweto, South Africa. Methods This was a cross-sectional record review at a high-volume VMMC centre in South Africa. We collated pre-circumcision demographic and genital examination findings from clients 8 years and older who had undergone VMMC from 01 May 2013 to 30 April 2014. Logistic regression was used to determine factors associated with preputial abnormalities. Findings During the review period, 6861 circumcisions were conducted and 37.1% (n = 2543) were 8–13 year olds. Median age was 15 years (IQR: 12–23 years). Fifteen percent (n = 1030) had preputial abnormalities or major penile scrotal abnormalities. Age-specific prevalence of preputial or major genital abnormalities were 27.3%, 10.6% and 6.0% in 8–13, 14–18 and > 18 year olds respectively. The odds of preputial or major penile scrotal abnormality were higher in younger clients aged 8–13 years (OR = 5.9; 95% CI = 4.8–7.1) and 14–18 years (OR = 1.9; 95% CI = 1.5–2.4) compared to older clients above18 years and in those testing for HIV outside our clinic network (OR = 1.9; 95% CI = 1.4–2.7). Conclusion The high prevalence of preputial and penile scrotal abnormalities observed suggests a need for VMMC sites to provide for both open surgical and devices methods in the provision of VMMC services. This is especially so among young male subjects presenting themselves for VMMC services at the various sites being developed in sub Saharan African countries. PMID:27253372

  3. Safety, Acceptability, and Feasibility of Early Infant Male Circumcision Conducted by Nurse-Midwives Using the AccuCirc Device: Results of a Field Study in Zimbabwe

    PubMed Central

    Mavhu, Webster; Larke, Natasha; Hatzold, Karin; Ncube, Getrude; Weiss, Helen A; Mangenah, Collin; Chonzi, Prosper; Mugurungi, Owen; Mufuka, Juliet; Samkange, Christopher A; Gwinji, Gerald; Cowan, Frances M; Ticklay, Ismail

    2016-01-01

    ABSTRACT Background: For prevention of HIV, early infant male circumcision (EIMC) needs to be scaled up in countries with high HIV prevalence. Routine EIMC will maintain the HIV prevention gains anticipated from current adult male circumcision initiatives. We present here the results of a field study of EIMC conducted in Zimbabwe. Methods: The study was observational and based on the World Health Organization (WHO) framework for clinical evaluation of male circumcision devices. We recruited parents of newborn male infants between August 2013 and July 2014 from 2 clinics. Nurse-midwives used the AccuCirc device to circumcise eligible infants. We followed participants for 14 days after EIMC. Outcome measures were EIMC safety, acceptability, and feasibility. Results: We enrolled 500 male infants in the field study (uptake 11%). The infants were circumcised between 6 and 60 days postpartum. The procedure took a median of 17 minutes (interquartile range of 5 to 18 minutes). Mothers’ knowledge of male circumcision was extensive. Of the 498 mothers who completed the study questionnaire, 91% knew that male circumcision decreases the risk of HIV acquisition, and 83% correctly stated that this prevention is partial. Asked about their community’s perception of EIMC, 40% felt that EIMC will likely be viewed positively in their community; 13% said negatively; and 47% said the perception could be both ways. We observed 7 moderate or severe adverse events (1.4%; 95% confidence interval, 0.4% to 2.4%). All resolved without lasting effects. Nearly all mothers (99%) reported great satisfaction with the outcome, would recommend EIMC to other parents, and would circumcise their next sons. Conclusion: This first field study in sub-Saharan Africa of the AccuCirc device for EIMC demonstrated that EIMC conducted by nurse-midwives with this device is safe, feasible, and acceptable to parents. PMID:27413083

  4. Veracity and rhetoric in paediatric medicine: a critique of Svoboda and Van Howe's response to the AAP policy on infant male circumcision.

    PubMed

    Morris, Brian J; Tobian, Aaron A R; Hankins, Catherine A; Klausner, Jeffrey D; Banerjee, Joya; Bailis, Stefan A; Moses, Stephen; Wiswell, Thomas E

    2014-07-01

    In a recent issue of the Journal of Medical Ethics,Svoboda and Van Howe commented on the 2012 changein the American Academy of Pediatrics (AAP) policy on newborn male circumcision, in which the AAP stated that benefits of the procedure outweigh the risks. Svoboda and Van Howe disagree with the AAP conclusions. We show here that their arguments against male circumcision are based on a poor understanding of epidemiology,erroneous interpretation of the evidence, selective citation of the literature, statistical manipulation of data, and circular reasoning. In reality, the scientific evidence indicates that male circumcision, especially when performed in the newborn period, is an ethically and medically sound low-risk preventive health procedure conferring a lifetime of benefits to health and well-being.Policies in support of parent-approved elective newborn circumcision should be embraced by the medical,scientific and wider communities.

  5. Strength of Evidence on Demand Creation for Voluntary Medical Male Circumcision From 7 Impact Evaluations in Southern and Eastern Africa

    PubMed Central

    Brown, Annette N.

    2016-01-01

    Background: Seven new impact evaluations of pilot programs for increasing the demand for voluntary medical male circumcision (VMMC) provide evidence of what works and what does not. The study findings suggest that financial compensation designed to relieve the opportunity or transportation costs from undergoing the procedure can increase the uptake of VMMC. There is also evidence that programs using peer influence can be effective, although so far only sports-based programs demonstrate a strong effect. We explore the strength of evidence in each of these 7 studies to better interpret the findings for policy making. Methods: We perform a risk of bias assessment and conduct power calculations using actual values for each of the 7 studies. Results: Three of the 7 studies have a medium risk of bias, whereas the other 4 have a low risk of bias. All but 2 of the studies have adequate power to detect meaningful effects. In the 2 with insufficient power, the estimated effects are large but statistically insignificant. Conclusion: The positive evidence that financial incentives presented as compensation for opportunity costs to men seeking and obtaining VMMC can increase uptake comes from strong studies, which have high power and low to medium risk of bias. The positive evidence that a comprehensive sports-based program for young men can increase uptake also comes from a strong study. The strength of the studies further validates these findings. PMID:27749599

  6. Obtaining a male circumcision prevalence rate of 80% among adults in a short time: An observational prospective intervention study in the Orange Farm township of South Africa.

    PubMed

    Marshall, Esaie; Rain-Taljaard, Reathe; Tsepe, Motlalepule; Monkwe, Cornelius; Taljaard, Dirk; Hlatswayo, Florence; Xaba, Dumazile; Molomo, Tebogo; Lissouba, Pascale; Puren, Adrian; Auvert, Bertran

    2017-01-01

    World Health Organization recommends a target for the male circumcision prevalence rate of 80%. This rate will have a substantial impact on the human immunodeficiency virus-acquired immunodeficiency syndrome epidemic in Eastern and Southern Africa. The objective of the study was to assess whether an innovative intervention can lead to an increased voluntary male medical circumcision (VMMC) uptake among adults in a short time. This prospective observational study of a demand generation intervention was conducted in the township of Orange Farm (South Africa) in August to November 2015. In this community male circumcision prevalence rate among adults was stable between 2010 and 2015 at 55% and 57%, despite regular VMMC campaigns at community level and the presence of a VMMC clinic that offered free VMMC. The intervention took place in a random sample of 981 households where 522 men aged 18 to 49 years accepted to participate in the study. Among the 226 uncircumcised men, 212 accepted to be enrolled in the intervention study. A personal male circumcision adviser trained in interpersonal communication skills was assigned to each uncircumcised participant. The male circumcision advisers were trained to explain the risks and benefits of VMMC, and to discuss 24 possible reasons given by men for not being circumcised. Participants were then followed for 9 weeks. Each participant had a maximum of 3 motivational interviews at home. Participants who decided to be circumcised received financial compensation for their time equivalent to 2.5 days of work at the minimum South African salary rate. Among the 212 uncircumcised men enrolled in the intervention, 69.8% (148/212; 95% confidence interval [CI]; 63.4%-75.7%) agreed to be circumcised, which defines the uptake of the intervention. The male circumcision prevalence rate of the sample increased from 56.7% (296/522) to 81.4% (425/522; 77.9%-84.6%), P < 0.001, corresponding to a relative increase of 43.6% (95% CI: 35

  7. Early infant male circumcision: Systematic review, risk-benefit analysis, and progress in policy

    PubMed Central

    Morris, Brian J; Kennedy, Sean E; Wodak, Alex D; Mindel, Adrian; Golovsky, David; Schrieber, Leslie; Lumbers, Eugenie R; Handelsman, David J; Ziegler, John B

    2017-01-01

    AIM To determine whether recent evidence-based United States policies on male circumcision (MC) apply to comparable Anglophone countries, Australia and New Zealand. METHODS Articles in 2005 through 2015 were retrieved from PubMed using the keyword “circumcision” together with 36 relevant subtopics. A further PubMed search was performed for articles published in 2016. Searches of the EMBASE and Cochrane databases did not yield additional citable articles. Articles were assessed for quality and those rated 2+ and above according to the Scottish Intercollegiate Grading System were studied further. The most relevant and representative of the topic were included. Bibliographies were examined to retrieve further key references. Randomized controlled trials, recent high quality systematic reviews or meta-analyses (level 1++ or 1+ evidence) were prioritized for inclusion. A risk-benefit analysis of articles rated for quality was performed. For efficiency and reliability, recent randomized controlled trials, meta-analyses, high quality systematic reviews and large well-designed studies were used if available. Internet searches were conducted for other relevant information, including policies and Australian data on claims under Medicare for MC. RESULTS Evidence-based policy statements by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) support infant and later age male circumcision (MC) as a desirable public health measure. Our systematic review of relevant literature over the past decade yielded 140 journal articles that met our inclusion criteria. Together, these showed that early infant MC confers immediate and lifelong benefits by protecting against urinary tract infections having potential adverse long-term renal effects, phimosis that causes difficult and painful erections and “ballooning” during urination, inflammatory skin conditions, inferior penile hygiene, candidiasis, various sexually transmissible

  8. A Kenyan newspaper analysis of the limitations of voluntary medical male circumcision and the importance of sustained condom use

    PubMed Central

    2012-01-01

    Background Since the completion of three clinical trials indicating that voluntary medical male circumcision (VMMC) is an effective method to reduce men’s chances of acquiring HIV, use of the procedure has been advocated in Kenya. Media messages shape popular understandings of the benefits and limitations of male circumcision. The objectives of this study were to (1) investigate promotion messages in a popular online newspaper to determine how the limitations of male circumcision are represented, and whether condom use is still being promoted; and (2) gain insight into popular understandings of the limitations of this new procedure through newspaper reader comments. Methods A content analysis was conducted on 34 online media articles published by the Daily Nation between January 1, 2008 and December 31, 2010. Information about condom promotion, partial immunity, limitations and complications of the procedure, as well as emergent themes, were analyzed. Results Results demonstrated an irregular and occasionally misleading presentation of these topics and a perceived lack of objective information about the risks and limitations of VMMC. Conclusions There is a need for governmental and non-governmental public health organizations to engage with the media to improve risk messaging. PMID:22720748

  9. Single-arm evaluation of the AccuCirc device for early infant male circumcision in Botswana.

    PubMed

    Plank, Rebeca M; Wirth, Kathleen E; Ndubuka, Nnamdi O; Abdullahi, Rasak; Nkgau, Maggie; Lesetedi, Chiapo; Powis, Kathleen M; Mmalane, Mompati; Makhema, Joseph; Shapiro, Roger; Lockman, Shahin

    2014-05-01

    : Existing devices for early infant male circumcision (EIMC) have inherent limitations. We evaluated the newly developed AccuCirc device by circumcising 151 clinically well, full-term male infants with birth weight ≥2.5 kg within the first 10 days of life from a convenience sample in 2 hospitals in Botswana. No major adverse events were observed. There was 1 local infection, 5 cases of minor bleeding, and 1 case of moderate bleeding. In 3 cases, the device made only partial incisions that were completed immediately by the provider without complications. Parental satisfaction was high: >96% of mothers stated that they would circumcise a future son. The pre-assembled, sterile AccuCirc kit has the potential to overcome obstacles related to supply chain management and on-site instrument disinfection that can pose challenges in resource-limited settings. In our study, the AccuCirc was safe and it should be considered for programmatic EIMC in resource-limited settings.

  10. Male Circumcision and the Epidemic Emergence of HIV-2 in West Africa

    PubMed Central

    Hewlett, Barry Stephen; Camacho, Ricardo Jorge

    2016-01-01

    Background Epidemic HIV-2 (groups A and B) emerged in humans circa 1930–40. Its closest ancestors are SIVsmm infecting sooty mangabeys from southwestern Côte d'Ivoire. The earliest large-scale serological surveys of HIV-2 in West Africa (1985–91) show a patchy spread. Côte d'Ivoire and Guinea-Bissau had the highest prevalence rates by then, and phylogeographical analysis suggests they were the earliest epicenters. Wars and parenteral transmission have been hypothesized to have promoted HIV-2 spread. Male circumcision (MC) is known to correlate negatively with HIV-1 prevalence in Africa, but studies examining this issue for HIV-2 are lacking. Methods We reviewed published HIV-2 serosurveys for 30 cities of all West African countries and obtained credible estimates of real prevalence through Bayesian estimation. We estimated past MC rates of 218 West African ethnic groups, based on ethnographic literature and fieldwork. We collected demographic tables specifying the ethnic partition in cities. Uncertainty was incorporated by defining plausible ranges of parameters (e.g. timing of introduction, proportion circumcised). We generated 1,000 sets of past MC rates per city using Latin Hypercube Sampling with different parameter combinations, and explored the correlation between HIV-2 prevalence and estimated MC rate (both logit-transformed) in the 1,000 replicates. Results and Conclusions Our survey reveals that, in the early 20th century, MC was far less common and geographically more variable than nowadays. HIV-2 prevalence in 1985–91 and MC rates in 1950 were negatively correlated (Spearman rho = -0.546, IQR: -0.553–-0.546, p≤0.0021). Guinea-Bissau and Côte d'Ivoire cities had markedly lower MC rates. In addition, MC was uncommon in rural southwestern Côte d'Ivoire in 1930.The differential HIV-2 spread in West Africa correlates with different historical MC rates. We suggest HIV-2 only formed early substantial foci in cities with substantial uncircumcised

  11. Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review

    PubMed Central

    Van Lith, Lynn M.; Mallalieu, Elizabeth C.; Waxman, Aliza; Hatzhold, Karin; Marcell, Arik V.; Kasedde, Susan; Lija, Gissenge; Hasen, Nina; Ncube, Gertrude; Samuelson, Julia L.; Bonnecwe, Collen; Seifert-Ahanda, Kim; Njeuhmeli, Emmanuel; Tobian, Aaron A. R.

    2016-01-01

    Background Voluntary medical male circumcision (VMMC) is a critical HIV prevention tool. Since 2007, sub-Saharan African countries with the highest prevalence of HIV have been mobilizing resources to make VMMC available. While implementers initially targeted adult men, demand has been highest for boys under age 18. It is important to understand how male adolescents can best be served by quality VMMC services. Methods and Findings A systematic literature review was performed to synthesize the evidence on best practices in adolescent health service delivery specific to males in sub-Saharan Africa. PubMed, Scopus, and JSTOR databases were searched for literature published between January 1990 and March 2014. The review revealed a general absence of health services addressing the specific needs of male adolescents, resulting in knowledge gaps that could diminish the benefits of VMMC programming for this population. Articles focused specifically on VMMC contained little information on the adolescent subgroup. The review revealed barriers to and gaps in sexual and reproductive health and VMMC service provision to adolescents, including structural factors, imposed feelings of shame, endorsement of traditional gender roles, negative interactions with providers, violations of privacy, fear of pain associated with the VMMC procedure, and a desire for elements of traditional non-medical circumcision methods to be integrated into medical procedures. Factors linked to effective adolescent-focused services included the engagement of parents and the community, an adolescent-friendly service environment, and VMMC counseling messages sufficiently understood by young males. Conclusions VMMC presents an opportune time for early involvement of male adolescents in HIV prevention and sexual and reproductive health programming. However, more research is needed to determine how to align VMMC services with the unique needs of this population. PMID:26938639

  12. Reasons for the low uptake of adult male circumcision for the prevention of HIV transmission in Swaziland.

    PubMed

    Maibvise, Charles; Mavundla, Thandisizwe R

    2014-09-01

    Swaziland is currently experiencing the worst impact of HIV and AIDS of any country in the world. In an effort to curb further spread of the virus, the country adopted mass male circumcision (MC) as recommended by the World Health Organization in 2007. Despite intense campaigns to promote the procedure over the past three years, the uptake of circumcision remains very low for reasons that are not very clear. The purpose of this study was to explore the reasons for the low uptake of MC in Swaziland despite the massive national MC campaigns. A qualitative research design was used, in which all men who were targeted by the mass MC campaign were eligible. Participants were identified as they came for sexual and reproductive health services at the Family Life Association of Swaziland (FLAS) Clinic, Mbabane. In-depth, individual face-to-face unstructured interviews were conducted to elicit the reasons why men were not going for circumcision. A total of 17 men were interviewed. Results showed that these reasons include fear of the procedure and the possible outcome, perception of no significant benefit of the procedure, impatience about waiting for the procedure or the healing process, religious/cultural beliefs, and worries about the fate of the foreskin. These reasons were attributed to misconceptions and lack of accurate and specific information about some aspects of the circumcision strategy of HIV preventions. Physiological changes and economic activities associated with adulthood were also found to be hindrances to MC uptake. The study recommended that a comprehensive description of the procedure and more precise facts and scientific bases of the MC strategy be incorporated and emphasised in the MC campaigns. Involvement of religious leaders will also facilitate clarification of religious or cultural misunderstandings or misconceptions. A focus on neonatal MC would also help.

  13. Implementation of Adolescent-Friendly Voluntary Medical Male Circumcision Using a School Based Recruitment Program in Rural KwaZulu-Natal, South Africa

    PubMed Central

    Montague, Carl; Ngcobo, Nelisiwe; Mahlase, Gethwana; Frohlich, Janet; Pillay, Cheryl; Yende-Zuma, Nonhlanhla; Humphries, Hilton; Dellar, Rachael; Naidoo, Kogieleum; Karim, Quarraisha Abdool

    2014-01-01

    Background Epidemiological data from South Africa demonstrate that risk of human immunodeficiency virus (HIV) infection in males increases dramatically after adolescence. Targeting adolescent HIV-negative males may be an efficient and cost-effective means of maximising the established HIV prevention benefits of voluntary medical male circumcision (VMMC) in high HIV prevalence–, low circumcision practice–settings. This study assessed the feasibility of recruiting male high school students for VMMC in such a setting in rural KwaZulu-Natal. Methods and Findings Following community and key stakeholder consultations on the acceptability of VMMC recruitment through schools, information and awareness raising sessions were held in 42 high schools in Vulindlela. A three-phase VMMC demand-creation strategy was implemented in partnership with a local non-governmental organization, ZimnadiZonke, that involved: (i) community consultation and engagement; (ii) in-school VMMC awareness sessions and centralized HIV counselling and testing (HCT) service access; and (iii) peer recruitment and decentralized HCT service access. Transport was provided for volunteers to the Centre for the AIDS Programme of Research in South Africa (CAPRISA) clinic where the forceps-guided VMMC procedure was performed on consenting HIV-negative males. HIV infected volunteers were referred to further care either at the CAPRISA clinic or at public sector clinics. Between March 2011 and February 2013, a total of 5165 circumcisions were performed, the majority (71%) in males aged between 15 and 19 years. Demand-creation strategies were associated with an over five-fold increase in VMMC uptake from an average of 58 procedures/month in initial community engagement phases, to an average of 308 procedures/month on initiation of the peer recruitment–decentralized service phase. Post-operative adverse events were rare (1.2%), mostly minor and self-resolving. Conclusions Optimizing a high volume, adolescent

  14. Perceptions of HIV and Safe Male Circumcision in High HIV Prevalence Fishing Communities on Lake Victoria, Uganda

    PubMed Central

    Nevin, Paul E.; Pfeiffer, James; Kibira, Simon P. S.; Lubinga, Solomon J.; Mukose, Aggrey; Babigumira, Joseph B.

    2015-01-01

    Background In 2010, the Uganda Ministry of Health introduced its Safe Male Circumcision (SMC) strategy for HIV prevention with the goal of providing 4.2 million voluntary medical male circumcisions by 2015. Fishing communities, where HIV prevalence is approximately 3–5 times higher than the national average, have been identified as a key population needing targeted HIV prevention services by the National HIV Prevention Strategy. This study aimed to understand perceptions of HIV and identify potential barriers and facilitators to SMC in fishing communities along Lake Victoria. Methods We conducted 8 focus group discussions, stratified by sex and age, with 67 purposefully sampled participants in 4 communities in Kalangala District, Uganda. Results There was universal knowledge of the availability of SMC services, but males reported high uptake in the community while females indicated that it is low. Improved hygiene, disease prevention, and improved sexual performance and desirability were reported facilitators. Barriers included a perceived increase in SMC recipients’ physiological libido, post-surgical abstinence, lost income during convalescence, and lengthier recovery due to occupational hazards. Both males and females reported concerns about spousal fidelity during post-SMC abstinence. Reported misconceptions and community-held cultural beliefs include fear that foreskins are sold after their removal, the belief that a SMC recipient’s first sexual partner after the procedure should not be his spouse, and the belief that vaginal fluids aid circumcision wound healing. Conclusions Previous outreach efforts have effectively reached these remote communities, where availability and health benefits of SMC are widely understood. However, community-specific intervention strategies are needed to address the barriers identified in this study. We recommend the development of targeted counseling, outreach, and communication strategies to address barriers

  15. Voluntary Medical Male Circumcision for HIV Prevention: New Mathematical Models for Strategic Demand Creation Prioritizing Subpopulations by Age and Geography

    PubMed Central

    Hankins, Catherine; Warren, Mitchell

    2016-01-01

    Over 11 million voluntary medical male circumcisions (VMMC) have been performed of the projected 20.3 million needed to reach 80% adult male circumcision prevalence in priority sub-Saharan African countries. Striking numbers of adolescent males, outside the 15-49-year-old age target, have been accessing VMMC services. What are the implications of overall progress in scale-up to date? Can mathematical modeling provide further insights on how to efficiently reach the male circumcision coverage levels needed to create and sustain further reductions in HIV incidence to make AIDS no longer a public health threat by 2030? Considering ease of implementation and cultural acceptability, decision makers may also value the estimates that mathematical models can generate of immediacy of impact, cost-effectiveness, and magnitude of impact resulting from different policy choices. This supplement presents the results of mathematical modeling using the Decision Makers’ Program Planning Tool Version 2.0 (DMPPT 2.0), the Actuarial Society of South Africa (ASSA2008) model, and the age structured mathematical (ASM) model. These models are helping countries examine the potential effects on program impact and cost-effectiveness of prioritizing specific subpopulations for VMMC services, for example, by client age, HIV-positive status, risk group, and geographical location. The modeling also examines long-term sustainability strategies, such as adolescent and/or early infant male circumcision, to preserve VMMC coverage gains achieved during rapid scale-up. The 2016–2021 UNAIDS strategy target for VMMC is an additional 27 million VMMC in high HIV-prevalence settings by 2020, as part of access to integrated sexual and reproductive health services for men. To achieve further scale-up, a combination of evidence, analysis, and impact estimates can usefully guide strategic planning and funding of VMMC services and related demand-creation strategies in priority countries. Mid

  16. Voluntary Medical Male Circumcision for HIV Prevention: New Mathematical Models for Strategic Demand Creation Prioritizing Subpopulations by Age and Geography.

    PubMed

    Hankins, Catherine; Warren, Mitchell; Njeuhmeli, Emmanuel

    2016-01-01

    Over 11 million voluntary medical male circumcisions (VMMC) have been performed of the projected 20.3 million needed to reach 80% adult male circumcision prevalence in priority sub-Saharan African countries. Striking numbers of adolescent males, outside the 15-49-year-old age target, have been accessing VMMC services. What are the implications of overall progress in scale-up to date? Can mathematical modeling provide further insights on how to efficiently reach the male circumcision coverage levels needed to create and sustain further reductions in HIV incidence to make AIDS no longer a public health threat by 2030? Considering ease of implementation and cultural acceptability, decision makers may also value the estimates that mathematical models can generate of immediacy of impact, cost-effectiveness, and magnitude of impact resulting from different policy choices. This supplement presents the results of mathematical modeling using the Decision Makers' Program Planning Tool Version 2.0 (DMPPT 2.0), the Actuarial Society of South Africa (ASSA2008) model, and the age structured mathematical (ASM) model. These models are helping countries examine the potential effects on program impact and cost-effectiveness of prioritizing specific subpopulations for VMMC services, for example, by client age, HIV-positive status, risk group, and geographical location. The modeling also examines long-term sustainability strategies, such as adolescent and/or early infant male circumcision, to preserve VMMC coverage gains achieved during rapid scale-up. The 2016-2021 UNAIDS strategy target for VMMC is an additional 27 million VMMC in high HIV-prevalence settings by 2020, as part of access to integrated sexual and reproductive health services for men. To achieve further scale-up, a combination of evidence, analysis, and impact estimates can usefully guide strategic planning and funding of VMMC services and related demand-creation strategies in priority countries. Mid-course corrections

  17. Men's attitudes: A hindrance to the demand for voluntary medical male circumcision--a qualitative study in rural Mhondoro-Ngezi, Zimbabwe.

    PubMed

    Moyo, Stanzia; Mhloyi, Marvellous; Chevo, Tafadzwa; Rusinga, Oswell

    2015-01-01

    Male circumcision has witnessed a paradigm shift from being regarded as a religious and cultural practice to a global intervention strategy meant to curb transmission of HIV. This is particularly evident in sub-Saharan African countries where the HIV prevalence is greater than 15%. Zimbabwe adopted the voluntary medical male circumcision (VMMC) strategy in 2009; however, since then the uptake of the intervention has only 10% of the adult male population has reported having been circumcised. To better understand this limited uptake of VMMC, we conducted a qualitative study with uncircumcised men aged 15-79 years in Mhondoro-Ngezi, Zimbabwe. Through assessing men's attitudes towards VMMC in seven focus group discussions, conducted between July and August 2012, this article seeks to provide improved strategies for delivering this intervention in Zimbabwe. These data reveal that, in general, men have a negative attitude towards VMMC. Specific barriers to the uptake of VMMC included the perceived challenge to masculinity, post-circumcision stigma, lack of reliable and adequate information and perceptions about the appropriateness of VMMC. These results suggest that structural interventions aimed at reducing stigma related to circumcision, in addition to increased efforts to disseminate accurate information about VMMC, are required in order to dispel men's attitudes that hinder demand for VMMC.

  18. Transfer of the Kenyan Kikuyu Male Circumcision Ritual to Future Generations Living in the United States

    ERIC Educational Resources Information Center

    Mbito, Michael N.; Malia, Julia A.

    2009-01-01

    This phenomenological research report from analysis of interviews with 18 participants focuses on the theme of transferring an age-old initiation-into-manhood circumcision ritual to future generations of Kenyan Kikuyu who are living in the US. We identified three subthemes and found a strong indication that, while personally meaningful to the…

  19. Toward a Systematic Approach to Generating Demand for Voluntary Medical Male Circumcision: Insights and Results From Field Studies

    PubMed Central

    Sgaier, Sema K; Baer, James; Rutz, Daniel C; Njeuhmeli, Emmanuel; Seifert-Ahanda, Kim; Basinga, Paulin; Parkyn, Rosie; Laube, Catharine

    2015-01-01

    By the end of 2014, an estimated 8.5 million men had undergone voluntary medical male circumcision (VMMC) for HIV prevention in 14 priority countries in eastern and southern Africa, representing more than 40% of the global target. However, demand, especially among men most at risk for HIV infection, remains a barrier to realizing the program's full scale and potential impact. We analyzed current demand generation interventions for VMMC by reviewing the available literature and reporting on field visits to programs in 7 priority countries. We present our findings and recommendations using a framework with 4 components: insight development; intervention design; implementation and coordination to achieve scale; and measurement, learning, and evaluation. Most program strategies lacked comprehensive insight development; formative research usually comprised general acceptability studies. Demand generation interventions varied across the countries, from advocacy with community leaders and community mobilization to use of interpersonal communication, mid- and mass media, and new technologies. Some shortcomings in intervention design included using general instead of tailored messaging, focusing solely on the HIV preventive benefits of VMMC, and rolling out individual interventions to address specific barriers rather than a holistic package. Interventions have often been scaled-up without first being evaluated for effectiveness and cost-effectiveness. We recommend national programs create coordinated demand generation interventions, based on insights from multiple disciplines, tailored to the needs and aspirations of defined subsets of the target population, rather than focused exclusively on HIV prevention goals. Programs should implement a comprehensive intervention package with multiple messages and channels, strengthened through continuous monitoring. These insights may be broadly applicable to other programs where voluntary behavior change is essential to achieving

  20. A Randomized Evaluation of a Demand Creation Lottery for Voluntary Medical Male Circumcision Among Adults in Tanzania

    PubMed Central

    Mahler, Hally; Machaku, Michael; Lemwayi, Ruth; Kulindwa, Yusuph; Gisenge Lija, Jackson; Mpora, Baraka; Ochola, Denice; Sarkar, Supriya; Williams, Emma; Plotkin, Marya; Juma, James

    2016-01-01

    Background: Uptake of voluntary medical male circumcision (VMMC) among adult men has fallen short of targets in Tanzania. We evaluated a smartphone raffle intervention designed to increase VMMC uptake in three regions. Methods: Among 7 matched pairs of health facilities, 1 in each pair was randomly assigned to the intervention, consisting of a weekly smartphone raffle for clients returning for follow-up and monthly raffle for peer promoters and providers. VMMC records of clients aged 20 and older were analyzed over three months, with the number performed compared with the same months in the previous year. In multivariable models, the intervention's effect on number of VMMCs was adjusted for client factors and clustering. Focus groups with clients and peer promoters explored preferences for VMMC incentives. Results: VMMCs increased 47% and 8% in the intervention and control groups, respectively; however, the changes were not significantly different from one another. In the Iringa region subanalysis, VMMCs in the intervention group increased 336% (exponentiated coefficient of 3.36, 95% CI: 1.14 to 9.90; P = 0.028), after controlling for facility pair, percentage of clients ≥ age 30, and percentage testing HIV positive; the control group had a more modest 63% increase (exponentiated coefficient 1.63, 95% CI: 1.18 to 2.26; P = 0.003). The changes were not significantly different. Focus group respondents expressed mixed opinions about smartphone raffles; some favored smaller cash incentive or transportation reimbursement. Implications: A smartphone raffle might increase VMMC uptake in some settings by helping late adopters move from intention to action; however, this study did not find strong evidence to support its implementation broadly. PMID:27404009

  1. Sutureless Adult Voluntary Male Circumcision with Topical Anesthetic: A Randomized Field Trial of Unicirc, a Single-Use Surgical Instrument

    PubMed Central

    2016-01-01

    Introduction The World Health Organization has solicited rapid and minimally invasive techniques to facilitate scale-up of voluntary medical male circumcision (VMMC). Study design Non-blinded randomized controlled field trial with 2:1 allocation ratio. Participants 75 adult male volunteers. Setting Outpatient primary care clinic. Intervention Open surgical circumcision under local anesthetic with suturing vs. Unicirc disposable instrument under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive. Primary Outcome Intraoperative duration. Secondary Outcomes Intraoperative and postoperative pain; adverse events; time to healing; patient satisfaction; cosmetic result. Results The intraoperative time was less with the Unicirc technique (median 12 vs. 25 min, p < 0.001). Wound healing and cosmetic results were superior in the Unicirc group. Adverse events were similar in both groups. Conclusions VMMC with Unicirc under topical anesthetic and wound sealing with cyanoacrylate tissue adhesive is rapid, heals by primary intention with superior cosmetic results, and is potentially safer and more cost-effective than open surgical VMMC. Trial Registration Clinicaltrials.gov NCT02443792 PMID:27299735

  2. Towards a gender perspective in qualitative research on voluntary medical male circumcision in east and southern Africa

    PubMed Central

    Pérez, Guillermo Martínez; Durán, Laura Triviño; Gasch, Angel; Desmond, Nicole

    2016-01-01

    The World Health Organization endorsed voluntary medical male circumcision (VMMC) in 2007 as an effective method to provide partial protection against heterosexual female-to-male transmission of HIV in regions with high rates of such transmission, and where uptake of VMMC is low. Qualitative research conducted in east and southern Africa has focused on assessing acceptability, barriers to uptake of VMMC and the likelihood of VMMC increasing men’s adoption of risky sexual behaviours. Less researched, however, have been the perceptions of women and sexual minorities towards VMMC, even though they are more vulnerable to HIV/AIDS transmission than are heterosexual men. The purpose of this paper is to identify core areas in which a gendered perspective in qualitative research might improve the understanding and framing of VMMC in east and southern Africa. Issues explored in this analysis are risk compensation, the post-circumcision appearance of the penis, inclusion of men who have sex with men as study respondents and the antagonistic relation between VMMC and female genital cutting. If biomedical and social science researchers explore these issues in future qualitative inquiry utilising a gendered perspective, a more thorough understanding of VMMC can be achieved, which could ultimately inform policy and implementation. PMID:25727455

  3. Towards a gender perspective in qualitative research on voluntary medical male circumcision in east and southern Africa.

    PubMed

    Martínez Pérez, Guillermo; Triviño Durán, Laura; Gasch, Angel; Desmond, Nicole

    2015-01-01

    The World Health Organization endorsed voluntary medical male circumcision (VMMC) in 2007 as an effective method to provide partial protection against heterosexual female-to-male transmission of HIV in regions with high rates of such transmission, and where uptake of VMMC is low. Qualitative research conducted in east and southern Africa has focused on assessing acceptability, barriers to uptake of VMMC and the likelihood of VMMC increasing men's adoption of risky sexual behaviours. Less researched, however, have been the perceptions of women and sexual minorities towards VMMC, even though they are more vulnerable to HIV/AIDS transmission than are heterosexual men. The purpose of this paper is to identify core areas in which a gendered perspective in qualitative research might improve the understanding and framing of VMMC in east and southern Africa. Issues explored in this analysis are risk compensation, the post-circumcision appearance of the penis, inclusion of men who have sex with men as study respondents and the antagonistic relation between VMMC and female genital cutting. If biomedical and social science researchers explore these issues in future qualitative inquiry utilising a gendered perspective, a more thorough understanding of VMMC can be achieved, which could ultimately inform policy and implementation.

  4. Male circumcision and HIV status among Latino immigrant MSM in New York City.

    PubMed

    Reisen, Carol A; Zea, Maria Cecilia; Poppen, Paul J; Bianchi, Fernanda T

    2007-01-01

    This study investigated protective effects of circumcision in a sample of immigrant Latino men who have sex with men (MSM). A survey in Portuguese, Spanish, or English was administered with computer-assisted self-interview technology with audio enhancement (A-CASI) to 482 MSM from Brazil (n=146), Colombia (n=169), and the Dominican Republic (n=167), living in the New York metropolitan area. Logistic regression revealed that after controlling for age, income, education, having had syphilis, having done sex work, and preferring the receptive role in anal intercourse, uncircumcised men were almost twice as likely to be HIV-positive as circumcised men. Follow-up analyses revealed, however, that the protective effects occurred only among the group of Colombian men.

  5. Modeling Impact and Cost-Effectiveness of Increased Efforts to Attract Voluntary Medical Male Circumcision Clients Ages 20–29 in Zimbabwe

    PubMed Central

    Kripke, Katharine; Hatzold, Karin; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Gold, Elizabeth; Ahanda, Kim Seifert; Kruse-Levy, Natalie

    2016-01-01

    Background Zimbabwe aims to increase circumcision coverage to 80% among 13- to 29-year-olds. However, implementation data suggest that high coverage among men ages 20 and older may not be achievable without efforts specifically targeted to these men, incurring additional costs per circumcision. Scale-up scenarios were created based on trends in implementation data in Zimbabwe, and the cost-effectiveness of increasing efforts to recruit clients ages 20–29 was examined. Methods Zimbabwe voluntary medical male circumcision (VMMC) program data were used to project trends in male circumcision coverage by age into the future. The projection informed a base scenario in which, by 2018, the country achieves 80% circumcision coverage among males ages 10–19 and lower levels of coverage among men above age 20. The Zimbabwe DMPPT 2.0 model was used to project costs and impacts, assuming a US$109 VMMC unit cost in the base scenario and a 3% discount rate. Two other scenarios assumed that the program could increase coverage among clients ages 20–29 with a corresponding increase in unit cost for these age groups. Results When circumcision coverage among men ages 20–29 is increased compared with a base scenario reflecting current implementation trends, fewer VMMCs are required to avert one infection. If more than 50% additional effort (reflected as multiplying the unit cost by >1.5) is required to double the increase in coverage among this age group compared with the base scenario, the cost per HIV infection averted is higher than in the base scenario. Conclusions Although increased investment in recruiting VMMC clients ages 20–29 may lead to greater overall impact if recruitment efforts are successful, it may also lead to lower cost-effectiveness, depending on the cost of increasing recruitment. Programs should measure the relationship between increased effort and increased ability to attract this age group. PMID:27783637

  6. Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe

    PubMed Central

    Jennings, Larissa; Bertrand, Jane; Rech, Dino; Harvey, Steven A.; Hatzold, Karin; Samkange, Christopher A.; Omondi Aduda, Dickens S.; Fimbo, Bennett; Cherutich, Peter; Perry, Linnea; Castor, Delivette; Njeuhmeli, Emmanuel

    2014-01-01

    Background The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria. Methods and Findings A comparative process evaluation was used to examine data from SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up, among health facilities providing VMMC across two years of program scale-up. Site-level assessments examined the availability of guidelines, supplies and equipment, infection control, and continuity of care services. Direct observation of VMMC surgeries were used to assess care quality. Two sample tests of proportions and t-tests were used to examine differences in the percent of facilities meeting requisite preparedness standards and the mean number of directly-observed surgical tasks performed correctly. Results showed that safe, high quality VMMC can be implemented and sustained at-scale, although substantial variability was observed over time. In some settings, facility preparedness and VMMC service quality improved as the number of VMMC facilities increased. Yet, lapses in high performance and expansion of considerably deficient services were also observed. Surgical tasks had the highest quality scores, with lower performance levels in infection control, pre-operative examinations, and post-operative patient monitoring and counseling. The range of scale-up models used across countries additionally underscored the complexity of delivering high quality VMMC. Conclusions Greater efforts are needed to integrate VMMC scale-up and quality improvement processes in sub-Saharan African settings. Monitoring of service quality, not just adverse events reporting, will be essential in realizing the full health impact of VMMC for HIV prevention. PMID:24801073

  7. Voluntary Medical Male Circumcision for HIV Prevention in Malawi: Modeling the Impact and Cost of Focusing the Program by Client Age and Geography

    PubMed Central

    Kripke, Katharine; Chimbwandira, Frank; Mwandi, Zebedee; Matchere, Faustin; Schnure, Melissa; Reed, Jason; Castor, Delivette; Sgaier, Sema

    2016-01-01

    Background In 2007, the World Health Organization (WHO) recommended scaling up voluntary medical male circumcision (VMMC) in priority countries with high HIV prevalence and low male circumcision (MC) prevalence. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), an estimated 5.8 million males had undergone VMMC by the end of 2013. Implementation experience has raised questions about the need to refocus VMMC programs on specific subpopulations for the greatest epidemiological impact and programmatic effectiveness. As Malawi prepared its national operational plan for VMMC, it sought to examine the impacts of focusing on specific subpopulations by age and region. Methods We used the Decision Makers’ Program Planning Toolkit, Version 2.0, to study the impact of scaling up VMMC to different target populations of Malawi. National MC prevalence by age group from the 2010 Demographic and Health Survey was scaled according to the MC prevalence for each district and then halved, to adjust for over-reporting of circumcision. In-country stakeholders advised a VMMC unit cost of $100, based on implementation experience. We derived a cost of $451 per patient-year for antiretroviral therapy from costs collected as part of a strategic planning exercise previously conducted in- country by UNAIDS. Results Over a fifteen-year period, circumcising males ages 10–29 would avert 75% of HIV infections, and circumcising males ages 10–34 would avert 88% of infections, compared to the current strategy of circumcising males ages 15–49. The Ministry of Health’s South West and South East health zones had the lowest cost per HIV infection averted. Moreover, VMMC met WHO’s definition of cost-effectiveness (that is, the cost per disability-adjusted life-year [DALY] saved was less than three times the per capita gross domestic product) in all health zones except Central East. Comparing urban versus rural areas in the country, we found that circumcising men in urban

  8. Needs Assessment and Theory-Based Promotion of Voluntary Medical Male Circumcision (VMMC) Among Male Sexually Transmitted Diseases Patients (MSTDP) in China.

    PubMed

    Wang, Zixin; Feng, Tiejian; Lau, Joseph T F

    2016-11-01

    Voluntary medical male circumcision (VMMC) is an evidence-based biomedical HIV prevention method. It is under-utilized in countries outside Africa, including China. The present single-arm, non-blinded test-of-concept trial was designed to promote VMMC among 179 male sexually transmitted diseases patients (MSTDP) in Shenzhen, China. It was based on behavioral health theories and results of a formative survey. At month 4, 45.5 % of the MSTDP responded positively to the intervention (19.9 % had taken up VMMC and 25.6 % intended to do so in the next 6 months). Adjusted analysis showed that cognitive variables measured at baseline (perceived self-efficacy, subjective norm and behavioral intention) significantly predicted adoption of VMMC during the 4-month follow-up period. Process evaluation involving clinicians of the STD clinics was positive. At month 6, 36.0 % of the circumcised participants used condom less frequently with their regular sex partner. We recommend scaling up the intervention, taking prevention of risk compensation into account.

  9. Voluntary Medical Male Circumcision Scale-Up in Nyanza, Kenya: Evaluating Technical Efficiency and Productivity of Service Delivery

    PubMed Central

    Omondi Aduda, Dickens S.; Ouma, Collins; Onyango, Rosebella; Onyango, Mathews; Bertrand, Jane

    2015-01-01

    Background Voluntary medical male circumcision (VMMC) service delivery is complex and resource-intensive. In Kenya’s context there is still paucity of information on resource use vis-à-vis outputs as programs scale up. Knowledge of technical efficiency, productivity and potential sources of constraints is desirable to improve decision-making. Objective To evaluate technical efficiency and productivity of VMMC service delivery in Nyanza in 2011/2012 using data envelopment analysis. Design Comparative process evaluation of facilities providing VMMC in Nyanza in 2011/2012 using output orientated data envelopment analysis. Results Twenty one facilities were evaluated. Only 1 of 7 variables considered (total elapsed operation time) significantly improved from 32.8 minutes (SD 8.8) in 2011 to 30 minutes (SD 6.6) in 2012 (95%CI = 0.0350–5.2488; p = 0.047). Mean scale technical efficiency significantly improved from 91% (SD 19.8) in 2011 to 99% (SD 4.0) in 2012 particularly among outreach compared to fixed service delivery facilities (CI -31.47959–4.698508; p = 0.005). Increase in mean VRS technical efficiency from 84% (SD 25.3) in 2011 and 89% (SD 25.1) in 2012 was not statistically significant. Benchmark facilities were #119 and #125 in 2011 and #103 in 2012. Malmquist Productivity Index (MPI) at fixed facilities declined by 2.5% but gained by 4.9% at outreach ones by 2012. Total factor productivity improved by 83% (p = 0.032) in 2012, largely due to progress in technological efficiency by 79% (p = 0.008). Conclusions Significant improvement in scale technical efficiency among outreach facilities in 2012 was attributable to accelerated activities. However, ongoing pure technical inefficiency requires concerted attention. Technological progress was the key driver of service productivity growth in Nyanza. Incorporating service-quality dimensions and using stepwise-multiple criteria in performance evaluation enhances comprehensiveness and validity. These findings

  10. The Relationship Between Distance and Post-operative Visit Attendance Following Medical Male Circumcision in Nyanza Province, Kenya.

    PubMed

    Golub, Ginger; Herman-Roloff, Amy; Hoffman, Susie; Jaoko, Walter; Bailey, Robert C

    2016-11-01

    To date, there is no research on voluntary medical male circumcision (VMMC) catchment areas or the relationship between distance to a VMMC facility and attendance at a post-operative follow-up visit. We analyzed data from a randomly selected subset of males self-seeking circumcision at one of 16 participating facilities in Nyanza Province, Kenya between 2008 and 2010. Among 1437 participants, 46.7 % attended follow-up. The median distance from residence to utilized facility was 2.98 km (IQR 1.31-5.38). Nearly all participants (98.8 %) lived within 5 km from a facility, however, 26.3 % visited a facility more than 5 km away. Stratified results demonstrated that among those utilizing fixed facilities, greater distance was associated with higher odds of follow-up non-attendance (OR5.01-10km vs. 0-1km = 1.71, 95 % CI 1.08, 2.70, p = 0.02; OR>10km vs. 0-1 km = 2.80, 95 % CI 1.26, 6.21, p = 0.01), adjusting for age and district of residence. We found 5 km marked the threshold distance beyond which follow-up attendance significantly dropped. These results demonstrate distance is an important predictor of attending follow-up, and this relationship appears to be modified by facility type.

  11. A Sport-Based Intervention to Increase Uptake of Voluntary Medical Male Circumcision Among Adolescent Male Students: Results From the MCUTS 2 Cluster-Randomized Trial in Bulawayo, Zimbabwe

    PubMed Central

    DeCelles, Jeff; Bhauti, Kenneth; Hershow, Rebecca B.; Weiss, Helen A.; Chaibva, Cynthia; Moyo, Netsai; Mantula, Fennie; Hatzold, Karin; Ross, David A.

