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Circumcision dilemma for men with ‘small’ organs

By Robin Muchetu

Men with small reproductive organs cannot be circumcised using the PrePex device leaving them with only the option of a surgical operation, experts have said.

An officially sanctioned circumcision in Zimbabwe (Photo by Stringer/Zimbabwe/Reuters)
An officially sanctioned circumcision in Zimbabwe (Photo by Stringer/Zimbabwe/Reuters)

Health experts have been marketing the PrePex method of circumcision which is a non-surgical method of circumcision that consists of a device made of a plastic and rubber ring that stops the flow of blood to the part of the foreskin that is to be removed.

After seven days the foreskin and the device can be removed.

However, in an e-mail to Sunday News, MedTech Medical Solutions, who manufacture the equipment used in the PrePex method of circumcision said the method was not feasible for “small” reproductive organs.

The sizing plates for PrePex are grouped from Size A to E. Size A is the smallest possible with a diametre of 26 millimetres, Size B — 28 mm, Size C — 30 mm, Size D — 32 mm and Size E —34 mm.

“Use of the PrePex device on men who have penis size smaller than size A is contra-indicated until further notice. Failure to recognise non-eligibility is likely to lead to adverse events such as increased infection risk due to failure to adequately prepare the skin prior to device placement or incomplete skin removal due to failure to apply the device in the correct anatomical position,” the company said.

He added: “Because after measurement using the PrePex Sizing Plate (PSP) some patients will be excluded due to small penis size.”

However, director of Aids and TB Unit in the Ministry of Health and Child Care Dr Owen Mugurungi said PrePex has been proven safe and effective for adult men over the age of 18 in Zimbabwe and there were several sizes of the devices for men and boys, according to the makeup of each person.

“This is just like the variation in sizes of injections for small children and for older people. The suitability of any size therefore is not only depended on the size of the device, but also on how each man is made up. There are certain situations such as the diametre of the foreskin which even if the size of the device is correct but because of the way the man is made up he may still not be able to use the device,” he said.

Dr Mugurungi said it was not about the size of the organs but the devices. He said so far in Zimbabwe PrePex has been approved for use only to males who are 18 years and above, irrespective of the size of reproductive organ.

He said for this age group, the device was fully researched and the manufacturing plant assessed and approved that it meets the required standards. PrePex devices were designed and tested with the use of adults in mind, he said, and in this regard, the sizes that have been designed specifically are for adult males, aged 18 and above and not for adolescents.

However, he said this was not to say that PrePex cannot work for adolescent boys.

The manufacturer further said PrePex can now be used for adolescent boys, a move that the Health Ministry has not yet been adopted in Zimbabwe.

“The standard is that when World Health Organisation (WHO) approves or recommends new standards, the country then decides on an adoption or adaptation process. In this case, the Ministry of Health and Child Care will consider the same approach in view of this recommendation and issue a communication at the appropriate time,” said Dr Mugurungi.

He said if Zimbabwe adopts the method for adolescence, this could result in the number of people who are being circumcised increasing.

“This therefore means that VMMC through the PrePex device can be available to more sites in Zimbabwe and more adolescents can access the service. So the numbers will definitely increase. It is important to note that for us in Zimbabwe, we are excited about the introduction of this new innovation, the PrePex device as it will help us in increasing options for VMMC services and we can also introduce the service to more sites.

“Men now to some extent can make the choice of which method they can be circumcised with. However, it is also important to note that the PrePex is not replacing the surgical method and both options are available in Zimbabwe and both are safe and effective,” he said.

Many men often prefer a non-surgical circumcision because it does not involve being injected with anaesthesia, cutting of live tissue, bleeding, or sutures. Nonetheless, the PrePex procedure takes only five minutes and is reported to be less painful than surgical circumcision and doesn’t require time off from work.

Zimbabwe has been on a drive to promote circumcision with a target to circumcise 1,3 million men between 13 and 29 years by 2017. In 2007, WHO and UNAIDS proved that circumcised men reduce their risk of HIV Infection by 60 percent in high risk areas such as Sub-Saharan Africa. Sunday News

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