Manual for Male Circumcision under Local Anaesthesia

Male circumcision under local anaesthesia Version 2.5C (Jan08)
Contents
Preface vii
Acknowledgements ix
Photo credits x
Financial support x
Abbreviations and acronyms used in this manual xi
1. Benefits and risks of male circumcision
Summary 1-1
Introduction to male circumcision 1-1
What is male circumcision? 1-1
How circumcision is performed 1-1
Benefits and risks of circumcision 1-2
Benefits 1-2
Risks 1-2
Male circumcision and HIV infection 1-3
The evidence linking male circumcision and HIV 1-3
Male circumcision and regional differences in HIV prevalence 1-3
Randomized controlled trials to assess the efficacy of male circumcision in
reducing risk of HIV infection 1-5
Possible biological explanations for the protective effect of male circumcision 1-5
Protection for women 1-6
Other health benefits of circumcision 1-6
Acceptability of circumcision among African men 1-6
References 1-7
2. Linking male circumcision to other male sexual and reproductive health services
Summary 2-1
Men’s sexual and reproductive health needs and services 2-2
Counselling and testing for HIV infection 2-3
Barriers related to male sexual and reproductive health services 2-4
Meeting the sexual and reproductive health needs of men 2-4
Men’s role in women’s and children’s health 2-5
Who should provide sexual and reproductive health services to boys and men? 2-6
Detection and treatment of selected male sexual and reproductive health problems 2-7
Sexually transmitted infections 2-7
Balanitis 2-8
Phimosis 2-9
Paraphimosis 2-10
Urinary tract infections 2-11
Infertility 2-12
References 2-13
3. Educating and counselling clients, and obtaining informed consent
Summary 3-1
Education about sexual and reproductive health and male circumcision 3-1
Group education script 3-2
Summary 3-4
Counselling 3-5
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Male circumcision under local anaesthesia Version 2.5C (Jan08)
Basic facts about counselling 3-5
Confidentiality 3-5
Counselling skills 3-6
Informed consent for surgery 3-10
General 3-10
Adolescent boys: consent and confidentiality 3-11
Documenting informed consent for surgery 3-12
Infant circumcision 3-12
Integration of traditional circumcision events with clinical circumcision 3-12
Appendix 3.1: Additional reproductive health counselling script 3-14
Appendix 3.2: Sample information sheet for adult and adolescent clients 3-19
Appendix 3.3: Sample certificate of consent for adults and adolescents 3-23
4. Facilities and supplies, screening patients and preparations for surgery
Summary 4-1
Equipment and supplies 4-1
Maintenance and review of equipment 4-3
Screening adult clients 4-4
History 4-4
Physical examination 4-4
HIV testing and informed consent for surgery 4-6
Preoperative washing by the patient 4-7
Scrubbing and putting on protective clothing 4-8
Whether to use a gown 4-10
Face masks and protective eyewear 4-10
Appendix 4.1: Sample client record form for adults and adolescents 4-11
Appendix 4.2: Sample disposable consumables for one adult male circumcision 4-15
Appendix 4.3: Detailed anatomy of the penis 4-17
Appendix 4.4: Selected anatomical abnormalities of the penis 4-21
5. Surgical procedures for adults and adolescents
Summary 5-1
Required surgical skills for safe circumcision 5-1
Anatomy of the penis and choice of surgical technique 5.1
Tissue handling 5-1
Haemostasis 5-2
Suture material 5-4
Suturing 5-5
Tying knots 5-8
Skin preparation and draping 5-9
Skin preparation with povidone iodine 5-9
Draping 5-9
Anaesthesia 5-10
Penile nerve supply 5-10
Maximum dose of local anaesthetic 5-11
Safe injection of local anaesthetic 5-12
Additional analgesia 5-12
Ring block technique 5-12
Retraction of the foreskin and dealing with adhesions 5-13
Marking the line of circumcision 5-14
Surgical methods 5-15
Forceps-guided method of circumcision 5-16
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