    2016-01-01

    Background: Mathematical models suggest that 570,000 HIV infections could be averted between 2011 and 2025 in Zimbabwe if the country reaches 80% voluntary medical male circumcision (VMMC) coverage among 15- to 49-year-old male subjects. Yet national coverage remains well below this target, and there is a need to evaluate interventions to increase the uptake. Methods: A cluster-randomized trial was conducted to assess the effectiveness of Make-The-Cut-Plus (MTC+), a single, 60-minute, sport-based intervention to increase VMMC uptake targeting secondary school boys (14–20 years). Twenty-six schools in Bulawayo, Zimbabwe, were randomized to either receive MTC+ at the start (intervention) or end (control) of a 4-month period (March to June 2014). VMMC uptake over these 4 months was measured via probabilistic matching of participants in the trial database (n = 1226 male participants; age, 14–20 years; median age, 16.2 years) and the registers in Bulawayo's 2 free VMMC clinics (n = 5713), using 8 identifying variables. Results: There was strong evidence that the MTC+ intervention increased the odds of VMMC uptake by approximately 2.5 fold (odds ratio = 2.53; 95% confidence interval, 1.21 to 5.30). Restricting to participants who did not report being already circumcised at baseline, MTC+ increased VMMC uptake by 7.6% (12.2% vs 4.6%, odds ratio = 2.65; 95% confidence interval, 1.19 to 5.86). Sensitivity analyses related to the probabilistic matching did not change these findings substantively. The number of participants who would need to be exposed to the demand creation intervention to yield one additional VMMC client was 22.7 (or 13.2 reporting not already being circumcised). This translated to approximately US dollars 49 per additional VMMC client. Conclusions: The MTC+ intervention was an effective and cost-effective strategy for increasing VMMC uptake among school-going adolescent male subjects in Bulawayo. PMID:27404011

  12. Prevalence of Circumcision and its Association With HIV and Sexually Transmitted Infections in a Male US Navy Population

    DTIC Science & Technology

    2004-07-01

    STI acquisition, several studies among western populations have shown circumcision to have a strong protective effect against urinary tract infections (UTIs...WE. Urinary tract infections and the uncircumcised state: an update. Clin Pediatr (Phila) 1993; 32:130–134. 16. Shaw KN, Gorelick M, McGowan KL...Herzog LW. Urinary tract infections and circumcision. A case-control study. Am J Dis Child 1989; 143:348–350. Circumcision and HIV/STI association 16

  13. Prevalence and associated factors of behavioral intention for risk compensation following voluntary medical male circumcision among male sexually transmitted diseases patients in China.

    PubMed

    Wang, Zixin; Feng, Tiejian; Lau, Joseph T F

    2016-10-01

    Risk compensation was an important concern of voluntary medical male circumcision (VMMC) promotion campaigns. No study investigated risk compensation following VMMC among male sexually transmitted diseases patients (MSTDP). A cross-sectional survey interviewed 308 uncircumcised MSTDP in Shenzhen, China. 26.9% of them intended to perform at least one of the five types of risk compensation behaviors following VMMC. In the summary stepwise model, provision of incorrect response to HIV/sexually transmitted diseases knowledge items (multivariate odds ratios (ORm) = 2.30), genital herpes infection (ORm = 3.19), Risk Reduction Score for Unprotected Sex, and Negative Condom Attitudes Scale (ORm = 1.13) were significantly associated with behavioral intention to perform at least one type of risk compensation behavior following VMMC. The results provided a framework for developing related interventions. Prevention of risk compensation should be an essential component of VMMC promotion for all MSTDP, irrespective of their intention for VMMC.

  14. Covering the Last Kilometer: Using GIS to Scale-Up Voluntary Medical Male Circumcision Services in Iringa and Njombe Regions, Tanzania

    PubMed Central

    Mahler, Hally; Plotkin, Marya; Kulindwa, Yusuph; Greenberg, Seth; Mlanga, Erick; Njeuhmeli, Emmanuel; Lija, Gissenje

    2015-01-01

    Background: Based on the established protective effect of voluntary medical male circumcision (VMMC) in reducing female-to-male HIV transmission, Tanzania's Ministry of Health and Social Welfare (MOHSW) embarked on the scale-up of VMMC services in 2009. The Maternal and Child Health Integrated Project (MCHIP) supported the MOHSW to roll out VMMC services in Iringa and Njombe, 2 regions of Tanzania with among the highest HIV and lowest circumcision prevalence. With ambitious targets of reaching 264,990 males aged 10–34 years with VMMC in 5 years, efficient and innovative program approaches were necessary. Program Description: Outreach campaigns, in which mobile teams set up temporary services in facilities or non-facility settings, are used to reach lesser-served areas with VMMC. In 2012, MCHIP began using geographic information systems (GIS) to strategically plan the location of outreach campaigns. MCHIP gathered geocoded data on variables such as roads, road conditions, catchment population, staffing, and infrastructure for every health facility in Iringa and Njombe. These data were uploaded to a central database and overlaid with various demographic and service delivery data in order to identify the VMMC needs of the 2 regions. Findings: MCHIP used the interactive digital maps as decision-making tools to extend mobile VMMC outreach to “the last kilometer.” As of September 2014, the MOHSW with MCHIP support provided VMMC to 267,917 men, 259,144 of whom were men were aged 10–34 years, an achievement of 98% of the target of eligible males in Iringa and Njombe. The project reached substantially more men through rural dispensaries and non-health care facilities each successive year after GIS was introduced in 2012, jumping from 48% of VMMCs performed in rural areas in fiscal year 2011 to 88% in fiscal year 2012 and to 93% by the end of the project in 2014. Conclusion: GIS was an effective tool for making strategic decisions about where to prioritize VMMC

  15. Healthcare providers’ knowledges, attitudes and practices towards medical male circumcision and their understandings of its partial efficacy in HIV prevention: Qualitative research in KwaZulu-Natal, South Africa

    PubMed Central

    Milford, Cecilia; Rambally, Letitia; Mantell, Joanne E.; Kelvin, Elizabeth A.; Mosery, Nzwakie F.; Smit, Jennifer A.

    2015-01-01

    Background Medical male circumcision has been shown to reduce HIV transmission to an uninfected male partner. In South Africa, medical male circumcision programs were rolled-out in 2010. Objectives Prior to roll-out, we explored healthcare providers’ knowledge, attitudes and practices about medical male circumcision and their understandings of partial efficacy for HIV prevention. Design We conducted qualitative research, using in-depth interviews. Setting Participants were from three rural and three urban primary healthcare clinics, randomly selected in eThekwini District, KwaZulu-Natal. Participants 25 healthcare providers (including nurse managers, nurses and counselors) were purposively selected from the clinics. Methods In-depth interviews were recorded, transcribed and translated. Independent researchers reviewed the transcripts and developed a codebook based on emergent themes, using thematic analysis. NVivo 8 was used to facilitate data management, coding and analysis. Results Although most providers had heard that medical male circumcision can reduce risk of HIV acquisition in men, most did not have accurate scientific understandings of this. Some providers had misperceptions about the limited/partial protection medical male circumcision offers. Many had concerns that their communities would misunderstand it, causing increased risky sexual behavior. Conclusions These data provide a baseline of providers’ understandings of medical male circumcision prior to roll-out, and can be used to compare current data and ensure accurate messaging to clients. Healthcare provider messaging should build client understandings of the meaning of partially efficacious technologies. PMID:26302657

  16. Circumcision - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Male Circumcision (Arabic) العربية Bilingual PDF Health Information Translations Chinese - Simplified (简体中文) Male Circumcision 男性包皮环切术 - 简体中文 (Chinese - Simplified) Bilingual PDF Health Information Translations Chinese - Traditional (繁體中文) Male Circumcision 男性包皮環切術 - 繁體中文 (Chinese - ...

  17. [Circumcision: history, religion and law].

    PubMed

    Totaro, Angelo; Volpe, Andrea; Racioppi, Marco; Pinto, Francesco; Sacco, Emilio; Bassi, Pier Francesco

    2011-01-01

    The aim of this article is to describe the circumcision procedure during history, its therapeutic and preventive goals, with focus on bioethical, economic and law issues. The origins of this practice are lost in antiquity. It was performed since 3000 BC by the Egyptians for hygienic and religious reasons. Moreover, male circumcision is a religious commandment in Judaism and Islam, and it is customary in some Oriental Orthodox and other Christian churches of Africa. Nowadays, circumcision is performed as a routine procedure by the Jews and the Muslims for religious reasons. The world prevalence of men with circumcision is 12.5-33%, especially in USA, Canada, Islamic people and Africa; in Europe the prevalence rate is low (in Great Britain it is 1.5%). Currently, male circumcision is being highly debated because of ethical, law and scientific issues and the different roles of this procedure: therapeutic, prophylactic (but there is no universal consensus) and ritualistic role. Nowadays, in Italy there is a strong debate about the consensus for this practice and its indications. The Italian law does not allow performing ritualistic circumcision, as a free of charge procedure in public hospitals, at the government's expenses, because the Italian law must protect different religious cultures, in name of the laity of the State. Thus, national bioethical committee (CNB) has established that ritualistic circumcision may only be performed on a paying basis in public hospitals. As a protective practice, circumcision has decreased in the entire world because of the improvement of hygienical conditions and, above all, the lack of unanimous consent on the real usefulness of protective circumcision, even if several studies have recently demonstrated the protecting role of male circumcision against HIV infection.

  18. Chemokine Levels in the Penile Coronal Sulcus Correlate with HIV-1 Acquisition and Are Reduced by Male Circumcision in Rakai, Uganda

    PubMed Central

    Gray, Ronald H.; Shannon, Brett; Shahabi, Kamnoosh; Kong, Xiangrong; Grabowski, Kate; Kigozi, Godfrey; Nalugoda, Fred; Serwadda, David; Reynolds, Steven J.; Liu, Cindy M.; Tobian, Aaron A. R.

    2016-01-01

    Individual susceptibility to HIV is heterogeneous, but the biological mechanisms explaining differences are incompletely understood. We hypothesized that penile inflammation may increase HIV susceptibility in men by recruiting permissive CD4 T cells, and that male circumcision may decrease HIV susceptibility in part by reducing genital inflammation. We used multi-array technology to measure levels of seven cytokines in coronal sulcus (penile) swabs collected longitudinally from initially uncircumcised men enrolled in a randomized trial of circumcision in Rakai, Uganda. Coronal sulcus cytokine levels were compared between men who acquired HIV and controls who remained seronegative. Cytokines were also compared within men before and after circumcision, and correlated with CD4 T cells subsets in foreskin tissue. HIV acquisition was associated with detectable coronal sulcus Interleukin-8 (IL-8 aOR 2.26, 95%CI 1.04–6.40) and Monokine Induced by γ-interferon (MIG aOR 2.72, 95%CI 1.15–8.06) at the visit prior to seroconversion, and the odds of seroconversion increased with detection of multiple cytokines. Coronal sulcus chemokine levels were not correlated with those in the vagina of a man’s female sex partner. The detection of IL-8 in swabs was significantly reduced 6 months after circumcision (PRR 0.59, 95%CI 0.44–0.87), and continued to decline for at least two years (PRR 0.29, 95%CI 0.16–0.54). Finally, prepuce IL-8 correlated with increased HIV target cell density in foreskin tissues, including highly susceptible CD4 T cells subsets, as well as with tissue neutrophil density. Together, these data suggest that penile inflammation increases HIV susceptibility and is reduced by circumcision. PMID:27898732

  19. Sexual Satisfaction, Performance, and Partner Response Following Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project

    PubMed Central

    Zulu, Robert; Jones, Deborah; Chitalu, Ndashi; Cook, Ryan; Weiss, Stephen

    2015-01-01

    Background: Voluntary medical male circumcision (VMMC) is an important HIV prevention strategy, particularly in regions with high HIV incidence and low rates of male circumcision. However, 88% of the Zambian male population remain uncircumcised, and of these 80% of men surveyed expressed little interest in undergoing VMMC. Methods: The Spear and Shield study (consisting of 4 weekly, 90-minute sexual risk reduction/VMMC promotion sessions) recruited and enrolled men (N = 800) who self-identified as at risk of HIV by seeking HIV testing and counseling at community health centers. Eligible men tested HIV-negative, were uncircumcised, and expressed no interest in VMMC. Participants were encouraged (but not required) to invite their female partners (N = 668) to participate in the program in a gender-concordant intervention matched to their partners’. Men completed assessments at baseline, post-intervention (about 2 months after baseline), and 6 and 12 months post-intervention; women completed assessments at baseline and post-intervention. For those men who underwent VMMC and for their partners, an additional assessment was conducted 3 months following the VMMC. The ancillary analysis in this article compared the pre- and post-VMMC responses of the 257 Zambian men who underwent circumcision during or following study participation, using growth curve analyses, as well as of the 159 female partners. Results: Men were satisfied overall with the procedure (mean satisfaction score, 8.4 out of 10), and nearly all men (96%) and women (94%) stated they would recommend VMMC to others. Approximately half of the men reported an increase or no change in erections, orgasms, and time to achieve orgasms from pre-VMMC, while one-third indicated fewer erections and orgasms and decreased time to achieve orgasms post-VMMC. Nearly half (42%) of the men, and a greater proportion (63%) of the female partners, said their sexual pleasure increased while 22% of the men reported less

  20. Female circumcision.

    PubMed

    Abu Daia, J M

    2000-10-01

    It is uncertain when female circumcision was first practiced, but it certainly preceded the founding of both Christianity and Islam. A review of past and current historical, popular and professional literature was undertaken, and 4 types of female circumcision were identified. Typically female circumcision is performed by a local village practitioner, lay person or by untrained midwives. Female genital mutilation is not accepted by any religious or medical opinion, and is a violation of human rights against helpless individuals who are unable to provide informed consent and who must therefore be protected through education and legislation. Complications of female circumcision can present after many years. Any medical practitioner (either for adult or pediatric) can be confronted with this issue of female circumcision, even in countries where this custom is not present, thus mandating the understanding of this complex issue.

  1. Libertarianism and circumcision.

    PubMed

    Testa, Patrick; Block, Walter E

    2014-06-01

    Despite the millenniums-old tradition in Abrahamic circles of removing the foreskin of a penis at birth, the involuntary and aggressive practice of circumcision must not be made an exception to the natural, negative right to self-ownership-a birthright which should prevent a parent from physically harming a child from the moment of birth going forward. This paper will present a natural rights argument against the practice of male child circumcision, while also looking into some of the potential physical and psychological consequences of the practice. It will compare the practice with that of female circumcision, which is banned in developed nations but still practiced in the third world, as well as other forms of aggressive action, some once-prevalent, while disputing arguments made for parental ownership of the child, religious expression, cultural tradition, cleanliness, cosmetics, and conformity.

  2. Libertarianism and circumcision

    PubMed Central

    Testa, Patrick; Block, Walter E.

    2014-01-01

    Despite the millenniums-old tradition in Abrahamic circles of removing the foreskin of a penis at birth, the involuntary and aggressive practice of circumcision must not be made an exception to the natural, negative right to self-ownership—a birthright which should prevent a parent from physically harming a child from the moment of birth going forward. This paper will present a natural rights argument against the practice of male child circumcision, while also looking into some of the potential physical and psychological consequences of the practice. It will compare the practice with that of female circumcision, which is banned in developed nations but still practiced in the third world, as well as other forms of aggressive action, some once-prevalent, while disputing arguments made for parental ownership of the child, religious expression, cultural tradition, cleanliness, cosmetics, and conformity. PMID:24987720

  3. "Now we are in a different time; various bad diseases have come." understanding men's acceptability of male circumcision for HIV prevention in a moderate prevalence setting

    PubMed Central

    2012-01-01

    Background Adult male surgical circumcision (MC) has been shown to reduce HIV acquisition in men and is recommended by the WHO for inclusion in comprehensive national HIV prevention programs in high prevalence settings. Only limited research to date has been conducted in countries experiencing moderate burden epidemics, where the acceptability, operational feasibility and potential epidemiological impact of MC remain unclear. Methods A multi-method qualitative research study was conducted at four sites in Papua New Guinea (PNG), with 24 focus group discussions and 65 in-depth interviews carried out among 276 men. Results The majority of men were in favour of MC being introduced for HIV prevention in PNG and considered improved genital hygiene, enhanced sexual pleasure and culturally appropriateness key factors in the acceptability of a future intervention. A minority of men were against the introduction of MC, primarily due to concerns regarding sexual risk compensation and that the intervention went against prevailing cultural and religious beliefs. Conclusion This is one of the first community-based MC acceptability studies conducted in a moderate prevalence setting outside of Africa. Research findings from this study suggest that a future MC program for HIV prevention would be widely accepted by men in PNG. PMID:22264256

  4. Male circumcision for protection against HIV infection in sub-Saharan Africa: the evidence in favour justifies the implementation now in progress.

    PubMed

    Wamai, Richard G; Morris, Brian J; Bailey, Robert C; Klausner, Jeffrey D; Boedicker, Mackenzie N

    2015-01-01

    This article responds to a recent 'controversy study' in Global Public Health by de Camargo et al. directed at three randomised controlled trials (RCTs) of male circumcision (MC) for HIV prevention. These trials were conducted in three countries in sub-Saharan Africa (SSA) and published in 2005 and 2007. The RCTs confirmed observational data that had accumulated over the preceding two decades showing that MC reduces by 60% the risk of HIV infection in heterosexual men. Based on the RCT results, MC was adopted by global and national HIV policy-makers as an additional intervention for HIV prevention. Voluntary medical MC (VMMC) is now being implemented in 14 SSA countries. Thus referring to MC for HIV prevention as 'debate' and viewing MC through a lens of controversy seems mistaken. In their criticism, de Camargo et al. misrepresent and misinterpret current science supporting MC for HIV prevention, omit previous denunciations of arguments similar to theirs, and ignore evidence from ongoing scientific research. Here we point out the flaws in three areas de Camargo et al. find contentious. In doing so, we direct readers to growing evidence of MC as an efficacious, safe, acceptable, relatively low-cost one-off biomedical intervention for HIV prevention.

  5. A Model for the Roll-Out of Comprehensive Adult Male Circumcision Services in African Low-Income Settings of High HIV Incidence: The ANRS 12126 Bophelo Pele Project

    PubMed Central

    Lissouba, Pascale; Taljaard, Dirk; Rech, Dino; Doyle, Sean; Shabangu, Daniel; Nhlapo, Cynthia; Otchere-Darko, Josephine; Mashigo, Thabo; Matson, Caitlin; Lewis, David; Billy, Scott; Auvert, Bertran

    2010-01-01

    Background World Health Organization (WHO)/Joint United Nations Programme on AIDS (UNAIDS) has recommended adult male circumcision (AMC) for the prevention of heterosexually acquired HIV infection in men from communities where HIV is hyperendemic and AMC prevalence is low. The objective of this study was to investigate the feasibility of the roll-out of medicalized AMC according to UNAIDS/WHO operational guidelines in a targeted African setting. Methods and Findings The ANRS 12126 “Bophelo Pele” project was implemented in 2008 in the township of Orange Farm (South Africa). It became functional in 5 mo once local and ethical authorizations were obtained. Project activities involved community mobilization and outreach, as well as communication approaches aimed at both men and women incorporating broader HIV prevention strategies and promoting sexual health. Free medicalized AMC was offered to male residents aged 15 y and over at the project's main center, which had been designed for low-income settings. Through the establishment of an innovative surgical organization, up to 150 AMCs under local anesthesia, with sterilized circumcision disposable kits and electrocautery, could be performed per day by three task-sharing teams of one medical circumciser and five nurses. Community support for the project was high. As of November 2009, 14,011 men had been circumcised, averaging 740 per month in the past 12 mo, and 27.5% of project participants agreed to be tested for HIV. The rate of adverse events, none of which resulted in permanent damage or death, was 1.8%. Most of the men surveyed (92%) rated the services provided positively. An estimated 39.1% of adult uncircumcised male residents have undergone surgery and uptake is steadily increasing. Conclusion This study demonstrates that a quality AMC roll-out adapted to African low-income settings is feasible and can be implemented quickly and safely according to international guidelines. The project can be a model for

  6. Hybrid forum or network? The social and political construction of an international 'technical consultation': male circumcision and HIV prevention.

    PubMed

    Giami, Alain; Perrey, Christophe; Mendonça, André Luiz de Oliveira; de Camargo, Kenneth Rochel

    2015-01-01

    The technical consultation in Montreux, organised by World Health Organization and UNAIDS in 2007, recommended male circumcision as a method for preventing HIV transmission. This consultation came out of a long process of releasing reports and holding international and regional conferences, a process steered by an informal network. This network's relations with other parties is analysed along with its way of working and the exchanges during the technical consultation that led up to the formal adoption of a recommendation. Conducted in relation to the concepts of a 'hybrid forum' and 'network', this article shows that the decision was based on the formation and consolidation of a network of persons. They were active in all phases of this process, ranging from studies of the recommendation's efficacy, feasibility and acceptability to its adoption and implementation. In this sense, this consultation cannot be described as the constitution of a 'hybrid forum', which is characterised by its openness to a debate as well as a plurality of issues formulated by the actors and of resources used by them. On the contrary, little room was allowed for contradictory discussions, as if the decision had already been made before the Montreux consultation.

  7. What device would be best for early infant male circumcision in east and southern Africa? Provider experiences and opinions with three different devices in Kenya

    PubMed Central

    Nyaboke, Irene; Otieno, Fredrick O.

    2017-01-01

    Voluntary medical male circumcision (VMMC) reduces risk of HIV acquisition in heterosexual men by approximately 60%. As some countries approach targets for proportions of adolescents and adults circumcised, some are considering early infant male circumcision (EIMC) as a means to achieve sustainability of VMMC for long term reduction of HIV incidence. Evaluations of specialized devices for EIMC are important to provide programs with information required to make informed decisions about how to design safe, effective EIMC programs. We provide assessments by 11 providers with experience in Kenya employing all three of the devices most likely to be considered by various EIMC programs in east and Southern Africa. There was no one device that was seen to be clearly superior to the others. Each had its own advantages and disadvantages. Provider preferences were situation-specific. Most preferred the Mogen Clamp if they themselves were performing the procedure. However, most were concerned that not everyone will have the skills necessary for optimal safety. If someone else were circumcising their son, most would opt for the AccuCirc because of the risk of severing the glans when using the Mogen. A minority preferred the PrePex, but only if the baby received local anesthesia, not EMLA cream (a eutectic mixture of lidocaine 2.5% and prilocaine 2.5%), as presently prescribed by the manufacturer. In the context of a national EIMC program, all participants agreed that AccuCirc would be the device they would recommend due to protection of the glans from laceration and to the provision of a pre-assembled sterile kit that overcomes the need for additional supplies or autoclaving. All agreed that scaling up EIMC, integrating it with existing maternal child health services, will face significant challenges, not least of which is persuading already over-burdened providers to take on additional workload. These results will be useful to programmers considering introduction of EIMC

  8. Impact of male circumcision on the HIV epidemic in Papua New Guinea: a country with extensive foreskin cutting practices.

    PubMed

    Gray, Richard T; Vallely, Andrew; Wilson, David P; Kaldor, John; MacLaren, David; Kelly-Hanku, Angela; Siba, Peter; Murray, John M

    2014-01-01

    The degree to which adult medical male circumcision (MC) programs can reduce new HIV infections in a moderate HIV prevalence country like Papua New Guinea (PNG) are uncertain especially given the widespread prevalence of longitudinal foreskin cuts among adult males. We estimated the likely impact of a medical MC intervention in PNG using a mathematical model of HIV transmission. The model was age-structured and incorporated separate components for sex, rural/urban, men who have sex with men and female sex workers. Country-specific data of the prevalence of foreskin cuts, sexually transmitted infections, condom usage, and the acceptability of MC were obtained by our group through related studies. If longitudinal foreskin cutting has a protective efficacy of 20% compared to 60% for MC, then providing MC to 20% of uncut males from 2012 would require 376,000 procedures, avert 7,900 HIV infections by 2032, and require 143 MC per averted infection. Targeting uncut urban youths would achieve the most cost effective returns of 54 MC per HIV infection averted. These numbers of MC required to avert an HIV infection change little even with coverage up to 80% of men. The greater the protective efficacy of longitudinal foreskin cuts against HIV acquisition, the less impact MC interventions will have. Dependent on this efficacy, increasing condom use could have a much greater impact with a 10 percentage point increase averting 18,400 infections over this same period. MC programs could be effective in reducing HIV infections in PNG, particularly in high prevalence populations. However the overall impact is highly dependent on the protective efficacy of existing longitudinal foreskin cutting in preventing HIV.

  9. Impact of Male Circumcision on the HIV Epidemic in Papua New Guinea: A Country with Extensive Foreskin Cutting Practices

    PubMed Central

    Gray, Richard T.; Vallely, Andrew; Wilson, David P.; Kaldor, John; MacLaren, David; Kelly-Hanku, Angela; Siba, Peter; Murray, John M.

    2014-01-01

    The degree to which adult medical male circumcision (MC) programs can reduce new HIV infections in a moderate HIV prevalence country like Papua New Guinea (PNG) are uncertain especially given the widespread prevalence of longitudinal foreskin cuts among adult males. We estimated the likely impact of a medical MC intervention in PNG using a mathematical model of HIV transmission. The model was age-structured and incorporated separate components for sex, rural/urban, men who have sex with men and female sex workers. Country-specific data of the prevalence of foreskin cuts, sexually transmitted infections, condom usage, and the acceptability of MC were obtained by our group through related studies. If longitudinal foreskin cutting has a protective efficacy of 20% compared to 60% for MC, then providing MC to 20% of uncut males from 2012 would require 376,000 procedures, avert 7,900 HIV infections by 2032, and require 143 MC per averted infection. Targeting uncut urban youths would achieve the most cost effective returns of 54 MC per HIV infection averted. These numbers of MC required to avert an HIV infection change little even with coverage up to 80% of men. The greater the protective efficacy of longitudinal foreskin cuts against HIV acquisition, the less impact MC interventions will have. Dependent on this efficacy, increasing condom use could have a much greater impact with a 10 percentage point increase averting 18,400 infections over this same period. MC programs could be effective in reducing HIV infections in PNG, particularly in high prevalence populations. However the overall impact is highly dependent on the protective efficacy of existing longitudinal foreskin cutting in preventing HIV. PMID:25111058

  10. Circumcision - slideshow

    MedlinePlus

    ... gov/ency/presentations/100081.htm Circumcision - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  11. How Much Does It Cost to Improve Access to Voluntary Medical Male Circumcision among High-Risk, Low-Income Communities in Uganda?

    PubMed Central

    Larson, Bruce; Tindikahwa, Allan; Mwidu, George; Kibuuka, Hannah; Magala, Fred

    2015-01-01

    Background The Ugandan Ministry of Health has endorsed voluntary medical male circumcision as an HIV prevention strategy and has set ambitious goals (e.g., 4.2 million circumcisions by 2015). Innovative strategies to improve access for hard to reach, high risk, and poor populations are essential for reaching such goals. In 2009, the Makerere University Walter Reed Project began the first facility-based VMMC program in Uganda in a non-research setting. In addition, a mobile clinic began providing VMMC services to more remote, rural locations in 2011. The primary objective of this study was to estimate the average cost of performing VMMCs in the mobile clinic compared to those performed in health facilities (fixed sites). The difference between such costs is the cost of improving access to VMMC. Methods A micro-costing approach was used to estimate costs from the service provider’s perspective of a circumcision. Supply chain and higher-level program support costs are not included. Results The average cost (US$2012) of resources used per circumcision was $61 in the mobile program ($72 for more remote locations) compared to $34 at the fixed site. Costs for community mobilization, HIV testing, the initial medical exam, and staff for performing VMMC operations were similar for both programs. The cost of disposable surgical kits, the additional upfront cost for the mobile clinic, and additional costs for staff drive the differences in costs between the two programs. Cost estimates are relatively insensitive to patient flow over time. Conclusion The MUWRP VMMC program improves access for hard to reach, relatively poor, and high-risk rural populations for a cost of $27-$38 per VMMC. Costs to patients to access services are almost certainly less in the mobile program, by reducing out-of-pocket travel expenses and lost time and associated income, all of which have been shown to be barriers for accessing treatment. PMID:25774677

  12. Scale-Up of Early Infant Male Circumcision Services for HIV Prevention in Lesotho: A Review of Facilitating Factors and Challenges

    PubMed Central

    Kikaya, Virgile; Kakaire, Rajab; Thompson, Elizabeth; Ramokhele, Mareitumetse; Adamu, Tigistu; Curran, Kelly; Njeuhmeli, Emmanuel

    2016-01-01

    ABSTRACT Background: The World Health Organization and the Joint United Nations Programme on HIV/AIDS recommend early infant male circumcision (EIMC) as a component of male circumcision programs in countries with high HIV prevalence and low circumcision rates. Lesotho began incorporating EIMC into routine maternal, newborn, and child health (MNCH) services in 2013 with funding from the United States Agency for International Development and United Nations Children’s Fund. This presented unique challenges: Lesotho had no previous experience with EIMC and cultural traditions link removal of the foreskin to rites of passage. This process evaluation provides an overview of EIMC implementation. Methodology: The Lesotho Ministry of Health and Jhpiego conducted a baseline assessment before service implementation. Baseline information from an initial assessment was used to develop and implement an EIMC program that had a pilot and a scale-up phase. Key program activities such as staff training, quality assurance, and demand creation were included at the program design phase. Facilitating factors and challenges were identified from a review of information collected during the baseline assessment as well as the pilot. Results: Between September 2013 and March 2015, 592 infants were circumcised at 9 sites: 165 (28%) between 1 day and 6 days after birth; 196 (33%) between 7 and 30 days, and 231 (39%) between 31 and 60 days. Facilitating factors included strong support from the Ministry of Health, collaboration with stakeholders, and donor funding. Providers were enthusiastic about the opportunity to offer new services and receive training. Challenges included gaining consent from family members other than mothers, and parents’ concern about pain and complications. The EIMC program also had to manage providers’ expectations of compensation because overtime was paid to providers who took part in adult circumcision programming but not for EIMC. Limited human resources

  13. Mucosal cuff length to penile length ratio may affect the risk of premature ejaculation in circumcised males.

    PubMed

    Yuruk, E; Temiz, M Z; Colakerol, A; Muslumanoglu, A Y

    2016-01-01

    Data regarding the relation between premature ejaculation (PE) and post-circumcision mucosal cuff length are controversial. The aim of this study is to analyze the relation between post-circumcision mucosal cuff length/penile length ratio (MCR) and PE. After exclusion of patients with erectile dysfunction, penile deformity, history of penile surgery and severe lower urinary tract symptoms, 49 circumcised men with PE were included. The control group is constituted of 50 healthy volunteers with normal ejaculatory function. Self-estimated intravaginal ejaculation latency time (IELT) and premature ejaculation profile (PEP) measures of all subjects were recorded, and the MCRs of patients and controls were compared. The mean age of PE patients and controls was 35.82 ± 7.73 (range 23-54) and 38.78 ± 13.42 (range 19-71) years, respectively (P=0.183). Although mucosal cuff length was not associated with either self-estimated IELT (r=-0.185, P=0.067) or PEP (r=-0.098, P=0.336), there was a negative correlation between MCR and self-estimated IELT (r=-0.205, P=0.0001) and PEP measures (r=-0.308, P=0.002). The length of the mucosal cuff after circumcision may have an impact on ejaculatory function. Surgeons should avoid leaving excessive amount of mucosa during circumcision.

  14. Acceptability of Male Circumcision among College Students in Medical Universities in Western China: A Cross-Sectional Study

    PubMed Central

    Yang, Xiaobo; Huang, Mingbo; Deng, Wei; Huang, Jiegang; Liang, Bingyu; Qin, Bo; Upur, Halmurat; Zhong, Chaohui; Wang, Qianqiu; Wang, Qian; Ruan, Yuhua; Ye, Li; Liang, Hao

    2015-01-01

    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. PMID:26390212

  15. Electrosurgery use in circumcision in children: Is it safe?

    PubMed Central

    Altokhais, Tariq Ibrahim

    2017-01-01

    Circumcision is one of the most common procedures performed worldwide. Bleeding is one of the most common complications following male circumcision, and to decrease the risk of bleeding, electrosurgery may be utilized. However, the use of diathermy on the penis is controversial, and there are reported complications due to the use of electrosurgery for circumcision. The aim of this review is to evaluate the utilization and relative safety of monopolar and bipolar electrosurgery for circumcision in children. PMID:28216919

  16. Women’s knowledge and perception of male circumcision before and after its roll-out in the South African township of Orange Farm from community-based cross-sectional surveys

    PubMed Central

    Maraux, Barbara; Lissouba, Pascale; Rain-Taljaard, Reathe; Taljaard, Dirk; Bouscaillou, Julie; Lewis, David; Puren, Adrian

    2017-01-01

    The roll-out of medical male circumcision (MC) is progressing in Southern and Eastern Africa. Little is known about the effect of this roll-out on women. The objective of this study was to assess the knowledge and perceptions of women regarding MC in a setting before and after the roll-out. This study was conducted in the South African township of Orange Farm where MC prevalence among men increased from 17% to 53% in the period 2008–2010. Data from three community-based cross sectional surveys conducted in 2007, 2010 and 2012 among 1258, 1197 and 2583 adult women, respectively were studied. In 2012, among 2583 women, 73.7% reported a preference for circumcised partners, and 87.9% knew that circumcised men could become infected with HIV. A total of 95.8% preferred to have their male children circumcised. These three proportions increased significantly during the roll-out. In 2007, the corresponding values were 64.4%, 82.9% and 80.4%, respectively. Among 2581 women having had sexual intercourse with circumcised and uncircumcised men, a majority (55.8%, 1440/2581) agreed that it was easier for a circumcised man to use a condom, 20.5% (530/2581) disagreed; and 23.07 (611/2581) did not know. However, some women incorrectly stated that they were fully (32/2579; 1.2%; 95%CI: 0.9% to 1.7%) or partially (233/2579; 9.0%; 95%CI: 8.0% to 10.2%) protected when having unprotected sex with a circumcised HIV-positive partner. This study shows that the favorable perception of women and relatively correct knowledge regarding VMMC had increased during the roll-out of VMMC. When possible, women should participate in the promotion of VMMC although further effort should be made to improve their knowledge. PMID:28339497

  17. Challenges in data quality: the influence of data quality assessments on data availability and completeness in a voluntary medical male circumcision programme in Zimbabwe

    PubMed Central

    Xiao, Y; Bochner, A F; Makunike, B; Holec, M; Xaba, S; Tshimanga, M; Chitimbire, V; Barnhart, S; Feldacker, C

    2017-01-01

    Objectives To assess availability and completeness of data collected before and after a data quality audit (DQA) in voluntary medical male circumcision (VMMC) sites in Zimbabwe to determine the effect of this process on data quality. Setting 4 of 10 VMMC sites in Zimbabwe that received a DQA in February, 2015 selected by convenience sampling. Participants Retrospective reviews of all client intake forms (CIFs) from November, 2014 and May, 2015. A total of 1400 CIFs were included from those 2 months across four sites. Primary and secondary outcomes Data availability was measured as the percentage of VMMC clients whose CIF was on file at each site. A data evaluation tool measured the completeness of 34 key CIF variables. A comparison of pre-DQA and post-DQA results was conducted using χ2 and t-tests. Results After the DQA, high record availability of over 98% was maintained by sites 3 and 4. For sites 1 and 2, record availability increased by 8.0% (p=0.001) and 9.7% (p=0.02), respectively. After the DQA, sites 1, 2 and 3 improved significantly in data completeness across 34 key indicators, increasing by 8.6% (p<0.001), 2.7% (p=0.003) and 3.8% (p<0.001), respectively. For site 4, CIF data completeness decreased by 1.7% (p<0.01) after the DQA. Conclusions Our findings suggest that CIF data availability and completeness generally improved after the DQA. However, gaps in documentation of vital signs and adverse events signal areas for improvement. Additional emphasis on data completeness would help support high-quality programme implementation and availability of reliable data for decision-making. PMID:28132009

  18. Assessing Odor Level when Using PrePex for HIV Prevention: A Prospective, Randomized, Open Label, Blinded Assessor Trial to Improve Uptake of Male Circumcision.

    PubMed

    Mutabazi, Vincent; Bitega, Jean Paul; Ngeruka, Leon Muyenzi; Karema, Corine; Binagwaho, Agnes

    2015-01-01

    The PrePex is a WHO--prequalified medical device for adult male circumcision for HIV prevention. The Government of Rwanda was the first country to implement the PrePex device and acts as the leading center of excellence providing training and formal guidelines. As part of the Government's efforts to improve PrePex implementation, it made efforts to improve the psychological acceptability of device by men, thus increasing uptake with VMMC in sub-Saharan Africa. Some men who underwent the PrePex procedure complained of foreskin odor while wearing the PrePex 3-7 days after it was placed. This complaint was identified as potential risk for uptake of the device. Researchers from Rwanda assumed there is a possible relation between the level of foreskin odor and patient foreskin hygiene technique. The Government of Rwanda decided to investigate those assumptions in a scientific way and conduct a trial to test different hygiene-cleaning methods in order to increase the acceptability of PrePex and mitigate the odor concern. The main objective of the trial was to compare odor levels between three arms, having identical personal hygiene but different foreskin hygiene techniques using either clear water with soap during a daily shower, soapy water using a syringe, or chlorhexidine using a syringe. One hundred and one subjects were enrolled to the trial and randomly allocated into three trial arms. Using chlorhexidine solution daily almost completely eliminated odor, and was statistically significant more effective that the other two arms. The trial results suggest that odor from the foreskin, while wearing the PrePex device, could be related to the growth of anaerobic bacteria, which can be prevented by a chlorhexidine cleaning method. This finding can be used to increase acceptability by men when considering PrePex as one of the leading methods for HIV prevention in VMMC programs.

  19. Is it all about the money? A qualitative exploration of the effects of performance-based financial incentives on Zimbabwe's voluntary male medical circumcision program

    PubMed Central

    Feldacker, Caryl; Bochner, Aaron F.; Herman-Roloff, Amy; Holec, Marrianne; Murenje, Vernon; Stepaniak, Abby; Xaba, Sinokuthemba; Tshimanga, Mufata; Chitimbire, Vuyelwa; Makaure, Shingirai; Hove, Joseph; Barnhart, Scott; Makunike, Batsirai

    2017-01-01

    Background In 2013, Zimbabwe’s voluntary medical male circumcision (VMMC) program adopted performance-based financing (PBF) to speed progress towards ambitious VMMC targets. The $25 USD PBF intended to encourage low-paid healthcare workers to remain in the public sector and to strengthen the public healthcare system. The majority of the incentive supports healthcare workers (HCWs) who perform VMMC alongside other routine services; a small portion supports province, district, and facility levels. Methods This qualitative study assessed the effect of the PBF on HCW motivation, satisfaction, and professional relationships. The study objectives were to: 1) Gain understanding of the advantages and disadvantages of PBF at the HCW level; 2) Gain understanding of the advantages and disadvantages of PBF at the site level; and 3) Inform scale up, modification, or discontinuation of PBF for the national VMMC program. Sixteen focus groups were conducted: eight with HCWs who received PBF for VMMC and eight with HCWs in the same clinics who did not work in VMMC and, therefore, did not receive PBF. Fourteen key informant interviews ascertained administrator opinion. Results Findings suggest that PBF appreciably increased motivation among VMMC teams and helped improve facilities where VMMC services are provided. However, PBF appears to contribute to antagonism at the workplace, creating divisiveness that may reach beyond VMMC. PBF may also cause distortion in the healthcare system: HCWs prioritized incentivized VMMC services over other routine duties. To reduce workplace tension and improve the VMMC program, participants suggested increasing HCW training in VMMC to expand PBF beneficiaries and strengthening integration of VMMC services into routine care. Conclusion In the low-resource, short-staffed context of Zimbabwe, PBF enabled rapid VMMC scale up and achievement of ambitious targets; however, side effects make PBF less advantageous and sustainable than envisioned. Careful

  20. Listening to diverse community voices: the tensions of responding to community expectations in developing a male circumcision program for HIV prevention in Papua New Guinea

    PubMed Central

    2013-01-01

    Background The success of health programs is influenced not only by their acceptability but also their ability to meet and respond to community expectations of service delivery. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have recommended medical male circumcision (MC) as an essential component of comprehensive HIV prevention programs in high burden settings. This study investigated community-level perceptions of MC for HIV prevention in Papua New Guinea (PNG), a setting where diverse traditional and contemporary forms of penile foreskin cutting practices have been described. Methods A multi-method qualitative study was undertaken in four provinces in two stages from 2009 to 2011. A total of 82 in-depth interviews, and 45 focus group discussions were completed during Stage 1. Stage 2 incorporated eight participatory workshops that were an integral part of the research dissemination process to communities. The workshops also provided opportunity to review key themes and consolidate earlier findings as part of the research process. Qualitative data analysis used a grounded theory approach and was facilitated using qualitative data management software. Results A number of diverse considerations for the delivery of MC for HIV prevention in PNG were described, with conflicting views both between and within communities. Key issues included: location of the service, service provider, age eligibility, type of cut, community awareness and potential shame amongst youth. Key to developing appropriate health service delivery models was an appreciation of the differences in expectations and traditions of unique cultural groups in PNG. Establishing strong community coalitions, raising awareness and building trust were seen as integral to success. Conclusions Difficulties exist in the implementation of new programs in a pluralistic society such as PNG, particularly if tensions arise between biomedical knowledge and medico

  1. Assessing Progress, Impact, and Next Steps in Rolling Out Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa through 2014

    PubMed Central

    Kripke, Katharine; Samuelson, Julia; Schnure, Melissa; Dalal, Shona; Farley, Timothy; Hankins, Catherine; Thomas, Anne G.; Reed, Jason; Stegman, Peter; Bock, Naomi

    2016-01-01

    Background In 2007, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) identified 14 priority countries across eastern and southern Africa for scaling up voluntary medical male circumcision (VMMC) services. Several years into this effort, we reflect on progress. Methods Using the Decision Makers’ Program Planning Tool (DMPPT) 2.1, we assessed age-specific impact, cost-effectiveness, and coverage attributable to circumcisions performed through 2014. We also compared impact of actual progress to that of achieving 80% coverage among men ages 15–49 in 12 VMMC priority countries and Nyanza Province, Kenya. We populated the models with age-disaggregated VMMC service statistics and with population, mortality, and HIV incidence and prevalence projections exported from country-specific Spectrum/Goals files. We assumed each country achieved UNAIDS’ 90-90-90 treatment targets. Results More than 9 million VMMCs were conducted through 2014: 43% of the estimated 20.9 million VMMCs required to reach 80% coverage by the end of 2015. The model assumed each country reaches the UNAIDS targets, and projected that VMMCs conducted through 2014 will avert 240,000 infections by the end of 2025, compared to 1.1 million if each country had reached 80% coverage by the end of 2015. The median estimated cost per HIV infection averted was $4,400. Nyanza Province in Kenya, the 11 priority regions in Tanzania, and Uganda have reached or are approaching MC coverage targets among males ages 15–24, while coverage in other age groups is lower. Across all countries modeled, more than half of the projected HIV infections averted were attributable to circumcising 10- to 19-year-olds. Conclusions The priority countries have made considerable progress in VMMC scale-up, and VMMC remains a cost-effective strategy for epidemic impact, even assuming near-universal HIV diagnosis, treatment coverage, and viral suppression. Examining circumcision coverage by five

  2. "There's evidence that this really works and anything that works is good": views on the introduction of medical male circumcision for HIV prevention in South Africa.

    PubMed

    Milford, Cecilia; Smit, Jennifer A; Beksinska, Mags E; Ramkissoon, Arthi

    2012-01-01

    Three clinical trials have demonstrated the partial efficacy (40-60%) of surgically conducted medical male circumcision (MMC) in preventing HIV transmission to circumcised men. This research formed part of a larger study exploring the importance of integration of sexual and reproductive health with HIV services. The objective was to elicit key informant views on the introduction of MMC for HIV prevention in South Africa. Twenty-one key informants representing the South African Health Department, local and international NGOs and universities, were asked, via semi-structured interviews about their views on introducing MMC as an HIV prevention strategy in South Africa. Interviews were transcribed and all discussions on MMC were coded for analysis using NVivo 8. The majority of the key informants were knowledgeable about MMC for HIV prevention and felt that making MMC available in South Africa was a good idea, with some recommending immediate introduction. Others felt that MMC should be introduced with caution. Various factors were recommended for consideration, including culture, the impact of circumcision on women, possible increase in sexual risk behaviour from behavioural disinhibition and that MMC may become another vertical health service programme. Most felt that MMC should be undertaken in neonates, however, acknowledged concerns about cultural responses to this. Recommendations on the implementation of MMC ranged from integrating services at primary health care level, to provision by private medical practitioners. In conclusion, MMC is viewed as a key HIV prevention strategy. However, there are numerous factors which could hinder introduction and uptake in South Africa and in the region. It is important to explore and understand these factors and for these to be aligned in the national MMC policy.

  3. Bridging the accountability divide: male circumcision planning in Rwanda as a case study in how to merge divergent operational planning approaches.

