Paidamoyo Chipunza Senior Health Reporter
A number of men with penile abnormalities are having the condition corrected during the circumcision procedure and getting a chance to lead a normal sexual experience.
Dr Shingi Makamure – a consultant with the Zimbabwe Community Health Intervention Research Project (ZICHIRE) – an organisation working with Government to scale up male circumcision in the country said penile conditions such as phimosis (the inability to retract the foreskin) and paraphimosis (a painful inability to pull the retracted foreskin back down) were common among men.
Paraphimosis can obstruct urine and blood flow and needs to be treated as a medical emergency.
Dr Makamure said at one point they corrected the organ of a 50-year old man whose foreskin was still tight and had not retracted over the years.
“His foreskin was abnormally tight but he was having sex and has four children. What this means is this man was not enjoying sex all these years because the sensitive glands were covered by the foreskin. His condition had to be corrected through circumcision,” said Dr Makamure.
He said despite the prevalence of such deformities, few men ever sought medical advice to get the condition rectified because of their general reluctance to visit health institutions or to consult doctors.
According to Dr Makamure, abnormality of the foreskin was not the only condition men were hiding as others also lived with abnormalities on the structure of the organ such as hypospadias or epispadias.
“This is a relatively common birth defect where the opening of the urethra is in the wrong place. Some men will actually have two openings on the organ. These conditions should be corrected first before the men are circumcised,” he said.
Dr Makamure said penile abnormalities resulted in a lot of emotional stress for the affected men. Some men cannot pee while standing as they risk wetting their pants through the openings.
“The good news though is that it can be corrected through surgery. So circumcision is helping in identifying some of these conditions that otherwise would not have been detected in an ordinary setup because men generally do not seek health services if they are not in pain,” he said.
Circumcision is arguably one of the most hygienic practices to maintain a male organ.
According to Dr Makamure, the warm, moist space under the foreskin is a prime breeding ground for bacteria, which can harbour sexually transmitted disease organisms, and produces a cheese-like, foul-smelling substance called smegma.
It is likely that this could contribute to infections among men and their partners, and even to cancer.
Speaking to journalists during a recent Population Services International organised media tour of Shurungwi in the Midlands province, an 18-year old boy who had just been circumcised said he opted for circumcision because his organ was producing a funny odour.
The boy, who spoke on condition of anonymity, said his condition was embarrassing as he always thought everyone close to him would smell the odour.
“I never thought I would go for circumcision as I was scared of blood. But when I heard of the new circumcision method (Pre-pex) that is bloodless, I said why not,” he said.
Pre-pex is an innovative non-surgical medical adult male circumcision device. It does not require an anaesthesia injection, no sutures, no cutting of live tissue and above all no loss of blood.
According to the Ministry of Health and Child Care, Pre-pex is easy to perform and has very little risk of complications.
It takes five minutes to perform against 30 minutes for surgical circumcision.
The client can quickly return to his normal duties after the procedure.
Circumcision promotes hygiene and early detection of abnormal organs, although these are not the only benefits of cutting!
Voluntary Medical Male circumcision programme coordinator in the Ministry of Health and Child Care Ms Patience Kunaka said randomised controlled trials showed consistently that MC was 60 percent effective in reducing HIV incidences.
The World Health Organisation (WHO) and UNAIDS recommend MC for HIV prevention in countries where HIV prevalence is high and MC low such as Zimbabwe.
Research has shown that the inner part of the foreskin is less stronger than normal skin hence prone to tearing during sex, thus facilitating transmission of HIV.
The same inner part is rich in blood supply, thus prone to bleeding during intercourse especially with the “dry sex” practices common in Zimbabwe.
With this evidence versus a high rate of HIV prevalence in the country, Government adopted the WHO/UNADS recommendations to roll out circumcision throughout the country.
According to national HIV estimates for 2014, about 1,4 million Zimbabweans are living with HIV and Aids and 92 percent of all new infections are through sex.
Although the national prevalence is declining, HIV and Aids still constitute 47 percent of the country’s disease burden.
Ms Kunaka said there was
no “single magic bullet” intervention to preventing HIV hence adoption of many strategies, including MC.
“There is no single magic bullet prevention method to HIV hence adoption of a mix of biomedical, behavioural and structural interventions to meet the current HIV prevention needs of particular individuals and communities,” she argued.
It is in light of this background that Zimbabwe is targeting to circumcise at least 80 percent of 13-29-year old HIV negative men, which translates to 1,3 million by 2017 as part of a comprehensive HIV prevention programme.
Should these men be circumcised, the country has a potential of averting 600 000 new HIV infections by 2025, 42 percent of which happen in men who are uncircumcised.
A total of $2,9 billion will also be saved by having few people going for treatment and hospitalisation among other costs that go into the continuum of care.
Given all these benefits of MC and its proven efficacy in reducing HIV – never mind the percentage – there is a national push to have more men circumcised to reduce new infections.
The good thing about MC is that it does not replace existing preventive interventions but should be used in combination with others like condoms.
Moreso, there is a selection of methods to choose from when one decides to get circumcised, from the pre-pex device to the surgical method. A total of 106 sites dotted across the country offer MC of different types for people to choose from.