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In 2007, the World Health Organization (WHO) and UNAIDS announced recommendations,based on extensive studies, to scale up Voluntary Medical Male Circumcision (VMMC) to men in areas of high risk for heterosexual HIV transmission. The studies showed that men with a circumcised penis are approximately 70 percent less likely to contract HIV from heterosexual intercourse than men with an uncircumcised penis–in addition to other health and hygiene benefits.
This finding, replicated in rigorous, repeated studies across several countries, has led doctors and public health professionals to recommend that men in high-risk areas have access to VMMC.
“Voluntary Medical Male Circumcision” is a term used by the global health community to emphasize that circumcision is a personal choice.
Medical male circumcision is a one-time health intervention that provides men with life-long partial protectionn against HIV. Apart from reducing HIV infection, male circumcision decreases the risk of urinary tract infections; reduces risk of sexually transmitted diseases in men; protects against cancer of the penis and prevents inflammation of the glands and foreskin altogether.
Moreover, Male Circumcision also benefits women: improving hygiene, reducing STI’s, and reducing the risk of cervical cancer (Human Papilloma Virus – HPV). Men’s health is as much about women’s health when it comes to sexually transmitted diseases.
Most recently, results from a 5-year follow up study in Uganda showed that men who chose surgical VMMC were 70% less likely to be infected with HIV than men who were not circumcised. Similar results were reported from extensive follow-up studies in Kenya and South Africa.
Simply put, circumcision can save lives and plays a major role in turning the tide on AIDS.
More information can be obtained at www.malecircumcision.org
It is critical to remember that male circumcision offers men partial protection against HIV/AIDS. A 70% reduction still leaves a man at personal risk. He and his partner must take additional steps, such as condom use, to protect themselves. Male Circumcision indirectly reduces the risk to women in the long-term,to the degree that her partner is less likely to carry the virus.
Men will often prefer a non-surgical circumcision because it does not involve injected anesthesia, cutting of live tissue, bleeding, or sutures. The PrePex procedure takes only five minutes, is reported to be less painful than surgical circumcision and doesn’t require time off from work. Nurses can be properly trained and certified within just three days and can competently conduct safe procedures, in any clean setting, as validated in multiple clinical studies.
PrePex is the only non-surgical circumcision procedure available for men over 13. It was invented and designed specifically as a means to overcome the limitations of surgical circumcision.
|Surgical Circumcision||PrePex Circumcision|
|Surgical skill level||High||Low|
|Sterile environment||Mandatory||Not required|
|Control of bleeding||Sutureor cautery||No bleeding|
|Placement time||20 minutes, not including time for injection and anesthesia to take effect||Approximately 2.5 minutes|
|Removal time||Not applicable||Approximately 2.5 minutes|
|Displacement possibility||Not applicable||Self removal or detachment|
|Abstinence||6 weeks following surgery||6 weeks after removal|
PrePex is one key resource in a comprehensive HIV/AIDS prevention campaign, designed to provide additional options to men and communities. The health community needs a strategically comprehensive mix of approaches. These approaches include counseling and testing, non- surgical and surgical circumcision, information and health education campaigns, male and female condoms, and other education and prevention resources.
Low rate of complications. PrePex has been extensively reviewed by the WHO, with its safety and efficacy validated in a series of comprehensive, rigorous studies. In addition, PrePex is Class II CE certified and a sterile version for adults has been cleared by the FDA.
For both health providers and patients. PrePex was specifically designed to be simple and easy to administer on any eligible man wanting to be circumcised. It has been extensively tested, researched, and evaluated. It is ready to use anywhere there is a demand for circumcision— from remote rural communities to fully equipped hospital settings.
Maximizing limited resources and expanding access. Unlike surgical methods, PrePex can be safely and effectively implemented in non-sterile environments by trained low cadre health care providers (nurses), thus minimizing the burden on the existing healthcare system. PrePex allows healthcare providers to reach 3-5 times as many subjects compared to surgical circumcision, in the same amount of time.
The manufacturers of PrePex are committed to assisting males of all ages with appropriate male circumcision technology. Non-surgical circumcision using PrePex is now available for males ages 13 years and above. Devices for Infants & Children (0 days to 13 years) based on the existing PrePex technology are underway.
The PrePex device applies controlled radial elastic pressure to the foreskin between a rigid Inner Ring and an Elastic Ring to gently stop distal blood flow. The necrotic foreskin and the device are removed after 7 days.
The procedure can be viewed on: https://www.prepex.com/ProcedureVideo.aspx
PrePex has been proven safe and effective for adult and adolescent men over the age of 13. In studies to date, approximately 90% of men who volunteered were eligible to undergo the procedure. Men interested in medical male circumcision should consult with a trained healthcare provider to determine whether PrePex is right for them.
As of 2016, PrePex is being used and/or researched in Rwanda, Uganda, Zimbabwe, South Africa, Kenya, Botswana, Zambia, Tanzania, Namibia, Lesotho, Mozambique, Indonesia (Papua) and India. It is expected to be available in other countries soon.
No method of male circumcision is completely painless. However, men using PrePex report less pain than men who undergo surgical circumcision.
Unlike surgical circumcision, PrePex doesn’t require injected anesthesia, so the device placement is not associated with pain. Device removal is associated with brief pain when removing the Inner Ring for approximately 5 seconds. Men may experience discomfort while wearing the device.
The PrePex device is designed to be placed, worn, and removed with minimal disruption to a man’s daily activities. He can resume work and almost all daily activities shortly after the procedure.
The device remains in place for 7 days. Following device removal, men should abstain from sexual activity for a period of 6 weeks even if the area appears to be completely healed.
Any medical procedure, including surgical adult male circumcision, comes with potential risks. One of the risks of male circumcision, regardless of the circumcision method used, is contracting tetanus. It is important to ensure that all PrePex clients are protected by adequate vaccination with tetanus toxoid containing vaccine (TTCV)1 prior to placement of the PrePex device.
Unlike the alternatives, PrePex is non-surgical. This means there is no need for injectable anesthesia, cutting of a live tissue, bleeding and sutures. These factors reduce the risk of adverse effects such as bleeding, hematomas and infection. Adverse events are un-common and mostly preventable with proper personal care.
The PrePex procedure has been extensively tested, researched, and evaluated across several countries in Sub-Saharan Africa. PrePex safety and efficacy has been assessed through extensive clinical evaluations, which was performed by Rwanda and Zimbabwe with additional information from sites in Uganda.
For detailed scientific evidence and links to clinical studies, visit: https://www.prepex.com/Scientific.aspx.
As defined by WHO, “prequalification” aims to ensure that diagnostics, medicines, vaccines and immunization-related equipment and devices for high burden diseases meet global standards of quality, safety and efficacy, in order to optimize use of health resources and improve health outcomes.
The prequalification process consists of a transparent, scientifically sound assessment, which includes dossier review, consistency testing or performance evaluation and site visits to manufacturers. This information, in conjunction with other procurement criteria, is used by UN and other procurement agencies to make purchasing decisions regarding diagnostics, medicines and/or vaccines.
The WHO does not “approve” devices, as this is the sole prerogative of each national government. The list of WHO Prequalified VMMC devices can be found at: http://www.who.int/diagnostics_laboratory/evaluations/PQMCdevices_list/en/index.html