    PubMed

    McPherson, Dacia B; Balisanga, Helene N; Mbabazi, Jennifer K

    2014-10-01

    When voluntary medical male circumcision (MC) was confirmed as an effective tool for HIV prevention in sub-Saharan Africa in 2007, many public health policy makers and practitioners were eager to implement the intervention. How to roll out the tool as part of comprehensive strategy however was less clear. At the time, very little was known about the capacity of health systems to scale delivery of the new intervention. Today, nearly all countries prioritized for the intervention are far behind their targets. To contribute to the discourse on why this is, we develop a historical analysis of medical MC planning in sub-Saharan Africa using our own experience of this process in Rwanda. We compare our previously unpublished feasibility analysis from 2008 with international research published in 2009, which suggested how Rwanda could reduce HIV incidence through a rapid MC intervention, and Rwanda's eventual 2010 official operational plan. We trace how, in the face of uncertainty, operational plans avoided discussing the details of feasibility and focused instead on defining optimal circumcision capacity needed to achieve country level target reductions in HIV incidence. We show a distinct gap between the targets set in the official operational plan and what we determined was feasible in 2008. With actual data from the ground now available, we show our old feasibility models more closely approximate circumcision delivery rates to date. With an eye toward the future of long-term policy planning, we discuss the mechanics of how accountability gaps like this occur in global health policy making and how practitioners can better create achievable operational targets.

  4. Female Partner Acceptance as a Predictor of Men's Readiness to Undergo Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project.

    PubMed

    Cook, Ryan; Jones, Deborah; Redding, Colleen A; Zulu, Robert; Chitalu, Ndashi; Weiss, Stephen M

    2016-11-01

    The World Health Organization has recommended the scale-up of voluntary medical male circumcision (VMMC) for HIV prevention in sub-Saharan Africa; however, men are often uninterested in undergoing VMMC. The Spear & Shield project enrolled 668 men and female partners from ten Zambian community health centers into parallel interventions promoting VMMC for HIV prevention or time-matched control conditions. A mediation model was utilized to examine the relationships between changes in women's acceptance of VMMC and men's readiness to undergo the procedure. Results demonstrated that, at 12 months post-intervention, a 5.9 % increase in the likelihood of undergoing VMMC among men in the experimental condition could be attributed to increased women's acceptance. From a public health perspective, involving women in VMMC promotion interventions such as the Spear & Shield project could significantly impact the demand for VMMC in Zambia.

  5. Female Partner Acceptance as a Predictor of Men's Readiness to Undergo Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project

    PubMed Central

    Cook, Ryan; Jones, Deborah; Redding, Colleen A.; Zulu, Robert; Chitalu, Ndashi; Weiss, Stephen M.

    2015-01-01

    The World Health Organization has recommended the scale-up of voluntary medical male circumcision (VMMC) for HIV prevention in sub-Saharan Africa; however, men are often uninterested in undergoing VMMC. The Spear & Shield project enrolled 668 men and female partners from ten Zambian community health centers into parallel interventions promoting VMMC for HIV prevention or time-matched control conditions. A mediation model was utilized to examine the relationships between changes in women's acceptance of VMMC and men's readiness to undergo the procedure. Results demonstrated that, at 12 months post-intervention, a 5.9 % increase in the likelihood of undergoing VMMC among men in the experimental condition could be attributed to increased women's acceptance. From a public health perspective, involving women in VMMC promotion interventions such as the Spear & Shield project could significantly impact the demand for VMMC in Zambia. PMID:25931242

  6. Parental circumcision preferences and early outcome of plastibell circumcision in a Nigerian tertiary hospital

    PubMed Central

    Ekwunife, Okechukwu Hyginus; Ugwu, Jideofor Okechukwu; Okoli, Chinedu C.; Modekwe, Victor Ifeanyichukwu; Osuigwe, Andrew N.

    2015-01-01

    Background: Parents are central in decisions and choices concerning circumcision of their male children and plastibell circumcision is a widely practiced technique. This study determined parental preferences for male neonatal and infant circumcisions and evaluate the early outcomes of plastibell circumcisions in a tertiary centre. Patients and Methods: This is a prospective study on consecutive male neonates and infants who were brought for circumcisions at Nnamdi Azikiwe University Teaching Hospital Nnewi, South-East Nigeria and their respective parents between January 2012 and December 2012. Data on demography, parental choices and early outcome of plastibell circumcision were obtained and analysed. Results: A total of 337 requests for circumcisions were made for boys with age range of 2-140 days. Culture and religion were the most common reasons for circumcision requests in 200 (59.3%) and 122 (36.2%), respectively, other reasons were medical, cosmesis, to reduce promiscuity and just to follow the norm. Most parents, 249 (73.9%) preferred the procedure to be performed on the 8th day and 88.7% would like the doctors to perform the procedure while 84.6% preferred the plastibell method. Among those who had circumcision, 114 complied with follow-up schedules and there were complications in 22 (19.3%) patients. Parents assessed the early outcome as excellent, very good, good and poor in 30.7%, 45.6%, 18.4% and 5.3% of the patients, respectively. Conclusion: Parents request for male circumcision in our environment is largely for cultural and religious reasons; and prefer the procedure to be performed by a physician. Plastibell method is well known and preferred and its outcome is acceptable by most parents. PMID:26712290

  7. Mammography Findings of Male Breast Diseases

    PubMed Central

    Şafak, Kadihan Yalçın

    2015-01-01

    Over the past 2 decades, the percentage of men presenting with breast complaints has increased from 0.8% to 2.4%, and men now account for 1% of all breast cancer cases. The most common male breast mass is gynecomastia, followed by lipoma and epidermal inclusion cysts. Because there is a paucity of parenchyma as compared with the female breast, the malignancy rapidly progresses to the next stage, with the appearance of secondary signs like nipple retraction, fixation to deeper tissues, skin ulceration or adenopathy. Diagnostic evaluation is needed only when the palpable mass is unilateral, hard, fixed, peripheral to the nipple, or associated with nipple discharge, skin changes, or lymphadenopathy. Male breast cancer usually occurs in a subareolar location or is positioned eccentric to the nipple; occasionally, it occurs in a peripheral position. Secondary signs like skin thickening, nipple retraction, and axillary lymphadenopathy may be seen. Microcalcifications can occur. Mammography can accurately distinguish between malignant and benign male breast disease. Radiologists are generally less familiar with breast disease in males compared with females. In this article, we discuss the clinical, and mammographic features of a variety of benign and malignant diseases that can occur in the male breast.

  8. Impact and Cost of Scaling Up Voluntary Medical Male Circumcision for HIV Prevention in the Context of the New 90-90-90 HIV Treatment Targets

    PubMed Central

    Kripke, Katharine; Reed, Jason; Hankins, Catherine; Smiley, Gregory; Laube, Catey

    2016-01-01

    Background The report of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for World AIDS Day 2014 highlighted a Fast-Track Strategy that sets ambitious treatment and prevention targets to reduce global HIV incidence to manageable levels by 2020 and end the AIDS epidemic by 2030. The 90-90-90 treatment targets for 2020 call for 90% of people living with HIV to know their HIV status, 90% of people who know their status to receive treatment, and 90% of people on HIV treatment to be virally suppressed. This paper examines how scale-up of voluntary medical male circumcision (VMMC) services in four priority countries in sub-Saharan Africa could contribute to ending the AIDS epidemic by 2030 in the context of concerted efforts to close the treatment gap, and what the impact of VMMC scale-up would be if the 90-90-90 treatment targets were not completely met. Methods Using the Goals module of the Spectrum suite of models, this analysis modified ART (antiretroviral treatment) scale-up coverage from base scenarios to reflect the 90-90-90 treatment targets in four countries (Lesotho, Malawi, South Africa, and Uganda). In addition, a second scenario was created to reflect viral suppression levels of 75% instead of 90%, and a third scenario was created in which the 90-90-90 treatment targets are reached in women, with men reaching more moderate coverage levels. Regarding male circumcision (MC) coverage, the analysis examined both a scenario in which VMMCs were assumed to stop after 2015, and one in which MC coverage was scaled up to 90% by 2020 and maintained at 90% thereafter. Results Across all four countries, scaling up VMMC is projected to provide further HIV incidence reductions in addition to those achieved by reaching the 90-90-90 treatment targets. If viral suppression levels only reach 75%, scaling up VMMC leads to HIV incidence reduction to nearly the same levels as those achieved with 90-90-90 without VMMC scale-up. If only women reach the 90-90-90 targets

  9. Pros and cons of circumcision: an evidence-based overview.

    PubMed

    Friedman, B; Khoury, J; Petersiel, N; Yahalomi, T; Paul, M; Neuberger, A

    2016-09-01

    Based on three large randomized controlled trials (RCTs) conducted in Africa, it can clearly be stated that circumcision lowers the risk of infection with the human immunodeficiency virus (HIV) and some sexually transmitted infections (STIs) among males in settings of high HIV and STI endemicity. Similar effects on STI risk may exist for females, although this may result from an indirect effect of decreasing risk of infection among male partners. It is unknown whether circumcision prevents HIV acquisition in men who have sex with men (MSM), although there might be a protective effect for men who engage mainly in insertive anal intercourse. When the effects of adult circumcision on sexual function and satisfaction of men are examined, high-quality evidence strongly supports lack of harm. Whether circumcision alters sexual satisfaction of female partners is not known as fewer and smaller studies reported conflicting results. Circumcision rarely causes serious complications if practiced by trained practitioners, in a sterile setting, and with a proper follow-up. These conclusions are limited by the lack of high-quality data from areas outside of Africa. RCTs have not been conducted to assess the effects of circumcising infants or MSM. Circumcision has well-proven benefits for people residing in areas with high prevalence of STIs, including HIV, and is not unethical for those who choose to be circumcised or have their children circumcised on religious, social, or cultural grounds. For many others, a definite pro or con recommendation, based on a risk-benefit ratio, cannot be made.

  10. Neonatal circumcision revisited. Fetus and Newborn Committee, Canadian Paediatric Society.

    PubMed Central

    1996-01-01

    OBJECTIVE: To assist physicians in providing guidance to parents regarding neonatal circumcision. OPTIONS: Whether to recommend the routine circumcision of newborn male infants. OUTCOMES: Costs and complications of neonatal circumcision, the incidence of urinary tract infections, sexually transmitted diseases and cancer of the penis in circumcised and uncircumcised males, and of cervical cancer in their partners, and the costs of treating these diseases. EVIDENCE: The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed. VALUES: The literature was assessed to determine whether neonatal circumcision improves the health of boys and men and is a cost-effective approach to preventing penile problems and associated urinary tract conditions. Religious and personal values were not included in the assessment. BENEFITS, HARMS AND COSTS: The effect of neonatal circumcision on the incidence of urinary tract infection, sexually transmitted diseases, cancer of the penis, cervical cancer and penile problems; the complications of circumcision; and estimates of the costs of neonatal circumcision and of the treatment of later penile conditions, urinary tract infections and complications of circumcision. RECOMMENDATION: Circumcision of newborns should not be routinely performed. VALIDATION: This recommendation is in keeping with previous statements on neonatal circumcision by the Canadian Paediatric Society and the American Academy of Pediatrics. The statement was reviewed by the Infectious Disease Committee of the Canadian Paediatric Society. The Board of Directors of the Canadian Paediatric Society has reviewed its content and approved it for publication. SPONSOR: This is an official statement of the Canadian Paediatric Society. No external

  11. Circumcision: The Good, the Bad and American Values

    ERIC Educational Resources Information Center

    Buie, Mary E.

    2005-01-01

    National statistics estimate that 1.2 million newborn males are circumcised annually in the United States (70% to 80%). Such values as sanctity, equity, fraternity, paternity and liberty affect circumcision rates in America. The value of sanctity allows freedom of religious beliefs and traditions that often overcome medical impetus in…

  12. Self-assessment of circumcision status by adolescents.

    PubMed

    Risser, Jan M H; Risser, William L; Eissa, Mona A; Cromwell, Polly F; Barratt, Michelle S; Bortot, Andrea

    2004-06-01

    In epidemiologic studies of the relation between circumcision and sexually transmitted infections, it is necessary to rely on self-report of circumcision status. The purpose of this 2002 study in Houston, Texas, was to determine whether adolescent males could make correct self-reports. During physical examinations, adolescents were asked whether they were circumcised. The authors then examined the adolescents' genitalia. Circumcision status was recorded as complete (glans penis fully exposed), partial (glans partly covered), or uncircumcised (glans completely covered). The mean age of the 1,508 subjects was 15.0 (standard deviation, 1.63) years; 64% were Black, 29% Hispanic, and 7% White. Forty-nine percent had full, 1% partial, and 50% no circumcision. Of the 738 fully circumcised subjects, 512 (69%) considered themselves circumcised, 54 (7%) considered themselves uncircumcised, and 172 (23%) did not know. Of the 751 uncircumcised youth, 491 (65%) described themselves as uncircumcised, 27 (4%) reported being circumcised, and 233 (31%) did not know. The sensitivity of self-report among those who thought they knew their status was 90.5%, and the specificity was 94.8%; 27% did not know their status. In this population, self-report of circumcision status did not result in accurate information mainly because many adolescents were unsure of their status.

  13. Is there an association between female circumcision and perinatal death?

    PubMed Central

    Essen, Birgitta; Bodker, Birgit; Sjoberg, N-O; Gudmundsson, Saemundur; Ostergren, P-O; Langhoff-Roos, Jens

    2002-01-01

    OBJECTIVE: In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. METHOD: To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990-96 to circumcised women. FINDINGS: We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. CONCLUSION: The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women. PMID:12219153

  14. Sequential Cross-Sectional Surveys in Orange Farm, a Township of South Africa, Revealed a Constant Low Voluntary Medical Male Circumcision Uptake among Adults despite Demand Creation Campaigns and High Acceptability

    PubMed Central

    Marshall, Esaie; Rain-Taljaard, Reathe; Tsepe, Motlalepule; Monkwe, Cornelius; Hlatswayo, Florence; Tshabalala, Simphiwe; Khela, Simphiwe; Xulu, Lindo; Xaba, Dumazile; Molomo, Tebogo; Malinga, Thobile; Puren, Adrian; Auvert, Bertran

    2016-01-01

    Background WHO recommends a male circumcision (MC) prevalence rate higher than 80% to have a substantial impact on the HIV-AIDS epidemic in Eastern and Southern Africa. Orange Farm, a township in South Africa, has a free-for-service voluntary medical male circumcision (VMMC) clinic in operation since 2008. Following an intense campaign from 2008 to 2010, MC prevalence rate increased to 55.4% (ANRS-12126). Ongoing and past VMMC campaigns focused on youths, through school talks, and adults at a community level. The main objective of the study was to assess the change in MC prevalence rate among adults aged 18–19 and 18–49 years in the past 5 years. Methods A cross-sectional survey (ANRS-12285) was conducted among a random sample of 522 adult men in 2015. MC status and characteristics of participants were collected through a genital examination and a face-to-face questionnaire. Results MC prevalence rate among young adult men aged 18–19 years increased markedly from 61.2% (95%CI: 57.4% to 65.0%) in 2010 to 87.5% (76.0% to 94.6%) in 2015 (p<0.001). In the same period, among men aged 18–49 years, MC prevalence rate varied slightly from 55.4% (53.6% to 57.1%) to 56.7% (52.4% to 60.9%). In 2015, 84.9% (79.2% to 89.5%) of uncircumcised adult men reported that they were willing to be circumcised. However, we estimated that only 4.6% (11/237; 2.5% to 7.9%) of the uncircumcised men underwent circumcision in 2015, despite 117/185 (63.2%; 95%CI: 56.1% to 69.9%) who reported that they were definitely willing to become circumcised. Conclusions In Orange Farm, VMMC campaigns were successful among the youth and led to a sufficiently high MC prevalence rate to have a substantial impact in the future on the HIV-AIDS epidemic. However, despite high acceptability and a free VMMC service, VMMC campaigns since 2010 have failed to increase MC prevalence rate among adults to above 80%. These campaigns should be revisited. PMID:27427957

  15. Evaluating Opportunities for Achieving Cost Efficiencies Through the Introduction of PrePex Device Male Circumcision in Adult VMMC Programs in Zambia and Zimbabwe

    PubMed Central

    Chintu, Naminga; Yano, Nanako; Mugurungi, Owen; Tambatamba, Bushimbwa; Ncube, Gertrude; Xaba, Sinokuthemba; Mpasela, Felton; Muguza, Edward; Mangono, Tichakunda; Madidi, Ngonidzashe; Samona, Alick; Tagar, Elva; Hatzold, Karin

    2016-01-01

    Background: Results from recent costing studies have put into question potential Voluntary Medical Male Circumcision (VMMC) cost savings with the introduction of the PrePex device. Methods: We evaluated the cost drivers and the overall unit cost of VMMC for a variety of service delivery models providing either surgical VMMC or both PrePex and surgery using current program data in Zimbabwe and Zambia. In Zimbabwe, 3 hypothetical PrePex only models were also included. For all models, clients aged 18 years and older were assumed to be medically eligible for PrePex and uptake was based on current program data from sites providing both methods. Direct costs included costs for consumables, including surgical VMMC kits for the forceps-guided method, device (US $12), human resources, demand creation, supply chain, waste management, training, and transport. Results: Results for both countries suggest limited potential for PrePex to generate cost savings when adding the device to current surgical service delivery models. However, results for the hypothetical rural Integrated PrePex model in Zimbabwe suggest the potential for material unit cost savings (US $35 per VMMC vs. US $65–69 for existing surgical models). Conclusions: This analysis illustrates that models designed to leverage PrePex's advantages, namely the potential for integrating services in rural clinics and less stringent infrastructure requirements, may present opportunities for improved cost efficiency and service integration. Countries seeking to scale up VMMC in rural settings might consider integrating PrePex only MC services at the primary health care level to reduce costs while also increasing VMMC access and coverage. PMID:27331598

  16. Histological Correlates of Penile Sexual Sensation: Does Circumcision Make a Difference?

    PubMed Central

    Cox, Guy; Krieger, John N; Morris, Brian J

    2015-01-01

    Introduction The question of whether removal of sensory receptors in the prepuce by circumcision affects sensitivity and/or sexual pleasure is often debated. Aims To examine histological correlates relevant to penile sensitivity and sexual pleasure. Methods Systematic review of the scientific literature on penile structures that might affect sensitivity and sexual sensation. Articles were included if they contained original data on human male penile histology or anatomy. Individual articles, including reference lists, were evaluated. They were then considered in relation to physiological data from articles retrieved by a previous systematic review. Results We retrieved 41 publications on penile structure. Considered in the light of 12 reporting physiological measurements, our evaluation finds that sexual response is unlikely to involve Meissner’s corpuscles, whose density in the prepuce diminishes at the time of life when male sexual activity is increasing. Free nerve endings also show no correlation with sexual response. Because tactile sensitivity of the glans decreases with sexual arousal, it is unrelated to sexual sensation. Thermal sensitivity seems part of the reward mechanism of intercourse. Vibrational sensitivity is not related to circumcision status. Observations that penile sexual sensation is higher post circumcision are consistent with greater access of genital corpuscles to sexual stimuli after removal of the prepuce. This is based on the distribution of these corpuscles (which are located in the glans) and, in uncircumcised men, the position of the retracted prepuce during intercourse, rather than any change in the number of genital corpuscles. The scientific literature suggests that any sexual effect of circumcised men may depend solely on exposure of the glans and not on the absence of the prepuce. Conclusion Based on histological findings and correlates of sexual function, loss of the prepuce by circumcision would appear to have no adverse

  17. Prepuce health and childhood circumcision: Choices in Canada

    PubMed Central

    Abara, Emmanuel O.

    2017-01-01

    Introduction: Worldwide, almost 100% of boys are born with penises with a “hood” called prepuce or foreskin. In the course of the boy’s life, the prepuce can be circumcised, can become affected by diseased (e.g., phimosis), or a can become infected and hurt the neonate (and his sexual partner) in adulthood. The objectives of this report are to: 1) review the state, function, fate, and care of the prepuce in childhood, with focus on the neonate, in Canada; 2) understand the current practice of childhood male circumcision in terms of age, indications, performers, techniques, outcomes, and education; and 3) consider ways to sustain a good healthcare professional-parental dialogue for safe practices that are accessible, acceptable, and culturally sensitive in the care of the prepuce. Methods: A literature review was carried out in the English language through the major databases: PubMed (MEDLINE), EMBASE, the Cochrane Library, CINAHL, Web of Science (WOS) Core Collection, LILAC, WHO/UNAIDS, Clinical Trials (www.clinicaltrials.gov), Google Scholar, and grey literature. Search words included: prepuce, diseases of prepuce, prepuce in the neonate, prepuce in the neonate in Canada, male circumcision, childhood male circumcision, neonatal circumcision, neonatal circumcision in Canada, complications of neonatal circumcision in Canada, and circumcision adverse events. Results: From 1970–1999, three of 10 Canadian newborn males were circumcised for religious, cultural, and medical reasons. The rest of the neonates, if alive, are living with their prepuce; <4% expected to require treatment for afflictions of the prepuce at some point. There are several providers of circumcision with different levels of training and competencies and using a diversity of devices and techniques. Neonatal and childhood circumcision in Canada is carried out to fulfill parental wishes, as well as for medical, religious, and cultural reasons. Appropriate informed consent and education regarding

  18. [The effect of circumcision on the mental health of children: a review].

    PubMed

    Yavuz, Mesut; Demir, Türkay; Doğangün, Burak

    2012-01-01

    Circumcision is one of the oldest and most frequently performed surgical procedures in the world. It is thought that the beginning of the male circumcision dates back to the earliest times of history. Approximately 13.3 million boys and 2 million girls undergo circumcision each year. In western societies, circumcision is usually performed in infancy while in other parts of the world, it is performed at different developmental stages. Each year in Turkey, especially during the summer months, thousands of children undergo circumcision. The motivations for circumcision include medical-therapeutic, preventive-hygienic and cultural reasons. Numerous publications have suggested that circumcision has serious traumatic effects on children's mental health. Studies conducted in Turkey draw attention to the positive meanings attributed to the circumcision in the community and emphasize that social effects limit the negative effects of circumcision. Although there are many publications in foreign literature about the mental effects of the circumcision on children's mental health, there are only a few studies in Turkey about the mental effects of the one of the most frequently performed surgical procedures in our country. The aim of this study is to review this issue. The articles related to circumcision were searched by keywords in Pubmed, Medline, EBSCHOHost, PsycINFO, Turkish Medline, Cukurova Index Database and in Google Scholar and those appropriate for this review were used by authors.

  19. Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have?

    PubMed

    Morris, Brian J; Bailis, Stefan A; Wiswell, Thomas E

    2014-05-01

    The objective of this review was to assess the trend in the US male circumcision rate and the impact that the affirmative 2012 American Academy of Pediatrics policy statement might have on neonatal circumcision practice. We searched PubMed for the term circumcision to retrieve relevant articles. This review was prompted by a recent report by the Centers for Disease Control and Prevention that found a slight increase, from 79% to 81%, in the prevalence of circumcision in males aged 14 to 59 years during the past decade. There were racial and ethnic disparities, with prevalence rising to 91% in white, 76% in black, and 44% in Hispanic males. Because data on neonatal circumcision are equivocal, we undertook a critical analysis of hospital discharge data. After correction for underreporting, we found that the percentage had declined from 83% in the 1960s to 77% by 2010. A risk-benefit analysis of conditions that neonatal circumcision protects against revealed that benefits exceed risks by at least 100 to 1 and that over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin. Other analyses show that neonatal male circumcision is cost-effective for disease prevention. The benefits of circumcision begin in the neonatal period by protection against infections that can damage the pediatric kidney. Given the substantial risk of adverse conditions and disease, some argue that failure to circumcise a baby boy may be unethical because it diminishes his right to good health. There is no long-term adverse effect of neonatal circumcision on sexual function or pleasure. The affirmative 2012 American Academy of Pediatrics policy supports parental education about, access to, and insurance and Medicaid coverage for elective infant circumcision. As with vaccination, circumcision of newborn boys should be part of public health policies. Campaigns should prioritize population subgroups with lower circumcision

  20. "I Feel Like More of a Man": A Mixed Methods Study of Masculinity, Sexual Performance, and Circumcision for HIV Prevention.

    PubMed

    Fleming, Paul J; Barrington, Clare; Pearce, Lisa D; Lerebours, Leonel; Donastorg, Yeycy; Brito, Maximo O

    2017-01-01

    Ethnographic studies from numerous societies have documented the central role of male circumcision in conferring masculinity and preparing boys for adult male sexuality. Despite this link between masculinity, sexuality, and circumcision, there has been little research on these dynamics among men who have been circumcised for HIV prevention. We employed a mixed methods approach with data collected from recently circumcised men in the Dominican Republic (DR) to explore this link. We analyzed survey data collected six to 12 months post-circumcision (N = 293) as well as in-depth interviews conducted with a subsample of those men (n = 30). We found that 42% of men felt more masculine post-circumcision. In multivariate analysis, feeling more masculine was associated with greater concern about being perceived as masculine (OR = 1.70, 95% CI: 1.25-2.32), feeling more potent erections post-circumcision (OR = 2.25, 95% CI: 1.26-4.03), and reporting increased ability to satisfy their partners post-circumcision (OR = 2.30, 95% CI: 1.11-4.77). In qualitative interviews, these factors were all related to masculine norms of sexually satisfying one's partner, and men's experiences of circumcision were shaped by social norms of masculinity. This study highlights that circumcision is not simply a biomedical intervention and that circumcision programs need to incorporate considerations of masculine norms and male sexuality into their programming.

  1. The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme.

    PubMed

    Hodges, F M

    2001-01-01

    This study examines the evolution of Greek and Roman medical conceptualizations of preputial aesthetics, utilizing evidence found in classical medical texts as well as clues from literature, legal sources, and art. A conclusive picture emerges that the Greeks valued the longer prepuce and pathologized the penis characterized by a deficient prepuce--especially one that had been surgically ablated--under the disease concept of lipodermos. The medical conceptualization of lipodermos is also placed in the historical context of the legal efforts to abolish ritual circumcision throughout the Seleucid and Roman empires.

  2. “What do You Mean I’ve Got to Wait for Six Weeks?!” Understanding the Sexual Behaviour of Men and Their Female Partners after Voluntary Medical Male Circumcision in the Western Cape

    PubMed Central

    Toefy, Yoesrie; Skinner, Donald; Thomsen, Sarah C.

    2015-01-01

    Background Several studies have shown that voluntary male medical circumcision (VMMC) reduces the incidence of the Type-1 human immunodeficiency virus (HIV) in heterosexual men by up to 60%. However, there is an increased risk of transmission of STIs, including HIV, in the immediate post-operative period after receiving VMMC. This study is to understand sexual practices of couples in the post-operative period in a Coloured population in the Western Cape Province of South Africa. Methods Coloured Males who had undergone VMMC in the previous six months in the Cape Town area and their partners participated in eight single-gender focus group discussions. The groups explored why the men decided to undergo VMMC, what kind of counselling they received, and how they experienced the 6-week post-operative period, including sexually. Results The primary motivation to VMMC uptake included religious injunction and hygiene reasons and protection against sexually transmitted infections not necessarily HIV. There was some exploration of alternative sexual practices. During the period immediately post operation the respondents spoke of pain and fear of any sexual arousal, but towards the end of the six week period, sexual desire returned. Both men and women felt that sex was important to maintain the relationship. Gaps were identified in the pre- and post-MC procedure counselling. Conclusions There is a real risk that men in this population may begin sex before complete healing has occurred. VMMC counselling to encourage men to stay sexually safe in the wound-healing period, needs to take into account the real-life factors of the circumcised men. It is essential from a public health, and gender perspective that effective counselling strategies for the VMMC post-operative period, and the longer term, are developed and tested. PMID:26176946

  3. [Circumcision: what do we cut when we are cutting?].

    PubMed

    Calcagno, C

    2007-01-01

    1968. The prepuce is an integrant part of the male genital system. It has three functions: protective, immunological and sexual. The extremely complex innervation of the prepuce explains its sensibility and makes it an extraordinary erogenous zone. In view of these features, the excision of the prepuce necessarily interferes with the patient's sexual function, and possibly involves serious psychological concerns. Circumcision represents a minor surgical procedure but, like any other surgical techniques, can result in complications: A) operative: hemorrhage, removal of too much skin from the penile shaft infection; B) post-operative: sepsis, urethrocutaneous fistula, gangrene of the penis; C) long-term complications: meatal stenosis, skin bridge between the glans and the penile shaft. Sometimes complications are severe and can cause death of the patient, especially during ritual circumcision. Given these aspects, a well informed consent is mandatory both in terms of potential complications linked to surgical procedures, and in terms of sexual and psychological consequences.

  4. Complications of Circumcision

    PubMed Central

    Krill, Aaron J.; Palmer, Lane S.; Palmer, Jeffrey S.

    2011-01-01

    In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events. PMID:22235177

  5. High Flow Priapism in a Pediatric Patient after Circumcision with Dorsal Penile Nerve Block

    PubMed Central

    Fantony, Joseph J.; Routh, Jonathan C.

    2016-01-01

    We report the first documented case of high flow priapism after circumcision with dorsal penile nerve block. A 7-year-old male who had undergone circumcision three years before presented to our institution with a 3-year history of persistent nonpainful erections. Workup revealed a high flow priapism and, after discussion of the management options, the patient's family elected continued observation. PMID:27648333

  6. Nigeria: female circumcision row.

    PubMed

    Ezeh, P

    1990-02-01

    In October 1989 midwives and nurses held mass demonstrations in Benin city, the capital of Bendel State, Nigeria, to protest against female circumcision. This practice, which is firmly entrenched in the area, may involve cutting off the clitoris or more extensive removal of girls' genitalia, either in infancy or at puberty. Nigerian hospitals no longer perform circumcision, so people do it themselves or have traditional practitioners do so. Recent demonstrations reflect outrage on the part of Western-trained health care activists regarding aesthetic and obstetric complications, as well as added risk of spreading tetanus and AIDS by unsanitary procedures.

  7. Female circumcision and child mortality in urban Somalia.

    PubMed

    Mohamud, O A

    1991-01-01

    In Somalia, a demographer analyzed urban data obtained from the Family Health Survey to examine the effect female circumcision has on child mortality and the mechanism of that effect. Girls undergo female circumcision between 5-12 years old in Somalia. Since sunni circumcision (removal of the clitoral prepuce and tip of the clitoris) and clitoridectomy (removal of the entire clitoris) did not affect child mortality, he used them as the reference group. Infibulation (entire removal of the clitoris and of the labia minora and majora with the remains of the labia majora being sewn together allowing only a small opening for passage of urine) did affect child mortality. Female children who underwent infibulation and whose mothers most likely also underwent infibulation experienced higher mortality (13-72%) than those from other circumcised mothers. Female mortality exceeded male mortality indicating possible son preference. Mothers with clitoridectomy or infibulation had significantly higher infant mortality than those with sunni circumcision with the strongest effects during the neonatal period (95% and 42% higher mortality, respectively; p=.01). The effect of female circumcision on child mortality decreased with increased child's age. This higher than expected mortality among women with clitoridectomy may have been because women with infibulation had more stillbirths which were not counted as births. The exposed vagina of clitoridectomized women is more likely to be infected resulting in high risk of stillbirths and premature births than the closed vagina of infibulated women. The researcher suggested that the policies promoting education and consciousness raising may eventually eradicate female circumcision. This longterm campaign should use mass media, senior women of high status, and respected religious leaders. Legislation prohibiting this practice would only drive it underground under unsanitary conditions. Demographers should no longer ignore female circumcision

  8. The culture of female circumcision.

    PubMed

    Morris, R

    1996-12-01

    The issue of female circumcision takes on special significance as more women migrate to the United States from countries where the practice has religious and traditional underpinnings. Female circumcision is a problem unfamiliar to most Western health care practitioners. This article describes an ethnographic study of the types of female circumcision, the reasons for and against the practice, the health implications of this practice, and cultural attitudes of circumcised women both in Western Africa and as migrant refugees living in the United States. Ethical dilemmas in dealing with this practice and implications for nurses and health care providers are discussed.

  9. Circumcision Is Unethical and Unlawful.

    PubMed

    Svoboda, J Steven; Adler, Peter W; Van Howe, Robert S

    2016-06-01

    The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision-the removal of this structure-is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.Circumcision is usually performed for religious, cultural and personal reasons. Early claims about its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.Circumcision violates the cardinal principles of medical ethics, to respect autonomy (self-determination), to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics' position, also risk liability for misleading parents about circumcision.

  10. The International Student: Female Circumcision Issues.

    ERIC Educational Resources Information Center

    Bengston, Barbara; Baldwin, Cynthia

    1993-01-01

    Describes the process and practice of female circumcision, the impact it may have on circumcised female international college students, and some counseling strategies for the college counselor who works with this population. Explains variety of reasons for performing female circumcision, different types of female circumcisions, and psychological…

  11. Discourses of masculinity, femininity and sexuality in Uganda's Stand Proud, Get Circumcised campaign.

    PubMed

    Rudrum, Sarah; Oliffe, John L; Benoit, Cecilia

    2017-02-01

    This paper analyses discourses of masculinity, femininity and sexuality in Stand Proud, Get Circumcised, a public health campaign promoting circumcision as an HIV-prevention strategy in Uganda. The campaign includes posters highlighting the positive reactions of women to circumcised men, and is intended to support the national rollout of voluntary medical male circumcision. We offer a critical discourse analysis of representations of masculinity, femininity and sexuality in relation to HIV prevention. The campaign materials have a playful feel and, in contrast to ABC (Abstain, Be faithful, Use condoms) campaigns, acknowledge the potential for pre-marital and extra-marital sex. However, these posters exploit male anxieties about appearance and performance, drawing on hegemonic masculinity to promote circumcision as an idealised body aesthetic. Positioning women as the campaign's face reasserts a message that women are the custodians of family health and simultaneously perpetuates a norm of estrangement between men and their health. The wives' slogan, 'we have less chance of getting HIV', is misleading, because circumcision only directly prevents female-to-male HIV transmission. Reaffirming hegemonic notions of appearance- and performance-based heterosexual masculinity reproduces existing unsafe norms about masculinity, femininity and sexuality. In selling male circumcision, the posters fail to promote an overall HIV-prevention message.

  12. Student Teachers' Perception on Integration of Traditional Circumcision Education into the School Curriculum

    ERIC Educational Resources Information Center

    Seloana, S. M.

    2011-01-01

    The purpose of this article is to report on the research findings of the views of student-teachers on the integration of some aspects of a traditional circumcision curriculum into higher education. The main question is: Could a traditional circumcision curriculum be integrated into the higher education curriculum? Seventy five participants were…

  13. Comparative study of meanings, beliefs, and practices of female circumcision among three Nigerian tribes in the United States and Nigeria.

    PubMed

    Anuforo, Prisca O; Oyedele, Lola; Pacquiao, Dula F

    2004-04-01

    The study was conducted to gain insight into the meanings, beliefs, and practices of female circumcision among three Nigerian tribes in the United States and Nigeria. Participant-observations occurred in three sites in Nigeria (Ibadan, Lagos, and Owerri) and in Essex County, New Jersey (Newark, Irvington, and East Orange). A total of 50 informants included adult males and females from the three main Nigerian ethnic tribes: Igbo, Yoruba, and Hausa. Leininger's culture care theory of diversity and universality was the study framework. Findings revealed existence of similarities and differences in the cultural meanings, beliefs, and practices among the tribes. Religion, education, and occupation were significant factors influencing informants' attitudes toward continuation of the practice. Government-sponsored public education and influence by the media were found to increase informants' awareness of complications of female circumcision. Changes in attitudes toward the practice and use of alternative practices were evident.

  14. A 'snip' in time: what is the best age to circumcise?

    PubMed Central

    2012-01-01

    Background Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves. Discussion We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used. Summary Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision. PMID:22373281

  15. A study on female circumcision in Nigeria.

    PubMed

    Odujinrin, O M; Akitoye, C O; Oyediran, M A

    1989-01-01

    A total of 181 women were randomly chosen from the women attending the family planning clinic of the Department of Community Health, College of Medicine, University of Lagos, from February 1984 to September 1984. Of these, 84.7% were aged between 25 and 44 years and most of them are Yorubas (70.7%). A high proportion (56.4%) claimed to have been circumcised but examination revealed that 24.5% had no clinical evidence of circumcision. The Edo tribe had the highest proportion circumcised amongst the respondents, 76.7%, followed by the Ibos, 61%, and least of all the Efiks, 20%. Age at circumcision revealed that most had their circumcision as infants (78.8%) and only 5.9% had theirs as adults, however, the Ibos and Yorubas had high rates of infant circumcision. Some of the respondents were aware of the associated side effects and it was found that the more educated women were less likely to circumcise their daughters. All circumcised daughters were from circumcised mothers except one and she had to circumcise her daughter in conformity with her husband's tribal practice. Accurate statistics of morbidity and mortality from female circumcision will be difficult to gather as circumcision is performed mostly in the houses, nevertheless, the complications are severe enough to merit authoritative intervention. It is recommended that public awareness of female circumcision, its complications and other attendant health hazards should be embarked upon by health authorities especially amongst the tribes practising it.

  16. Why Thailand should consider promoting neonatal circumcision?

    PubMed

    Srithanaviboonchai, Kriengkrai; Grimes, Richard M

    2012-09-01

    Male circumcision (MC) has been proven to reduce the risk of HIV transmission. The WHO and UNAIDS jointly recommend the international community consider MC as an HIV prevention measure. MC reduces the risk of acquiring other sexually transmitted infections (STIs) among men, urinary tract infections among children and penile cancer. Lowering the prevalence of STIs in men may reduce the incidence of STIs among women. High levels of adult MC are difficult to achieve in cultures where it has not been customary. Adult MC is associated with a high prevalence of post-operative complications. Neonatal male circumcision (NC) is simpler, safer, and cheaper. Higher coverage with MC can be achieved through NC. Thailand is a good country to promoting NC for the following reasons: most HIV infections are contracted through heterosexual transmission, there is a low MC rate, most newborn deliveries occur in hospitals, there is a relatively strong health care infrastructure and Thailand has well developed HIV care services. Issues of concern regarding promoting NC include length of time before seeing benefits, cost effectiveness of the intervention, the burden to the health care delivery system and concerns about children's rights. NC is an efficacious HIV prevention strategy that should be considered by those involved in HIV/AIDS prevention planning in Thailand. Further studies are needed to determine whether NC should be promoted in Thailand.

  17. The ultrasonic harmonic scalpel for circumcision: experimental evaluation using dogs.

    PubMed

    Peng, Mou; Meng, Zhe; Yang, Zhong-Hua; Wang, Xing-Huan

    2013-01-01

    Male circumcision is one of the most commonly performed operations worldwide, and many novel techniques have been developed for better postoperative outcomes. The purpose of this study was to explore the feasibility of applying the ultracision harmonic scalpel (UHS) for circumcision by using dogs. Sixteen adult male dogs were divided into two groups: the UHS group and the control group. The dogs were circumcised with either the UHS or a conventional scalpel. The UHS circumcision procedure and the effects were imaged 1 week after surgery. The two groups were compared with respect to the operative time and volume of blood loss. Postoperative complications, including oedema, infection, bleeding of the incision and wound dehiscence, were recorded for both groups. The mean operative time for the UHS group was only 5.1 min compared with the 35.5 min of the conventional group. The mean blood loss was less than 2 ml for the UHS group and 15 ml for the conventional group. There was only one case of mild oedema in the UHS group, but the postoperative complications in the conventional group included two cases of mild oedema, one infection of the incision and one case of bleeding of the incision. In conclusion, circumcision using UHS is a novel technique to treat patients with phimosis and excessive foreskin, and this method has a short operative time, less blood loss and fewer complications than the conventional scalpel method. This small animal study provides a basis for embarking on a larger-scale clinical trial of the UHS.

  18. Women and health: female circumcision.

    PubMed

    Hosken, F

    1978-01-01

    Documented cases of female circumcision are reported for Malaysia, Indonesia, East and West Africa. Infibulation is reported for East and West Africa. A specific village listing is provided. Female circumcision as practised in African villages is designed to reduce sexual enjoyment. Those girls who refuse the operation are often ostracized. Sunna circumcision, the cutting of the prepuce of the clitoris, is performed with razor blades and knives by old women. In some areas cuts in the vagina are made to make childbearing easier. The result is the opposite. Moslems perform infibulation (fastening the labia majora together) to insure virginity and paternity. In Kenya defenders of the practise of clitoridectomy say its opposers are viewing the situation emotionally from a Western perspective. Changes are typically resisted by men, especially if they are perceived as being determined by outsiders.

  19. Voice-Message–Based mHealth Intervention to Reduce Postoperative Penetrative Sex in Recipients of Voluntary Medical Male Circumcision in the Western Cape, South Africa: Protocol of a Randomized Controlled Trial

    PubMed Central

    Skinner, Donald; Toefy, Yoesrie; Esterhuizen, Tonya; McCaul, Michael; Petzold, Max; Diwan, Vinod

    2016-01-01

    Background There is an increased risk of transmission of sexually transmitted infections (STIs), including HIV, in the postoperative period after receiving voluntary medical male circumcision (VMMC). In South Africa, over 4 million men are being targeted with VMMC services but the health system is not able to offer quality counseling. More innovative strategies for communicating with and altering behavior in men and their partners in the postoperative period after VMMC are needed. Objective This paper presents a study protocol to test the effectiveness of an mHealth intervention designed to task-shift behavior change communication from health care personnel to an automated phone message system, encouraging self-care. Methods A single-blind, randomized controlled trial will be used. A total of 1188 participants will be recruited by nurses or clinicians at clinics in the study districts that have a high turnover of VMMC clients. The population will consist of men aged 18 years and older who indicate at the precounseling session that they possess a mobile phone and consent to participating in the study. Consenting participants will be randomized into either the control or intervention arm before undergoing VMMC. The control arm will receive the standard of care (pre- and postcounseling). The intervention arm will received standard of care and will be sent 38 messages over the 6-week recovery period. Patients will be followed up after 42 days. The primary outcome is self-reported sexual intercourse during the recovery period. Secondary outcomes include nonpenetrative sexual activity, STI symptoms, and perceived risk of acquiring HIV. Analysis will be by intention-to-treat. Results Enrollment is completed. Follow-up is ongoing. Loss to follow-up is under 10%. No interim analyses have been conducted. Conclusions The intervention has the potential of reducing risky sexual behavior after VMMC. The platform itself can be used for many other areas of health that require task

  20. The effect of male teenage passengers on male teenage drivers: findings from a driving simulator study.

    PubMed

    Ouimet, Marie Claude; Pradhan, Anuj K; Simons-Morton, Bruce G; Divekar, Gautam; Mehranian, Hasmik; Fisher, Donald L

    2013-09-01

    Studies have shown that teenage drivers are less attentive, more frequently exhibit risky driving behavior, and have a higher fatal crash risk in the presence of peers. The effects of direct peer pressure and conversation on young drivers have been examined. Little is known about the impact on driving performance of the presence of a non-interacting passenger and subtle modes of peer influence, such as perceived social norms. The goal of this study was to examine if teenagers would engage in more risky driving practices and be less attentive in the presence of a passenger (vs. driving alone) as well as with a risk-accepting (vs. risk-averse) passenger. A confederate portrayed the passenger's characteristics mainly by his non-verbal attitude. The relationship between driver characteristics and driving behavior in the presence of a passenger was also examined. Thirty-six male participants aged 16-17 years old were randomly assigned to drive with a risk-accepting or risk-averse passenger. Main outcomes included speed, headway, gap acceptance, eye glances at hazards, and horizontal eye movement. Driver characteristics such as tolerance of deviance, susceptibility to peer pressure, and self-esteem were measured. Compared to solo driving, the presence of a passenger was associated with significantly fewer eye glances at hazards and a trend for fewer horizontal eye movements. Contrary to the hypothesis, however, Passenger Presence was associated with waiting for a greater number of vehicles to pass before initiating a left turn. Results also showed, contrary to the hypothesis, that participants with the risk-accepting passenger maintained significantly longer headway with the lead vehicle and engaged in more eye glances at hazards than participants with the risk-averse passenger. Finally, when driving with the passenger, earlier initiation of a left turn in a steady stream of oncoming vehicles was significantly associated with higher tolerance of deviance and

  1. The effect of male teenage passengers on male teenage drivers: findings from a driving simulator study

    PubMed Central

    Ouimet, Marie Claude; Pradhan, Anuj K.; Simons-Morton, Bruce G.; Divekar, Gautam; Mehranian, Hasmik; Fisher, Donald L.

    2014-01-01

    Studies have shown that teenage drivers are less attentive, more frequently exhibit risky driving behavior, and have a higher fatal crash risk in the presence of peers. The effects of direct peer pressure and conversation on young drivers have been examined. Little is known about the impact on driving performance of the presence of a non-interacting passenger and subtle modes of peer influence, such as perceived social norms. The goal of this study was to examine if teenagers would engage in more risky driving practices and be less attentive in the presence of a passenger (vs. driving alone) as well as with a risk-accepting (vs. risk-averse) passenger. A confederate portrayed the passenger's characteristics mainly by his non-verbal attitude. The relationship between driver characteristics and driving behavior in the presence of a passenger was also examined. Thirty-six male participants aged 16-17 years old were randomly assigned to drive with a risk-accepting or risk-averse passenger. Main outcomes included speed, headway, gap acceptance, eye glances at hazards, and horizontal eye movement. Driver characteristics such as tolerance of deviance, susceptibility to peer pressure, and self-esteem were measured. Compared to solo driving, the presence of a passenger was associated with significantly fewer eye glances at hazards and a trend for fewer horizontal eye movements. Contrary to the hypothesis, however, passenger presence was associated with a greater number of vehicles before initiating a left turn. Results also showed, contrary to the hypothesis, that participants with the risk-accepting passenger maintained significantly longer headway with the lead vehicle and engaged in more eye glances at hazards than participants with the risk-averse passenger. Finally, when driving with the passenger, earlier initiation of a left turn in a steady stream of oncoming vehicles was significantly associated with higher tolerance of deviance and susceptibility to peer pressure

  2. Ischemia of the glans penis following circumcision: case report and revision of the literature.

    PubMed

    Pepe, Pietro; Pietropaolo, Francesco; Candiano, Giuseppe; Pennisi, Michele

    2015-03-31

    Ischemic complications of the glans penis are rare and commonly result from trauma, inadvertent administration of vasoconstrictive solutions, diabetes mellitus, circumcision and vasculitis; we refer about a young man with severe ischemia of the glans penis following circumcision. The patient had undergone circumcision 5 days before in a surgery department under local anesthesia (1% mepivacaine hydrochloride). The patient noticed a brownish color and edema of the glans penis at 24 h after he opened the wound dressing, but arrived to our hospital only 5 days after circumcision because these findings had progressed. Physical examination revealed the black color or necrotic appearance of the glans penis, and edema on the dorsal penile skin. The patient underwent antibiotic, antiplatatelet, corticosteroid and iperbaric therapy achieving a complete restitutio ad integrum.

