The Observer (Kampala)

2 July 2013

Uganda: Men, Here Are Your Circumcision Options

Photo: Edward Echwalu/IRIN
Surgical circumcision is more complex than PrePex

The World Health Organisation (WHO) recently approved a circumcision device, Prepex, which should be of interest to men seeking to be circumcised.

Circumcision has been said to reduce risk of getting urinary tract infections, penile and cervical cancer, as well as HIV.

Back to Prepex. Why should men be interested in this device? Because according to its manufacturer, Prepex enables non-surgical circumcision. It works by cutting off blood supply to the foreskin, which then falls off or is painlessly cut off.

The widely-used methods of circumcision in Uganda are the conventional, open/dissection methods that are surgically based, according to Dr Jamil Mubiru of Kibuli hospital who has performed circumcision, for six years. These, which include forceps assisted, dorsal slit and sleeve resection methods, have their advantages and disadvantages.

Device-assisted circumcision, which is sometimes referred to as non-surgical method of circumcision is also available in Uganda and it has its pros and cons. Note that device-assisted circumcision, which includes use of clamps such as the Prepex, Tara Klamp, Sunathrone Clamp, Smart Clamp, Shang ring, Plastibel (these are disposable single-use clamps), the Mogen, Gomco and Sheldon clamps (these are re-usable), may sometimes require surgical removal of the foreskin.

Pros and cons of conventional methods of circumcision:

The book, Essential Guide for Medical Male Circumcision by the department of health of the Kwazulu-Natal province of South Africa, says the conventional circumcision process involves: anaesthetising the penis, retraction of the foreskin, marking the incision point, removal of foreskin using a scalpel (after anaesthesia), suturing after circumcision and dressing. The dressing, according to the book, shouldn't stay longer than 48 hours.

Mubiru says that as conventional circumcision has been widely practised in Uganda over a long period of time, there is enough skilled manpower to safely conduct it.

He also says conventional methods put one at little risk of infection, as the suturing closes the wound (antibiotics are also given to limit infection) and he says the various methods of conventional circumcision are quick: "It takes no more than 30 minutes."

Mubiru also mentions that conventional methods of circumcision allow one to quickly resume normal life.

"If someone is circumcised on Saturday, they will be at work on Monday," he says. "We don't allow people to come with lesus [wrappers] here. After circumcision, someone wears their trousers and they go. This eliminates stigma."

Mubiru says the disadvantages of conventional circumcision include risks to bleeding, stitch abscess and sensitivity of the tip of the penis.

"We close the bleeders but these may break; so, we advise that when one sees bleeding, they come back," Mubiru says. Where stitch abscess occurs, the stitch is removed and the wound is cleaned.

The Essential Guide for Medical Male Circumcision says conventional circumcision is less advantageous than device-assisted circumcision because it requires sutures and dressing, there is surgical bleeding and post-surgical bleeding may occur, they are time-consuming, require three revisits to the doctor and time off work - about ten days - are required as one heals.

However, good cosmetic results are possible with conventional circumcision.

Pros and cons of device-assisted circumcision:

Generally, device-assisted circumcision involves separating the foreskin from the head of the penis, fitting your clamp of choice over the head of the penis and under the foreskin, pulling the foreskin over the bell, tightening the clamp to reduce blood flow to the area and then using a scalpel to cut off the foreskin. In some instances, the foreskin is left to fall off.

This type of circumcision may be disadvantageous because of lack of skilled manpower in Uganda. According to the Essential Guide for Medical Male Circumcision, this type of circumcision is easy to learn.

The pros of device-assisted circumcision, more specifically the Tara Klamp method which the aforementioned book bills the best for Africa, are: the procedure safeguards against bleeding, is clean and neat, no dressing is required, is time-saving (takes about two minutes to complete), requires one revisit to the doctor and requires less time off work.

And oh yes, it too guarantees good cosmetic results.

Can you suffer adverse effects or disadvantages because of circumcision?

The Essential Guide for Medical Male Circumcision and various sources say there is no evidence that shows that circumcision has any adverse effects or puts a man at disadvantage; not even sexual disadvantage.

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