  3. Preliminary findings exploring the social determinants of Black males' lay health perspectives.

    PubMed

    Mount, David L; Johnson, Darin M; Rego, Maria Isabel; Schofield, Kandyce; Amponsah, Alethea; Graham, Louis F

    2012-01-01

    The unequal discussion of Black males' health is a pressing social problem. This study addressed Black males' lay perspectives regarding their health, illness, and mortality, with attention to the determinants of men's health, prevention, lifestyle, and opportunities for health promotion using an exploratory/qualitative research methodology. Participants were 68 Black males aged 15 to 68 years, with an average age of 44 years (SD = 14.5). The narratives represented a complex interplay of biopsychosocial factors, ranging from intrapersonal attitudes, interpersonal experiences to discussions about community and public policy injustices. Five prominent themes emerged: (a) lack of chronic disease awareness, (b) fatalism, (c) fear and anxiety of academic-medical settings, (d) hyperactive masculinity fatigue, and (e) the gay-straight divide. The term Tired Black Male Health syndrome was coined in the forum. Implications of these findings are discussed in the context of culturally relevant strategies for improving Black male community health engagement.

  4. Urosepsis and postrenal acute renal failure in a neonate following circumcision with Plastibell device.

    PubMed

    Kalyanaraman, Meena; McQueen, Derrick; Sykes, Joseph; Phatak, Tej; Malik, Farhaan; Raghava, Preethi S

    2015-04-01

    Plastibell is one of the three most common devices used for neonatal circumcision in the United States, with a complication rate as low as 1.8%. The Plastibell circumcision device is commonly used under local anesthesia for religious circumcision in male neonates, because of cosmetic reasons and ease of use. Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine. Furthermore, the foreskin of neonates is highly vascularized, and hence, hemorrhage and infection are possible when the skin is cut. Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention. We report a case of fulminant urosepsis, acute renal failure, and pyelonephritis in a 4-day-old male neonate secondary to impaction of a Plastibell circumcision device. Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications. Pediatricians and Emergency Department physicians should be cognizant of the complications from Plastibell circumcision device in order to institute appropriate and timely management in neonates.

  5. Is the mass circumcision drive in KwaZulu-Natal involving neonates and children less than 16 years of age legal? What should doctors do?

    PubMed

    McQuoid-Mason, D J

    2013-05-01

    As a result of the revival of male circumcision among Zulu males as a cultural practice and an attempt to reduce the incidence of HIV infection, the KwaZulu-Natal government has implemented a programme of mass circumcision of Zulu males. The question arises whether the implementation of such a programme on neonates and children under 16 years of age is legal in terms of the Constitution and the Children's Act. The answer hinges on whether the circumcision is done as a cultural practice or for medical reasons. Doctors are provided with guidance as to what they should do when faced with neonates or males under 16 years of age being presented for circumcision.

  6. Bullying Victimisation and Social Support of Adolescent Male Dance Students: An Analysis of Findings

    ERIC Educational Resources Information Center

    Risner, Doug

    2014-01-01

    This analysis (n?=?33), drawn from the findings of the author's larger mixed method research study, investigated bullying and harassment of adolescent male students (ages 13-18) pursuing dance study at the pre-professional level in the United States. Procedures for this analysis included review of primary and secondary sources from the…

  7. Neonatal herpes simplex virus infection following Jewish ritual circumcisions that included direct orogenital suction - New York City, 2000-2011.

    PubMed

    2012-06-08

    Herpes simplex virus (HSV) infection commonly causes "cold sores" (HSV type 1 [HSV-1]) and genital herpes (HSV-1 or HSV type 2 [HSV-2]); HSV infection in newborns can result in death or permanent disability. During November 2000-December 2011, a total of 11 newborn males had laboratory-confirmed HSV infection in the weeks following out-of-hospital Jewish ritual circumcision, investigators from the New York City Department of Health and Mental Hygiene (DOHMH) learned. Ten of the 11 newborns were hospitalized; two died. In six of the 11 cases, health-care providers confirmed parental reports that the ritual circumcision included an ultra-Orthodox Jewish practice known as metzitzah b'peh, in which the circumciser (mohel, plural: mohelim) places his mouth directly on the newly circumcised penis and sucks blood away from the circumcision wound (direct orogenital suction). In the remaining cases, other evidence suggested that genital infection was introduced by direct orogenital suction (probable direct orogenital suction). Based on cases reported to DOHMH during April 2006-December 2011, the risk for neonatal herpes caused by HSV-1 and untyped HSV following Jewish ritual circumcision with confirmed or probable direct orogenital suction in New York City was estimated at 1 in 4,098 or 3.4 times greater than the risk among male infants considered unlikely to have had direct orogenital suction. Oral contact with a newborn's open wound risks transmission of HSV and other pathogens. Circumcision is a surgical procedure that should be performed under sterile conditions. Health-care professionals advising parents and parents choosing Jewish ritual circumcision should inquire in advance whether direct orogenital suction will be performed, and orogenital suction should be avoided.

  8. Circumstances surrounding male sexual assault and rape: findings from the National Violence Against Women Survey.

    PubMed

    Light, David; Monk-Turner, Elizabeth

    2009-11-01

    Much work in the area of male sexual assault and rape relies on small clinical samples. From these samples, researchers reported that most male victims were physically injured during the attack and that penetration occurred. This work rests on a subsample of 219 men from the 1994-1996 Violence and Threats of Violence Against Women and Men in the United States Survey. Findings from the National Violence Against Women Survey (NVAW) show that the vast majority of male sexual assault victims reported that they were not physically injured during the assault, that a weapon was not used, that there was no substance use at the time of the assault, and that penetration did not occur. Only 29% of male respondents in the NVAW sought medical or psychological help after the assault. Prior work may have overrepresented men who reported being physically injured and/or penetrated. An analysis is presented of how those who presented for help in the NVAW differ from the whole sample. Results show that men who presented for help were more likely to have reported being physically injured during the assault and that penetration occurred. Thus, findings from prior work make sense; however, they may not be representative of male assault victims as a whole.

  9. Assessment of the impact of female circumcision on the gynecological, genitourinary and obstetrical health problems of women from Somalia: literature review and case series.

    PubMed

    Arbesman, M; Kahler, L; Buck, G M

    1993-01-01

    Approximately 80 million women worldwide have undergone surgery for circumcision. A variety of health risks resulting from the procedure have been reported in the literature including: bleeding, infection, shock, difficulties with menstruation and urination as well as painful intercourse. Prolonged labor and perinatal difficulties have also been noted. After an extensive literature review, a description of gynecological and obstetrical complications is provided. We had the opportunity to survey 12 Somali refugee women who were temporarily residing in a refugee center in Western New York about their personal experience with circumcision. We were interested in determining whether this convenient sample of women substantiated the clinical sequelae of circumcision reported in the literature. Structured interviews were conducted and included questions on sociodemographic, circumcision and health factors. Our findings, however limited, support the presence of heavy bleeding at the time of the surgery as a complication arising from circumcision.

  10. Neonatal Herpes Simplex Virus Type 1 Infection and Jewish Ritual Circumcision With Oral Suction: A Systematic Review.

    PubMed

    Leas, Brian F; Umscheid, Craig A

    2015-06-01

    Jewish ritual circumcision rarely but occasionally includes a procedure involving direct oral suction of the wound, which can expose an infant to infection with herpes simplex virus type 1 (HSV-1). This practice has provoked international controversy in recent years, but no systematic review of the clinical literature has previously been published. We designed this review to identify and synthesize all published studies examining the association between circumcision with direct oral suction and HSV-1 infection. Our search strategy identified 6 published case series or case reports, documenting 30 cases between 1988 and 2012. Clinical findings were consistent with transmission of infection during circumcision, although the evidence base is limited by the small number of infections and incomplete case data. Published evidence suggests that circumcision with direct oral suction has resulted in severe neonatal illness and death from HSV-1 transmission, but further research is necessary to clarify the risk of infection.

  11. Economics of antiretroviral treatment vs. circumcision for HIV prevention.

    PubMed

    Bärnighausen, Till; Bloom, David E; Humair, Salal

    2012-12-26

    The HIV Prevention Trials Network (HPTN) 052 study, which showed the effectiveness of antiretroviral treatment in reducing HIV transmission, has been hailed as a "game changer" in the fight against HIV, prompting calls for scaling up treatment as prevention (TasP). However, it is unclear how TasP can be financed, given flat-lining support for global HIV programs. We assess whether TasP is indeed a game changer or if comparable benefits are obtainable at similar or lower cost by increasing coverage of medical male circumcision (MMC) and antiretroviral treatment (ART) at CD4 <350/μL. We develop a new mathematical model and apply it to South Africa, finding that high ART coverage combined with high MMC coverage provides approximately the same HIV incidence reduction as TasP, for $5 billion less over 2009-2020. MMC outperforms ART significantly in cost per infection averted ($1,096 vs. $6,790) and performs comparably in cost per death averted ($5,198 vs. $5,604). TasP is substantially less cost effective at $8,375 per infection and $7,739 per death averted. The prevention benefits of HIV treatment are largely reaped with high ART coverage. The most cost-effective HIV prevention strategy is to expand MMC coverage and then scale up ART, but the most cost-effective HIV-mortality reduction strategy is to scale up MMC and ART jointly. TasP is cost effective by commonly used absolute benchmarks but it is far less cost effective than MMC and ART. Given South Africa's current annual ART spending, the $5 billion in savings offered by MMC and ART over TasP in the next decade, for similar health benefits, challenges the widely hailed status of TasP as a game changer.

  12. Finding "Los Científicos" within: Latino Male Science Identity Development in the First College Semester

    ERIC Educational Resources Information Center

    Lu, Charles

    2015-01-01

    Latino males are the lowest male ethnic subgroup to attain a four-year STEM college degree. This phenomenological qualitative research study used two rounds of interviews with twelve Latino male students in Central Texas to examine their first semester science experiences using a science identity framework. Findings indicate that developing a…

  13. History of circumcision: a religious obligation or a medical necessity.

    PubMed

    Massry, Shaul G

    2011-01-01

    Circumcision is the oldest documented surgical procedure. Practiced for ritual religious and likely medical purposes, it seems to have emerged in Egypt and was adopted by the western Semitic tribes. In biblical times, circumcision became a religious doctrine described in the Covenant between God and Abraham in the book of Genesis. Although some claim that there are medical advantages to being circumcised, available data do not support a medical benefit for circumcision.

  14. Bilateral bloody nipple discharge in a male infant: sonographic findings and proposed diagnostic approach.

    PubMed

    Djilas-Ivanovic, Dragana; Boban, Jasmina; Katanic, Dragan; Ivkovic-Kapicl, Tatjana; Lucic, Milos Alexandar

    2012-01-01

    Bloody nipple discharge is an uncommon finding in the pediatric population, without clear diagnostic and therapeutic guidelines established. We noted a case of a 3-month-old male infant who presented with bilateral blood-stained nipple discharge, with unremarkable medical history. Sonographic findings revealed bilaterally dilated ducts and cysts with mixed iso- and hypoechoic intraductal content. Possible causes of this condition include hyperlaxity syndrome with decreased function of elastic fibers and fibrocystic changes in breasts, and unusual response to maternal hormones, transferred to the neonate either transplacentally or through breastfeeding. Given the most probable benign etiology and self-limiting nature of the described condition, a conservative approach is suggested. Unnecessary invasive procedures should be avoided.

  15. Allocation of healthcare dollars: analysis of nonneonatal circumcisions in Florida.

    PubMed

    Gutwein, Luke G; Alvarez, Juan F; Gutwein, Jenny L; Kays, David W; Islam, Saleem

    2013-09-01

    Circumcision remains a controversial operation. Most procedures are performed in the neonatal period and avoid general anesthesia. Legislation driven by policy statements from the American Academy of Pediatrics led to significant changes in circumcisions in Florida with a shift to nonneonatal procedures as a result of costs. We sought to study the prevalence and financial implications of nonneonatal circumcisions in Florida. A retrospective population study was performed using the Florida Agency for Health Care Administration outpatient procedure database. We queried for patients 0 to 17 years of age undergoing circumcision between 2003 and 2008. Demographics, charges, and insurance status were analyzed. From 2003 to 2008, 31,741 outpatient circumcisions were performed. Publicly funded circumcisions accounted for 17,537 charging the state $6,263 on average for each circumcision at an expense of $111.8 million for the 5-year time period analyzed. Publicly funded circumcision procedures increased more than sixfold (P < 0.0001) than those covered by private insurance. Black circumcision procedures increased 77.3 per cent, whereas white circumcisions increased 28.7 per cent. There has been a significant increase in the number of nonneonatal circumcisions performed. This has resulted in an increase in economic health care. Public funding of neonatal circumcision could result in significant cost savings and avoid potential complications of general anesthesia.

  16. Making the case for circumcision as a public health strategy: opening the dialogue.

    PubMed

    Castro, José G; Jones, Deborah Lynne; Lopez, Maria; Barradas, Isabel; Weiss, Stephen M

    2010-06-01

    Hispanics in the United States have lower rates of male circumcision and higher rates of HIV. Although MC has been demonstrated to reduce the risk of acquisition of several sexual transmitted diseases such as HIV, human papilloma virus infection, and herpes simplex virus type 2, MC is only medically reimbursable by insurance for adults or children following recurrent infection, injury, or malformation of the penis. We conducted two studies of attitudes regarding MC among health care providers to Hispanic clients at Miami, Florida STD and Prenatal Clinics. This study presents qualitative data drawn from intensive interviews with 21 providers, including a mohel. Qualitative data was analyzed for dominant themes and collapsed into overarching themes. Thirteen themes emerged; acceptability, appearance, circumcision and children, circumcision and HIV, cost, cultural differences, health benefits, knowledge and personal experiences, pain and injury to the penis, perceived HIV risk, religion, sexual performance, and sexual pleasure. Except for the mohel, Hispanic male providers related MC acceptability to American Pediatric Association guidelines, personal circumcision status, and were skeptical regarding health benefits for sexually transmitted disease (STD)/HIV risk reduction. Female providers focused on the financial burden to parents, lack of information, and low acceptability among Hispanic men. This study illustrates the differing attitudes on circumcision held by providers, and suggests that gender, culture, cost, and providers themselves may limit MC acceptability among Hispanic clients. Results suggest that promotion of MC as an HIV risk reduction strategy must begin with the support of medical practitioners to promote the endorsement of MC as a prevention strategy.

  17. Is female circumcision evolving or dissolving in Norway? A qualitative study on attitudes toward the practice among young Somalis in the Oslo area

    PubMed Central

    Gele, Abdi A; Sagbakken, Mette; Kumar, Bernadette

    2015-01-01

    Female genital mutilation or female circumcision (FC) is increasingly visible on the global health and development agenda – both as a matter of social justice and equality for women and as a research priority. Norway is one of the global nations hosting a large number of immigrants from FC-practicing countries, the majority from Somalia. To help counteract this practice, Norway has adopted a multifaceted policy approach that employs one of the toughest measures against FC in the world. However, little is known about the impact of Norway’s approach on the attitudes toward the practice among traditional FC-practicing communities in Norway. Against this background, this qualitative study explores the attitudes toward FC among young Somalis between the ages of 16 to 22 living in the Oslo and Akershus regions of Norway. Findings indicate that young Somalis in the Oslo area have, to a large extent, changed their attitude toward the practice. This was shown by the participants’ support and sympathy toward criminalization of FC in Norway, which they believed was an important step toward saving young girls from the harmful consequences of FC. Most of the uncircumcised girls see their uncircumcised status as being normal, whereas they see circumcised girls as survivors of violence and injustice. Moreover, the fact that male participants prefer a marriage to uncircumcised girls is a strong condition for change, since if uncut girls are seen as marriageable then parents are unlikely to want to circumcise them. As newly arrived immigrants continue to have positive attitudes toward the practice, knowledge of FC should be integrated into introduction program classes that immigrants attend shortly after their residence permit is granted. This study adds to the knowledge of the process of the abandonment of FC among immigrants in Western countries. PMID:26648760

  18. Articulation Rate and Vowel Space Characteristics of Young Males with Fragile X Syndrome: Preliminary Acoustic Findings

    ERIC Educational Resources Information Center

    Zajac, David J.; Roberts, Joanne E.; Hennon, Elizabeth A.; Harris, Adrianne A.; Barnes, Elizabeth F.; Misenheimer, Jan

    2006-01-01

    Purpose: Increased speaking rate is a commonly reported perceptual characteristic among males with fragile X syndrome (FXS). The objective of this preliminary study was to determine articulation rate--one component of perceived speaking rate--and vowel space characteristics of young males with FXS. Method: Young males with FXS (n = 38), …

  19. Complications of female circumcision in Nigerian Igbos.

    PubMed

    Egwuatu, V E; Agugua, N E

    1981-11-01

    An analysis is made of 43 children and 15 adult female patients who presented with post-circumcision complications at the University of Nigeria Teaching Hospital, Enugu, between January 1973 and December 1980; 57 patients had been circumcised within 21 days of birth and one patient in the seventh month of her first pregnancy. Age of presentation varied with the severity of the symptoms: 21 children and 11 adults presented with varying degrees of labial occlusion, while 9 children and 4 adults had implantation dermoids. Urinary retention was the problem in 12 children and one adult.

  20. Acceptability and Satisfaction Associated With the Introduction of the PrePex Circumcision Device in Maputo, Mozambique

    PubMed Central

    Necochea, Edgar; Ferreira, Thais; Soares, Benilde; Mahomed, Mehebub; Muquingue, Humberto; Nhambi, Leonel; Bossemeyer, Debora; Ashengo, Tigistu A.

    2016-01-01

    Background: Adult device circumcision may potentially reach more men in Sub-Saharan Africa, with fewer human resource and capacity needs than surgical procedures. Despite these advantages, little is known about device acceptability, including pain and maintaining the device in situ. Methods: Healthy, HIV-negative men, between 18 and 49 years, in a Maputo clinic, were consecutively asked to participate in a circumcision device study that included assessing acceptability. Clinical forms and self-administered surveys were used to collect data at various times during the circumcision process for consenting men. Data were entered into a central database and analyzed using statistical software. Results: Between May and July, 2013, 504 men received device circumcision. Placement was painless for 98.2% of the male population, but the pain was more common during removal with 38.3% reporting severe or unbearable and 21.5% moderate pain. Satisfaction was high at both time points with 88.8% and 92.6% of men being very or somewhat satisfied at placement and removal, respectively. Half of the male population (50.2%) was very or somewhat comfortable with the device in situ; whereas, 36.8% were somewhat or very uncomfortable. Common device difficulties experienced were painful erections (38.5%) and difficult urination (21.8%) and hygiene (21.4%). By the final clinic visit at day 49, 90.4% of them were very or somewhat satisfied with the procedure. Discussion: High levels of satisfaction were reported for device circumcision, despite the pain noted during removal and some challenges with the device in situ. Given the advantages and acceptability among Mozambican men in this study, device circumcision could be offered, when clinically appropriate, as an alternative to surgery. PMID:27331592

  1. Eavesdropping to Find Mates: The Function of Male Hearing for a Cicada-Hunting Parasitoid Fly, Emblemasoma erro (Diptera: Sarcophagidae).

    PubMed

    Stucky, Brian J

    2016-01-01

    Females of several species of dipteran parasitoids use long-range hearing to locate hosts for their offspring by eavesdropping on the acoustic mating calls of other insects. Males of these acoustic eavesdropping parasitoids also have physiologically functional ears, but so far, no adaptive function for male hearing has been discovered. I investigated the function of male hearing for the sarcophagid fly Emblemasoma erro Aldrich, an acoustic parasitoid of cicadas, by testing the hypothesis that both male and female E. erro use hearing to locate potential mates. I found that both male and nongravid female E. erro perform phonotaxis to the sounds of calling cicadas, that male flies engage in short-range, mate-finding behavior once they arrive at a sound source, and that encounters between females and males at a sound source can lead to copulation. Thus, cicada calling songs appear to serve as a mate-finding cue for both sexes of E. erro Emblemasoma erro's mate-finding behavior is compared to that of other sarcophagid flies, other acoustic parasitoids, and nonacoustic eavesdropping parasitoids.

  2. Eavesdropping to Find Mates: The Function of Male Hearing for a Cicada-Hunting Parasitoid Fly, Emblemasoma erro (Diptera: Sarcophagidae)

    PubMed Central

    Stucky, Brian J.

    2016-01-01

    Females of several species of dipteran parasitoids use long-range hearing to locate hosts for their offspring by eavesdropping on the acoustic mating calls of other insects. Males of these acoustic eavesdropping parasitoids also have physiologically functional ears, but so far, no adaptive function for male hearing has been discovered. I investigated the function of male hearing for the sarcophagid fly Emblemasoma erro Aldrich, an acoustic parasitoid of cicadas, by testing the hypothesis that both male and female E. erro use hearing to locate potential mates. I found that both male and nongravid female E. erro perform phonotaxis to the sounds of calling cicadas, that male flies engage in short-range, mate-finding behavior once they arrive at a sound source, and that encounters between females and males at a sound source can lead to copulation. Thus, cicada calling songs appear to serve as a mate-finding cue for both sexes of E. erro. Emblemasoma erro’s mate-finding behavior is compared to that of other sarcophagid flies, other acoustic parasitoids, and nonacoustic eavesdropping parasitoids. PMID:27382133

  3. Are Male Judokas with Visual Impairments Training Properly? Findings from an Observational Study

    ERIC Educational Resources Information Center

    Gutierrez-Santiago, Alfonso; Cancela, Jose M.; Zubiaur, Marta; Ayan, Carlos

    2012-01-01

    Introduction: One aim of the study was to describe the temporal structure of judo combat among male judokas with visual impairments. Another aim was to determine the possible differences between the judokas with visual impairments and sighted male judokas to determine whether judokas with visual impairments need specific training to achieve their…

  4. Adult Female and Male Siblings of Persons with Disabilities: Findings from a National Survey

    ERIC Educational Resources Information Center

    Hodapp, Robert M.; Urbano, Richard C.; Burke, Meghan M.

    2010-01-01

    In this study, the authors used a national, Web-based survey to examine female and male siblings of individuals with disabilities. More than 1,160 adult siblings completed a 163-question survey about themselves, their siblings, and their sibling relationships. Most respondents reported fairly close contact with their siblings and positive sibling…

  5. Circumcising Circumcision: Renegotiating Beliefs and Practices among Somali Women in Johannesburg and Nairobi.

    PubMed

    Jinnah, Zaheera; Lowe, Lucy

    2015-01-01

    Female circumcision among Somalis is a deeply personal and subjective practice, framed within traditional norms and cultural practices, but negotiated within contemporary realities to produce a set of processes and practices that are nuanced, differentiated, and undergoing change. Based on ethnographic research among Somali women in Johannesburg and Nairobi, we argue that the context of forced migration provides women with opportunities to renegotiate and reinvent what female circumcision means to them. The complex, subjective, and diverse perceptions and experiences of circumcision as embedded processes, within the context of migration, we argue has been overlooked in the literature, which has tended to be framed within a normative discourse concerned with the medical effects of the practice, or in anthropological studies, counter to the normative discourse based on personal narratives.

  6. Male Escorts' and Male Clients' Sexual Behavior During Their Last Commercial Sexual Encounter: Comparing and Contrasting Findings from Two Online Studies.

    PubMed

    Grov, Christian; Rodríguez-Díaz, Carlos E; Jovet-Toledo, Gerardo G

    2016-05-01

    Much of what is known about commercial sexual encounters between men is based on data gathered from escorts. With few exceptions, studies have not compared male clients' reports of behavior during commercial sexual encounters with male escorts'. The present study draws from two datasets, a 2012 survey of clients (n = 495) and a 2013 survey of escorts (n = 387)--both used virtually identical measures of sexual behavior during the most recent commercial sexual encounter. For clients and escorts, the majority eschewed having sex without a condom, and kissing and oral sex were among the most common behaviors reported. Using logistic regression, both samples were compared across 15 sexual behaviors, finding significant differences in six--the escort sample had greater odds of reporting their last commercial sexual encounter involved watching the client masturbate, viewing porn, role play (dad/son, dominant/submissive), and having prior sexual experience with their commercial partner. The escort sample had lower odds of reporting that the client watched the escort masturbate, and being told partner's HIV status. In multivariable modeling, both samples did not significantly differ in reports of condomless anal sex. Male-male commercial sexual encounters appear to be involved in a wide range of sexual behaviors, many of which convey low-to-no risk of HIV transmission.

  7. 'We go to the bush to prove that we are also men': traditional circumcision and masculinity in the accounts of men who have sex with men in township communities in South Africa.

    PubMed

    Lynch, Ingrid; Clayton, Matthew

    2017-03-01

    In predominantly isiXhosa-speaking township communities in South Africa, men who have sex with men negotiate their identities and sexual practices alongside heteronormative cultural scripts of what it means to be a man. Such idealised notions of masculinity are predicated on the selective appropriation of cultural practices that preserve (heterosexual) male privilege and power. In this paper, we explore the identity work done by men who have sex with men, with particular reference to male circumcision as a cultural practice widely drawn on to inform and regulate normative masculinity. Through a narrative-discursive analysis of the accounts provided by men who have sex with men from township communities, we highlight how participants' dissident sexualities are constructed as compromising their masculine identities. Participating in cultural practices such as traditional circumcision aligns participants to the idealised forms of masculinity that afford men full citizenship in their communities. Study findings suggest that sexual dissidence is less troubling to participants than deviating from gendered markers of hegemonic masculinity, and point to ways in which marginalised men might have an interest in maintaining the dominant gendered order. We conclude with implications for research and programmatic work with gay, bisexual and other men who have sex with men.

  8. Psychosocial Results from a Phase I Trial of a Nonsurgical Circumcision Device for Adult Men in Zimbabwe

    PubMed Central

    Montaño, Daniel E.; Hamilton, Deven T.; Down, Kayla L.; Marrett, Karl D.; Tshimanga, Mufuta; Xaba, Sinokuthemba; Mugurungi, Owen

    2016-01-01

    Abstract Male circumcision (MC), an effective HIV prevention tool, has been added to Zimbabwe's Ministry of Health and Child Care HIV/AIDS Prevention Program. A Phase I safety trial of a nonsurgical male circumcision device was conducted and extensive psychosocial variables were assessed. Fifty-three men (18 and older) were recruited for the device procedure; 13 follow-up clinical visits were completed. Interviews conducted three times (before the procedure, at 2 weeks and 90 days post-procedure) assessed: Satisfaction; expectations; actual experience; activities of daily living; sexual behavior; and HIV risk perception. Using the Integrated Behavioral Model, attitudes towards MC, sex, and condoms, and sources of social influence and support were also assessed. Men (mean age 32.5, range 18–50; mean years of education = 13.6; 55% employed) were satisfied with device circumcision results. Men understand that MC is only partially protective against HIV acquisition. Most (94.7%) agreed that they will continue to use condoms to protect themselves from HIV. Pain ratings were surprisingly negative for a procedure billed as painless. Men talked to many social networks members about their MC experience; post-procedure (mean of 14 individuals). Minimal impact on activities of daily living and absenteeism indicate possible cost savings of device circumcisions. Spontaneous erections occurred frequently post-procedure. The results had important implications for changes in the pre-procedure clinical counseling protocol. Clear-cut counseling to manage pain and erection expectations should result in improved psychosocial outcomes in future roll-out of device circumcisions. Men's expectations must be managed through evidence-based counseling, as they share their experiences broadly among their social networks. PMID:26745142

  9. How the circumcision solution in Africa will increase HIV infections

    PubMed Central

    Van Howe, Robert S.; Storms, Michelle R.

    2011-01-01

    The World Health Organization and UNAIDS have supported circumcision as a preventive for HIV infections in regions with high rates of heterosexually transmitted HIV; however, the circumcision solution has several fundamental flaws that undermine its potential for success. This article explores, in detail, the data on which this recommendation is based, the difficulty in translating results from high risk adults in a research setting to the general public, the impact of risk compensation, and how circumcision compares to existing alternatives. Based on our analysis it is concluded that the circumcision solution is a wasteful distraction that takes resources away from more effective, less expensive, less invasive alternatives. By diverting attention away from more effective interventions, circumcision programs will likely increase the number of HIV infections.

  10. Findings

    MedlinePlus

    ... Issue All Issues Explore Findings by Topic Cell Biology Cellular Structures, Functions, Processes, Imaging, Stress Response Chemistry ... Glycobiology, Synthesis, Natural Products, Chemical Reactions Computers in Biology Bioinformatics, Modeling, Systems Biology, Data Visualization Diseases Cancer, ...

  11. HIV/STI risk among male Mexican immigrants in Dallas, Texas: findings from a pilot study.

    PubMed

    Wilson, Kate S; Eggleston, Elizabeth; Diaz-Olavarrieta, Claudia; Garcia, Sandra G

    2010-12-01

    Rates of HIV and STIs are higher among Latinos than the general U.S. population. A number of factors place Latino immigrants at particularly high risk. 128 male Mexican immigrants in Dallas, Texas completed personal interviews. We measured the prevalence of HIV/STI risk factors and identified sociodemographic and behavioral characteristics associated with higher risk. 9% of the total sample had 3 or more sexual partners in the past year. 5% had sex with a commercial sex worker (CSW). 11% had sex with another man. 11% had a previous STI diagnosis. Risk behaviors and STI history were more prevalent among men who had used illegal drugs or frequently consumed alcohol (18% of the sample) than among others. The overall prevalence of HIV/STI risk factors in this population was moderate. However, men who drank alcohol frequently and used illegal drugs were more likely than others to report engaging in behaviors that put them at risk for acquiring HIV/STI.

  12. Two XX males diagnosed in childhood. Endocrine, renal, and laboratory findings.

    PubMed Central

    Laurance, B M; Darby, C W; Vanderschueren-Lodeweyckx, M

    1976-01-01

    Two prepubertal boys with bilateral cryptorchidism were identified as 46,XX after nuclear sexing studies in several tissues. Gonadal histology and chromosome studies suggested that true hermaphroditism or mosaicism were unlikely. Xg blood grouping was informative in one patient. Accepting paternity, this suggested either that both Xs were maternal, with loss, for example, of the male determining Y chromosome, or that the paternal X chromosome did not express, probably because of a deletion, the allele for the positive Xg blood group. The patients had normal thyroid stimulating hormone reserves but subnormal responses to human chorionic gonadotrophin stimulation, and may need hormonal replacement at puberty. Both had renal anomalies. We suggest that chromosome analysis is essential when cryptorchidism, hypospadias, or microgenitalia are found and that an intravenous pyelogram is desirable. Images FIG. PMID:4036

  13. Ritual circumcision and risk of autism spectrum disorder in 0- to 9-year-old boys: national cohort study in Denmark

    PubMed Central

    Simonsen, Jacob

    2015-01-01

    Objective Based on converging observations in animal, clinical and ecological studies, we hypothesised a possible impact of ritual circumcision on the subsequent risk of autism spectrum disorder (ASD) in young boys. Design National, register-based cohort study. Setting Denmark. Participants A total of 342,877 boys born between 1994 and 2003 and followed in the age span 0–9 years between 1994 and 2013. Main outcome measures Information about cohort members’ ritual circumcisions, confounders and ASD outcomes, as well as two supplementary outcomes, hyperkinetic disorder and asthma, was obtained from national registers. Hazard ratios (HRs) with 95% confidence intervals (CIs) associated with foreskin status were obtained using Cox proportional hazards regression analyses. Results With a total of 4986 ASD cases, our study showed that regardless of cultural background circumcised boys were more likely than intact boys to develop ASD before age 10 years (HR = 1.46; 95% CI: 1.11–1.93). Risk was particularly high for infantile autism before age five years (HR = 2.06; 95% CI: 1.36–3.13). Circumcised boys in non-Muslim families were also more likely to develop hyperkinetic disorder (HR = 1.81; 95% CI: 1.11–2.96). Associations with asthma were consistently inconspicuous (HR = 0.96; 95% CI: 0.84–1.10). Conclusions We confirmed our hypothesis that boys who undergo ritual circumcision may run a greater risk of developing ASD. This finding, and the unexpected observation of an increased risk of hyperactivity disorder among circumcised boys in non-Muslim families, need attention, particularly because data limitations most likely rendered our HR estimates conservative. Considering the widespread practice of non-therapeutic circumcision in infancy and childhood around the world, confirmatory studies should be given priority. PMID:25573114

  14. Male foreskin and oncogenic human papillomavirus infection in men and their female partners.

    PubMed

    Tobian, Aaron A R; Gray, Ronald H

    2011-07-01

    Persistent high-risk human papillomavirus (HR-HPV) infection causes cervical cancer, the third leading cause of cancer mortality in women worldwide. High rates of HR-HPV and cervical cancer occur in sub-Saharan Africa and are exacerbated by the HIV epidemic, making prevention of HR-HPV and HIV priorities. Male circumcision reduces HIV acquisition in men. As presented in this article, randomized controlled trial data also demonstrate that male circumcision reduces penile HR-HPV infection in both HIV-negative and -positive men. Male circumcision of HIV-negative men also reduces the prevalence and incidence of HR-HPV infections in their female partners. However, male circumcision of HIV-positive men has no effect on HR-HPV infection in their female partners. These data demonstrate that male circumcision is most effective prior to sexual debut, and the presence of the male foreskin facilitates HIV and HR-HPV infection in men and their female partners. Additional studies that utilize the foreskin mucosa obtained at the time of male circumcision are needed to assess the mucosal microenvironment in HIV and HR-HPV coinfections to develop additional preventive and therapeutic approaches.

  15. The Effect of Health Education Program for Caregivers on Circumcision Outcome in Neonates and Infants

    ERIC Educational Resources Information Center

    Gafer, Youser abd Elsalam; Nafee, Houda Mohammed; Pal, Kamlish

    2015-01-01

    Circumcision is a surgical excision of the foreskin to the level of the coronal sulcus which may perform in the neonatal period or in later life. Circumcision has many medical benefits such as minimizing urinary tract infection, reduces the incidence of balanitis and enhances of penile hygiene, prevents of penile cancer. However, Circumcision may…

  16. Self-efficacy, male rape myth acceptance, and devaluation of emotions in sexual trauma sequelae: Findings from a sample of male veterans.

    PubMed

    Voller, Emily; Polusny, Melissa A; Noorbaloochi, Siamak; Street, Amy; Grill, Joseph; Murdoch, Maureen

    2015-11-01

    Sexual trauma is an understudied but regrettably significant problem among male Veterans. As in women, sexual trauma often results in serious mental health consequences for men. Therefore, to guide potential future interventions in this important group, we investigated associations among self-efficacy, male rape myth acceptance, devaluation of emotions, and psychiatric symptom severity after male sexual victimization. We collected data from 1,872 Gulf War era Veterans who applied for posttraumatic stress disorder (PTSD) disability benefits using standard mailed survey methods. The survey asked about history of childhood sexual abuse, sexual assault during the time of Gulf War I, and past-year sexual assault as well as Veterans' perceived self-efficacy, male rape myth acceptance, devaluation of emotions, PTSD, and depression symptoms. Structural equation modeling revealed that self-efficacy partially mediated the association between participants' sexual trauma history and psychiatric symptoms. Greater male rape myth acceptance and greater devaluation of emotions were directly associated with lower self-efficacy, but these beliefs did not moderate associations between sexual trauma and self-efficacy. In this population, sexual trauma, male rape myth acceptance, and devaluation of emotions were associated with lowered self-efficacy, which in turn was associated with more severe psychiatric symptoms. Implications for specific, trauma-focused treatment are discussed.

  17. Aerobic Fitness Linked to Cortical Brain Development in Adolescent Males: Preliminary Findings Suggest a Possible Role of BDNF Genotype

    PubMed Central

    Herting, Megan M.; Keenan, Madison F.; Nagel, Bonnie J.

    2016-01-01

    Aerobic exercise has been shown to impact brain structure and cognition in children and adults. Exercise-induced activation of a growth protein known as brain derived neurotrophic factor (BDNF) is thought to contribute to such relationships. To date, however, no study has examined how aerobic fitness relates to cortical brain structure during development and if BDNF genotype moderates these relationships. Using structural magnetic resonance imaging (MRI) and FreeSurfer, the current study examined how aerobic fitness relates to volume, thickness, and surface area in 34 male adolescents, 15 to 18 years old. Moreover, we examined if the val66met BDNF genotype moderated these relationships. We hypothesized that aerobic fitness would relate to greater thickness and volumes in frontal, parietal, and motor regions, and that these relationships would be less robust in individuals carrying a Met allele, since this genotype leads to lower BDNF expression. We found that aerobic fitness positively related to right rostral middle frontal cortical volume in all adolescents. However, results also showed BDNF genotype moderated the relationship between aerobic fitness and bilateral medial precuneus surface area, with a positive relationship seen in individuals with the Val/Val allele, but no relationship detected in those adolescents carrying a Met allele. Lastly, using self-reported levels of aerobic activity, we found that higher-fit adolescents showed larger right medial pericalcarine, right cuneus and left precuneus surface areas as compared to their low-fit peers. Our findings suggest that aerobic fitness is linked to cortical brain development in male adolescents, and that more research is warranted to determine how an individual’s genes may influence these relationships. PMID:27445764

  18. Anesthesia methods used by anesthetic specialists for circumcision cases

    PubMed Central

    Altaş, Cafer; Küçükosman, Gamze; Yurtlu, Bülent S.; Okyay, Rahşan D.; Aydın, Bengü G.; Pişkin, Özcan; Çimencan, Murat; Ayoğlu, Hilal; Hancı, Volkan; Özkoçak-Turan, Işıl

    2017-01-01

    Objectives: To examine the anesthesiologist’s choice for anesthesia techniques and drugs in circumcision and determine the preoperative examination, intraoperative monitoring techniques, postoperative analgesia methods, and common complications among anesthesiologists working in Turkey. Methods: This cross-sectional study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between May and July 2012. Survey data were obtained via survey forms through electronic data over the web. The questionnaire consists of 20 questions. These questions included demographic data, methods of anesthesia for circumcision, postoperative analgesia methods, and monitoring methods. Results: The data were obtained from 206 anesthesiologists who agreed to participate in the survey. Circumcision was performed most frequently in the age group of 3-6 years old. It was found that 47% of routine preoperative laboratory tests were coagulation parameters and complete blood count tests. The most common method of anesthesia was laryngeal mask. The frequency of administration of regional anesthesia was 37.4%, and caudal block was more preferable. Bupivacaine as a local anesthetic in regional anesthesia and midazolam and ketamine were the most preferred agents in sedoanalgesia. During regional anesthesia, ultrasound was most often used by anesthesiologists (31.6%). Conclusion: Ambulatory anesthesia protocols, which are also needed in circumcision, can be improved with international recommendation, and these protocols could be conformed as sociocultural structure in societies. This study should be regarded as a preliminary study to attract attention on anesthesia techniques in circumcision. PMID:28042634

  19. Popular perceptions of circumcision among Colombian men who have sex with men

    PubMed Central

    Gonzales, Felisa A.; Zea, Maria Cecilia; Reisen, Carol A.; Bianchi, Fernanda T.; Rodríguez, Carlos Fabian Betancourt; Pardo, Marcela Aguilar; Poppen, Paul J.

    2012-01-01

    Circumcision has received increased attention for its potential to reduce sexual transmission of HIV. Research on the acceptability of circumcision as a means of HIV prevention among MSM is virtually non-existent. Men who have sex with men (MSM) in Bogotá, Colombia either participated in a focus group in which they shared information regarding their perceptions of circumcision, or completed a survey which assessed circumcision experiences, attitudes, beliefs, and willingness. Few participants reported they were circumcised, yet most participants reported knowing something about the procedure. Overall, attitudes towards circumcision were mixed: although circumcision was viewed as safe, it was also viewed as unnatural and cruel to babies. Beliefs that circumcision could improve sexual functioning and protect against STIs and HIV were not widely endorsed by survey participants, although focus group participants discussed the potential impacts of circumcision on the availability of sexual partners and sexual performance. Some focus group participants and many survey participants reported a hypothetical willingness to get circumcised if strong evidence of its effectiveness could be provided, barriers removed, and recovery time minimised. PMID:22917475

  20. The Structure of Male Adolescent Peer Networks and Risk for Intimate Partner Violence Perpetration: Findings from a National Sample

    PubMed Central

    Casey, Erin A.; Beadnell, Blair

    2015-01-01

    Although peer networks have been implicated as influential in a range of adolescent behaviors, little is known about relationships between peer network structures and risk for intimate partner violence (IPV) among youth. This study is a descriptive analysis of how peer network “types” may be related to subsequent risk for IPV perpetration among adolescents using data from 3,030 male respondents to the National Longitudinal Study of Adolescent Health. Sampled youth were a mean of 16 years of age when surveyed about the nature of their peer networks, and 21.9 when asked to report about IPV perpetration in their adolescent and early adulthood relationships. A latent class analysis of the size, structure, gender composition and delinquency level of friendship groups identified four unique profiles of peer network structures. Men in the group type characterized by small, dense, mostly male peer networks with higher levels of delinquent behavior reported higher rates of subsequent IPV perpetration than men whose adolescent network type was characterized by large, loosely connected groups of less delinquent male and female friends. Other factors known to be antecedents and correlates of IPV perpetration varied in their distribution across the peer group types, suggesting that different configurations of risk for relationship aggression can be found across peer networks. Implications for prevention programming and future research are addressed. PMID:20422351

  1. Coping with Aversive Stimulation in the Neonatal Period: Quiet Sleep and Plasma Cortisol Levels during Recovery from Circumcision.

    ERIC Educational Resources Information Center

    Gunnar, Megan R.; And Others

    1985-01-01

    Determines the time course of circulating cortisol following circumcision in 80 healthy newborns and investigates whether changes in behavioral state following circumcision in anyway paralleled the adrenocortical time course. Adrenocortical and behavioral data indicated that subjects were able to cope with circumcision trauma. Cortisol levels…

  2. Circumcision using CO2 laser: report of 860 cases

    NASA Astrophysics Data System (ADS)

    Chen, Wen B.; Chen, Zi-Fu; Zhan, Tian-qi; Gao, Xiang-Xun; Huang, Chao

    1993-03-01

    Eight-hundred-sixty cases of circumcision using CO2 laser are reported. The age of patients ranged from 9 - 65 years, with a mean age of 23.8 years. The technique was simple and can be quickly accomplished by a single operator. After local anesthesia the glans penis was protected by a protector. Then, circumcision was performed with a CO2 laser -- HeNe laser combined machine. There was an HeNe laser aiming system in this machine thus the surgeon had a three-dimensional visible indicator of the incision. The focusing CO2 laser beam was used for cutting the prepuce during the operation. There was almost no operative bleeding. All the patients needed no antibiotic postoperatively. Complications were minimal and satisfactory results were achieved.

  3. Shared Decision Making for Routine Infant Circumcision: A Pilot Study

    PubMed Central

    Mitchell, Teri M.; Beal, Claudia

    2015-01-01

    ABSTRACT It is important that expectant parents receive accurate information about the benefits and risks of circumcision as well as the benefits and risks of having an intact foreskin when making a decision about routine infant circumcision (RIC). A pilot study was conducted using the shared decision making (SDM) conceptual model to guide expectant parents through a 3-phase decision-making program about RIC as part of their childbirth education class. The participants showed a high level of preparedness following each of the 3 phases. Preparedness score were highest for those who decided to keep their expected sons’ penises natural. This SDM program was an effective way of guiding expectant parents through the decision-making process for RIC. PMID:26834440

  4. Health implications of traditional female circumcision in pregnancy.

    PubMed

    Adetoro, O O; Ebomoyi, E

    1986-12-01

    A case of traditional female circumcision during pregnancy, as practiced by her ethnic group, the Igbomina-Ekiti of Kawra State, with loss of the fetus as a result of infection, is presented. The woman was circumcised at age 20 at approximately 34 weeks' gestation. She had bled profusely during the procedure and was treated locally with herbs and snail juice. She had 5 days of pain and purulent bloody discharge. On hospital admission the patient was febrile and anemic, her vulva was hemorrhagic and edematous with partially excised clitoris and labia minora. Fetal heart sounds were present. She was given 2 units of blood, anti-tetanus toxoid, and prophylactic antibiotics. 2 days later the infecting organisms and their antibiotic sensitivity were identified, pseudomonas pyocyanea and Staph. Aureus, sensitive to erythromycin and gentamycin. Her fever abated, but she developed pre-eclampsia and she went into labor spontaneously. At 3 cm dilation, labor failed to progress despite artificial rupture of the membranes. A fresh stillborn female preterm infant was delivered by cesarean section. It was felt that the fetus died because of the infection. In Nigeria, female circumcision may be done in infancy by the Yorubas in the Western States, at puberty by the Igbos in Abakaliki, before marriage by the Isoko in Bendel States and the Hausas in the North, and during the 1st pregnancy by the Ogbaru in Anambra State and the Igbomina-Ekiti in Kawra State.

  5. The relation of female circumcision to sexual behavior in Kenya and Nigeria.

    PubMed

    Mpofu, Sibonginkosi; Odimegwu, Clifford; De Wet, Nicole; Adedini, Sunday; Akinyemi, Joshua

    2016-06-29

    One of the reasons for the perpetuation of female circumcision is that it controls female sexuality. In this study, the authors examined the relationship between female circumcision and the sexual behavior of women in Kenya and Nigeria. Data on women who were aware of circumcision and were circumcised were extracted from the Kenya Demographic and Health Survey of 2008-09 as well as the Nigeria Demographic and Health Survey of 2008. The sample size was 7,344 for Kenya and 16,294 for Nigeria. The outcome variables were age at first intercourse and total lifetime number of sexual partners. The study hypothesis was that women who were circumcised were less likely to have initiated sex early and to have only one sex partner. Cox proportional hazards regression and Poisson regression were used to examine the relations of female circumcision and other selected variables to sexual behavior. No association was observed between female circumcision and the outcomes for sexual behavior of women in Kenya and Nigeria. The argument of sexual chastity is insufficient to sustain the perpetuation of female circumcision.

  6. German law on circumcision and its debate: how an ethical and legal issue turned political.

    PubMed

    Aurenque, Diana; Wiesing, Urban

    2015-03-01

    The article aims to illuminate the recent debate in Germany about the legitimacy of circumcision for religious reasons. The aim is both to evaluate the new German law allowing religious circumcision, and to outline the resulting conflict between the surrounding ethical and legal issues. We first elucidate the diversity of legal and medical views on religious circumcision in Germany. Next we examine to what extent invasive and irreversible physical interventions on infant boys unable to given their consent should be carried out for non-medical reasons. To this end, the potential benefits and harms of circumcision for non-medical reasons are compared. We argue that circumcision does not provide any benefits for the 'child as a child' and poses only risks to boys. We then set out to clarify and analyse political (rather than ethical) justifications of the new circumcision law. We demonstrate through this analysis how the circumcision debate in Germany has been transformed from a legal and ethical problem into a political issue, due at least in part to Germany's unique historical context. Although such a particular political sensibility is entirely comprehensible, it raises particular problems when it comes to framing and responding to medical ethical issues - as in the case of religious circumcision.

  7. Circumcision with Glubran® 2 in children: experience of Italian Center

    PubMed Central

    Cerchia, Elisa; Molinaro, Francesco; Bulotta, Anna Lavinia; Ferrara, Francesco; Bindi, Edoardo; Messina, Mario

    2016-01-01

    Background Circumcision is one of the most common surgical procedures in the world. Despite it is known its wide prevalence for religious and medical reasons in children, it remains a controversial practice in paediatric age. To date, there is no described the gold standard technique to circumcise paediatric patients. We started to use glue for circumcision about 2 years ago. We designed this prospective study with the aim to compare two surgical techniques, which were used in our hospital to perform circumcision in children. The implication for practice was the understanding if there were differences between these approaches related to patient’s and parents benefits to manage this condition and benefits for surgeon and hospital in term of saving money and time. Methods This is a randomized, single-blind one-center study. It was conducted at the Department of Paediatric Surgery of Siena. Data were collected between March 2011 and December 2012. Study’s population involved all patients who required circumcision. Two randomizes groups: group one which involved patients who underwent circumcision using sutures and group two, which involved patients who underwent circumcision using surgical glue (Glubran® 2). Two exclusion criteria were used: the redo-circumcision and the allergy or hyper-sensibility to cyanoacrylate (main component of glue). Results We report 99 patients who underwent circumcision with Glubran® 2 in comparison with a group of children circumcised with sutures (vycril rapide). We measured three outcomes (operating time, postoperative pain and assessment of cosmetic), which, even if not all statistically significant, allowed us to draw any conclusions about the use of glue in circumcision. Conclusions Traditional circumcision is performed using a standard sleeve technique with sutures for the approximation of the skin edges. However, since some years a tissue adhesive as N-butyl-2-cyanoacrylate (NBCA) (Glubran® 2) is used in many centers to

  8. Occupational segregation, gender essentialism and male primacy as major barriers to equity in HIV/AIDS caregiving: Findings from Lesotho

    PubMed Central

    2011-01-01

    Background Gender segregation of occupations, which typically assigns caring/nurturing jobs to women and technical/managerial jobs to men, has been recognized as a major source of inequality worldwide with implications for the development of robust health workforces. In sub-Saharan Africa, gender inequalities are particularly acute in HIV/AIDS caregiving (90% of which is provided in the home), where women and girls make up the informal (and mostly unpaid) workforce. Men's and boy's entry into HIV/AIDS caregiving in greater numbers would both increase the equity and sustainability of national and community-level HIV/AIDS caregiving and mitigate health workforce shortages, but notions of gender essentialism and male primacy make this far from inevitable. In 2008 the Capacity Project partnered with the Lesotho Ministry of Health and Social Welfare in a study of the gender dynamics of HIV/AIDS caregiving in three districts of Lesotho to account for men's absence in HIV/AIDS caregiving and investigate ways in which they might be recruited into the community and home-based care (CHBC) workforce. Methods The study used qualitative methods, including 25 key informant interviews with village chiefs, nurse clinicians, and hospital administrators and 31 focus group discussions with community health workers, community members, ex-miners, and HIV-positive men and women. Results Study participants uniformly perceived a need to increase the number of CHBC providers to deal with the heavy workload from increasing numbers of patients and insufficient new entries. HIV/AIDS caregiving is a gender-segregated job, at the core of which lie stereotypes and beliefs about the appropriate work of men and women. This results in an inequitable, unsustainable burden on women and girls. Strategies are analyzed for their potential effectiveness in increasing equity in caregiving. Conclusions HIV/AIDS and human resources stakeholders must address occupational segregation and the underlying gender

  9. Perceptions of the PrePex Device Among Men Who Received or Refused PrePex Circumcision and People Accompanying Them

    PubMed Central

    Taruberekera, Noah; Martinson, Neil; Lebina, Limakatso

    2016-01-01

    Background: The PrePex medical male circumcision (MMC) device has been approved for MMC scale-up. However, the WHO has recommended that a country-specific situation analysis should be carried out before MMC device rollout. Method: A cross-sectional survey was conducted over 12 months in 3 MMC clinics, by trained nurses and researchers, to ascertain attitudes toward PrePex MMC in 3 groups: men consenting for PrePex MMC (PrePex recipients), people accompanying men, and adolescents coming for either PrePex or surgical circumcision (MMC escorts) and men refusing the PrePex device MMC (PrePex rejecters). All participants received information on surgical and the PrePex device MMC methods. Results: A total of 312 PrePex recipients, 117 MMC escorts, and 21 PrePex rejecters were recruited into the study. Ninety-nine percent of PrePex recipients thought that their expectations (safe, convenient, minimal pain) were met, and they were pleased with cosmetic outcome. Fifty-nine percent of PrePex rejecters opted for surgical circumcision because they perceived PrePex to be novel and risky. All 3 groups of participants were concerned about odor, dead skin, discomfort, healing time, and wound care. Ninety-eight percent of MMC escorts, 99% of PrePex recipient, and 81% of PrePex rejecters perceived PrePex circumcision as an acceptable option for South African MMC programmes. Conclusions: This acceptability study suggests that PrePex MMC is considered safe and convenient and could be incorporated into existing MMC programmes. Concerns about odor, pain, wound care, and healing time suggest that the need for more research to further optimize methods and that MMC clients should be counseled on available methods to enable them to choose among options based on their preferences. PMID:27331596

  10. Cultural change after migration: Circumcision of girls in Western migrant communities.

    PubMed

    Johnsdotter, Sara; Essén, Birgitta

    2016-04-01

    This paper reviews the current knowledge on cultural change after migration in the practice of female circumcision, also named genital cutting or mutilation. Explorative studies show trends of radical change of this practice, especially the most extensive form of its kind (type III or the 'Pharaonic' type). The widespread interpretation that Islam would require circumcision of girls is questioned when, for example, Somalis meet other Muslim migrants, such as Arab Muslims, who do not circumcise their daughters. The few criminal court cases for circumcision of girls that have taken place in Western countries corroborate the conclusion that substantial change in the practice has occurred among migrants. In this literature review, an absence of reports is identified from healthcare providers who have witnessed circumcision after migration. Concurrently, a substantial knowledge exists on how to take care of already circumcised women and girls, and there is a system of recommendations in place regarding best practices for prevention. There is a great potential for healthcare providers to encourage this development towards general abandonment of circumcision of girls. The challenge for the future is how to incorporate culturally sensitive efforts of prevention on the one hand, and the examination of suspicious cases of illegal circumcision on the other. We recommend using--in a cautious way--the existing routines for identifying child abuse in general. Experiences from African contexts show that failure to generate significant change of the harmful practices/tradition may be due to the lack of multidisciplinary collaboration in different sectors of the society. In Western societies, the tendency toward abandonment of the practice could be reinforced by professionals who work toward better inclusion of men and women originally from countries where circumcision is practised.

  11. Female circumcision: desperately seeking a space for women.

    PubMed

    Ladjali, M; Toubia, N

    1990-04-01

    Female Circumcision (FC) is "the total or partial cutting away of the female external genital organs." There are 3 types of FC: 1) Sunna where the foreskin of the clitoris is removed; 2) excision which involved removal of a part or all of the clitoris with a part or all of the labia minora; and 3) infibulation or pharaonic circumcision (the most severe type) which includes excision and removal of the labia majora only leaving a small hole to allow the exit of urine and menstrual fluid. FC carries the high risk of HIV infection because it is often practiced without anesthesia and with either a razor blade or a knife. The damages go beyond the physical--they include long-term side effects on women's physical and psychological health. The international battle against FC includes a series of legislative and political acts: 1) In 1946 the British Colonial government made one of the earliest efforts of its kind by making pharaonic circumcision in Sudan a felony and punishable by imprisonment; 2) In 1959 Egypt passed a law making circumcision illegal; 3) In 1977 the Special Committee of Non- Governmental Organizations on Human Rights of the United Nations in collaboration with WHO and UNICEF organized a sub-committee to investigate the status of women in 20 African countries and published a report; 4) In 1979 WHO held a conference in Sudan entitled "The Traditional Practices Affecting the Health of Women and Children" whose outcomes were published in a report; 5) In 1980 WHO forbade the practice of FC; 6) In 1984 a Pan-African seminar was held in Dakar, Senegal that established the Inter-African Committee Against Harmful Practices Affecting Women and Children (IAC); 7) In 1985 the UN Nairobi Conference on The Women's Decade passed resolutions against FC; 8) In 1988 the 39th Assembly of the WHO/Africa Region passed a resolution calling for the abolition of female sexual mutilation. Presidents of several African countries have condemned FC including Benin, Burkina Faso

  12. Attitudes toward Female Circumcision among Men and Women in Two Districts in Somalia: Is It Time to Rethink Our Eradication Strategy in Somalia?

    PubMed Central

    Gele, Abdi A.; Bø, Bente P.; Sundby, Johanne

    2013-01-01

    Somalia has the highest global prevalence (98%) of female circumcision (FC), and, despite a long history of abandonment efforts, it is not clear as to whether or not these programmes have changed people's positive attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Hargeisa and Galkayo districts to the practice of FC. Methods. A purposive sampling of 24 Somalis, including activists and practitioners, men and women, was conducted in Somalia. Unstructured interviews were employed to explore the participants' knowledge of FC, their attitudes toward the continuation/discontinuation of the practice, and the type they want to continue or not to continue. Result. The findings of this qualitative study indicate that there is a strong resistance towards the abandonment of the practice in Somalia. The support for the continuation of Sunna circumcision is widespread, while there is a quite large rejection of Pharaonic circumcision. Conclusion. Therefore, since the “zero tolerance policy” has failed to change people's support for the continuation of the practice in Somalia, programmes that promote the pinch of the clitoral skin and verbal alteration of status, with the goal of leading to total abandonment of FC, should be considered for the Somali context. PMID:23710186

  13. Attitudes toward Female Circumcision among Men and Women in Two Districts in Somalia: Is It Time to Rethink Our Eradication Strategy in Somalia?

    PubMed

    Gele, Abdi A; Bø, Bente P; Sundby, Johanne

    2013-01-01

    Somalia has the highest global prevalence (98%) of female circumcision (FC), and, despite a long history of abandonment efforts, it is not clear as to whether or not these programmes have changed people's positive attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Hargeisa and Galkayo districts to the practice of FC. Methods. A purposive sampling of 24 Somalis, including activists and practitioners, men and women, was conducted in Somalia. Unstructured interviews were employed to explore the participants' knowledge of FC, their attitudes toward the continuation/discontinuation of the practice, and the type they want to continue or not to continue. Result. The findings of this qualitative study indicate that there is a strong resistance towards the abandonment of the practice in Somalia. The support for the continuation of Sunna circumcision is widespread, while there is a quite large rejection of Pharaonic circumcision. Conclusion. Therefore, since the "zero tolerance policy" has failed to change people's support for the continuation of the practice in Somalia, programmes that promote the pinch of the clitoral skin and verbal alteration of status, with the goal of leading to total abandonment of FC, should be considered for the Somali context.

  14. Risk Factors for Urethral Condyloma among Heterosexual Young Male Patients with Condyloma Acuminatum of Penile Skin

    PubMed Central

    2016-01-01

    To our knowledge, this is the first study that focuses on risk factor of urethral condyloma (UC). The subjects of our study included genital warts patients who had been diagnosed as having condyloma acuminatum of penile skin (CAPS) with/without UC. Relationship with UC of number of life time female partners, co-infection with urethritis, circumcision status, number of CAPS and wart diameter were studied by use of multivariate analysis. Co-infection with urethritis, circumcision status were risk factors of UC in heterosexual young male patients with CAPS. This information will be helpful for providing more professional counseling to patients with genital warts. PMID:27659432

  15. Somatosensory evoked potentials assess the efficacy of circumcision for premature ejaculation.

    PubMed

    Xia, J-D; Jiang, H-S; Zhu, L-L; Zhang, Z; Chen, H; Dai, Y-T

    2016-07-01

    To assess the efficacy and mechanism of circumcision in the treatment of premature ejaculation (PE) with redundant prepuce, we enrolled a total of 81 PE patients who received circumcision. The patients' ejaculatory ability and sexual performances were evaluated before and after circumcision by using questionnaires (Intravaginal ejaculation latency time (IELT), Chinese Index of PE with 5 questions (CIPE-5) and International Index of Erectile function- 5 (IIEF-5)). Furthermore, somatosensory evoked potentials (SEPs) including dorsal nerve (DNSEP) and glans penis (GPSEP) of the patients were also measured. The mean IELTs of preoperation and post operation were 1.10±0.55 and 2.48±2.03 min, respectively (P<0.001). In addition, the geometric mean IELT after operation was 2.16 min, compared with the baseline 1.07 min before the operation, the fold increase of the IELT was 2.02. Compared with the uncircumcised status, scores of CIPE-5 showed a significant increase after circumcision (P<0.001). The mean latencies (and amplitudes) of GPSEP and DNSEP were 38.1±4.0 ms (3.0±1.9 uV) and 40.5±3.4 ms (2.8±1.6 uV) before circumcision, respectively; and 42.8±3.3 ms (2.8±1.6 uV) and 40.5±4.1 ms (2.4±1.2 uV) in the follow-up end point after circumcision. Only the latencies of GPSEP showed significant prolongation before and after circumcision (P<0.001). The ejaculation time improvement after circumcision is so small, and equal to placebo response, therefore it could not be interpreted as a therapeutic method in men with PE.

  16. [Infectious complications with herpes virus after ritual Jewish circumcision: a historical and cultural analysis].

    PubMed

    Gesundheit, Benjamin; Greenberg, David; Walfish, Shlomo; Dagan, Ron; Koren, Gideon; Malkin, David; Tendeler, Moshe David

    2005-02-01

    Ritual circumcision performed on eight-day-old male infants is rooted in the Bible and is discussed in the earliest Jewish sources. The practice has been observed across the generations in every Jewish community in Israel and the Diaspora. According to Jewish ritual, the mohel--the ritual circumcisor--amputates the foreskin and then folds back the membrane that lies beneath it. This is followed by metzitza--"suction"--a practice performed throughout the ages by mouth. Halakhic literature sets down strict rules regarding this surgical intervention in order to prevent medical complications for the newborn. Metzitza by mouth has been recognized as a risk factor in the transfer of infection from the mohel to the newborn. A recent study relates to eight infants who became infected with herpes virus as a result of the procedure. We shall review the halakhic literature in order to clarify the custom of metzitza by mouth and understand the principles underlying the controversy that surrounds it. The custom of metzitza by mouth has been the subject of extensive rabbinic discussion since the middle of the nineteenth century. A better understanding of the historical, social and cultural background of the issue might allow us to formulate alternatives to the practice. The metzitza controversy gave rise to a stimulating discussion in the rabbinic literature with diverse and conflicting opinions. We shall undertake a precise analysis of the rabbinic discussion and its historical and social background, and attempt to identify the ideological underpinnings of the various positions. Rabbinic literature is replete with cautionary measures to be observed when circumcising a newborn child. The halakhic disputes beginning in the middle of the nineteenth century reflect ideological considerations and objectives. Metzitza was performed throughout the generations by mouth because that was the recognized method of disinfection at the time. Beginning in the nineteenth century, medical and

  17. Neonatal circumcision in severe haemophilia: a survey of paediatric haematologists at United States Hemophilia Treatment Centers.

    PubMed

    Kearney, S; Sharathkumar, A; Rodriguez, V; Chitlur, M; Valentino, L; Boggio, L; Gill, J

    2015-01-01

    Neonatal circumcision in patients with severe haemophilia has not been well studied. We performed a survey of paediatric haematologists from Hemophilia Treatment Centers (HTC) across the United States to better understand the attitudes toward and management of neonatal circumcision in haemophilia patients. Response rate to our survey was 40% (n = 64/159). Thirty-eight percent of respondents (n = 24) said that they would allow this procedure in the newborn period but in many cases this was against medical advice. The most reported concern regarding neonatal circumcision in haemophilia patients was the risk of development of an inhibitor (n = 25; 39%) followed by the concern for bleeding (n = 22; 34%) and issues related to vascular access in the neonate (n = 11; 17%). All respondents recommended at least one preprocedure dose of factor replacement. Twenty-two percent (n = 14) of respondents did not use more than one dose of factor replacement but 32% (n = 21) used 1-2 postoperative doses. The remainder of paediatric haematologists surveyed recommended between 3-5 (16%; n = 10) and 6-10 (3%, n = 2) additional days postoperatively. There was wide variation in both techniques of circumcision as well as adjuvant haemostatic agents used. Only 22% of respondents said that they had an established protocol for management of circumcision in the newborn haemophilia patient. These survey results highlight the need for evidence-based guidelines regarding the optimal management of circumcision in neonates with severe haemophilia.

  18. Attitudes toward female circumcision among Somali immigrants in Oslo: a qualitative study

    PubMed Central

    Gele, Abdi A; Kumar, Bernadette; Hjelde, Karin Harsløf; Sundby, Johanne

    2012-01-01

    Due to its negative impact on public health, female circumcision (FC) has gained increased attention from international communities and the Norwegian public in recent decades. In 1995, the Norwegian government outlawed the practice and simultaneously developed a package of measures aimed at preventing and ultimately eradicating FC in Norway. Like many other Western countries, immigrants of Somali descent constitute the largest immigrant group in Norway from countries with FC traditions. Although this immigrant group is often perceived as a cultural society that supports FC generally as a practice, there appears to be a lack of studies that explore the impact of acculturation and the Western social context on Somali immigrants’ attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Oslo, Norway to the practice of FC. Findings from this qualitative study indicate that Somalis in Oslo have, to a large extent, changed their attitude toward the practice. This was proven by the presence in Oslo of a large number of Somali parents who left their daughters uncut as well as Somali girls, boys, men, and women who attribute being uncircumcised a high status. This study adds to the knowledge of the process of abandonment of FC among immigrants in the Western countries. The study highlights the success that has been achieved in improving attitudes toward the practice of the Somali community in Oslo, Norway, as well as emerging challenges that need to be addressed further. PMID:22312195

  19. "Circumcision", culture, and health-care provision in Tower Hamlets, London.

    PubMed

    Cameron, J; Anderson, K R

    1998-11-01

    Tower Hamlets (London, England) has a sizable Somali community whose members maintain close links with their families in Africa. The London Black Women's Health Action Project (LBWAP) was established in Tower Hamlets, in 1982, to address the health needs of Somali women, especially those related to female circumcision. The major focus in the UK has been on protecting girls from undergoing this practice, with little attention to the needs of women who have already been circumcised. Of 200 Somali women interviewed by LBWAP, 61% had been infibulated in their native country by people with no medical training. Among the long-term health consequences were dysmenorrhea, recurrent urinary problems, urethral damage, and painful intercourse. Although deinfibulation can be obtained, both health care professionals and circumcised women tend to be unaware of this service. LBWAP has proposed a study to assess the expressed health care needs of circumcised Somali women and match these desires with actual health care provision. To raise the consciousness of British health care professionals, parallels between female circumcision and the indiscriminate, unnecessary use of episiotomy are being made.

  20. The Preliminary Findings of a Study Exploring the Perceptions of a Sample of Young Heterosexual Males regarding HIV Prevention Education Programming in Nova Scotia, Canada

    ERIC Educational Resources Information Center

    Gahagan, Jacqueline; Rehman, Laurene; Barbour, Laura; McWilliam, Susan

    2007-01-01

    Despite the increasing numbers of young Canadian females becoming infected with HIV through heterosexual transmission with an infected male sexual partner, the majority of current HIV prevention programs and services in Canada continue to ignore the needs of young heterosexual males. This research is derived from 30 in-depth interviews, 9 focus…

  1. Does Grade Level Relate to School-Based Youth Health Center Utilization among Male Youth? Quantitative Findings from a Mixed-Methods Study in Nova Scotia, Canada

    ERIC Educational Resources Information Center

    Gahagan, Jacqueline C.; Jason, Timothy; Leduc, Derek

    2012-01-01

    Background: Male adolescents underutilize youth health centers' (YHC) services despite facing a variety of significant health issues. The purpose of our study was to explore adolescent males' perceptions of health service needs, utilization of YHC services, and barriers and facilitators for such utilization as a function of school grade among a…

  2. Effects of fluoxetine on the amygdala and the hippocampus after administration of a single prolonged stress to male Wistar rates: In vivo proton magnetic resonance spectroscopy findings.

    PubMed

    Han, Fang; Xiao, Bing; Wen, Lili; Shi, Yuxiu

    2015-05-30

    Posttraumatic stress disorder (PTSD) is an anxiety- and memory-based disorder. The hippocampus and amygdala are key areas in mood regulation. Fluoxetine was found to improve the anxiety-related symptoms of PTSD patients. However, little work has directly examined the effects of fluoxetine on the hippocampus and the amygdala. In the present study, male Wistar rats received fluoxetine or vehicle after exposure to a single prolonged stress (SPS), an animal model of PTSD. In vivo proton magnetic resonance spectroscopy ((1)H-MRS) was performed -1, 1, 4, 7 and 14 days after SPS to examine the effects of fluoxetine on neurometabolite changes in amygdala, hippocampus and thalamus. SPS increased the N-acetylaspartate (NAA)/creatine (Cr) and choline moieties (Cho)/Cr ratios in the bilateral amygdala on day 4, decreased the NAA/Cr ratio in the left hippocampus on day 1, and increased both ratios in the right hippocampus on day 14. But no significant change was found in the thalamus. Fluoxetine treatment corrected the SPS increases in the NAA/Cr and Cho/Cr levels in the amygdala on day 4 and in the hippocampus on day 14, but it failed to normalise SPS-associated decreases in NAA/Cr levels in the left hippocampus on day 1. These results suggested that metabolic abnormalities in the amygdala and the hippocampus were involved in SPS, and different effects of fluoxetine in correcting SPS-induced neurometabolite changes among the three areas. These findings have implications for fluoxetine treatment in PTSD.

  3. Reliability and Construct Validity of the Dutch Psychopathy Checklist: Youth Version--Findings from a Sample of Male Adolescents in a Juvenile Justice Treatment Institution

    ERIC Educational Resources Information Center

    Das, Jacqueline; de Ruiter, Corine; Doreleijers, Theo; Hillege, Sanne

    2009-01-01

    The present study examines the reliability and construct validity of the Dutch version of the Psychopathy Check List: Youth Version (PCL:YV) in a sample of male adolescents admitted to a secure juvenile justice treatment institution (N = 98). Hare's four-factor model is used to examine reliability and validity of the separate dimensions of…

  4. Sexual Health in Male and Female Iraq and Afghanistan U. S. War Veterans With and Without PTSD: Findings From the VALOR Cohort

    PubMed Central

    Breyer, Benjamin N.; Fang, Shona C.; Seal, Karen H.; Ranganathan, Gayatri; Marx, Brian P.; Keane, Terence M.; Rosen, Raymond C.

    2016-01-01

    We sought to determine whether posttraumatic stress disorder (PTSD) was associated with sexual health in returned warzone-deployed veterans from the recent Iraq and Afghanistan conflicts. We studied 1,581 males and females from the Veterans After-Discharge Longitudinal Registry, a gender-balanced U.S. Department of Veterans Affairs registry of health care-seeking veterans with and without PTSD. Approximately one quarter (25.1%) of males (n = 198) and 12.7% of females (n = 101) had a sexual dysfunction diagnosis and/or prescription treatment for sexual dysfunction. Both genders were more likely to have a sexual dysfunction diagnosis and/or prescription treatment if they had PTSD compared with those without PTSD (male: 27.3% vs. 21.1%, p = .054; female: 14.9% vs. 9.4%, p = .022). Among the 1,557 subjects analyzed here, males with PTSD had similar levels of sexual activity compared to those without PTSD (71.2% vs. 75.4%, p = .22), whereas females with PTSD were less likely to be sexually active compared to females without PTSD (58.7% vs. 72.1%, p < .001). Participants with PTSD were also less likely to report sex-life satisfaction (male: 27.6% vs. 46.0%, p < .001; female: 23.0% vs. 45.7%, p < .001) compared with those without PTSD. Although PTSD was not associated with sexual dysfunction after adjusting for confounding factors, it was significantly negatively associated with sex-life satisfaction in female veterans with a prevalence ratio of .71, 95% confidence interval [.57, .90]. PMID:27128485

  5. Sexual Health in Male and Female Iraq and Afghanistan U. S. War Veterans With and Without PTSD: Findings From the VALOR Cohort.

    PubMed

    Breyer, Benjamin N; Fang, Shona C; Seal, Karen H; Ranganathan, Gayatri; Marx, Brian P; Keane, Terence M; Rosen, Raymond C

    2016-06-01

    We sought to determine whether posttraumatic stress disorder (PTSD) was associated with sexual health in returned warzone-deployed veterans from the recent Iraq and Afghanistan conflicts. We studied 1,581 males and females from the Veterans After-Discharge Longitudinal Registry, a gender-balanced U.S. Department of Veterans Affairs registry of health care-seeking veterans with and without PTSD. Approximately one quarter (25.1%) of males (n = 198) and 12.7% of females (n = 101) had a sexual dysfunction diagnosis and/or prescription treatment for sexual dysfunction. Both genders were more likely to have a sexual dysfunction diagnosis and/or prescription treatment if they had PTSD compared with those without PTSD (male: 27.3% vs. 21.1%, p = .054; female: 14.9% vs. 9.4%, p = .022). Among the 1,557 subjects analyzed here, males with PTSD had similar levels of sexual activity compared to those without PTSD (71.2% vs. 75.4%, p = .22), whereas females with PTSD were less likely to be sexually active compared to females without PTSD (58.7% vs. 72.1%, p < .001). Participants with PTSD were also less likely to report sex-life satisfaction (male: 27.6% vs. 46.0%, p < .001; female: 23.0% vs. 45.7%, p < .001) compared with those without PTSD. Although PTSD was not associated with sexual dysfunction after adjusting for confounding factors, it was significantly negatively associated with sex-life satisfaction in female veterans with a prevalence ratio of .71, 95% confidence interval [.57, .90].

  6. African-American Men and Higher Education in Maryland. Addressing the Future. Findings and Recommendations of the Task Force To Address the Decline in Enrollment and Graduation of the Black Male from Institutions of Higher Education.

    ERIC Educational Resources Information Center

    NAACP, Rockville, MD. Montgomery County Branch.

    Original data is presented which examines some of the factors that contribute to the low number of African-American males receiving baccalaureate degrees in Maryland. The data represents findings which resulted from research by an appointed task force; a "Town Meeting" of students, parents, and other interested adults; consultation with…

  7. Relations between circumcision status, sexually transmitted infection history, and HIV serostatus among a national sample of men who have sex with men in the United States.

    PubMed

    Jozkowski, Kristen; Rosenberger, Joshua G; Schick, Vanessa; Herbenick, Debby; Novak, David S; Reece, Michael

    2010-08-01

    Circumcision's potential link to HIV/sexually transmitted infections (STI) has been at the center of recent global public health debates. However, data related to circumcision and sexual health remain limited, with most research focused on heterosexual men. This study sought to assess behavioral differences among a large sample of circumcised and noncircumcised men who have sex with men (MSM) in the United States. Data were collected from 26,257 U.S. MSM through an online survey. Measures included circumcision status, health indicators, HIV/STI screening and diagnosis, sexual behaviors, and condom use. Bivariate and regression analyses were conducted to determine differences between HIV/STI status, sexual behaviors, and condom use among circumcised and noncircumcised men. Circumcision status did not significantly predict HIV testing (p > 0.05), or HIV serostatus (p > 0.05), and there were no significant differences based on circumcision status for most STI diagnosis [syphilis, gonorrhea, chlamydia, human papilloma virus (HPV)]. Being noncircumcised was predictive of herpes-2 diagnosis, however, condom use mediated this relationship. These data provide one of the first large national assessments of circumcision among MSM. While being noncircumcised did not increase the likelihood of HIV and most STI infections, results indicated that circumcision was associated with higher rates of condom use, suggesting that those who promote condoms among MSM may need to better understand condom-related behaviors and attitudes among noncircumcised men to enhance the extent to which they are willing to use condoms consistently.

  8. Distinct Relationships of Intramuscular and Subcutaneous Fat With Cortical Bone: Findings From a Cross-Sectional Study of Young Adult Males and Females

    PubMed Central

    Deere, K.; Sayers, A.; Viljakainen, H. T.; Lawlor, D. A.; Sattar, N.; Kemp, J. P.; Fraser, W. D.

    2013-01-01

    Context: Intracellular fat within muscle and visceral tissue has been suggested to adversely influence bone development. Objective: The aim of the study was to evaluate associations between im fat, as reflected by muscle density as measured by peripheral quantitative computed tomography, and cortical bone parameters in young adults. Design/Setting/Participants: We conducted a cross-sectional analysis of 1703 males and 2243 females aged 17.8 years from the Avon Longitudinal Study of Parents and Children. Outcome Measures: We measured cortical bone parameters from midtibial peripheral quantitative computed tomography scans. Results: Muscle density (inversely related to im fat) was inversely associated with periosteal circumference (PC) (beta = −0.07 [95% confidence interval (CI), −0.1, −0.04]), cortical bone mineral density (BMDC) (beta = −0.21 [95% CI, −0.26, −0.17]), and cortical thickness (CT) (beta = −0.37 [95% CI, −0.42, −0.33]) (males and females combined, adjusted for age, height, gender, and muscle cross-sectional area). In contrast, sc fat area was positively associated with PC (beta = 0.10 [95% CI, 0.07, 0.12]), but no association was seen with BMDC or CT. To examine the role of candidate intermediary metabolic pathways, analyses were repeated after adjustment for insulin, C-reactive protein, and β-C-telopeptides of type I collagen. Whereas similar associations were observed after adjustment for insulin and C-reactive protein, the association between muscle density and BMDC was partially attenuated by adjustment for β-C-telopeptides of type I collagen (beta = −0.14 [95% CI, −0.20, −0.08]). Conclusion: Although im and sc fat were both positively associated with cortical bone mass, the nature of these relationships differed in that im fat was predominantly associated with CT and BMDC, whereas sc fat was mainly associated with PC. These relationships were largely independent of candidate metabolic pathways, such as altered bone

  9. Fatal paradoxical cryptic miliary tuberculosis and immune reconstitution disease in a young non-HIV immunocompromised male patient: case report with autopsy findings.

    PubMed

    Man, Milena Adina; Arghir, Oana Cristina; Man, Sorin; Streba, Costin Teodor; Olteanu, Mihai; Nitu, Mimi

    2014-01-01

    Non-HIV immunocompromised patients may develop immune reconstitution inflammatory syndrome (IRIS) as an abnormal response to invading microorganisms, such as Mycobacterium tuberculosis (MTB). IRIS consists in a sudden change in the dominant T-helper responses to inflammation, which is not balanced by anti-inflammatory response, playing a critical role in microbial pathogenesis. A patient with restoration of host immunity during anti-tuberculosis treatment can become gravely ill with a paradoxical severe form of tuberculosis (TB) disease named TB immune reconstitution disease (IRD).The diagnosis of acute cryptic miliary TB is difficult and requires an accurate histopathology. We report a fatal association between a generalized lymphadenitis tuberculosis and IRD in a 34-year-old male patient, non-smoker, non-HIV immunocompromised, but with a previously co-morbid diabetes mellitus (DM) type I. The purpose of this report is to describe an unusual and rare case of a progressive extrapulmonary TB disease to a liver involvement, mimicking a hepatotoxicity secondary to anti-tuberculosis therapy. The diagnosis of disseminated miliary TB with cryptic pulmonary was confirmed later after performing necropsy. Formalin-fixed paraffin-embedded pulmonary and extrapulmonary miliary foci were processed for histology and stained with Hematoxylin and Eosin. This rare entity of cryptic miliary involvement of the lungs is described more in elderly than in young individuals. In the reported case, IRD induced a paradoxical progressive dissemination of TB lesions leading to death in a patient with an apparent uncomplicated form of lymphadenitis TB.

  10. [The use of preputial skin as cutaneous graft after circumcision. Report of 30 clinical cases].

    PubMed

    Chlihi, A; Benbrahim, A; Diouri, M; Terrab, S; Bahechar, N; Boukind, E H

    2002-06-01

    Through a study of 30 clinical cases, collected at the service center of plastic surgery and burns in Averroes University hospital at Casablanca, the authors underline the interest of using preputial skin as full-thickness skin graft for the treatment of burns and their sequelaes in non-circumcised boys, whose age ranged from one to four years. At this age, they are more exposed to domestic accidents. The preputial skin graft gives the advantage of the absence of scare prejudice at the donor site each time the circumcision is possible; and provides a skin of good elastic quality avoiding secondary retraction with a very favorable rate of graft intake. Although the application of this technique for other affections is possible, but remains limited by the hyperpigmentation of the graft.

  11. What is the efficacy of circumcision in boys with complex urinary tract abnormalities?

    PubMed

    Bader, Mohammed; McCarthy, Liam

    2013-12-01

    The risk of urinary tract infection (UTI) in normal boys is 1%. This risk is significantly increased in boys with congenital abnormalities of the urinary tract, which includes such abnormalities as vesico-ureteric reflux, obstructive megaureter (VUJO) and posterior urethral valves. UTI in these boys can lead to urosepsis, a potentially life-threatening complication, and in the longer term renal scarring complicating pyelonephritis can lead to chronic renal impairment or even end-stage renal disease. Circumcision has been shown in normal boys to reduce the risk of UTI by 90%, and potentially could be a simple intervention to reduce the risk of urosepsis and renal scarring. In order to make this decision a clinician really needs to have the answers to two questions: 1) What is the risk of UTI in this particular boy? 2) What is the evidence of efficacy of circumcision in this particular condition? This article reviews what evidence exists to make a calculation of the risk/benefit ratio for circumcision in boys with abnormalities of the urinary tract.

  12. Risks from circumcision during the first month of life compared with those for uncircumcised boys.

    PubMed

    Wiswell, T E; Geschke, D W

    1989-06-01

    The records of 136,086 boys born in US Army hospitals from 1980 to 1985 were reviewed for indexed complications related to circumcision status during the first month of life. For 100,157 circumcised boys, there were 193 complications (0.19%). These included 62 local infections, eight cases of bacteremia, 83 incidences of hemorrhage (31 requiring ligature and three requiring transfusion), 25 instances of surgical trauma, and 20 urinary tract infections. There were no deaths or reported losses of the glans or entire penis. By contrast, the complications in the 35,929 uncircumcised infants were all related to urinary tract infections. Of the 88 boys with such infections (0.24%), 32 had concomitant bacteremia, three had meningitis, two had renal failure, and two died. The frequencies of urinary tract infection (P less than .0001) and bacteremia (P less than .0002) were significantly higher in the uncircumcised boys. Serious complications from routine prepuce removal are rare and relatively minor. Circumcision may be beneficial in reducing the occurrence of urinary tract infections and their associated sequelae.

  13. The child's right to an open future: is the principle applicable to non-therapeutic circumcision?

    PubMed

    Darby, Robert J L

    2013-07-01

    The principle of the child's right to an open future was first proposed by the legal philosopher Joel Feinberg and developed further by bioethicist Dena Davis. The principle holds that children possess a unique class of rights called rights in trust-rights that they cannot yet exercise, but which they will be able to exercise when they reach maturity. Parents should not, therefore, take actions that permanently foreclose on or pre-empt the future options of their children, but leave them the greatest possible scope for exercising personal life choices in adulthood. Davis particularly applies the principle to genetic counselling, arguing that parents should not take deliberate steps to create physically abnormal children, and to religion, arguing that while parents are entitled to bring their children up in accordance with their own values, they are not entitled to inflict physical or mental harm, neither by omission nor commission. In this paper, I aim to elucidate the open future principle, and consider whether it is applicable to non-therapeutic circumcision of boys, whether performed for cultural/religious or for prophylactic/health reasons. I argue that the principle is highly applicable to non-therapeutic circumcision, and conclude that non-therapeutic circumcision would be a violation of the child's right to an open future, and thus objectionable from both an ethical and a human rights perspective.

  14. Comparison of a CO2 (Carbon Dioxide) Laser and Tissue Glue with Conventional Surgical Techniques in Circumcision

    PubMed Central

    Mungnirandr, Akkrapol; Wiriyakamolphan, Suwanna; Ruangtrakool, Ravit; Ngerncham, Monawat; Tumrongsombutsakul, Sureerat; Leumcharoen, Bungorn

    2015-01-01

    Introduction: CO2 (Carbon Dioxide) laser application in circumcision, for cutting and coagulation, has been reported to have excellent results. Also, tissue glue has been reported to have advantages over sutures for approximation of wound edges. Most previous studies focused on comparisons between CO2 laser and scalpel, or between tissue glue and sutures. This study prospectively compared the results and complications CO2 laser and tissue glue, with standard surgical techniques in circumcision. Methods: Thirty boys were prospectively divided into two groups. Group 1 (n = 17) underwent circumcision by scalpel with approximation of the wound edges using chromic catgut sutures. Group 2 (n = 13) underwent circumcision with CO2 laser and approximation of the wound edges using tissue glue. Patient age, indications for surgery, operative time, wound swelling, bleeding, wound infection, local irritation, pain score, and cosmetic appearance were recorded. Results: Group 1 had a significantly longer operative time (P= 0.011), higher rate of local irritation (P= 0.016), and poorer cosmetic appearance (P< 0.001) than group 2. Bleeding only occurred in one patient in group 1. There were no significant differences in pain score, wound infection rate, or cost of surgery between the two groups. Conclusions: CO2 laser and tissue glue have advantages over standard surgical techniques in circumcision, with a significantly shorter operative time, lower rate of local irritation, and better cosmetic appearance. The cost of surgery is similar between the two groups. PMID:25699165

  15. Predictive Factors of Postoperative Pain and Postoperative Anxiety in Children Undergoing Elective Circumcision: A Prospective Cohort Study

    PubMed Central

    Tsamoudaki, Stella; Ntomi, Vasileia; Yiannopoulos, Ioannis; Christianakis, Efstratios; Pikoulis, Emmanuel

    2015-01-01

    Background Although circumcision for phimosis in children is a minor surgical procedure, it is followed by pain and carries the risk of increased postoperative anxiety. This study examined predictive factors of postoperative pain and anxiety in children undergoing circumcision. Methods We conducted a prospective cohort study of children scheduled for elective circumcision. Circumcision was performed applying one of the following surgical techniques: sutureless prepuceplasty (SP), preputial plasty technique (PP), and conventional circumcision (CC). Demographics and base-line clinical characteristics were collected, and assessment of the level of preoperative anxiety was performed. Subsequently, a statistical model was designed in order to examine predictive factors of postoperative pain and postoperative anxiety. Assessment of postoperative pain was performed using the Faces Pain Scale (FPS). The Post Hospitalization Behavior Questionnaire study was used to assess negative behavioral manifestations. Results A total of 301 children with a mean age of 7.56 ± 2.61 years were included in the study. Predictive factors of postoperative pain measured with the FPS included a) the type of surgical technique, b) the absence of siblings, and c) the presence of postoperative complications. Predictive factors of postoperative anxiety included a) the type of surgical technique, b) the level of education of mothers, c) the presence of preoperative anxiety, and d) a history of previous surgery. Conclusions Although our study was not without its limitations, it expands current knowledge by adding new predictive factors of postoperative pain and postoperative anxiety. Clearly, further randomized controlled studies are needed to confirm its results. PMID:26495079

  16. Routine (non-religious) neonatal circumcision and bodily integrity: a transatlantic dialogue.

    PubMed

    Dekkers, Wim

    2009-06-01

    In the current debate about the pros and cons of routine (non-religious) neonatal circumcision (RNC), the emphasis is on medical justifications for the practice. Questions of human rights also are widely discussed. However, even if the alleged medical benefits of RNC were to outweigh the harms and risks, this is not a sufficient justification for RNC. The practice of RNC is questionable from a variety of viewpoints including not only the ideal of evidence-based medicine and human rights considerations, but also the notion of respect for bodily integrity.

  17. Foreskin analysis of circumcised boys with and without previous topical corticosteroid.

    PubMed

    Sabino Borges, Luis Gustavo; Perez-Bóscollo, Adriana Cartafina; Rocha, Laura Penna; Silva, Renata Calciolari Rossi; Guimarães, Camila Souza de Oliveira; Castro, Eumenia Costa da Cunha; Corrêa, Rosana Rosa Miranda

    2012-10-01

    Problems with the foreskin are common reasons for pediatric surgery consultations. We collected the foreskin of 40 patients for 2 years and these samples were divided into groups with and without previous topical corticosteroid. We carried out histochemical hematoxylin & eosin and Picrosirius analyses of the foreskin. Collagen fibers and inflammatory infiltrate was higher in samples from patients who had complications related to phimosis. Fibrosis was higher in patients who used topical corticosteroid. A histopathologic study of the foreskin may provide an additional analysis of patients undergoing circumcision and it can also improve the accuracy of surgical indication.

  18. The relevance of castration and circumcision to the origins of psychoanalysis: 1. The medical context.

    PubMed

    Bonomi, Carlo

    2009-06-01

    In this paper the author outlines and discusses the origins and the decline of castration and circumcision as a cure for the nervous and psychic disturbances in women and little girls between 1875 and 1905. The author argues that the opposition to this medical practice affected the conception of hysteria, promoting a distinction between sexuality and the genital organs, and the emergence of an enlarged notion of sexuality, during the period from Freud's medical education to the publication of the Three Essays on the Theory of Sexuality. The hypothesis is put forward that Freud came directly in contact with the genital theory of the neurosis at the time of his training on the nervous disturbances in children with the paediatrician, Adolf Baginsky, in Berlin, in March 1886. It is hypothesized that this experience provoked in Freud an abhorrence of circumcision 'as a cure or punishment for masturbation', prompting an inner confrontation which resulted in a radical reorganization of the way of thinking about sexuality. It is also suggested that this contributed to Freud developing a capacity to stay with contradictions, something which would become a central quality of the psychoanalytic attitude.

  19. Traumatic Penile Injury: From Circumcision Injury to Penile Amputation

    PubMed Central

    Park, Jae Young; Song, Yun Seob

    2014-01-01

    The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish a strategy of treatment; however, to date there has been less effort to make a classification for trauma of external genitalia. The classification of external trauma in male could be established by the nature of injury mechanism or anatomic site: accidental versus self-mutilation injury and penis versus penis plus scrotum or perineum. Accidental injury covers large portion of external genitalia trauma because of high prevalence and severity of this disease. The aim of this study is to summarize the mechanism and treatment of the traumatic injury of penis. This study is the first review describing the issue. PMID:25250318

  20. Transient Peripheral Immune Activation follows Elective Sigmoidoscopy or Circumcision in a Cohort Study of MSM at Risk of HIV Infection

    PubMed Central

    Lama, Javier R.; Karuna, Shelly T.; Grant, Shannon P.; Swann, Edith M.; Ganoza, Carmela; Segura, Patricia; Montano, Silvia M.; Lacherre, Martin; De Rosa, Stephen C.; Buchbinder, Susan; Sanchez, Jorge; McElrath, M. Juliana; Lemos, Maria P.

    2016-01-01

    Background Rectal and genital sampling in HIV prevention trials permits assessments at the site of HIV entry. Yet the safety and acceptability of circumcision and sigmoidoscopy (and associated abstinence recommendations) are unknown in uncircumcised men who have sex with men (MSM) at high risk of HIV infection. Methods Twenty-nine HIV-seronegative high-risk Peruvian MSM agreed to elective sigmoidoscopy biopsy collections (weeks 2 and 27) and circumcision (week 4) in a 28-week cohort study designed to mimic an HIV vaccine study mucosal collection protocol. We monitored adherence to abstinence recommendations, procedure-related complications, HIV infections, peripheral immune activation, and retention. Results Twenty-three (79.3%) underwent a first sigmoidoscopy, 21 (72.4%) were circumcised, and 16 (55.2%) completed a second sigmoidoscopy during the study period. All who underwent procedures completed the associated follow-up safety visits. Those completing the procedures reported they were well tolerated, and complication rates were similar to those reported in the literature. Immune activation was detected during the healing period (1 week post-sigmoidoscopy, 6 weeks post-circumcision), including increases in CCR5+CD4+T cells and α4β7+CD4+T cells. Most participants adhered to post-circumcision abstinence recommendations whereas reduced adherence occurred post-sigmoidoscopy. Conclusion Rectosigmoid mucosal and genital tissue collections were safe in high-risk MSM. Although the clinical implications of the post-procedure increase in peripheral immune activation markers are unknown, they reinforce the need to provide ongoing risk reduction counseling and support for post-procedure abstinence recommendations. Future HIV vaccine studies should also consider the effects of mucosal and tissue collections on peripheral blood endpoints in trial design and analysis. Trial Registration ClinicalTrials.gov NCT02630082 PMID:27536938

  1. Clinical Features, Complications and Autoimmunity in Male Lichen Sclerosus.

    PubMed

    Kantere, Despina; Alvergren, Gunilla; Gillstedt, Martin; Pujol-Calderon, Fani; Tunbäck, Petra

    2017-03-10

    Lichen sclerosus is a chronic inflammatory disease associated with substantial morbidity. Knowledge of the aetiology and progression of lichen sclerosus is therefore needed. In this cross-sectional study, 100 male patients diagnosed with lichen sclerosus were interviewed and examined. Since there is a possible link between lichen sclerosus and autoimmunity, blood tests were analysed for thyroid disease, antinuclear antibodies and antibodies to extracellular matrix protein 1, but autoimmunity was found to be infrequent. In 72 participants active genital lichen sclerosis was observed and complications were common; 27 patients had preputial constriction and 12 meatal engagement. In total, 13 patients needed a referral to the Department of Urology, including 1 patient with suspected penile cancer. In conclusion, despite available treatment with ultra-potent steroids and circumcision, lichen sclerosus in males is frequently complicated by phimosis and meatal stenosis. However, the disease can also go into remission, as seen in 27% of our patients.

  2. Counseling Males.

    ERIC Educational Resources Information Center

    Scher, Murray, Ed.

    1981-01-01

    Contains 16 articles about counseling males including: (1) gender role conflict; (2) sex-role development; (3) counseling adolescent, adult, and gay males; (4) teenage fathers; (5) female therapists and male clients; (6) career development; (7) hypermasculinity; (8) counseling physically abusive men, uncoupling men; (9) group therapy, men's…

  3. Gay Xhosa men’s experiences of ulwaluko (traditional male initiation)

    PubMed Central

    Ntozini, Anathi; Ngqangweni, Hlonelwa

    2016-01-01

    Abstract This paper explores the lives of gay men undergoing traditional initiation in the Eastern Cape. Nine participants aged between 18 and 26 reported their reasons for becoming traditionally circumcised, which included personal validation of cultural manhood, the desire to conform to societal norms and expectations, and pressure from family members to ‘convert’ them to heterosexuality. While homosexuality remains a target for vilification and abuse both in Southern Africa and across the African continent, practices such as ulwaluko (traditional male initiation) must surely be among the most threatening to a young gay Xhosa man’s self-esteem. PMID:27232591

  4. Female circumcision and its health implications: a study of the Uruan Local Government Area of Akwa Ibom State, Nigeria.

    PubMed

    Ebong, R D

    1997-04-01

    A total of 400 subjects was randomly selected from 40 villages in the Uruan Local Government Area of Akwa Ibom State for the study. The purposes of the study were to: i. identify the 'established benefits' of female circumcision; ii. identify the health hazards that accompany the practice; and iii. create awareness among community members of the ill-effects of the practice. The study discovered a strong belief in the established benefits and poor appreciation of the health hazards of female circumcision by the participants. Recommendations were made for more efforts in public health education programmes on the ill-effects of the practice. Studies were also recommended to be conducted in other parts of the country to assess the level of awareness on the ill-effects of such an operation and the institution of educational programmes where applicable.

  5. A fast, easy circumcision procedure combining a CO2 laser and cyanoacrylate adhesive: a non-randomized comparative trial

    PubMed Central

    Gorgulu, Tahsin; Olgun, Abdulkerim; Torun, Merve; Kargi, Eksal

    2016-01-01

    ABSTRACT Background Circumcision is performed as a routine operation in many countries, more commonly for religious and cultural reasons than for indicated conditions, such as phimosis and balanitis. There are many techniques available, and recently electrocautery and both Nd:YAG and CO2 lasers, instead of blades, have been used for skin and mucosal incisions. However, the infection risk in circumcisions performed using a CO2 laser was 10% higher. There are also reports of sutureless procedures using cyanoacrylate, but these have higher risks of hematoma and hemorrhage. We combined a CO2 laser and cyanoacrylate to shorten the operation time and to decrease bleeding complications. Materials and Methods : Circumcisions were performed under general anesthesia with CO2 laser and cyanoacrylate combination in 75 6–9-year-old boys between May 2013 and August 2014 only for religious reasons. As a control, we compared them retrospectively with 75 age-matched patients who were circumcised using the conventional guillotine method in our clinic. Results No hematomas, bleeding, or wound infections were observed. One wound dehiscence (1.33%) occurred during the early postoperative period and healed without any additional procedures. The median operating time was 7 (range 6–9) minutes. The conventional guillotine group comprised one hematoma (1.3%), two wound dehiscences (2.6%), and two hemorrhages (2.6%), and the median operating time was 22 (range 20–26) minutes. The difference in surgical time was significant (p<0.001), with no significant difference in the rate of complications between the two groups. Conclusion The combined CO2 laser and cyanoacrylate procedure not only decreased the operating time markedly, but also eliminated the disadvantages associated with each individual procedure alone. PMID:27136476

  6. True hermaphroditism in a 46, XY individual, caused by a postzygotic somatic point mutation in the male gonadal sex-determining locus (SRY): Molecular genetics and histological findings in a sporadic case

    SciTech Connect

    Braun, A.; Kammerer, S.; Cleve, H.; Loehrs, U.; Schwarz, H.P.; Kuhnle, U. )

    1993-03-01

    Recently, the gene for the determination of maleness has been identified in the sex-determining region on the short arm of the Y chromosome (SRY) between the Y-chromosomal pseudoautosomal boundary (PABY) and the ZFY gene locus. Experiments with transgenic mice confirmed that SRY is a part of the testis-determining factor (TDF). The authors describe a sporadic case of a patient with intersexual genitalia and the histological finding of ovotestes in the gonad, which resembles the mixed type of gonadal tissue without primordial follicle structures. The karyotype of the patient was 46,XY. By PCR amplification, they tested for the presence of SRY by using DNA obtained from histological gonadal slices. The SRY products of both DNA preparations were further analyzed by direct sequencing. All three parts of the sex-determining region of the Y chromosome could be amplified from leukocytic DNA. The patient's and the father's SRY sequences were identical with the published sequence. In the SRY PCR product of gonadal DNA, the wild-type and two point mutations were present in the patient's sequence, simulating a heterozygous state of a Y-chromosomal gene: one of the mutations was silent, while the other encoded for a nonconservative amino acid substitution from leucine to histidine. Subcloning procedures showed that the two point mutations always occurred together. The origin of the patient's intersexuality is a postzygotic mutation of the SRY occurring in part of the gonadal tissue. This event caused the loss of the testis-determining function in affected cells. 37 refs., 6 figs.

  7. Condoms - male

    MedlinePlus

    Prophylactics; Rubbers; Male condoms; Contraceptive - condom; Contraception - condom; Barrier method - condom ... rubber Polyurethane Condoms are the only method of birth control for men that are not permanent. They can ...

  8. Male contraception.

    PubMed

    Wang, Christina; Swerdloff, Ronald S

    2002-04-01

    Currently approved male-directed contraceptive methods include condoms and vas occlusion. Vas occlusion is very effective but is intended to be non-reversible. Condoms have a relatively high failure rate, at least partially due to compliance problems and are not accepted by many couples. The only other male-oriented methods in clinical trials utilize the administration of testosterone alone or its combination with another gonadotropin-suppressing agent such as a progestin or a gonadotropin-releasing hormone antagonist. Studies published in the 1990s demonstrated that a testosterone-containing hormonal contraceptive method suppressed spermatogenesis to azoospermia in most men and severe oligozoospermia in the remaining. The contraceptive efficacy after treatment with testosterone alone was comparable to that of female hormonal methods. Having proven that reversible male contraception is a reality, present trials are attempting to identify the best androgen delivery system and the most effective androgen plus progestin preparation. It is likely that the first marketed male hormonal contraceptive method will be a long-acting (injectable or implant) combination of an androgen plus a progestin. Research is continuing to identify other target areas for male contraceptive development, including agents with post-testicular and epididymal sites of action.

  9. Eating Disordered Adolescent Males.

    ERIC Educational Resources Information Center

    Eliot, Alexandra O.; Baker, Christina Wood

    2001-01-01

    Described a sample of eating disordered adolescent males who were seen for treatment at Boston Children's Hospital Outpatient Eating Disorders Clinic. Findings suggest the idea that clinicians, coaches, peers, and family should encourage young men to share concerns about body image and weight at an earlier, less severe juncture, with the assurance…

  10. Rock Finding

    ERIC Educational Resources Information Center

    Rommel-Esham, Katie; Constable, Susan D.

    2006-01-01

    In this article, the authors discuss a literature-based activity that helps students discover the importance of making detailed observations. In an inspiring children's classic book, "Everybody Needs a Rock" by Byrd Baylor (1974), the author invites readers to go "rock finding," laying out 10 rules for finding a "perfect" rock. In this way, the…

  11. [Male contraception].

    PubMed

    Demery, A

    1987-05-01

    Except for condoms, male contraception is very slightly utilized in France. Several male experimental methods are under study. A synthetic luteinizing hormone-releasing hormone (LHRH) analog has been used successfully in women and offers promise in men of blocking LHRH and thus blocking spermatogenesis. Several nonsteroid substances such an hypertensives and adrenaline would suppress follicle stimulating hormone and luteinizing hormone release, but are too toxic for use. The combination of 40 mcg ethinyl estradiol and 20 mg of methyltestosterone inhibits gonadotropin release and produces azoospermia in men, but at the risk of loss of libido, constant gynecomastia, and testicular atrophy. Several combinations of androgens and progestins have been evaluated. Percutaneous testosterone and medroxyprogesterone acetate appears to be the most effective, with good metabolic tolerance and maintenance of libido and sexual performance. Injections of inhibine, a testicular factor that controls secretion of follicle stimulating hormone by feedback, offer promise of suppressing spermatogenesis without affecting other systems. Numerous substances are known to inhibit spermatogenesis but are to toxic for use or entail an unacceptable loss of libido. Gossypol has been employed as a contraceptive by the Chinese for its action in inhibiting protein synthesis, but it is known to have serious secondary effects. Among male methods currently in use, the condom had a Pearl index of .4-1.6 in the most recent British studies. Coitus interruptus can seriously interfere with sexual pleasure and has a failure rate of 25-30%. Vasectomy is safe, effective, and easy to perform, but is not a reversible method. The combination of 20 mg of medroxyprogesterone acetate in 2 daily doses and 100 mg of testosterone applied in an abdominal spray has given very promising results in 2 small studies in France and merits further development and diffusion.

  12. Male catheterization.

    PubMed

    Hadfield-Law, L

    2001-10-01

    The insertion of catheters into male emergency patients is fairly common practice and is associated with a worryingly high rate of infection. Everyday pressures within the department, along with the added stress of resuscitation can result in inappropriately trained or skilled staff undertaking this procedure. The issue of gender and whether female nurses should catheterize male patients may also affect this vulnerable group of patients. Acquiring the psychomotor skills of inserting a urethral catheter is only one part of preparation for practice. Emergency nurses must know when and when not to resort to catheterization. Choosing the type and size of catheter requires careful judgment. What will you do if insertion proves difficult? Prevention of infection is of paramount importance and there are an increasing number of evidence-based sources of information, which are crucial to formulating procedures and informing every day practice. In the pressured surroundings of A&E departments, it is easy to ignore the vulnerability of men requiring catheterization, both from a physical and psychological point of view. Making the effort to explain the procedure, listen to questions and concerns and record relevant details in the notes, will take only a few extra moments. There is no doubt that urinary catheterization is not without complications. It is associated with significant morbidity and occasionally, mortality.

  13. Males adjust their signalling behaviour according to experience of male signals and male-female signal duets.

    PubMed

    Rebar, D; Rodríguez, R L

    2016-04-01

    Sexual signals are conspicuous sources of information about neighbouring competitors, and species in which males and females signal during pair formation provide various sources of public information to which individuals can adjust their behaviour. We performed two experiments with a duetting vibrational insect, Enchenopa binotata treehoppers (Hemiptera: Membracidae), to ask whether males adjust their signalling behaviour according to (1a) their own experience of competitors' signals, (1b) how females adjust their mate preferences on the basis of their experience of male signals (described in prior work), and/or (2) their own experience of female response signals to competitors' signals. We presented males with synthetic male signals of different frequencies and combinations thereof for 2 weeks. We recorded males a day after their last signal exposure, finding that (1a) male signal rate increased in response to experience of attractive competitors, but that (1b) male signal frequency did not shift in a manner consistent with how females adjust their mate preferences in those experience treatments. Second, we presented males with different male-female duets for 2 weeks, finding that (2) male signal length increased from experience of female duets with attractive competitors. Males thus make two types of adjustment according to two sources of public information: one provided by experience of male signals and another by experience of female responses to male signals. Signalling plasticity can generate feedback loops between the adjustments that males and females make, and we discuss the potential consequences of such feedback loops for the evolution of communication systems.

  14. Continuous human metastin 45-54 infusion desensitizes G protein-coupled receptor 54-induced gonadotropin-releasing hormone release monitored indirectly in the juvenile male Rhesus monkey (Macaca mulatta): a finding with therapeutic implications.

    PubMed

    Seminara, Stephanie B; Dipietro, Meloni J; Ramaswamy, Suresh; Crowley, William F; Plant, Tony M

    2006-05-01

    The effect of continuous administration of the C-terminal fragment of metastin, the ligand for the G protein-coupled receptor, GPR54, on GnRH-induced LH secretion was examined in three agonadal, juvenile male monkeys whose responsiveness to GnRH was heightened by pretreatment with a chronic pulsatile iv infusion of synthetic GnRH. After bolus injection of 10 microg human (hu) metastin 45-54 (equivalent to kisspeptin 112-121), the GPR54 agonist was infused continuously at a dose of 100 microg/h and elicited a brisk LH response for approximately 3 h. This rise was then followed by a precipitous drop in LH despite continuous exposure of GPR54 to metastin 45-54. On d 4, during the final 3 h of the infusion, single boluses of hu metastin 45-54 (10 microg), N-methyl-DL-aspartic acid (NMDA) (10 mg/kg) and GnRH (0.3 microg) were administered to interrogate each element of the metastin-GPR54-GnRH-GnRH receptor cascade. Although the NMDA and GnRH boluses were able to elicit LH pulses, that of hu metastin 45-54 was not, demonstrating functional integrity of GnRH neurons (NMDA) and GnRH receptors (NMDA and GnRH) but desensitization of GPR54. The desensitization of GPR54 by continuous hu metastin 45-54 administration has therapeutic implications for a variety of conditions currently being treated by GnRH and its analogs, including restoration of fertility in patients with abnormal GnRH secretion (i.e. idiopathic hypogonadotropic hypogonadism and hypothalamic amenorrhea) and selective, reversible suppression of the pituitary-gonadal axis to achieve suppression of gonadal steroids (i.e. precocious puberty, endometriosis, uterine fibroids, and prostate cancer).

  15. Mating and male pheromone kill Caenorhabditis males through distinct mechanisms

    PubMed Central

    Shi, Cheng; Runnels, Alexi M; Murphy, Coleen T

    2017-01-01

    Differences in longevity between sexes is a mysterious yet general phenomenon across great evolutionary distances. To test the roles of responses to environmental cues and sexual behaviors in longevity regulation, we examined Caenorhabditis male lifespan under solitary, grouped, and mated conditions. We find that neurons and the germline are required for male pheromone-dependent male death. Hermaphrodites with a masculinized nervous system secrete male pheromone and are susceptible to male pheromone killing. Male pheromone-mediated killing is unique to androdioecious Caenorhabditis, and may reduce the number of males in hermaphroditic populations; neither males nor females of gonochoristic species are susceptible to male pheromone killing. By contrast, mating-induced death, which is characterized by germline-dependent shrinking, glycogen loss, and ectopic vitellogenin expression, utilizes distinct molecular pathways and is shared between the sexes and across species. The study of sex- and species-specific regulation of aging reveals deeply conserved mechanisms of longevity and population structure regulation. DOI: http://dx.doi.org/10.7554/eLife.23493.001 PMID:28290982

  16. Quantifying male attractiveness.

    PubMed Central

    McNamara, John M; Houston, Alasdair I; Marques Dos Santos, Miguel; Kokko, Hanna; Brooks, Rob

    2003-01-01

    Genetic models of sexual selection are concerned with a dynamic process in which female preference and male trait values coevolve. We present a rigorous method for characterizing evolutionary endpoints of this process in phenotypic terms. In our phenotypic characterization the mate-choice strategy of female population members determines how attractive females should find each male, and a population is evolutionarily stable if population members are actually behaving in this way. This provides a justification of phenotypic explanations of sexual selection and the insights into sexual selection that they provide. Furthermore, the phenotypic approach also has enormous advantages over a genetic approach when computing evolutionarily stable mate-choice strategies, especially when strategies are allowed to be complex time-dependent preference rules. For simplicity and clarity our analysis deals with haploid mate-choice genetics and a male trait that is inherited phenotypically, for example by vertical cultural transmission. The method is, however, easily extendible to other cases. An example illustrates that the sexy son phenomenon can occur when there is phenotypic inheritance of the male trait. PMID:14561306

  17. Finding food

    PubMed Central

    Forsyth, Ann; Lytle, Leslie; Riper, David Van

    2011-01-01

    A significant amount of travel is undertaken to find food. This paper examines challenges in measuring access to food using Geographic Information Systems (GIS), important in studies of both travel and eating behavior. It compares different sources of data available including fieldwork, land use and parcel data, licensing information, commercial listings, taxation data, and online street-level photographs. It proposes methods to classify different kinds of food sales places in a way that says something about their potential for delivering healthy food options. In assessing the relationship between food access and travel behavior, analysts must clearly conceptualize key variables, document measurement processes, and be clear about the strengths and weaknesses of data. PMID:21837264

  18. [Male contraception].

    PubMed

    Demoulin, A

    1984-04-01

    Among the reasons why male hormonal contraception has lagged behind female methods are the necessity of preserving virility, the fact that spermatogenesis is a continuous process, the need to control secondary effects and toxicity, and the requirement that modes of administration be acceptable to both partners. Among currently available reversible mehtods, withdrawal is undoubtedly the most ancient. It is still widespread but cannot be recommended because of its limited effectiveness. The condom is used by about 10% of couples worldwide as a principal or temporary method, but its inter-ference with sensation has limited its acceptance. Condoms are nevertheless highly effective when used with a spermicide. Various androgens are currently under investigation. High doses of testosterone can induce azoospermia without affecting libido but their side effects may be serious. The use of combinations of steroids permits doses to be reduced and offers promise for the future. The combination of oral medroxyprogesterone acetate and percutaneous testosterone is one of the better approaches; the combination is effective and nontoxic but has the disadvantage of percutaneous administration. Gossypol, a pigment extracted from the cotton plant, has been used as a contraceptive in China with a reported efficacy of 99.89%, recovery of fertility within 3 months, and no effect on future fertility. However, its toxicity appears to be significant in the animal and its reversibility is uncertain. A search is on for analogs which would preserve the contraceptive effects while eliminating toxic effects. Several gonadotropin releasing hormone (GnRH) analogs under investigation for their interference with spermatogenesis have given promising results. Several chemicals tested for contraceptive effects have had unacceptably high toxicity. Chinese investigators have reported good results with various physical methods of interfering with sperm production, but their reversibility and innocuity

  19. Dermatoglyphic pattern in male infertility.

    PubMed

    Sontakke, B R; Talhar, S; Ingole, I V; Shende, M R; Pal, A K; Bhattacharaya, T

    2013-06-01

    Dermatoglyphics in infertile male patients were studied and compared with that of age matched controls to see whether any specific dermatoglyphic pattern exists in infertile male patients. Infertile male patients with abnormal semen profile were referred to Cytogenetic Laboratory for karyotyping. We selected twenty-four infertile male patients with abnormal semen profile. Out of twenty-four infertile male patients, nineteen were with normal Karyotype and five patients were with abnormal Karyotype. Loop was the commonest pattern observed in the infertile male patients. All these fingertip and palmar dermatoglyphic findings were compared with that of result on finger and palmar dermatoglyphics of equal number of age matched controls. Statistical evaluation was done with software "EPI- info, version-6.04 d". Infertile males had reduced number of loops as compared to that of controls which was statistically significant. Total whorls were increased in infertile male patients as compared to that of controls which was statistically insignificant. Percentage of true palmar pattern in I 3 and I 4 areas was reduced in infertile male patients as compared to that of controls which was statistically insignificant.

  20. Gene expression profiling in male genital lichen sclerosus

    PubMed Central

    Edmonds, Emma; Barton, Geraint; Buisson, Sandrine; Francis, Nick; Gotch, Frances; Game, Laurence; Haddad, Munther; Dinneen, Michael; Bunker, Chris

    2011-01-01

    Male genital lichen sclerosus (MGLSc) has a bimodal distribution in boys and men. It is associated with squamous cell carcinoma (SCC). The pathogenesis of MGLSc is unknown. HPV and autoimmune mechanisms have been mooted. Anti extracellular matrix protein (ECM)1 antibodies have been identified in women with GLSc. The gene expression pattern of LSc is unknown. Using DNA microarrays we studied differences in gene expression in healthy and diseased prepuces obtained at circumcision in adult males with MGLSc (n = 4), paediatric LSc (n = 2) and normal healthy paediatric foreskin (n = 4). In adult samples 51 genes with significantly increased expression and 87 genes with significantly reduced expression were identified; paediatric samples revealed 190 genes with significantly increased expression and 148 genes with significantly reduced expression. Concordance of expression profiles between adult and paediatric samples indicates the same disease process. Functional analysis revealed increased expression in the adult and child MGSLc samples in the immune response/cellular defence gene ontology (GO) category and reduced expression in other categories including genes related to squamous cancer. No specific HPV, autoimmune or squamous carcinogenesis-associated gene expression patterns were found. ECM1 and CABLES1 expression were significantly reduced in paediatric and adult samples respectively. PMID:21718371

  1. African American Males Navigate Racial Microaggressions

    ERIC Educational Resources Information Center

    Hotchkins, Bryan K.

    2016-01-01

    Background/Context: High school educational environments find Black males experience systemic racial microaggressions in the form of discipline policies, academic tracking and hegemonic curriculum (Allen, Scott, & Lewis, 2013). Black males in high school are more likely than their White male peers to have high school truancies and be viewed as…

  2. Misexpression of the white (w) gene triggers male-male courtship in Drosophila.

    PubMed Central

    Zhang, S D; Odenwald, W F

    1995-01-01

    We report here that the general ectopic expression of a tryptophan/guanine transmembrane transporter gene, white (w), induces male-male courtship in Drosophila. Activation of a hsp-70/miniwhite (mini-w) transgene in mature males results in a marked change in their sexual behavior such that they begin to vigorously court other mature males. In transformant populations containing equal numbers of both sexes, most males participate, thus forming male-male courtship chains, circles, and lariats. Mutations that ablate the w transgene function also abolish this inducible behavior. Female sexual behavior does not appear to be altered by ectopic w expression. By contrast, when exposed to an active homosexual courtship environment, non-transformant males alter their behavior and actively participate in the male-male chaining. These findings demonstrate that, in Drosophila, both genetic and environmental factors play a role in male sexual behavior. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:7777542

  3. Social Network and Risk-Taking Behavior Most Associated with Rapid HIV Testing, Circumcision, and Preexposure Prophylaxis Acceptability Among High-Risk Indian Men

    PubMed Central

    Kumar, Rupali; Dandona, Rakhi; Kumar, Prem; Kumar, Anil; Lakshmi, Vemu; Laumann, Edward; Mayer, Kenneth; Dandona, Lalit

    2012-01-01

    Abstract Indian truck drivers and their younger apprentice drivers are at increased risk of HIV infection. We determine network and risk practices associated with willingness to adopt HIV prevention interventions currently not being used in India: rapid HIV testing, circumcision, and preexposure prophylaxis (PrEP) in order to inform the National AIDS Control Program (NACP). Truck drivers and truck cleaners were systematically recruited to participate in a social network and risk survey in Hyderabad, Southern India. Three separate composite measures of acceptability of rapid HIV testing, circumcision, and PrEP acceptability were utilized to independently assess the relationship of these prevention interventions with risk-practices and social network characteristics. An 89% participation rate yielded 1602 truck drivers and truck cleaners with 54.2% younger than 30 years of age and 2.8% HIV infected. Twenty-five percent of respondents reported sex with female sex workers (FSW) and 5% with men (MSM). Rapid testing, circumcision, and PrEP acceptability were 97.4%, 9.1%, and 85.9%, respectively. Participants reporting prosocial network characteristics were more accepting of rapid testing (adjusted odds ratio [AORs] 3.07–6.71; p<0.05) and demonstrated variable PrEP acceptability (AORs 0.08–2.22; p<0.001). Sex with FSWs was associated with PrEP acceptability (AOR 4.27; p<0.001); sex with MSM was associated with circumcision acceptability only (AOR 2.66; p<0.01). Social network factors and risk-practices were associated with novel prevention acceptability, but not consistently across intervention type and with variable directionality. The NACP will need to consider that intervention uptake may likely be most successful when efforts are targeted to individuals with specific behavior and social network characteristics. PMID:22973951

  4. Male to male transmission of supernumerary nipples.

    PubMed

    Tsukahara, M; Uchida, M; Uchino, S; Fujisawa, R; Kamei, T; Itoh, T

    1997-03-17

    We report on a father and his son with supernumerary nipples. No male-to-male transmission has previously been described with this trait. This observation confirms that this trait is inherited in an autosomal dominant fashion.

  5. Male breast carcinoma

    PubMed Central

    Meguerditchian, Ari-Nareg; Falardeau, Maurice; Martin, Ginette

    2002-01-01

    Objective To review the epidemiology, presentation, diagnosis, molecular genetics, treatment and prognosis of male breast cancer. Data sources Articles, written in English or French, selected from the Medline database (1966 to January 2001), corresponding to the key words “male breast cancer,” according to the following criteria: covering institutional experience or comparing diagnostic and treatment modalities, and epidemiologic or general reviews. Study selection Of 198 articles found 50 fulfilled the review criteria. Data synthesis Risk factors included advanced age, a positive family history, Jewish origin, black race, excess exposure to female hormones (Klinefelter’s syndrome), environmental exposure (irradiation), alcohol, obesity, higher socioeconomic or higher educational status and childlessness. Gynecomastia remains a controversial factor, this term being used for both a histologic reality and a physical finding. Advanced disease is characterized by pain, bloody discharge and skin ulceration. There is no definitive diagnostic algorithm. Experience with male breast mammography is limited, and imaging is less informative for patients under 50 years of age. Fine-needle aspiration tends to overestimate the rate of malignancy. The commonest histologic finding is infiltrating ductal adenocarcinoma. Treatment includes modified radical mastectomy, followed by cyclophosphamide–methotrexate–5-fluo-rouracil or 5-fluorouracil–Adriamycin–cyclophosphamide chemotherapy for disease of stage II or greater. Radiotherapy does not seem to add any benefit. The disease is highly receptor-positive; however, many patients discontinue tamoxifen due to side effects. The most important prognostic factors are tumour size, lymphatic invasion and axillary node status. Conclusions Because of the low incidence of male breast cancer, advances will be obtained mainly with the rapid transfer of newly gained knowledge in female mammary neoplasia. The increased use of adjuvant

  6. Male Depression: Understanding the Issues

    MedlinePlus

    Diseases and Conditions Depression (major depressive disorder) Male depression is a serious medical condition, but many men try to ignore it or refuse treatment. Learn the signs and symptoms — and what to do. By Mayo Clinic Staff Do you feel irritable, isolated or withdrawn? Do you find yourself working all ...

  7. Male Reproductive System

    MedlinePlus

    ... Old Feeding Your 1- to 2-Year-Old Male Reproductive System KidsHealth > For Parents > Male Reproductive System Print A ... understand your son's reproductive health. continue About the Male Reproductive System Most species have two sexes: male and female. ...

  8. "Ngaitana (I will circumcise myself)": the gender and generational politics of the 1956 ban on clitoridectomy in Meru, Kenya.

    PubMed

    Thomas, L M

    1996-11-01

    This paper discusses the gender and generational politics of the 1956 ban on clitoridectomy in Meru, Kenya. Historically, clitoridectomy became an object of official concern in central Kenya in the 1920s, which prompted the Meru Local Native Council to pass resolutions prohibiting excision without the consent of the girl, limiting the severity of the operation and requiring the registration of the female circumcisers. These resolutions, however, proved largely ineffective. Since the approval and implementation of the Njuri Ncheke of Meru in 1956, which unanimously banned clitoridectomy, a great number of men, women, and girls have been charged by the African courts with defying the ban. In the absence of specialists performing excision, several adolescents resorted to excising themselves in form of retaliation. The administrative context within which officials attempted to regulate clitoridectomy in the 1920s and 1930s differed markedly from the 1956 ban. A shift from one of indirect rule to a post-war development agenda through the elaboration of economic and social reforms was also observed. The 1956 ban was much of a challenge to the relations of seniority among women as to relations of subordination between men and women. Furthermore, ban analysis also revealed the link between gender and generation shaped and limited the more interventionist policies of the post-World War II colonial state. Clitoridectomy and infibulation are now considered grounds for political asylum, and the legality of these practices among the African immigrant population continues to be debated within international conferences.

  9. [Genetic evaluation of male homosexuality].

    PubMed

    Gasztonyi, Z

    1998-02-01

    The family trees of 16 homosexual males are evaluated in the material of their Genetic Counselling Clinic. The familial cluster of three cases corresponded to the X-linked recessive inheritance. The results of family, twin and adoption studies are reviewed and the recent findings of molecular genetic and brain researches are summarised. Male homosexuality comprises of different subgroups, but one major entity is caused by X-linked recessive gene(s). This genetic background represent a predisposition which is triggered or suppressed by external factors.

  10. Strategic male mating effort and cryptic male choice in a scorpionfly.

    PubMed

    Engqvist, L; Sauer, K P

    2001-04-07

    In animal species with high male mating effort, males often find themselves in a dilemma: by increasing their mating effort, the gain from each copulation increases but simultaneously reduces available resources and, thus, the opportunity for future copulations. Therefore, we expect males to spend less reproductive resources on matings that provide low reproductive potential, thereby saving resources for future copulations, possibly with high-quality females, a sort of cryptic male choice. However, the strength of the trade-off between investment in a current mating and resources available for future matings must not be the same for all males. Males with relatively high mating costs should allocate their limited resources more cautiously than males with more plentiful resources. Here, we examine this prediction in the scorpionfly Panorpa cognata. Prior to copulation, males produce a large salivary mass on which females feed during copulation. We show that the production of larger salivary masses leads to longer copulations. Moreover, the size of the salivary gland and salivary mass increases with increasing male condition. However, males in poor condition make a relatively higher mating investment than males in good condition. We therefore expect male condition to influence cryptic male choice. In accordance with our hypothesis, only males in poor condition choose cryptically, producing larger salivary masses in copulations with females of high fecundity.

  11. Familial aspects of male homosexuality.

    PubMed

    Dawood, K; Pillard, R C; Horvath, C; Revelle, W; Bailey, J M

    2000-04-01

    Research has generally supported the existence of familial-genetic factors for male sexual orientation, but has not shed much light on the specific nature of those influences. Gay men with gay brothers provide the opportunity to examine several hypotheses. Sixty-six men, representing 37 gay male sibling pairs, completed questionnaires assessing behavior on various measures including childhood and adult gender nonconformity, timing of awareness of homosexual feelings, self-acceptance, and the quality of family relationships. Consistent with prior findings using twins, gay brothers were similar in their degree of childhood gender non-conformity, suggesting that this variable may distinguish etiologically (e.g., genetically) heterogeneous subtypes. The large majority of gay men with brothers knew about their own homosexual feelings before they learned about their brothers' homosexual feelings, suggesting that discovery of brothers' homosexuality is not an important cause of male homosexuality.

  12. Male pattern baldness (image)

    MedlinePlus

    Male pattern baldness is a sex-linked characteristic that is passed from mother to child. A man can more accurately predict his chances of developing male pattern baldness by observing his mother's father than by looking ...

  13. A Randomized Male Tolerance Study of Dapivirine Gel Following Multiple Topical Penile Exposures (MTN 012/IPM 010)

    PubMed Central

    Hoesley, Craig; Carballo-Diéguez, Alex; Hendrix, Craig W.; Husnik, Marla; Levy, Lisa; Hall, Wayne; Soto-Torres, Lydia; Nel, Annalene M.

    2014-01-01

    Abstract Dapivirine (DPV) is a nonnucleoside reverse transcriptase inhibitor with a favorable safety profile following vaginal application. A penile tolerance study was conducted prior to further development of DPV as a candidate vaginal microbicide. Twenty-four circumcised and 24 uncircumcised (N=48) healthy HIV-negative male participants aged 18 years or older were randomized 2:1:1 to apply DPV 0.05% gel, matched placebo gel, or universal placebo gel, respectively, to their penis once daily for 7 sequential days. The safety, acceptability, and pharmacokinetic profile of DPV 0.05% gel were assessed by the presence of Grade 2 or higher genitourinary adverse events (AEs) and systemic AEs, a behavioral questionnaire, and pharmacokinetic plasma blood draw, respectively, at the final clinic visit (FCV). There were no Grade 2 genitourinary AEs in 47 participants completing the FCV. One participant in the DPV arm failed to attend the FCV. There were 13 AEs reported; all were Grade 1 except one Grade 2 corneal laceration unrelated to study product. Participants liked the gel to a moderate extent, yet 72% reported they would be “very likely” to use a gel like the one they used in the study every time they have intercourse. DPV was detectable in plasma in all 23 DPV arm study participants at the FCV. On average, the circumcised participants' DPV concentrations were 54% of those in uncircumcised participants (p=0.07). Topical seven-day penile application of DPV 0.05% gel was locally and systemically safe, was acceptable to male participants, and resulted in systemic exposure to the drug. PMID:24070431

  14. The inner foreskin of healthy males at risk of HIV infection harbors epithelial CD4+ CCR5+ cells and has features of an inflamed epidermal barrier.

    PubMed

    Lemos, Maria P; Lama, Javier R; Karuna, Shelly T; Fong, Youyi; Montano, Silvia M; Ganoza, Carmela; Gottardo, Raphael; Sanchez, Jorge; McElrath, M Juliana

    2014-01-01

    Male circumcision provides partial protection against multiple sexually transmitted infections (STIs), including HIV, but the mechanisms are not fully understood. To examine potential vulnerabilities in foreskin epithelial structure, we used Wilcoxon paired tests adjusted using the false discovery rate method to compare inner and outer foreskin samples from 20 healthy, sexually active Peruvian males who have sex with males or transgender females, ages 21-29, at elevated risk of HIV infection. No evidence of epithelial microtrauma was identified, as assessed by keratinocyte activation, fibronectin deposition, or parakeratosis. However, multiple suprabasal tight junction differences were identified: 1) inner foreskin stratum corneum was thinner than outer (p = 0.035); 2) claudin 1 had extended membrane-bound localization throughout inner epidermis stratum spinosum (p = 0.035); 3) membrane-bound claudin 4 was absent from inner foreskin stratum granulosum (p = 0.035); and 4) occludin had increased membrane deposition in inner foreskin stratum granulosum (p = 0.042) versus outer. Together, this suggests subclinical inflammation and paracellular transport modifications to the inner foreskin. A setting of inflammation was further supported by inner foreskin epithelial explant cultures secreting higher levels of GM-CSF (p = 0.029), IP-10 (p = 0.035) and RANTES (p = 0.022) than outer foreskin, and also containing an increased density of CCR5+ and CD4+ CCR5+ cells (p = 0.022). Inner foreskin dermis also secreted more RANTES than outer (p = 0.036), and had increased density of CCR5+ cells (p = 0.022). In conclusion, subclinical changes to the inner foreskin of sexually active males may support an inflammatory state, with availability of target cells for HIV infection and modifications to epidermal barriers, potentially explaining the benefits of circumcision for STI prevention.

  15. Coaching the alpha male.

    PubMed

    Ludeman, Kate; Erlandson, Eddie

    2004-05-01

    Highly intelligent, confident, and successful, alpha males represent about 70% of all senior executives. Natural leaders, they willingly take on levels of responsibility most rational people would find overwhelming. But many of their quintessential strengths can also make alphas difficult to work with. Their self-confidence can appear domineering. Their high expectations can make them excessively critical. Their unemotional style can keep them from inspiring their teams. That's why alphas need coaching to broaden their interpersonal tool kits while preserving their strengths. Drawing from their experience coaching more than 1,000 senior executives, the authors outline an approach tailored specifically for the alpha. Coaches get the alpha's attention by inundating him with data from 360-degree feedback presented in ways he will find compelling--both hard-boiled metrics and vivid verbatim comments from colleagues about his strengths and weaknesses. A 360-degree assessment is a wake-up call for most alphas, providing undeniable proof that their behavior doesn't work nearly as well as they think it does. That paves the way for a genuine commitment to change. In order to change, the alpha must venture into unfamiliar--and often uncomfortable--psychological territory. He must admit vulnerability, accept accountability not just for his own work for others', connect with his underlying emotions, learn to motivate through a balance of criticism and validation, and become aware of unproductive behavior patterns. The goal of executive coaching is not simply to treat the alpha as an individual problem but to improve the entire team dynamic. Initial success creates an incentive to persevere, and the virtuous cycle reverberates throughout the entire organization.

  16. Self-Concept and Psychological Adjustment Differences Between Self-Identified Male Transexuals and Male Homosexuals

    ERIC Educational Resources Information Center

    Roback, Howard B.; And Others

    1977-01-01

    Self-concept and adjustment data from anatomical males seeking sexual reassignment surgery were compared with that from a male homosexual group. Findings indicated that the homosexual group had a better self-image and was better adjusted than the sex change group. (Author)

  17. Male Infertility and Its Causes in Human

    PubMed Central

    Miyamoto, Toshinobu; Tsujimura, Akira; Miyagawa, Yasushi; Koh, Eitetsu; Namiki, Mikio; Sengoku, Kazuo

    2012-01-01

    Infertility is one of the most serious social problems facing advanced nations. In general, approximate half of all cases of infertility are caused by factors related to the male partner. To date, various treatments have been developed for male infertility and are steadily producing results. However, there is no effective treatment for patients with nonobstructive azoospermia, in which there is an absence of mature sperm in the testes. Although evidence suggests that many patients with male infertility have a genetic predisposition to the condition, the cause has not been elucidated in the vast majority of cases. This paper discusses the environmental factors considered likely to be involved in male infertility and the genes that have been clearly shown to be involved in male infertility in humans, including our recent findings. PMID:22046184

  18. Will male advertisement be a reliable indicator of paternal care, if offspring survival depends on male care?

    PubMed

    Kelly, Natasha B; Alonzo, Suzanne H

    2009-09-07

    Existing theory predicts that male signalling can be an unreliable indicator of paternal care, but assumes that males with high levels of mating success can have high current reproductive success, without providing any parental care. As a result, this theory does not hold for the many species where offspring survival depends on male parental care. We modelled male allocation of resources between advertisement and care for species with male care where males vary in quality, and the effect of care and advertisement on male fitness is multiplicative rather than additive. Our model predicts that males will allocate proportionally more of their resources to whichever trait (advertisement or paternal care) is more fitness limiting. In contrast to previous theory, we find that male advertisement is always a reliable indicator of paternal care and male phenotypic quality (e.g. males with higher levels of advertisement never allocate less to care than males with lower levels of advertisement). Our model shows that the predicted pattern of male allocation and the reliability of male signalling depend very strongly on whether paternal care is assumed to be necessary for offspring survival and how male care affects offspring survival and male fitness.

  19. Using Masculine Generics: Does Generic He' Increase Male Bias in the User's Imagery?

    ERIC Educational Resources Information Center

    Hamilton, Mykol C.

    1988-01-01

    Studies the effect of the use of the male generic on imagery. Finds that male bias is higher in the masculine generic condition than in the unbiased condition, and that male subjects are more male-biased than female subjects. Discusses findings in terms of linguistic relativity, prototypicality, and activation of multiple meanings. (FMW)

  20. Overview and trends in male grooming.

    PubMed

    Elsner, P

    2012-03-01

    The use of cosmetics and medical cosmetic procedures by men has been widely ignored in dermatological research in the past, but it is finding increasing attention. As men are changing their habits and increasingly tend to use cosmetic products, the dermatologist will be asked for expert advice regarding efficacy and safety of cosmetics for male skin. For this service, dermatologists need to be aware of anatomical and physiological differences between male and female skin, about specific environmental stress factors affecting male skin, about cosmetic practices and product use especially regarding shaving, and about the counselling needs in men relating to protective cosmetic use.

  1. Consistent male-male paternity differences across female genotypes.

    PubMed

    Sherman, Craig D H; Wapstra, Erik; Olsson, Mats

    2009-04-23

    In a recent paper, we demonstrated that male-female genetic relatedness determines male probability of paternity in experimental sperm competition in the Peron's tree frog (Litoria peronii), with a more closely related male outcompeting his rival. Here, we test the hypothesis that a male-male difference in siring success with one female significantly predicts the corresponding difference in siring success with another female. With male sperm concentration held constant, and the proportion of viable sperm controlled statistically, the male-male difference in siring success with one female strongly predicted the corresponding difference in siring success with another female, and alone explained more than 62 per cent of the variance in male-male siring differences. This study demonstrates that male siring success is primarily dictated by among-male differences in innate siring success with less influence of male-female relatedness.

  2. The scent of inbreeding: a male sex pheromone betrays inbred males

    PubMed Central

    van Bergen, Erik; Brakefield, Paul M.; Heuskin, Stéphanie; Zwaan, Bas J.; Nieberding, Caroline M.

    2013-01-01

    Inbreeding depression results from mating among genetically related individuals and impairs reproductive success. The decrease in male mating success is usually attributed to an impact on multiple fitness-related traits that reduce the general condition of inbred males. Here, we find that the production of the male sex pheromone is reduced significantly by inbreeding in the butterfly Bicyclus anynana. Other traits indicative of the general condition, including flight performance, are also negatively affected in male butterflies by inbreeding. Yet, we unambiguously show that only the production of male pheromones affects mating success. Thus, this pheromone signal informs females about the inbreeding status of their mating partners. We also identify the specific chemical component (hexadecanal) probably responsible for the decrease in male mating success. Our results advocate giving increased attention to olfactory communication as a major causal factor of mate-choice decisions and sexual selection. PMID:23466986

  3. Bladder catheterization, male (image)

    MedlinePlus

    ... kept empty (decompressed) and urinary flow assured. The balloon holds the catheter in place for a duration of time. Catheterization in males is slightly more difficult and uncomfortable than in females because of the longer urethra.

  4. Chlamydial infections - male

    MedlinePlus

    ... Have sex without wearing a male or female condom Have more than one sexual partner Use drugs ... to have sexual contact, use latex or polyurethane condoms. Remember to: Use condoms for all vaginal, anal, ...

  5. Male Reproductive System

    MedlinePlus

    ... gamete, the egg or ovum, meet in the female's reproductive system to create a baby. Both the male and female reproductive systems are essential for reproduction. Humans pass certain characteristics ...

  6. Oxidative stress & male infertility.

    PubMed

    Makker, Kartikeya; Agarwal, Ashok; Sharma, Rakesh

    2009-04-01

    The male factor is considered a major contributory factor to infertility. Apart from the conventional causes for male infertility such as varicocoele, cryptorchidism, infections, obstructive lesions, cystic fibrosis, trauma, and tumours, a new and important cause has been identified: oxidative stress. Oxidative stress is a result of the imbalance between reactive oxygen species (ROS) and antioxidants in the body. It is a powerful mechanism that can lead to sperm damage, deformity and eventually, male infertility. This review discusses the physiological need for ROS and their role in normal sperm function. It also highlights the mechanism of production and the pathophysiology of ROS in relation to the male reproductive system and enumerate the benefits of incorporating antioxidants in clinical and experimental settings.

  7. Male Breast Cancer

    MedlinePlus

    ... hasn't spread beyond your breast tissue. Radiation therapy Radiation therapy uses high-energy beams to kill ... option for men with advanced breast cancer. Hormone therapy Most men with male breast cancer have tumors ...

  8. Finding Dental Care

    MedlinePlus

    ... Finding Dental Care Where can I find low-cost dental care? Dental schools often have clinics that allow dental ... can I find more information? See Finding Low Cost Dental Care . ​​​​ WWNRightboxRadEditor2 Contact Us 1-866-232-4528 nidcrinfo@ ...

  9. Hyperprolactinaemia in male diabetics.

    PubMed Central

    Mooradian, A. D.; Morley, J. E.; Billington, C. J.; Slag, M. F.; Elson, M. K.; Shafer, R. B.

    1985-01-01

    We recently investigated two patients with diabetes and elevated serum prolactin levels in whom no cause of hyperprolactinaemia could be found. For this reason we measured fasting serum prolactin levels in 72 diabetic males and compared the results with those of 63 healthy males and 90 nondiabetic males attending an Impotence Clinic. The diabetic group had significantly higher serum prolactin levels (13.1 +/- 0.9 ng/ml) than the two control groups (9.9 +/- 0.6 ng/ml for normal males and 7.7 +/- 0.3 ng/ml for the non-diabetic impotent group). Eighteen percent of the diabetics studied had serum prolactin levels above the normal range for males (greater than 20 ng/ml). There was no correlation between serum prolactin levels and duration of diabetes, glycosylated haemoglobin level or presence of clinically apparent retinopathy. The correlation between serum prolactin level and fasting plasma glucose was weak though statistically significant (r = 0.26, P less than 0.05). PMID:3991396

  10. Assessment of Male Reproductive Toxicity##

    EPA Science Inventory

    This review covers all aspects of male reproductive toxicology. It begins with an overview of male reproductive biology and then transitions to the considerations of conducting male reproductive toxicology studies. We discuss multigenerational study as proposed in EPAs harmoniz...

  11. Stages of Male Breast Cancer

    MedlinePlus

    ... Breast & Gynecologic Cancers Breast Cancer Screening Research Male Breast Cancer Treatment (PDQ®)–Patient Version General Information about Male Breast Cancer Go to Health Professional Version Key Points Male ...

  12. Natural variation in plep-1 causes male-male copulatory behavior in C. elegans

    PubMed Central

    Noble, Luke M.; Chang, Audrey; McNelis, Daniel; Kramer, Max; Yen, Mimi; Nicodemus, Jasmine P.; Riccardi, David D.; Ammerman, Patrick; Phillips, Matthew; Islam, Tangirul; Rockman, Matthew V.

    2015-01-01

    Summary In sexual species, gametes have to find and recognize one another. Signaling is thus central to sexual reproduction and involves a rapidly evolving interplay of shared and divergent interests [1-4]. Among Caenorhabditis nematodes, three species have evolved self-fertilization, changing the balance of intersexual relations [5]. Males in these androdioecious species are rare, and the evolutionary interests of hermaphrodites dominate. Signaling has shifted accordingly, with females losing behavioral responses to males [6, 7] and males losing competitive abilities [8, 9]. Males in these species also show variable same-sex and autocopulatory mating behaviors [6, 10]. These behaviors could have evolved by relaxed selection on male function, accumulation of sexually antagonistic alleles that benefit hermaphrodites and harm males [5, 11], or neither of these, because androdioecy also reduces the ability of populations to respond to selection [12-14]. We have identified the genetic cause of a male-male mating behavior exhibited by geographically dispersed C. elegans isolates, wherein males mate with and deposit copulatory plugs on one another's excretory pores. We find a single locus of major effect that is explained by segregation of a loss-of-function mutation in an uncharacterized gene, plep-1, expressed in the excretory cell in both sexes. Males homozygous for the plep-1 mutation have excretory pores that are attractive or receptive to copulatory behavior of other males. As excretory pore plugs are injurious and hermaphrodite activity is compromised in plep-1 mutants, the allele may be unconditionally deleterious, persisting in the population because the species' androdioecious mating system limits the reach of selection. PMID:26455306

  13. Organizing pneumonia: chest HRCT findings*

    PubMed Central

    Faria, Igor Murad; Zanetti, Gláucia; Barreto, Miriam Menna; Rodrigues, Rosana Souza; Araujo-Neto, Cesar Augusto; Silva, Jorge Luiz Pereira e; Escuissato, Dante Luiz; Souza, Arthur Soares; Irion, Klaus Loureiro; Mançano, Alexandre Dias; Nobre, Luiz Felipe; Hochhegger, Bruno; Marchiori, Edson

    2015-01-01

    OBJECTIVE: To determine the frequency of HRCT findings and their distribution in the lung parenchyma of patients with organizing pneumonia. METHODS: This was a retrospective review of the HRCT scans of 36 adult patients (26 females and 10 males) with biopsy-proven organizing pneumonia. The patients were between 19 and 82 years of age (mean age, 56.2 years). The HRCT images were evaluated by two independent observers, discordant interpretations being resolved by consensus. RESULTS: The most common HRCT finding was that of ground-glass opacities, which were seen in 88.9% of the cases. The second most common finding was consolidation (in 83.3% of cases), followed by peribronchovascular opacities (in 52.8%), reticulation (in 38.9%), bronchiectasis (in 33.3%), interstitial nodules (in 27.8%), interlobular septal thickening (in 27.8%), perilobular pattern (in 22.2%), the reversed halo sign (in 16.7%), airspace nodules (in 11.1%), and the halo sign (in 8.3%). The lesions were predominantly bilateral, the middle and lower lung fields being the areas most commonly affected. CONCLUSIONS: Ground-glass opacities and consolidation were the most common findings, with a predominantly random distribution, although they were more common in the middle and lower thirds of the lungs. PMID:26176521

  14. Male Pectoral Implants: Radiographic Appearance of Complications

    PubMed Central

    Kuzmiak, Cherie M; Damitz, Lynn; Burke, Rachael; Hwang, Michael

    2016-01-01

    There has been a significant surge in aesthetic chest surgery for men in the last several years. Male chest enhancement is performed with surgical placement of a solid silicone pectoral implant. In the past, male chest correction and implantation were limited to the treatment of men who had congenital absence or atrophy of the pectoralis muscle and pectus excavatum deformity. But today, the popularization of increased chest and pectoral size fostered by body builders has more men desiring chest correction with implantation for non-medical reasons. We present a case of a 44-year-old, male with a displaced left pectoral implant with near extrusion and with an associated peri-implant soft tissue mass and fluid collection. While the imaging of these patients is uncommon, our case study presents the radiographic findings of male chest enhancement with associated complications. PMID:27200162

  15. Reducing the Risk of Postoperative Genital Complications in Male Adolescents

    ERIC Educational Resources Information Center

    Dossanova, ?ssem; Lozovoy, Vasiliy; Wood, Dan; ??nekenova, ?enzhekyz; Botabayeva, ?igul; Dossanov, Bolatbek; Lozovaya, Yelena; ?marov, ?algat

    2016-01-01

    The reproductive system of adolescents is exposed to a high risk of anomalies. In spite of the successes of surgical correction, the percentage of postoperative complications remains high. Special attention should be paid to circumcision, which is regarded as a religious tradition in many countries and carried out with sanitary violations. This…

  16. Male Breast Cancer

    PubMed Central

    Yalaza, Metin; İnan, Aydın; Bozer, Mikdat

    2016-01-01

    Male breast cancer (MBC) is a rare disease, accounting for less than 1% of all breast cancer diagnoses worldwide. Although breast carcinomas share certain characteristics in both genders, there are notable differences. Most studies on men with breast cancer are very small. Thus, most data on male breast cancer are derived from studies on females. However, when a number of these small studies are grouped together, we can learn more from them. This review emphasizes the incidence, etiology, clinical features, diagnosis, treatment, pathology, survival, and prognostic factors related to MBC.

  17. Find a Surgeon

    MedlinePlus

    ... find out more. Head, Neck and Oral Pathology Head, Neck and Oral Pathology Close to 49,750 Americans ... find out more. Head, Neck and Oral Pathology Head, Neck and Oral Pathology Close to 49,750 Americans ...

  18. Anencephaly: MRI findings and pathogenetic theories.

    PubMed

    Calzolari, Ferdinando; Gambi, Beatrice; Garani, Giampaolo; Tamisari, Lalla

    2004-12-01

    We describe the MRI appearances of an anencephalic newborn who survived for 13 h; particularities of this case are male gender and the absence of other associated malformations. Moreover, we discuss the pathogenetic theories of anencephaly, correlating MRI findings with embryological data. An exencephaly-anencephaly sequence due to amnion rupture is hypothesized.

  19. Lycopene and male infertility

    PubMed Central

    Durairajanayagam, Damayanthi; Agarwal, Ashok; Ong, Chloe; Prashast, Pallavi

    2014-01-01

    Excessive amounts of reactive oxygen species (ROS) cause a state of oxidative stress, which result in sperm membrane lipid peroxidation, DNA damage and apoptosis, leading to decreased sperm viability and motility. Elevated levels of ROS are a major cause of idiopathic male factor infertility, which is an increasingly common problem today. Lycopene, the most potent singlet oxygen quencher of all carotenoids, is a possible treatment option for male infertility because of its antioxidant properties. By reacting with and neutralizing free radicals, lycopene could reduce the incidence of oxidative stress and thus, lessen the damage that would otherwise be inflicted on spermatozoa. It is postulated that lycopene may have other beneficial effects via nonoxidative mechanisms in the testis, such as gap junction communication, modulation of gene expression, regulation of the cell cycle and immunoenhancement. Various lycopene supplementation studies conducted on both humans and animals have shown promising results in alleviating male infertility—lipid peroxidation and DNA damage were decreased, while sperm count and viability, and general immunity were increased. Improvement of these parameters indicates a reduction in oxidative stress, and thus the spermatozoa is less vulnerable to oxidative damage, which increases the chances of a normal sperm fertilizing the egg. Human trials have reported improvement in sperm parameters and pregnancy rates with supplementation of 4–8 mg of lycopene daily for 3–12 months. However, further detailed and extensive research is still required to determine the dosage and the usefulness of lycopene as a treatment for male infertility. PMID:24675655

  20. Minority Male Afterschool Program.

    ERIC Educational Resources Information Center

    Dalton, Herbert F., Jr.

    Through a program called the Minority Male Afterschool Program (MMAP), college students at Mississippi Valley State University in Itta Bena (Mississippi) are working one-on-one with high school students. The MMAP is an enrichment program that encourages at-risk African American students aged 12 to 19 to complete high school and pursue…

  1. Male breast cancer.

    PubMed

    Reis, Leonardo Oliveira; Dias, Fernando Gf; Castro, Marcos As; Ferreira, Ubirajara

    2011-06-01

    Male breast cancer (MBC) is a rare disease. However, as global populace ages, there is a trend to MBC increasing. Although aetiology is still unclear, constitutional, environmental, hormonal (abnormalities in estrogen/androgen balance) and genetic (positive family history, Klinefelter syndrome, mutations in BRCA1 and specially BRCA2) risk factors are already known. Clinic manifestation is painless hard and fixed nodule in the subareolar region in 75% of cases, with nipple commitment earlier than in women. Breast cancer has similar prognostic factors in males and females, among which axillary adenopathy (present in 40-55% cases) is the most important one. Although mammography, ultrasonography and scintigraphy can be useful tools in diagnosis; clinical assessment, along with a confirmatory biopsy, remains the main step in the evaluation of men with breast lesions. Infiltrating ductal carcinoma is the most frequent histological type. The established standard of care is modified radical mastectomy followed by tamoxifen for endocrine-responsive positive disease, although other options are being explored. While similarities between breast cancer in males and females exist, it is not appropriate to extrapolate data from female disease to the treatment of male. There is a need for specific multi-institutional trials to better understanding of clinicopathologic features and establishment of optimal therapy for this disease.

  2. Understanding African American Males

    ERIC Educational Resources Information Center

    Bell, Edward Earl

    2010-01-01

    The purpose of this study was to assess the socialization skills, self-esteem, and academic readiness of African American males in a school environment. Discussions with students and the School Perceptions Questionnaire provided data for this investigation. The intended targets for this investigation were African American students; however, there…

  3. Educating African American Males

    ERIC Educational Resources Information Center

    Bell, Edward E.

    2010-01-01

    Background: Schools across America spend money, invest in programs, and sponsor workshops, offer teacher incentives, raise accountability standards, and even evoke the name of Obama in efforts to raise the academic achievement of African American males. Incarceration and college retention rates point to a dismal plight for many African American…

  4. Male rat sexual behavior.

    PubMed

    Agmo, A

    1997-05-01

    The male rat's sexual behavior constitutes a highly ordered sequence of motor acts involving both striate and smooth muscles. It is spontaneously displayed by most adult made rats in the presence of a sexually receptive female. Although the behavior is important for the survival of the species it is not necessary for survival of the individual. In that way it is different from other spontaneous behaviors such as eating, drinking, avoidance of pain, respiration or thermoregulation. Among other things, this means that it is difficult to talk about sexual deprivation or need. Nevertheless, studies of male sex behavior distinguish sexual motivation (the ease by which behavior is activated, "libido") from the execution of copulatory acts (performance, "potency") (Meisel, R.L. and Sachs, B.D., The physiology of male sexual behavior. In: E. Knobil and J.D. Neill (Eds.), The Physiology of Reproduction, 2nd Edn., Vol. 2, Raven Press, New York, 1994, pp. 3-105 [13]). The hormonal control of male sexual behavior has been extensively studied. It is clear that steroid hormones, androgens and estrogens, act within the central nervous system, modifying neuronal excitability. The exact mechanism by which these hormones activate sex behavior remains largely unknown. However, there exists a considerable amount of knowledge concerning the brain structures important for sexual motivation and for the execution of sex behavior. The modulatory role of some non-steroid hormones is partly known, as well as the consequences of manipulations of several neurotransmitter systems.

  5. Empowering Young Black Males

    ERIC Educational Resources Information Center

    Kafele, Baruti K.

    2012-01-01

    Of all the challenges we face in education today, the author can think of none greater than the challenge of motivating, educating, and empowering black male learners. The fact that this group of students is in crisis is evident on multiple levels, starting with graduation rates. According to the Schott Foundation (2008), the U.S. high school…

  6. Moi bans female circumcision.

    PubMed

    Nakalema, R

    1990-06-01

    A recent survey by the Inter-African Committee for Traditional Practices Affecting the Health of Women and Children found that 75-85 million women in Africa have undergone some form of female genital mutilation (FGM). FGM has long been practiced in Kenya. The ethnic groups which practice it, including the Kikuyu, Kamba, Kisii, Kalenjin, Maasai, and people of Somali origin, have a death rate of 170/1000 of their female populations. Approximately half of these deaths are the result of FGM, a practice which also contributes to the poor health of mutilated women. The adverse health consequences of FGM have led Kenya's President Daniel arap Moi to ban the practice in his country. In announcing the ban, President Moi advised Kenyans to discontinue cultural practices and customs which have no place in modern society and which will otherwise retard development. A number of prominent Kenyans have come forth in support of Moi's move.

  7. Nonparticipatory Stiffness in the Male Perioral Complex

    ERIC Educational Resources Information Center

    Chu, Shin-Ying; Barlow, Steven M.; Lee, Jaehoon

    2009-01-01

    Purpose: The objective of this study was to extend previous published findings in the authors' laboratory using a new automated technology to quantitatively characterize nonparticipatory perioral stiffness in healthy male adults. Method: Quantitative measures of perioral stiffness were sampled during a nonparticipatory task using a…

  8. Male facial anthropometry and attractiveness.

    PubMed

    Soler, Caries; Kekäläinen, Jukka; Núñez, Manuel; Sancho, María; Núñez, Javier; Yaber, Iván; Gutiérrez, Ricardo

    2012-01-01

    The symmetry and masculinity of the face are often considered important elements of male facial attractiveness. However, facial preferences are rarely studied on natural faces. We studied the effect of these traits and facial metric parameters on facial attractiveness in Spanish and Colombian raters. In total, 13 metric and 11 asymmetry parameters from natural, unmanipulated frontal face photographs of 50 Spanish men were measured with the USIA semiautomatic anthropometric software. All raters (women and men) were asked to rank these images as potential long-term partners for females. In both sexes, facial attractiveness was negatively associated with facial masculinity, and preference was not associated with facial symmetry. In Spanish raters, both sexes preferred male traits that were larger in the right side of the face, which may reflect a human tendency to prefer a certain degree of facial asymmetry. We did not find such preference in Colombian raters, but they did show stronger preference for facial femininity than Spanish raters. Present results suggest that facial relative femininity, which is expected to signal, eg good parenting and cooperation skills, may be an important signal of mate quality when females seek long-term partners. Facial symmetry appears unimportant in such long-term mating preferences.

  9. Female qualities in males: vitellogenin synthesis induced by ovary transplants into the male silkworm, Bombyx mori.

    PubMed

    Yang, Congwen; Lin, Ying; Shen, Guanwang; Chen, Enxiang; Wang, Yanxia; Luo, Juan; Zhang, Haiyan; Xing, Runmiao; Xia, Qingyou

    2014-10-10

    Female qualities in males are common in vertebrates but have not been extensively reported in insects. Vitellogenin (Vg) is highly expressed in the female fat body and is generally required for the formation of yolk proteins in the insect egg. Vg upregulation is generally regarded as a female quality in female oviparous animals. In this study, we found that Bombyx mori Vg (BmVg) is especially highly expressed in the female pupa. Downregulation of the BmVg gene in the female pupa by RNA interference (RNAi) interfered with egg formation and embryonic development, showing the importance of BmVg in these processes. So, we used BmVg as a biomarker for female qualities in the silkworm. Hematoxylin-eosin staining and immunofluorescence histochemistry showed that ovary transplants induced BmVg synthesis in the male pupa fat body. Ovaries transplanted into male silkworms produced only a few eggs with deformed yolk granules. These results suggested that the amount of BmVg in the male silkworm was insufficient for eggs to undergo complete embryonic development. After 17-beta-estradiol was used to treat male pupae and male pupal fat bodies, BmVg was upregulated in vivo and in vitro. These findings indicated that the male silkworm has innate female qualities that were induced by a transplanted ovary and 17β-estradiol. However, in silkworms, female qualities in males are not as complete as in females.

  10. Male Zuska's disease.

    PubMed

    Johnson, Shepard P; Kaoutzanis, Christodoulos; Schaub, George A

    2014-04-04

    Subareolar abscess of the male breast is a rare condition, which can be complicated by a fistula from the areolar skin into a lactiferous duct. In 1951, Zuska et al first characterised this entity in women. Literature on mammillary fistulas in men is scarce and therefore standardisation of treatment does not exist. We present two cases of recurrent subareolar abscesses with draining fistulas. Both patients were successfully treated by complete excision of the lactiferous duct fistula, and continue to do well with no evidence of disease recurrence. When male patients present with a draining subareolar abscess, one should have a high index of suspicion for a mammillary fistula. Failure to identify and surgically excise the fistula may lead to recurrence of the abscess and prolonged morbidity. The most effective management of this uncommon entity includes complete excision of the lactiferous duct fistula.

  11. Male Genital Lichen Sclerosus

    PubMed Central

    Bunker, Christopher Barry; Shim, Tang Ngee

    2015-01-01

    Male genital lichen sclerosus (MGLSc) is a chronic inflammatory skin disease responsible for male sexual dyspareunia and urological morbidity. An afeared complication is squamous cell carcinoma (SCC) of the penis. The precise etiopathogenesis of MGLSc remains controversial although genetic, autoimmune and infective (such as human papillomavirus (HPV) hepatitis C (HCV), Epstein-Barr virus (EBV) and Borrelia) factors have been implicated: Consideration of all the evidence suggests that chronic exposure of susceptible epithelium to urinary occlusion by the foreskin seems the most likely pathomechanism. The mainstay of treatment is topical ultrapotent corticosteroid therapy. Surgery is indicated for cases unresponsive to topical corticosteroid therapy, phimosis, meatal stenosis, urethral stricture, carcinoma in situ (CIS) and squamous cell carcinoma. PMID:25814697

  12. Leiomyosarcoma: computed tomographic findings

    SciTech Connect

    McLeod, A.J.; Zornoza, J.; Shirkhoda, A.

    1984-07-01

    The computed tomographic (CT) findings in 118 patients with the diagnosis of leiomyosarcoma were reviewed. The tumor masses visualized in these patients were often quite large; extensive necrotic or cystic change was a frequent finding. Calcification was not observed in these tumors. The liver was the most common site of metastasis in these patients, with marked necrosis of the liver lesions a common finding. Other manifestations of tumor spread included pulmonary metastases, mesenteric or omental metastases, retroperitoneal lymphadenopathy, soft-tissue metastases, bone metastases, splenic metastases, and ascites. Although the CT appearance of leiomyosarcoma is not specific, these findings, when present, suggest consideration of this diagnosis.

  13. Male only Systemic Lupus

    PubMed Central

    Aggarwal, Rachna; Namjou, Bahram; Li, Shibo; D'Souza, Anil; Tsao, Betty P; Bruner, Ben; James, Judith A.; Scofield, R. Hal

    2010-01-01

    Systemic lupus erythematosus (SLE) is more common among women than men with a ratio of about 10 to 1. We undertook this study to describe familial male SLE within a large cohort of familial SLE. SLE families (two or more patients) were obtained from the Lupus Multiplex Registry and Repository. Genomic DNA and blood samples were obtained using standard methods. Autoantibodies were determined by multiple methods. Medical records were abstracted for SLE clinical data. Fluorescent in situ hybridization (FISH) was performed with X and Y centromere specific probes, and a probe specific for the toll-like receptor 7 gene on the X chromosome. Among 523 SLE families, we found five families in which all the SLE patients were male. FISH found no yaa gene equivalent in these families. SLE-unaffected primary female relatives from the five families with only-male SLE patients had a statistically increased rate of positive ANA compared to SLE-unaffected female relatives in other families. White men with SLE were 5 times more likely to have an offspring with SLE than were White women with SLE but there was no difference in this likelihood among Black men. These data suggest genetic susceptibility factors that act only in men. PMID:20472921

  14. Adolescent male health

    PubMed Central

    Westwood, Michael; Pinzon, Jorge

    2008-01-01

    Although adolescent males have as many health issues and concerns as adolescent females, they are much less likely to be seen in a clinical setting. This is related to both individual factors and the health care system itself, which is not always encouraging and set up to provide comprehensive male health care. Working with adolescent boys involves gaining the knowledge and skills to address concerns such as puberty and sexuality, substance use, violence, risk-taking behaviours and mental health issues. The ability to engage the young male patient is critical, and the professional must be comfortable in initiating conversation about a wide array of topics with the teen boy, who may be reluctant to discuss his concerns. It is important to take every opportunity with adolescent boys to talk about issues beyond the presenting complain, and let them know about confidential care. The physician can educate teens about the importance of regular checkups, and that they are welcome to contact the physician if they are experiencing any concerns about their health or well-being. Parents of preadolescent and adolescent boys should be educated on the value of regular health maintenance visits for their sons beginning in their early teen years. PMID:19119350

  15. Melatonin and male reproduction.

    PubMed

    Li, Chunjin; Zhou, Xu

    2015-06-15

    Melatonin is a neurohormone secreted by the pineal gland whose concentrations in the body are regulated by both the dark-light and seasonal cycles. The reproductive function of seasonal breeding animals is clearly influenced by the circadian variation in melatonin levels. Moreover, a growing body of evidence indicates that melatonin has important effects in the reproduction of some non-seasonal breeding animals. In males, melatonin affects reproductive regulation in three main ways. First, it regulates the secretion of two key neurohormones, GnRH and LH. Second, it regulates testosterone synthesis and testicular maturation. Third, as a potent free radical scavenger that is both lipophilic and hydrophilic, it prevents testicular damage caused by environmental toxins or inflammation. This review summarizes the existing data on the possible biological roles of melatonin in male reproduction. Overall, the literature data indicate that melatonin affects the secretion of both gonadotropins and testosterone while also improving sperm quality. This implies that it has important effects on the regulation of testicular development and male reproduction.

  16. What Does Gender Have To Do with It? (Male Teachers in Early Childhood Education).

    ERIC Educational Resources Information Center

    Rodriguez, Edwin

    The role of male teachers in early childhood education can be examined from many perspectives, including the need for male teachers, advantages and disadvantages of being a male in the profession, or why there are not more of them. In order to find out what male teachers think about teaching at the early childhood level, a survey consisting of 26…

  17. Male genital leiomyomas showing androgen receptor expression.

    PubMed

    Suárez-Peñaranda, José Manuel; Vieites, Begoña; Evgenyeva, Elena; Vázquez-Veiga, Hugo; Forteza, Jeronimo

    2007-12-01

    Genital leiomyoma in men include those superficial leiomyomas arising in the scrotum and the areola. They are unusual neoplasms: few cases have been reported in the literature and they usually escape clinical diagnosis. Three cases of male genital leiomyomas are reported: two in the scrotum and one in the areola. They were all conservatively excised and the behaviour was completely benign in all cases. Histopathological examination showed the typical findings of superficial leiomyomas, with some minor differences between cases arising in the scrotum and those from the areola. Immunohistochemical findings not only confirmed the smooth muscle nature of all cases but also showed unequivocal immunostaining for androgen receptors in the leiomyomas from the scrotum. Immunostaining for androgen receptors in scrotal leiomyomas is, as far as we are aware, a previously unknown characteristic of male genital leiomyomas. This finding supports the role of steroid hormones in the growth of genital leiomyomas, similar to leiomyomas found in other locations.

  18. Sexual maturation and aging of adult male mealybug (Hemiptera: Pseudococcidae).

    PubMed

    Mendel, Z; Protasov, A; Jasrotia, P; Silva, E B; Zada, A; Franco, J C

    2012-08-01

    The physiological age of adult males of seven mealybug species was measured in relation to the elongation of the male pair of the waxy caudal filaments. These filaments begin to emerge after eclosion and reached their maximum length from 29.4-46.6 h. The studied males were divided into three age groups, expressed as percentages of the total waxy caudal filaments length. Attraction to a sex pheromone source was significantly higher in the oldest male group (maximum filaments growth) compared with youngest one. Only the oldest male group copulated successfully; few of the younger males tested displayed 'courtship' behavior towards conspecific virgin females. The calculated duration of the sexually active phase of the adult male life cycle varied among species ranging from 34.4 to 46.6 h. There were marked variations in the strength of attraction to a pheromone source according to time of day. There was a continuous decrease in sexual activity from morning to evening. Our findings reveal clear maturation periods for adult males of the seven studied species. The long immature phase of the adult male mealybug is probably also related to several physiological processes that are needed to complete male maturation. The most noticeable change is the elongation of the waxy caudal filaments. However, mating may be performed at any time ambient conditions are suitable. Whereas male mealybug flight towards a pheromone source is restricted to a few hours, the male may continue mating activity throughout its sexually active period.

  19. Endocrinological correlates of male bimaturism in wild Bornean orangutans.

    PubMed

    Marty, Pascal R; van Noordwijk, Maria A; Heistermann, Michael; Willems, Erik P; Dunkel, Lynda P; Cadilek, Manuela; Agil, Muhammad; Weingrill, Tony

    2015-11-01

    Among primates, orangutans are unique in having pronounced male bimaturism leading to two fully adult morphs that differ in both physical appearance and behavior. While unflanged males have a female-like appearance, flanged males have the full suite of secondary sexual characteristics, including cheek flanges and a large throat sac. So far, hormonal correlates of arrested development in unflanged males and the expression of secondary sexual characteristics in flanged males have only been studied in zoo-housed individuals. In this study, we investigated fecal androgen and glucocorticoid metabolites as hormonal correlates of male bimaturism in 17 wild adult Bornean orangutans (Pongo pygmaeus) in Central Kalimantan, Indonesia. We predicted and found higher androgen levels in flanged males compared to unflanged males, probably due to ongoing strong competition among flanged males who meet too infrequently to establish a clear linear dominance hierarchy. Furthermore, we found no difference in fecal glucocorticoid metabolite concentrations between flanged and unflanged males, indicating that social stress is unlikely to explain arrested development in unflanged wild orangutans. The only actively developing male in our study showed significantly higher androgen levels during the period of development than later as a fully flanged male. This supports earlier findings from zoo studies that elevated androgen levels are associated with the development of secondary sexual characteristics.

  20. Find a Midwife

    MedlinePlus

    ... The Find a Midwife practice locator is a web-based service that allows you to find midwifery practices in your area. It also supplies you with basic contact information like practice name, address, phone number, e-mail address, web site and a map of the area. If ...

  1. Predictors of dominance in male Betta splendens.

    PubMed

    Bronstein, P M

    1985-03-01

    The formation of dominance/subordinancy relations in pairs of male Siamese fighting fish was examined in six experiments. Dominant animals typically were those fish that built the largest nests and that attacked an image of a live, displaying male most intensely prior to combat. However, pretest performance on an operant task and reaction to an animal's own mirror image were not useful predictors of subsequent dominance. These findings are consistent with the suggestion that domesticated Bettas have a territorial social strategy that includes both nest-building and fighting behaviors.

  2. Hate crimes against gay males: an overview.

    PubMed

    Willis, Danny G

    2004-03-01

    As the United States has become more multicultural and diverse, there has been an increase in violence motivated by hate. Hate crimes against gay males are the most prevalent of the hate crimes based on sexual orientation. Hate crimes have their roots in normative, individual, and societal attitudes and ideologies that lead to intimidation, bullying, teasing, physical assault, rape, and murder. This paper provides an overview of the issues specific to hate crime assaults against gay males. Mental health nurses may find this knowledge useful in developing further nursing inquiry, education, and clinical practice related to hate crime and violence prevention.

  3. Causes of Male Infertility

    MedlinePlus

    ... Info Booklets FAQs Educational Videos State Infertility Insurance Laws Infographic Gallery Protect Your Fertility Infertility and Smoking Cessation Resources Overview Find a Healthcare Professional Fact ...

  4. Male Scientists’ Competing Devotions to Work and Family: Changing Norms in a Male-Dominated Profession

    PubMed Central

    Damaske, Sarah; Ecklund, Elaine Howard; Lincoln, Anne E.; White, Virginia Johnston

    2014-01-01

    Using in-depth interviews with 74 men across different ranks in biology and physics at prestigious US universities, we ask to what extent changing norms of fatherhood and a flexible workplace affect men working in a highly male-dominated profession and what variation exists in family forms. We conceptualize four typologies of men: those forgoing children, egalitarian partners, neo-traditional dual-earners, and traditional breadwinners. Findings suggest male scientists hold strong work devotions yet a growing number seek egalitarian relationships, which they frame as reducing their devotion to work. The majority of men find the all-consuming nature of academic science conflicts with changing fatherhood norms. PMID:25419040

  5. Old-male paternity advantage is a function of accumulating sperm and last-male precedence in a butterfly.

    PubMed

    Kehl, Tobias; Karl, Isabell; Fischer, Klaus

    2013-08-01

    Old-male mating advantage has been convincingly demonstrated in Bicyclus anynana butterflies. This intriguing pattern may be explained by two alternative hypotheses: (i) an increased aggressiveness and persistence of older males during courtship, being caused by the older males' low residual reproductive value; and (ii) an active preference of females towards older males what reflects a good genes hypothesis. Against this background, we here investigate postcopulatory sexual selection by double-mating Bicyclus anynana females to older and younger males, thus allowing for sperm competition and cryptic mate choice, and by genotyping the resulting offspring. Virgin females were mated with a younger virgin (2-3 days old) and afterwards an older virgin male (12-13 days old) or vice versa. Older males had a higher paternity success than younger ones, but only when being the second (=last) mating partner, while paternity success was equal among older and younger males when older males were the first mating partner. Older males produced larger spermatophores with much higher numbers of fertile sperm than younger males. Thus, we found no evidence for cryptic female mate choice. Rather, the findings reported here seem to result from a combination of last-male precedence and the number of sperm transferred upon mating, both increasing paternity success.

  6. Anorexia Nervosa: A Misdiagnosis of the Adolescent Male.

    ERIC Educational Resources Information Center

    Svec, Henry

    1987-01-01

    Discusses rarity of anorexia nervosa among male population with primary reference to differences from female symptomatology. Presents case which implies that anorexia nervosa in the male may be a marker for other more severe pathology. Presents findings which suggest a diagnostic strategy based on familial, behavioral, environmental, educational,…

  7. Modeling Manhood: Reimagining Black Male Identities in School

    ERIC Educational Resources Information Center

    Givens, Jarvis R.; Nasir, Na'ilah; ross, kihana; de Royston, Maxine McKinney

    2016-01-01

    This paper examines the process by which stereotypical mainstream representations of black males (as hard, as anti-school, and as disconnected from the domestic sphere) were reimagined in all-black, all-male manhood development classes for 9th graders in urban public high schools. Findings show that instructors debunked stereotypes and created new…

  8. HIV and Young Male Street Prostitutes: A Brief Report.

    ERIC Educational Resources Information Center

    Simon, Patricia M.; And Others

    1994-01-01

    Examined human immunodeficiency virus (HIV) seroprevalence data for young male street prostitutes. Examined sociodemographic characteristics, substance use patterns, HIV-related risk behaviors, and Acquired Immune Deficiency Syndrome knowledge as potential correlates to HIV status. Findings suggest that adolescent male prostitutes are exposed to…

  9. Body Image Disorder in Adolescent Males: Strategies for School Counselors

    ERIC Educational Resources Information Center

    Stout, Eric J.; Frame, Marsha Wiggins

    2004-01-01

    In recent decades, men have been bombarded with images in society that depict the "ideal" male: strong, muscular, lean, with perfect features. What many adolescents do not realize is that most of the male bodies that they idealize can be acquired only with the use of anabolic steroids. Thus, many adolescent boys find themselves pursuing a body…

  10. Find an Audiologist

    MedlinePlus

    ... Back | Close Find an Audiologist | Search Search By City/State City State/Territory: (Non U.S.) AA AB AE AK ... Heard and Mc Donald Islands Holy see (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia ...

  11. Find a Massage Therapist

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    ... for Massage Therapists Ethics Research Business Master the Classroom for Massage Educators Career Guidance Career Guidance Make ... a Massage Therapist » Browse by location » Browse by technique » Find a massage therapy school Proprietary Information and ...

  12. Find a Doctor

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  13. Find an Endocrinologist

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    ... Disorders Women's Health 5-Digit Zip Code Search Radius 10 miles 25 miles 50 miles Country ALBANIA ... Health Network is supported by network sponsors. Contact a Health Professional What is an Endocrinologist? Endocrinology Find ...

  14. Find a Dermatologist

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    ... in Dermatology™ Excellence in Dermatologic Surgery™ Excellence in Medical Dermatology™ Excellence in Dermatopathology™ Donate Search Menu Donate Member Resources & Programs Practice Tools Education Meetings & Events Advocacy Public & Patients Find a ...

  15. Find a Periodontist

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    ... Search Find a Periodontist - Advanced Search U.S. Zip Code Search The best way to locate periodontists in your area is to enter your zip code and select a maximum acceptable driving distance below. ...

  16. Find a Doctor

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  17. Find a Dentist

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    ... information you need from the Academy of General Dentistry Sunday, April 9, 2017 About | Contact Find an ... more. Disclaimer of Liabilities The Academy of General Dentistry's (AGD) Web site provides a listing of members ...

  18. Pheromone evolution and sexual behavior in Drosophila are shaped by male sensory exploitation of other males

    PubMed Central

    Ng, Soon Hwee; Shankar, Shruti; Shikichi, Yasumasa; Akasaka, Kazuaki; Mori, Kenji; Yew, Joanne Y.

    2014-01-01

    Animals exhibit a spectacular array of traits to attract mates. Understanding the evolutionary origins of sexual features and preferences is a fundamental problem in evolutionary biology, and the mechanisms remain highly controversial. In some species, females choose mates based on direct benefits conferred by the male to the female and her offspring. Thus, female preferences are thought to originate and coevolve with male traits. In contrast, sensory exploitation occurs when expression of a male trait takes advantage of preexisting sensory biases in females. Here, we document in Drosophila a previously unidentified example of sensory exploitation of males by other males through the use of the sex pheromone CH503. We use mass spectrometry, high-performance liquid chromatography, and behavioral analysis to demonstrate that an antiaphrodisiac produced by males of the melanogaster subgroup also is effective in distant Drosophila relatives that do not express the pheromone. We further show that species that produce the pheromone have become less sensitive to the compound, illustrating that sensory adaptation occurs after sensory exploitation. Our findings provide a mechanism for the origin of a sex pheromone and show that sensory exploitation changes male sexual behavior over evolutionary time. PMID:24516141

  19. [Orchitis and male infertility].

    PubMed

    Schuppe, H-C; Pilatz, A; Hossain, H; Meinhardt, A; Bergmann, M; Haidl, G; Weidner, W

    2010-05-01

    Infections and inflammations of the genital tract are considered the most frequent causes of reduced male fertility, but conclusive epidemiological data are not available. In view of the exposure of germ cells to pathogenic components as well as the cells and mediators involved in the inflammatory processes, irreversible damage to spermatogenesis and corresponding decline of ejaculate quality are to be expected, particularly in cases of chronic orchitis. While the consequences of orchitis and epididymo-orchitis that exhibit clinical symptoms due to systemic or local infections are well known, including testicular atrophy and complete loss of fertility, those cases of inflammatory reactions of the testicles that manifest an asymptomatic or subclinical course, or are not even due to an infection, have received little attention until now. However, systematic histopathological analyses have shown a high prevalence of asymptomatic inflammatory reactions in testicular biopsies from infertile men. The mostly focal lymphocytic infiltrates correlate with the degree of damage to spermatogenesis and corresponding clinical and endocrinological parameters of testicular function. Noninvasive diagnostic techniques are not yet available so that chronic asymptomatic inflammations of the testicles as the primary cause or cofactor of male fertility disorders are underestimated. Except for administration of pathogen-specific antibiotics, treatment recommendations are to a large extent still lacking.

  20. Male hormonal contraceptives.

    PubMed

    Amory, J K

    2006-06-01

    Efforts are underway to develop additional forms of contraception for men. The most promising approach to male contraceptive development involves the administration of exogenous testosterone (T). When administered to a man, T functions as a contraceptive by suppressing the secretion of luteinizing hormone and follicle-stimulating hormone from the pituitary, thereby depriving the testes of the signals required for spermatogenesis. After 2-3 months of treatment, low levels of these gonadotropins lead to markedly decreased sperm counts and effective contraception in a majority of men. Hormonal contraception with exogenous T has proven to be free from serious adverse effects and is well tolerated by men. In addition, sperm counts uniformly normalize when the exogenous T is discontinued. Thus, male hormonal is safe, effective and reversible; however, spermatogenesis is not suppressed to zero in all men, meaning that some diminished potential for fertility persists. Because of this recent studies have combined T with progestogens and/or gonadotropin-releasing antagonists to further suppress pituitary gonadotropins and optimize contraceptive efficacy. Current combinations of T and progestogens completely suppress spermatogenesis without severe side effects in 80-90% of men, with significant suppression in the remainder of individuals. Recent trials with newer, long-acting forms of injectable T, which can be administered every 8 weeks, combined with progestogens, administered either orally or by long-acting implant, have yielded promising results and may soon result in the marketing of a safe, reversible and effective hormonal contraceptive for men.

  1. Finding Prospective Mates by the Parasitoid Wasp Urolepis rufipes (Hymenoptera: Pteromalidae).

    PubMed

    Wittman, T N; Miller, K A; King, B H

    2016-10-05

    Cues from emergence sites may be predictive of mating opportunities if potential mates are slow to disperse after emergence, and particularly if emergence sites are clumped, as in the solitary parasitoid wasp Urolepis rufipes Ashmead. Males emerge before females, and the present study suggests that males may use emergence sites of conspecific males to locate mates. In choice experiments, virgin males spent more time on a male-emerged host (a host from which a male had recently emerged) than on a female-emerged host. Relative to when no host was present, virgin males also marked more in the presence of a male-emerged host, but did not mark more in the presence of a female-emerged host. Females, but not other males, are known to be attracted to male marks. Unlike for males, there was no evidence that females distinguished between male-emerged and female-emerged hosts. Virgin females preferred areas where multiple males had marked over areas where a single male had marked. Such areas had more total marks, yet marks per male did not differ between aggregated and solitary males. Thus, through his own attraction to male-emerged hosts and by marking near other males a male may find and attract females, and with no apparent increase in the cost of attraction.

  2. Finding Prospective Mates by the Parasitoid Wasp Urolepis rufipes (Hymenoptera: Pteromalidae).

    PubMed

    Wittman, T N; Miller, K A; King, B H

    2016-12-01

    Cues from emergence sites may be predictive of mating opportunities if potential mates are slow to disperse after emergence, and particularly if emergence sites are clumped, as in the solitary parasitoid wasp Urolepis rufipes Ashmead. Males emerge before females, and the present study suggests that males may use emergence sites of conspecific males to locate mates. In choice experiments, virgin males spent more time on a male-emerged host (a host from which a male had recently emerged) than on a female-emerged host. Relative to when no host was present, virgin males also marked more in the presence of a male-emerged host, but did not mark more in the presence of a female-emerged host. Females, but not other males, are known to be attracted to male marks. Unlike for males, there was no evidence that females distinguished between male-emerged and female-emerged hosts. Virgin females preferred areas where multiple males had marked over areas where a single male had marked. Such areas had more total marks, yet marks per male did not differ between aggregated and solitary males. Thus, through his own attraction to male-emerged hosts and by marking near other males a male may find and attract females, and with no apparent increase in the cost of attraction.

  3. Male androphilia in the ancestral environment. An ethnological analysis.

    PubMed

    VanderLaan, Doug P; Ren, Zhiyuan; Vasey, Paul L

    2013-12-01

    The kin selection hypothesis posits that male androphilia (male sexual attraction to adult males) evolved because androphilic males invest more in kin, thereby enhancing inclusive fitness. Increased kin-directed altruism has been repeatedly documented among a population of transgendered androphilic males, but never among androphilic males in other cultures who adopt gender identities as men. Thus, the kin selection hypothesis may be viable if male androphilia was expressed in the transgendered form in the ancestral past. Using the Standard Cross-Cultural Sample (SCCS), we examined 46 societies in which male androphilia was expressed in the transgendered form (transgendered societies) and 146 comparison societies (non-transgendered societies). We analyzed SCCS variables pertaining to ancestral sociocultural conditions, access to kin, and societal reactions to homosexuality. Our results show that ancestral sociocultural conditions and bilateral and double descent systems were more common in transgendered than in non-transgendered societies. Across the entire sample, descent systems and residence patterns that would presumably facilitate increased access to kin were associated with the presence of ancestral sociocultural conditions. Among transgendered societies, negative societal attitudes toward homosexuality were unlikely. We conclude that the ancestral human sociocultural environment was likely conducive to the expression of the transgendered form of male androphilia. Descent systems, residence patterns, and societal reactions to homosexuality likely facilitated investments in kin by transgendered males. Given that contemporary transgendered male androphiles appear to exhibit elevated kin-directed altruism, these findings further indicate the viability of the kin selection hypothesis.

  4. X-linked stapes gusher: CT findings in one patient.

    PubMed

    Kumar, Gaurav; Castillo, Mauricio; Buchman, Craig A

    2003-01-01

    A 31-year-old male patient presented with progressive mixed hearing loss since birth. A stapedectomy was attempted and was unsuccessful because of perilymph gushing. CT of the temporal bones showed bulbous dilatation of the fundi of the internal auditory canals and absence of the bone plates separating them from the base of the cochleas. This unusual abnormality was found after the attempted stapedectomy and explains the clinical findings. The findings in male patients are fairly typical X-linked congenital deafness.

  5. Mitochondria, maternal inheritance, and male aging.

    PubMed

    Camus, M Florencia; Clancy, David J; Dowling, Damian K

    2012-09-25

    The maternal transmission of mitochondrial genomes invokes a sex-specific selective sieve, whereby mutations in mitochondrial DNA can only respond to selection acting directly on females. In theory, this enables male-harming mutations to accumulate in mitochondrial genomes when these same mutations are neutral, beneficial, or only slightly deleterious in their effects on females. Ultimately, this evolutionary process could result in the evolution of male-specific mitochondrial mutation loads; an idea previously termed Mother's Curse. Here, we present evidence that the effects of this process are broader than hitherto realized, and that it has resulted in mutation loads affecting patterns of aging in male, but not female Drosophila melanogaster. Furthermore, our results indicate that the mitochondrial mutation loads affecting male aging generally comprise numerous mutations over multiple sites. Our findings thus suggest that males are subject to dramatic consequences that result from the maternal transmission of mitochondrial genomes. They implicate the diminutive mitochondrial genome as a hotspot for mutations that affect sex-specific patterns of aging, thus promoting the idea that a sex-specific selective sieve in mitochondrial genome evolution is a contributing factor to sexual dimorphism in aging, commonly observed across species.

  6. Male Mosquitoes as Vehicles for Insecticide

    PubMed Central

    Mains, James W.; Brelsfoard, Corey L.; Dobson, Stephen L.

    2015-01-01

    Background The auto-dissemination approach has been shown effective at treating cryptic refugia that remain unaffected by existing mosquito control methods. This approach relies on adult mosquito behavior to spread larvicide to breeding sites at levels that are lethal to immature mosquitoes. Prior studies demonstrate that ‘dissemination stations,’ deployed in mosquito-infested areas, can contaminate adult mosquitoes, which subsequently deliver the larvicide to breeding sites. In some situations, however, preventative measures are needed, e.g., to mitigate seasonal population increases. Here we examine a novel approach that combines elements of autocidal and auto-dissemination strategies by releasing artificially reared, male mosquitoes that are contaminated with an insecticide. Methodology Laboratory and field experiments examine for model-predicted impacts of pyriproxyfen (PPF) directly applied to adult male Aedes albopictus, including (1) the ability of PPF-treated males to cross-contaminate females and to (2) deliver PPF to breeding sites. Principal Findings Similar survivorship was observed in comparisons of PPF-treated and untreated males. Males contaminated both female adults and oviposition containers in field cage tests, at levels that eliminated immature survivorship. Field trials demonstrate an ability of PPF-treated males to transmit lethal doses to introduced oviposition containers, both in the presence and absence of indigenous females. A decline in the Ae. albopictus population was observed following the introduction of PPF-treated males, which was not observed in two untreated field sites. Conclusions/Significance The results demonstrate that, in cage and open field trials, adult male Ae. albopictus can tolerate PPF and contaminate, either directly or indirectly, adult females and immature breeding sites. The results support additional development of the proposed approach, in which male mosquitoes act as vehicles for insecticide delivery

  7. Field performance of engineered male mosquitoes.

    PubMed

    Harris, Angela F; Nimmo, Derric; McKemey, Andrew R; Kelly, Nick; Scaife, Sarah; Donnelly, Christl A; Beech, Camilla; Petrie, William D; Alphey, Luke

    2011-10-30

    Dengue is the most medically important arthropod-borne viral disease, with 50-100 million cases reported annually worldwide. As no licensed vaccine or dedicated therapy exists for dengue, the most promising strategies to control the disease involve targeting the predominant mosquito vector, Aedes aegypti. However, the current methods to do this are inadequate. Various approaches involving genetically engineered mosquitoes have been proposed, including the release of transgenic sterile males. However, the ability of laboratory-reared, engineered male mosquitoes to effectively compete with wild males in terms of finding and mating with wild females, which is critical to the success of these strategies, has remained untested. We report data from the first open-field trial involving a strain of engineered mosquito. We demonstrated that genetically modified male mosquitoes, released across 10 hectares for a 4-week period, mated successfully with wild females and fertilized their eggs. These findings suggest the feasibility of this technology to control dengue by suppressing field populations of A. aegypti.

  8. Flunitrazepam intake in male offenders.

    PubMed

    Dåderman, Anna M; Edman, Gunnar; Meurling, Ann Wirsén; Levander, Sten; Kristiansson, Marianne

    2012-04-01

    The abuse of flunitrazepam (FZ) compounds is worldwide, and several studies have reflected on the consequences with regard to violence, aggression and criminal lifestyle of FZ users. Criminals take high doses of FZ or some other benzodiazepines to "calm down" before the planned crime. There is support from earlier studies that most likely, all benzodiazepines may increase aggression in vulnerable males. Chronic intake of high doses of FZ increases aggression in male rats. Because psychopathy involves aggression, we have examined whether psychopathy as well as any of the four facets of the Psychopathy Checklist-Revised (PCL-R) (Interpersonal, Affective, Lifestyle and Antisocial) are related to different substance use disorders, with the focus on FZ. We have also examined the relationship between each PCL-R item and FZ use. Participants were 114 male offenders aged 14-35 years, all of whom were convicted for severe, predominantly violent, offences. Substance use, including FZ, was not more common in those who scored high in psychopathy. Use of FZ was more common in offenders who scored high in Facet 4 (Antisocial) of the PCL-R (odds ratio = 4.30, 95% CI 1.86-9.94). Only one of the PCL-R items, "Criminal versatility", was significantly associated with FZ use (odds ratio = 3.7). It may be concluded that intake of FZ has a specific relationship to only one of the facets and not to psychopathy per se. The findings have also important theoretical implications because Facet 4 is not a key factor of the construct of psychopathy. Clinical implications of the article: We have used the new two-factor and four-facet theoretical model of psychopathy in the young offender population, many of them with one or more substance use disorders. The present results suggest that antisocial behavior defined by Facet 4 (poor behavioral control, early behavior problems, juvenile delinquency, revocation of conditional release and criminal versatility) in the studied subjects is more typical

  9. Pathological findings in homocystinuria

    PubMed Central

    Gibson, J. B.; Carson, Nina A. J.; Neill, D. W.

    1964-01-01

    Pathological findings are described in four cases of a new aminoaciduria in which homocystine is excreted in the urine. All the patients were mentally retarded children. Three of them presented diagnostic features of Marfan's syndrome. Necropsy on one case and biopsy findings in the others are described. Fatty change occurs in the liver. The most striking lesions are vascular. Metachromatic medial degeneration of the aorta and of the elastic arteries in the necropsied case are considered in relation to Marfan's syndrome. Other changes, particularly thrombosis which is prevalent in homocystinuria, suggest the possibility of a platelet defect. The findings are discussed in respect of an upset in the metabolism of sulphur-containing amino-acids and with particular reference to Marfan's syndrome. Images PMID:14195630

  10. Mobious syndrome: MR findings

    PubMed Central

    Srinivas, Maskal Revanna; Vaishali, Dhulappa Mudabasappagol; Vedaraju, Kadaba Shamachar; Nagaraj, Bangalore Rangaswamy

    2016-01-01

    Möbius syndrome is an extremely rare congenital disorder. We report a case of Möbius syndrome in a 2-year-old girl with bilateral convergent squint and left-sided facial weakness. The characteristic magnetic resonance imaging (MRI) findings of Möbius syndrome, which include absent bilateral abducens nerves and absent left facial nerve, were noted. In addition, there was absence of left anterior inferior cerebellar artery (AICA) and absence of bilateral facial colliculi. Clinical features, etiology, and imaging findings are discussed. PMID:28104946

  11. Meiosis in male Drosophila

    PubMed Central

    McKee, Bruce D.; Yan, Rihui; Tsai, Jui-He

    2012-01-01

    Meiosis entails sorting and separating both homologous and sister chromatids. The mechanisms for connecting sister chromatids and homologs during meiosis are highly conserved and include specialized forms of the cohesin complex and a tightly regulated homolog synapsis/recombination pathway designed to yield regular crossovers between homologous chromatids. Drosophila male meiosis is of special interest because it dispenses with large segments of the standard meiotic script, particularly recombination, synapsis and the associated structures. Instead, Drosophila relies on a unique protein complex composed of at least two novel proteins, SNM and MNM, to provide stable connections between homologs during meiosis I. Sister chromatid cohesion in Drosophila is mediated by cohesins, ring-shaped complexes that entrap sister chromatids. However, unlike other eukaryotes Drosophila does not rely on the highly conserved Rec8 cohesin in meiosis, but instead utilizes two novel cohesion proteins, ORD and SOLO, which interact with the SMC1/3 cohesin components in providing meiotic cohesion. PMID:23087836

  12. Early-Life Social Isolation Influences Mouse Ultrasonic Vocalizations during Male-Male Social Encounters

    PubMed Central

    Finton, Caitlyn J.; Sell, Gabrielle L.; Hurley, Laura M.

    2017-01-01

    Early-life social isolation has profound effects on adult social competence. This is often expressed as increased aggression or inappropriate displays of courtship-related behaviors. The social incompetence exhibited by isolated animals could be in part due to an altered ability to participate in communicatory exchanges. House mice (Mus musculus) present an excellent model for exploring this idea, because social isolation has a well-established influence on their social behavior, and mice engage in communication via multiple sensory modalities. Here, we tested the prediction that social isolation during early life would influence ultrasonic vocalizations (USVs) emitted by adult male mice during same-sex social encounters. Starting at three weeks of age, male mice were housed individually or in social groups of four males for five weeks, after which they were placed in one of three types of paired social encounters. Pair types consisted of: two individually housed males, two socially housed males, or an individually housed and a socially housed male (“mixed” pairs). Vocal behavior (USVs) and non-vocal behaviors were recorded from these 15-minute social interactions. Pairs of mice consisting of at least one individually housed male emitted more and longer USVs, with a greater proportional use of USVs containing frequency jumps and 50-kHz components. Individually housed males in the mixed social pairs exhibited increased levels of mounting behavior towards the socially housed males. Mounting in these pairs was positively correlated with increased number and duration of USVs as well as increased proportional use of spectrally more complex USVs. These findings demonstrate that USVs are part of the suite of social behaviors influenced by early-life social isolation, and suggest that altered vocal communication following isolation reflects reduced social competence. PMID:28056078

  13. Sport and male sexuality.

    PubMed

    Sgrò, P; Di Luigi, L

    2017-03-22

    The relationships between sport and sexuality in males are of great social and clinical interest, because of sports and motor activities that highly promote social and sexual relationships. Even if few literature exist, two main questions should be taken into account: whether and how physical exercise and sport positively or negatively influence sexual health and behavior and/or whether and how sexual behavior may affect a sub-sequent sport performance. Physical exercise and sport per se can influence, positively or negatively, the hypothalamic-pituitary-testicular axis function and, consequently, the individual's reproductive and/or sexual health. This depends on individual factors such as genetic and epigenetic ones and on different variables involved in the practice of sport activities (type of sport, intensity and duration of training, doping and drug use and abuse, nutrition, supplements, psychological stress, allostatic load, etc.). If well conducted, motor and sport activities could have beneficial effects on sexual health in males. Among different lifestyle changes, influencing sexual health, regular physical activity is fundamental to antagonize the onset of erectile dysfunction (ED). However, competitive sport can lead both reproductive and/or sexual tract damages and dysfunctions, transient (genital pain, hypoesthesia of the genitalia, hypogonadism, DE, altered sexual drive, etc.) or permanent (hypogonadism, DE, etc.), by acting directly (traumas of the external genitalia, saddle-related disorders in cyclists, etc.) or indirectly (exercise-related hypogonadism, drug abuse, doping, stress, etc.). Sexual activities shortly performed before a sport competition could differently influence sport performance. Due to the few existing data, it is advisable to avoid an absolute pre-competition sexual abstinence.

  14. [Obesity and male fertility].

    PubMed

    Martini, Ana C; Molina, Rosa I; Ruiz, Rubén D; Fiol de Cuneo, Marta

    2012-01-01

    Obesity and male infertility have increased in the last decades; therefore, a possible association between these pathologies has been explored. Studies inform that obesity may affect fertility through different mechanisms, which alltogether could exert erectile dysfunction and/or sperm quality impairment. These include: 1) hypothalamic-pituitary-testicular (HPG) axis malfunction: obese hormonal profile is characterized by reduction of testosterone, gonadotrophins, SHBG and/or inhibin B concentrations (marker of Sertoli cells function) and hyperestrogenemy (consequence of aromatase overactivity ascribed to adipose tissue increase); 2) increased release of adipose-derived hormones: leptin increase could be responsible for some of the alterations on the HPG axis and could also exert direct deleterious effects on Leydig cells physiology, spermatogenesis and sperm function; 3) proinflammatory adipokines augmentation, higher scrotal temperature (due to fat accumulation in areas surrounding testes) and endocrine disruptors accumulation in adiposites, all of these responsible for the increase in testes oxidative stress and 4) sleep apnea, frequent in obese patients, suppresses the nocturnal testosterone rise needed for normal spermatogenesis. Finally, although controversial, all the above mentioned factors could comprise gametes quality; i.e. decrease sperm density and motility and increase DNA fragmentation, probably disturbing spermatogenesis and/or epididymal function. In summary, although obesity may impair male fertility by some/all of the described mechanisms, the fact is that only a small proportion of obese men are infertile, probably those genetically predisposed or morbidly obese. Nevertheless, it is likely that because the incidence of obesity is growing, the number of men with reduced fertility will increase as well.

  15. Finding the Common Ground.

    ERIC Educational Resources Information Center

    Wallace, Dawn

    1980-01-01

    Describes an attempt to combine secondary English instruction emphasizing United States literature with science and history by finding "common ground" between these disciplines in (1) the separation of truth from falsehood and (2) logical thinking. Biographies combined history and literature, and science fiction combined science and English;…

  16. Finding Their Identities

    ERIC Educational Resources Information Center

    Lum, Lydia

    2009-01-01

    Every time Dr. Larry Shinagawa teaches his "Introduction to Asian American Studies" course at the University of Maryland (UMD), College Park, he finds that 10 to 20 percent of his students are adoptees. Among other things, they hunger to better comprehend the social and political circumstances overseas leading to their adoption. In…

  17. Implementing Institutional Research Findings.

    ERIC Educational Resources Information Center

    Blai, Boris, Jr.

    Although many agree that institutional research in higher education has come of age and is accepted as a part of institutional management, great variations exist in the extent to which institutional research findings are synthesized and utilized in management decision-making. A number of reasons can be identified as accounting for this phenomenon,…

  18. Finding Those Missing Links

    ERIC Educational Resources Information Center

    Gunn, Holly

    2004-01-01

    In this article, the author stresses not to give up on a site when a URL returns an error message. Many web sites can be found by using strategies such as URL trimming, searching cached sites, site searching and searching the WayBack Machine. Methods and tips for finding web sites are contained within this article.

  19. Tooth Tutoring: The Findings.

    ERIC Educational Resources Information Center

    Cone, Richard; And Others

    Findings are reported on a three year cross-age tutoring program in which undergraduate dental hygiene students and college students from other disciplines trained upper elementary students to tutor younger students in the techniques of dental hygiene. Data includes pre-post scores on the Oral Hygiene Index of plaque for both experimental and…

  20. Finding Health Care Services

    Cancer.gov

    If you have been diagnosed with cancer, finding a doctor and treatment facility for your cancer care is an important step to getting the best treatment possible. Learn tips for choosing a doctor and treatment facility to manage your cancer care.

  1. Find a Therapist

    MedlinePlus

    ... Teens Treatment Tips for Parents and Caregivers Anxiety Disorders at School School Refusal Test Anxiety News and Research College Students Facts Find Help Tips National Stress Øut Day News and Research Resources Women Facts News and Research Pregnancy and Medication Postpartum ...

  2. Coalitions and male-male behavior in Alouatta palliata.

    PubMed

    Dias, Pedro Américo D; Rangel-Negrin, Ariadna; Veà, Joaquim J; Canales-Espinosa, Domingo

    2010-01-01

    Coalitions influence the establishment and maintenance of social relationships among males in primate species. In this study, we compare the social behavior of males between two groups of Alouatta palliata: a group that was recently taken over by a coalition of two males (Mt), and a group that had a stable composition for at least 9 months (Rh). We predicted that coalition partners would be more cooperative and less competitive than dyads formed by immigrant and long-term resident males, and dyads formed by long-term resident males. Additionally, we predicted that these dyadic trends should be reflected in more competition and less cooperation in the group that was taken over. As predicted, the coalition partners of Mt showed the highest levels of cooperation among all dyads and the second lowest rate of agonism. Cooperation was higher in the group that had a stable composition. Results from this study suggest that the social relationships of male mantled howlers vary as a function of familiarity between males and that in the context of coalitionary takeovers, coalitionary males are highly cooperative. Cooperation is lower in groups recently taken over and competition is more intense, perhaps as a consequence of the process of establishment and reorganization of power relationships within some dyads. In the future, we must determine the frequency of coalitionary takeovers in this population and assess its ultimate consequences for male-male social relationships.

  3. Effects of male social status on reproductive success and on behavior in mice (Mus musculus).

    PubMed

    D'Amato, F R

    1988-06-01

    Differences in reproduction as well as in behavior in the presence of females were evaluated according to dominant and subordinate male rank in albino mice, in the temporary absence of each male's antagonist. Dominant males reproduced more successfully than subordinate males. Subordinate males were generally inactive, except for displacement activities, during the first 15 min they were exposed to female partners. These findings suggest that mechanisms other than male-male interference or mating order may be operating or influencing behavior and reproductive results.

  4. Increasing Male Academic Achievement

    ERIC Educational Resources Information Center

    Jackson, Barbara Talbert

    2008-01-01

    The No Child Left Behind legislation has brought greater attention to the academic performance of American youth. Its emphasis on student achievement requires a closer analysis of assessment data by school districts. To address the findings, educators must seek strategies to remedy failing results. In a mid-Atlantic district of the Unites States,…

  5. Can too strong female choice deteriorate male ornamentation?

    PubMed Central

    Morrell, Lesley J.; Kokko, Hanna

    2004-01-01

    Competition for limited resources can have fundamental implications for population dynamics. However, the effects of resource depletion have rarely been discussed in the context of sexual selection, even though mate choice typically favours males who outperform others in securing access to some limited resource. Here, we develop a model to investigate the question of resource competition as a form of male-male competition in the context of male sexual displays. We phrase our model in terms of male bowerbirds either searching for or stealing resources (ornamental objects) valued by females, and compare the model findings with published studies of time allocation to various activities in different species of bowerbirds. The basic idea of the model, however, extends to cases where the resource is used less directly for the development of sexual ornamentation, such as males excluding others' access to food. We show that if males compete for resources used in sexual displays, intense female preference for high-quality displays can lead to poorer prospects for efficient choice by females. This is because males benefit from excluding others' access to resources used in displays, damaging the overall efficiency of resource use in the population, and the accuracy with which females can judge male ability to gain such resources. The evolution of female choice may therefore have a self-limiting nature when it poses a selection pressure on male resource acquisition. PMID:15306306

  6. Finding voices through writing.

    PubMed

    Gehrke, P

    1994-01-01

    Assisting students to find their writing "voices" is another way to emphasize writing as a professional tool for nursing. The author discusses a teaching strategy that required students to write using a variety of styles. Students wrote fables, poetry, and letters, and used other creative writing styles to illustrate their views and feelings on professional nursing issues. Creation of a class book empowered students to see versatility with writing styles can be a powerful communication tool to use with peers, clients, and society.

  7. Male-male interactions and mating kinetics in Drosophila.

    PubMed

    Wallace, B

    1990-05-01

    Male-male interaction (K) has been estimated from data on the attrition rate of virgin females per minute in a study of the mating kinetics in Drosophila. K is expressed as the time males expend on other males relative to that expended while searching for, courting, and copulating with females. The value of K in these studies ranged from 0 (approximately) to .695; it was affected both by strain (sepia or ebony D. melanogaster and wild-type D. simulans) and by size of the mating chamber. Host-parasitoid models of ecologists appear to be appropriate for examining mating kinetics in Drosophila.

  8. Effect of mating activity and dominance rank on male masturbation among free-ranging male rhesus macaques.

    PubMed

    Dubuc, Constance; Coyne, Sean P; Maestripieri, Dario

    2013-11-01

    The adaptive function of male masturbation is still poorly understood, despite its high prevalence in humans and other animals. In non-human primates, male masturbation is most frequent among anthropoid monkeys and apes living in multimale-multifemale groups with a promiscuous mating system. In these species, male masturbation may be a non-functional by-product of high sexual arousal or be adaptive by providing advantages in terms of sperm competition or by decreasing the risk of sexually transmitted infections. We investigated the possible functional significance of male masturbation using behavioral data collected on 21 free-ranging male rhesus macaques (Macaca mulatta) at the peak of the mating season. We found some evidence that masturbation is linked to low mating opportunities: regardless of rank, males were most likely to be observed masturbating on days in which they were not observed mating, and lower-ranking males mated less and tended to masturbate more frequently than higher-ranking males. These results echo the findings obtained for two other species of macaques, but contrast those obtained in red colobus monkeys (Procolobus badius) and Cape ground squirrels (Xerus inauris). Interestingly, however, male masturbation events ended with ejaculation in only 15% of the observed masturbation time, suggesting that new hypotheses are needed to explain masturbation in this species. More studies are needed to establish whether male masturbation is adaptive and whether it serves similar or different functions in different sexually promiscuous species.

  9. Mineral find highlights cruise

    NASA Astrophysics Data System (ADS)

    Katzoff, Judith A.

    Heavy minerals with potential commercial value were discovered last month by the U.S. Geological Survey (USGS) in seafloor deposits off the coasts of Virginia and Georgia. The USGS sent the research vessel J. W. Powell on a 25-day cruise along the East Coast to assess the concentrations of commercially important minerals in that segment of the U.S. Exclusive Economic Zone (EEZ).Assistant Secretary of the Interior Robert Broadbent called the findings of the Powell “promising” and said they served as a “reminder of just how little we do know about the seafloor resources just a few miles offshore.”

  10. "Promotores'" Perspectives on a Male-to-Male Peer Network

    ERIC Educational Resources Information Center

    Macia, Laura; Ruiz, Hector Camilo; Boyzo, Roberto; Documet, Patricia Isabel

    2016-01-01

    Little documentation exists about male community health workers ("promotores") networks. The experiences of "promotores" can provide input on how to attract, train, supervise and maintain male "promotores" in CHW programs. We present the experience and perspectives of "promotores" who participated in a male…

  11. Competition for Trophies Triggers Male Generosity

    PubMed Central

    Pan, Xiaofei Sophia; Houser, Daniel

    2011-01-01

    Background Cooperation is indispensable in human societies, and much progress has been made towards understanding human pro-social decisions. Formal incentives, such as punishment, are suggested as potential effective approaches despite the fact that punishment can crowd out intrinsic motives for cooperation and detrimentally impact efficiency. At the same time, evolutionary biologists have long recognized that cooperation, especially food sharing, is typically efficiently organized in groups living on wild foods, even absent formal economic incentives. Despite its evident importance, the source of this voluntary compliance remains largely uninformed. Drawing on costly signaling theory, and in light of the widely established competitive nature of males, we hypothesize that unique and displayable rewards (trophies) out of competition may trigger male generosity in competitive social environments. Principal Findings Here, we use a controlled laboratory experiment to show that cooperation is sustained in a generosity competition with trophy rewards, but breaks down in the same environment with equally valuable but non-unique and non-displayable rewards. Further, we find that males' competition for trophies is the driving force behind treatment differences. In contrast, it appears that female competitiveness is not modulated by trophy rewards. Significance Our results suggest new approaches to promoting cooperation in human groups that, unlike punishment mechanisms, do not sacrifice efficiency. This could have important implications in any domain where voluntary compliance matters — including relations between spouses, employers and employees, market transactions, and conformity to legal standards. PMID:21494668

  12. Cryptic female preference for colorful males in guppies.

    PubMed

    Pilastro, Andrea; Simonato, Martina; Bisazza, Angelo; Evans, Jonathan P

    2004-03-01

    Cryptic female choice (CFC) refers to female-mediated processes occurring during or after copulation that result in biased sperm use in favor of preferred or compatible males. Despite recent empirical support for this hypothesis, evidence that CFC contributes towards the evolution of male body ornaments, in the same way that precopulatory female choice does, is currently lacking. Here, we tested the possibility that CFC selects for increased male attractiveness in the guppy Poecilia reticulata, a freshwater fish exhibiting internal fertilization. Specifically, we examined whether females are able to manipulate the number of sperm transferred or retained at copulation in favor of relatively attractive males. In support of this prediction, we found that following solicited copulations the number of sperm inseminated is influenced exclusively by the female's perception of relative male coloration, independent of any direct manipulation of males themselves. Because females prefer brightly colored males during precopulatory mate choice, our finding that colorful males are also favored as a consequence of enhanced insemination success indicates that cryptic female choice can reinforce precopulatory preferences for extravagant male ornaments.

  13. Evidence for partial overlap of male olfactory cues in lampreys

    USGS Publications Warehouse

    Buchinger, Tyler J.; Li, Ke; Huertas, Mar; Baker, Cindy F.; Jia, Liang; Hayes, Michael C.; Li, Weiming; Johnson, Nicholas S.

    2016-01-01

    Animals rely on a mosaic of complex information to find and evaluate mates. Pheromones, often comprised of multiple components, are considered to be particularly important for species-recognition in many species. While the evolution of species-specific pheromone blends is well-described in many insects, very few vertebrate pheromones have been studied in a macro-evolutionary context. Here, we report a phylogenetic comparison of multi-component male odours that guide reproduction in lampreys. Chemical profiling of sexually mature males from eleven species of lamprey, representing six of ten genera and two of three families, indicated the chemical profiles of sexually mature male odours are partially shared among species. Behavioural assays conducted with four species sympatric in the Laurentian Great Lakes indicated asymmetric female responses to heterospecific odours, where Petromyzon marinus were attracted to male odour collected from all species tested but other species generally preferred only the odour of conspecifics. Electro-olfactogram recordings from P. marinusindicated that although P. marinus exhibited behavioural responses to odours from males of all species, at least some of the compounds that elicited olfactory responses were different in conspecific male odours compared to heterospecific male odours. We conclude that some of the compounds released by sexually mature males are shared among species and elicit olfactory and behavioural responses in P. marinus, and suggest that our results provide evidence for partial overlap of male olfactory cues among lampreys. Further characterization of the chemical identities of odour components is needed to confirm shared pheromones among species.

  14. Male-female relatedness and patterns of male reproductive investment in guppies.

    PubMed

    Fitzpatrick, Luisa J; Gasparini, Clelia; Fitzpatrick, John L; Evans, Jonathan P

    2014-05-01

    Inbreeding can cause reductions in fitness, driving the evolution of pre- and postcopulatory inbreeding avoidance mechanisms. There is now considerable evidence for such processes in females, but few studies have focused on males, particularly in the context of postcopulatory inbreeding avoidance. Here, we address this topic by exposing male guppies (Poecilia reticulata) to either full-sibling or unrelated females and determining whether they adjust investment in courtship and ejaculates. Our results revealed that males reduce their courtship but concomitantly exhibit short-term increases in ejaculate quality when paired with siblings. In conjunction with prior work reporting cryptic female preferences for unrelated sperm, our present findings reveal possible sexually antagonistic counter-adaptations that may offset postcopulatory inbreeding avoidance by females.

  15. Eating Disorders in Adolescent Males

    ERIC Educational Resources Information Center

    Ray, Shannon L.

    2004-01-01

    Research indicates that the primary onset of eating disorders occurs in adolescence and that there is a growing prevalence of adolescent males with eating disorders. This article describes the eating disorders of anorexia nervosa and bulimia nervosa as they relate to adolescent males. Diagnostic criteria, at-risk groups, and implications for…

  16. Educating Black Males with Dyslexia

    ERIC Educational Resources Information Center

    Robinson, Shawn Anthony

    2013-01-01

    Much of the scholarship on Black males in the educational literature focuses on the achievement gap; their underrepresentation in gifted and advanced placement programs; their overrepresentation in special education programs and their high rates of school suspensions and expulsions. Although overrepresented in special education, Black males with…

  17. Latino Males in Higher Education

    ERIC Educational Resources Information Center

    Excelencia in Education, 2016

    2016-01-01

    This 2016 fact sheet profiles the status of Latino males in higher education, providing information on population, college enrollment, and educational attainment. While college enrollment among Latino males continues to increase, they still lag behind Latino females in college enrollment--a disparity that increases as the level of higher education…

  18. Phylogeny of Courtship and Male-Male Combat Behavior in Snakes

    PubMed Central

    Senter, Phil; Harris, Shannon M.; Kent, Danielle L.

    2014-01-01

    Background Behaviors involved in courtship and male-male combat have been recorded in a taxonomically broad sample (76 species in five families) of snakes in the clade Boidae + Colubroidea, but before now no one has attempted to find phylogenetic patterns in such behaviors. Here, we present a study of phylogenetic patterns in such behaviors in snakes. Methodology/Principal Findings From the literature on courtship and male-male combat in snakes we chose 33 behaviors to analyze. We plotted the 33 behaviors onto a phylogenetic tree to determine whether phylogenetic patterns were discernible. We found that phylogenetic patterns are discernible for some behaviors but not for others. For behaviors with discernible phylogenetic patterns, we used the fossil record to determine minimum ages for the addition of each behavior to the courtship and combat behavioral repertoire of each snake clade. Conclusions/Significance The phylogenetic patterns of behavior reveal that male-male combat in the Late Cretaceous common ancestors of Boidae and Colubridae involved combatants raising the head and neck and attempting to topple each other. Poking with spurs was added in Boidae. In Lampropeltini the toppling behavior was replaced by coiling without neck-raising, and body-bridging was added. Phylogenetic patterns reveal that courtship ancestrally involved rubbing with spurs in Boidae. In Colubroidea, courtship ancestrally involved chin-rubbing and head- or body-jerking. Various colubroid clades subsequently added other behaviors, e.g. moving undulations in Natricinae and Lampropeltini, coital neck biting in the Eurasian ratsnake clade, and tail quivering in Pantherophis. The appearance of each group in the fossil record provides a minimum age of the addition of each behavior to combat and courtship repertoires. Although many gaps in the story of the evolution of courtship and combat in snakes remain, this study is an important first step in the reconstruction of the evolution of these

  19. [Clinical characteristics of male osteoporosis].

    PubMed

    Yamauchi, Mika; Sugimoto, Toshitsugu

    2016-07-01

    As men are less likely than women to develop osteoporosis, male osteoporosis remains poorly understood. However, elderly men have a clearly reduced bone mineral density and increased risk for fractures. In Japan, one in four patients with osteoporosis is male. Male osteoporosis is associated with not only reduction in androgen, but also estrogen, and differs from postmenopausal osteoporosis in that decreased bone formation is involved and that age-related changes in cortical bone structure and perforation of the trabeculae of cancellous bone are unlikely to occur. The proportion of secondary osteoporosis is higher for men than women;therefore, differential diagnosis is important in the diagnosis of male osteoporosis. In addition, it is recommended that bone mineral density be measured at the femoral neck or total hip in men. Men have a worse prognosis following fractures than women, and management of male osteoporosis is highly important for extending healthy life expectancy.

  20. Peritoneal carcinoma in a male patient.

    PubMed

    Jermann, Monika; Vogt, Peter; Pestalozzi, Bernhard C

    2003-01-01

    Peritoneal carcinoma is a rare primary tumor, described in the literature almost exclusively in women. This report describes our clinicopathological findings in a 51-year-old male patient with peritoneal carcinoma and ascites. Pathologic studies included routine histology, immunohistochemistry and electron microscopy on biopsy and autopsy tumor tissue. After chemotherapy, the patient achieved a complete remission twice, lasting for 14 months and 8 months, respectively, and died after 3 years. His clinical course was similar to that of female patients with peritoneal carcinoma or advanced ovarian cancer. Our case confirms the existence of primary peritoneal carcinoma in males. In addition, it shows that this entity responds to the same chemotherapy as used for ovarian cancer and primary peritoneal carcinoma in females.

  1. Relative age effect in Japanese male athletes.

    PubMed

    Nakata, Hiroki; Sakamoto, Kiwako

    2011-10-01

    The present study investigated the relative age effect, a biased distribution of elite athletes' birthdates, in Japanese male athletes. Japan applies a unique annual-age grouping for sport and education, which is from April 1 to March 31 of the following year. A total of 4,318 male athletes was evaluated from 12 sports: baseball, soccer, basketball, volleyball, handball, golf, horse racing, rugby, American football, sumo, Ekiden (track and field in long distance), and badminton. They played in the top level of Japanese leagues for each sport in 2010. The distribution of the birth dates was examined in each sport and showed significant relative age effect in baseball, soccer, volleyball, Ekiden, basketball, sumo, and horse racing, but not in all sports. The findings suggest that although the school year in Japan starts on April 1, significant relative age effects are observed in some sporting events.

  2. Masculinity and male sexual behaviour in Mozambique.

    PubMed

    Macia, Manuel; Maharaj, Pranitha; Gresh, Ashley

    2011-11-01

    Like many countries in sub-Saharan Africa, Mozambique is facing a severe HIV epidemic. Evidence suggests that male sexual behaviour is one of the driving forces behind the epidemic. Yet, there is limited understanding of how notions of masculinity influence such behaviour in the context of HIV. Using data collected through focus group discussions and in-depth interviews with sexually active men and women, this paper investigates how notions of masculinity influence the risk of HIV infection among men. The study findings suggest that traditional norms of masculinity, the man as the main provider and figure of authority, continue to exert a strong influence on male attitudes and behaviour. Alternative approaches are urgently needed in HIV programming that take into consideration notions of masculinity in order to reduce risky sexual behaviour.

  3. Finding the Next Earth

    NASA Astrophysics Data System (ADS)

    Batalha, Natalie M.; Kepler Team

    2013-01-01

    Twenty years ago, we knew of no planets orbiting other Sun-like stars, yet today, the roll call is nearly 1,000 strong. Statistical studies of exoplanet populations are possible, and words like "habitable zone" are heard around the dinner table. Theorists are scrambling to explain not only the observed physical characteristics but also the orbital and dynamical properties of planetary systems. The taxonomy is diverse but still reflects the observational biases that dominate the detection surveys. We've yet to find another planet that looks anything like home. The scene changed dramatically with the launch of the Kepler spacecraft in 2009 to determine, via transit photometry, the fraction of stars harboring earth-size planets in or near the Habitable Zone of their parent star. Early catalog releases hint that nature makes small planets efficiently: over half of the sample of 2,300 planet candidates discovered in the first two years are smaller than 2.5 times the Earth's radius. I will describe Kepler's milestone discoveries and progress toward an exo-Earth census. Humankind's speculation about the existence of other worlds like our own has become a veritable quest.

  4. Extremely rare borderline phyllodes tumor in the male breast: a case report.

    PubMed

    Kim, Jung Gyu; Kim, Shin Young; Jung, Hae Yoen; Lee, Deuk Young; Lee, Jong Eun

    2015-01-01

    Phyllodes tumor of the male breast is an extremely rare disease, and far fewer cases of borderline phyllodes tumors than benign or malignant tumors in the male breast have been reported. We report a case of borderline phyllodes tumor in the male breast with imaging findings of the tumor and pathologic correlation.

  5. Comparing Male and Female Juveniles Charged with Homicide: Child Maltreatment, Substance Abuse, and Crime Details

    ERIC Educational Resources Information Center

    Roe-Sepowitz, Dominique Eve

    2009-01-01

    This study examines a sample of 136 male and female juveniles charged with attempted homicide or homicide. The purpose of this study is to explore the differences between nondirect file male and female juvenile homicide offenders regarding individual, family, and crime circumstances. Findings suggest that compared to male juvenile offenders,…

  6. The visual system of male scale insects.

    PubMed

    Buschbeck, Elke K; Hauser, Martin

    2009-03-01

    Animal eyes generally fall into two categories: (1) their photoreceptive array is convex, as is typical for camera eyes, including the human eye, or (2) their photoreceptive array is concave, as is typical for the compound eye of insects. There are a few rare examples of the latter eye type having secondarily evolved into the former one. When viewed in a phylogenetic framework, the head morphology of a variety of male scale insects suggests that this group could be one such example. In the Margarodidae (Hemiptera, Coccoidea), males have been described as having compound eyes, while males of some more derived groups only have two single-chamber eyes on each side of the head. Those eyes are situated in the place occupied by the compound eye of other insects. Since male scale insects tend to be rare, little is known about how their visual systems are organized, and what anatomical traits are associated with this evolutionary transition. In adult male Margarodidae, one single-chamber eye (stemmateran ocellus) is present in addition to a compound eye-like region. Our histological investigation reveals that the stemmateran ocellus has an extended retina which is formed by concrete clusters of receptor cells that connect to its own first-order neuropil. In addition, we find that the ommatidia of the compound eyes also share several anatomical characteristics with simple camera eyes. These include shallow units with extended retinas, each of which is connected by its own small nerve to the lamina. These anatomical changes suggest that the margarodid compound eye represents a transitional form to the giant unicornal eyes that have been described in more derived species.

  7. The visual system of male scale insects

    NASA Astrophysics Data System (ADS)

    Buschbeck, Elke K.; Hauser, Martin

    2009-03-01

    Animal eyes generally fall into two categories: (1) their photoreceptive array is convex, as is typical for camera eyes, including the human eye, or (2) their photoreceptive array is concave, as is typical for the compound eye of insects. There are a few rare examples of the latter eye type having secondarily evolved into the former one. When viewed in a phylogenetic framework, the head morphology of a variety of male scale insects suggests that this group could be one such example. In the Margarodidae (Hemiptera, Coccoidea), males have been described as having compound eyes, while males of some more derived groups only have two single-chamber eyes on each side of the head. Those eyes are situated in the place occupied by the compound eye of other insects. Since male scale insects tend to be rare, little is known about how their visual systems are organized, and what anatomical traits are associated with this evolutionary transition. In adult male Margarodidae, one single-chamber eye (stemmateran ocellus) is present in addition to a compound eye-like region. Our histological investigation reveals that the stemmateran ocellus has an extended retina which is formed by concrete clusters of receptor cells that connect to its own first-order neuropil. In addition, we find that the ommatidia of the compound eyes also share several anatomical characteristics with simple camera eyes. These include shallow units with extended retinas, each of which is connected by its own small nerve to the lamina. These anatomical changes suggest that the margarodid compound eye represents a transitional form to the giant unicornal eyes that have been described in more derived species.

  8. Turn it off! the effects of exposure to male-male erotic imagery on heterosexuals' attitudes toward gay men.

    PubMed

    Golom, Frank D; Mohr, Jonathan J

    2011-01-01

    Despite the recent proliferation of lesbian, gay, and bisexual (LGB) thematic content in U.S. media, there have been relatively few empirical investigations examining its impact on heterosexuals' attitudes toward LGB individuals. This study examined the effect of one type of content, male-male homoerotic imagery, on male and female heterosexuals' attitudes toward, stereotypes about, and affective reactions to gay men. One hundred ninety-eight undergraduate students were assigned to either a male-male or male-female erotica condition, and their corresponding attitudes toward gay men were assessed. Results revealed that the effect of erotic imagery (male-male vs. male-female) on participants' stereotype and affect scores differed for men and women at varying levels of sexual anxiety. The implications of these findings are discussed in light of the literature on exposure to erotic imagery and attitudes toward gay men. In particular, the study highlights the need for additional research that acknowledges within-gender heterogeneity with respect to antigay attitude valence, extremity, and function.

  9. Costs of female odour in males of the parasitic wasp Lariophagus distinguendus (Hymenoptera: Pteromalidae).

    PubMed

    Ruther, Joachim; Steiner, Sven

    2008-06-01

    The display of female traits by males is widespread in the animal kingdom. In several species, this phenomenon has been shown to function adaptively as a male mating strategy to deceive sexual rivals (female mimicry). Freshly emerged males of the parasitic wasp Lariophagus distinguendus (Hymenoptera: Pteromalidae) are perceived by other males as if they were females because of a very similar composition of cuticular hydrocarbons which function as a sex pheromone in this species inducing courtship behaviour in males. Within 32 h, however, males deactivate the pheromone and are no longer courted by other males. In this paper, behavioural experiments were performed to test hypotheses on potential costs and benefits associated with the female odour in young males. We did not find any benefits, but demonstrated that young males were significantly more often outrivaled in male-male contests when competing with two older males for a female. Also, young males were significantly more often mounted in homosexual courtship events during these contests. Thus, display of female traits by males is not necessarily beneficial, and in fact, can be disadvantageous. We suggest that these costs have favoured the evolution of the pheromone deactivation mechanism in L. distinguendus males. The function of cuticular hydrocarbons as a female courtship pheromone in L. distinguendus might have evolved secondarily from a primary function relevant for both genders, and the deactivation of the signal in males might have caused a shift of specificity of the chemical signal from the species level to the sex level.

  10. Costs of female odour in males of the parasitic wasp Lariophagus distinguendus (Hymenoptera: Pteromalidae)

    NASA Astrophysics Data System (ADS)

    Ruther, Joachim; Steiner, Sven

    2008-06-01

    The display of female traits by males is widespread in the animal kingdom. In several species, this phenomenon has been shown to function adaptively as a male mating strategy to deceive sexual rivals (female mimicry). Freshly emerged males of the parasitic wasp Lariophagus distinguendus (Hymenoptera: Pteromalidae) are perceived by other males as if they were females because of a very similar composition of cuticular hydrocarbons which function as a sex pheromone in this species inducing courtship behaviour in males. Within 32 h, however, males deactivate the pheromone and are no longer courted by other males. In this paper, behavioural experiments were performed to test hypotheses on potential costs and benefits associated with the female odour in young males. We did not find any benefits, but demonstrated that young males were significantly more often outrivaled in male-male contests when competing with two older males for a female. Also, young males were significantly more often mounted in homosexual courtship events during these contests. Thus, display of female traits by males is not necessarily beneficial, and in fact, can be disadvantageous. We suggest that these costs have favoured the evolution of the pheromone deactivation mechanism in L. distinguendus males. The function of cuticular hydrocarbons as a female courtship pheromone in L. distinguendus might have evolved secondarily from a primary function relevant for both genders, and the deactivation of the signal in males might have caused a shift of specificity of the chemical signal from the species level to the sex level.

  11. Caring for female patients: The experiences of male nurses.

    PubMed

    Keogh, Brian; Gleeson, Madeline

    This article presents the results of two small qualitative studies, which examined the experiences of six male registered psychiatric nurses (RPN) and five male registered general nurses (RGN) when caring for patients of the opposite sex. Semi-structured interviews were used to collect the data. The focus of the interviews was an attempt to describe the male nurses' experiences of caring for women with a particular emphasis on interventions that involved physical touch. Themes were generated from both studies and the common themes are presented here. Male nurses in this study were often apprehensive about using physical touch and they used coping strategies in response to their fears of being accused of using touch inappropriately. Several factors also influenced the male nurses when using physical touch as an intervention. These findings suggest that learning about caring for female patients needs to be included in the undergraduate curriculum and that further research on the experience of men as nurses is required.

  12. Smoking and Male Infertility: An Evidence-Based Review

    PubMed Central

    Harlev, Avi; Gunes, Sezgin Ozgur; Shetty, Amit; du Plessis, Stefan Simon

    2015-01-01

    Many studies have reported that the contents of cigarette smoke negatively affect sperm parameters, seminal plasma, and various other fertility factors. Nevertheless, the actual effect of smoking on male fertility is not clear. The effect of smoking on semen parameters is based on the well-established biological finding that smoking increases the presence of reactive oxygen species, thereby resulting in oxidative stress (OS). OS has devastating effects on sperm parameters, such as viability and morphology, and impairs sperm function, hence reducing male fertility. However, not all studies have come to the same conclusions. This review sheds light upon the arguable association between smoking and male fertility and also assesses the impact of non-smoking routes of tobacco consumption on male infertility. It also highlights the evidence that links smoking with male infertility, including newly emerging genetic and epigenetic data, and discusses the clinical implications thereof. PMID:26770934

  13. Correlates of negative attitudes toward gay men: sexism, male role norms, and male sexuality.

    PubMed

    Davies, Michelle

    2004-08-01

    Research has shown that heterosexual men are more negative toward gay men than women are on measures of attitudes toward homosexual behaviour and homosexual persons (Kite & Whitley, 1996). Gender differences in attitudes toward gay men's civil rights are less clear. No empirical studies, however, have investigated these findings with a scale that measures specifically these three attitudinal subcomponents. This study was a preliminary test of a scale that measured these subcomponents. In addition, this study investigated the relationship between these subcomponents and other attitudinal measures: hostile sexism, male toughness, and attitudes toward male sexuality. Results revealed that attitudes toward homosexual behaviour and homosexual persons comprised one factor: affective reactions toward gay men. Results showed that men were more negative on affective reactions than women were. No gender differences were revealed on attitudes toward civil rights. I found significant correlations between affective reactions, hostile sexism, male toughness, and male sexuality. I discuss these findings in relation to traditional gender role beliefs and make suggestions for future research.

  14. Electrophysiological comparison between males and females in HNPP.

    PubMed

    Manganelli, Fiore; Pisciotta, Chiara; Dubbioso, Raffaele; Maruotti, Valerio; Iodice, Rosa; Notturno, Francesca; Ruggiero, Lucia; Vitale, Carmine; Nolano, Maria; Uncini, Antonino; Santoro, Lucio

    2013-08-01

    Some evidences highlighted a higher clinical expression of hereditary neuropathy with liability to pressure palsy (HNPP) in males, and a higher load of traumatic nerve injuries due to different occupational activity has been invoked to explain this observation. It is unknown whether this increased clinical impairment corresponds to a greater electrophysiological involvement. Thus, we compared clinical and electrophysiological features between men and women in a large cohort of HNPP patients. Nerve palsies and electrophysiological abnormalities were more frequent in men, and electrophysiological findings which differentiated males from females did not show any age-related worsening. In conclusion, our findings showed a higher clinical and electrophysiological involvement in males which does not seem related to different cumulative nerve damage over time. We believe that the higher disease expression may increase the chance to detect the disease in males and, thereby, to underestimate the HNPP diagnosis in females.

  15. Pulmonary talcosis: imaging findings.

    PubMed

    Marchiori, Edson; Lourenço, Sílvia; Gasparetto, Taisa Davaus; Zanetti, Gláucia; Mano, Cláudia Mauro; Nobre, Luiz Felipe

    2010-04-01

    Talc is a mineral widely used in the ceramic, paper, plastics, rubber, paint, and cosmetic industries. Four distinct forms of pulmonary disease caused by talc have been defined. Three of them (talcosilicosis, talcoasbestosis, and pure talcosis) are associated with aspiration and differ in the composition of the inhaled substance. The fourth form, a result of intravenous administration of talc, is seen in drug users who inject medications intended for oral use. The disease most commonly affects men, with a mean age in the fourth decade of life. Presentation of patients with talc granulomatosis can range from asymptomatic to fulminant disease. Symptomatic patients typically present with nonspecific complaints, including progressive exertional dyspnea, and cough. Late complications include chronic respiratory failure, emphysema, pulmonary arterial hypertension, and cor pulmonale. History of occupational exposure or of drug addiction is the major clue to the diagnosis. The high-resolution computed tomography (HRCT) finding of small centrilobular nodules associated with heterogeneous conglomerate masses containing high-density amorphous areas, with or without panlobular emphysema in the lower lobes, is highly suggestive of pulmonary talcosis. The characteristic histopathologic feature in talc pneumoconiosis is the striking appearance of birefringent, needle-shaped particles of talc seen within the giant cells and in the areas of pulmonary fibrosis with the use of polarized light. In conclusion, computed tomography can play an important role in the diagnosis of pulmonary talcosis, since suggestive patterns may be observed. The presence of these patterns in drug abusers or in patients with an occupational history of exposure to talc is highly suggestive of pulmonary talcosis.

  16. Thoracic textilomas: CT findings*

    PubMed Central

    Machado, Dianne Melo; Zanetti, Gláucia; Araujo, Cesar Augusto; Nobre, Luiz Felipe; Meirelles, Gustavo de Souza Portes; Pereira e Silva, Jorge Luiz; Guimarães, Marcos Duarte; Escuissato, Dante Luiz; Souza, Arthur Soares; Hochhegger, Bruno; Marchiori, Edson

    2014-01-01

    OBJECTIVE: The aim of this study was to analyze chest CT scans of patients with thoracic textiloma. METHODS: This was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. RESULTS: The majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred i