circumcision

South African Doctors Perform World’s First Penis Transplant

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South African doctors have successfully performed the world’s first penis transplant on a young man who had his organ amputated after a botched circumcision ritual, a hospital said on Friday.

The nine-hour transplant, which occurred in December last year, was part of a pilot study by Tygerberg Hospital in Cape Town and the University of Stellenbosch to help scores of initiates who either die or lose their penises in botched circumcisions each year.

“This is a very serious situation. For a young man of 18 or 19 years the loss of his penis can be deeply traumatic,” said Andre van der Merwe, head of the university’s urology unit and who led the operation said in a statement.

The young patient had recovered full use of his manhood, doctors said, adding that the procedure could eventually be extended to men who have lost their penises to cancer or as a last resort for severe erectile dysfunction.

“There is a greater need in South Africa for this type of procedure than elsewhere in the world, as many young men lose their penises every year due to complications from traditional circumcision,” Van der Merwe said.

The patient, who is not being named for ethical reasons, was 21 years old when his penis was amputated three years ago after he developed severe complications due to a traditional circumcision as a rite of passage into manhood.

Finding a donor organ was one of the major challenges of the study, a statement by the university said.

The donor was a deceased person who donated his organs for transplant, doctors said without elaborating.

Each year thousands of young men, mainly from the Xhosa tribe in South Africa, have their foreskins removed in traditional rituals, with experts estimating around 250 losing their penises each year to medical complications.

Initiates are required to live in special huts away from the community for several weeks, have their heads shaved and smear white clay from head to toe and they move into adulthood.

Another nine patients will receive penile transplants as part of the study, doctors said, but it was not clear when the operations could be carried out.

ASD And Circumcision Linked, With Thoughts Of Brain Development As A Factor

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A new study from the Statens Serum Institut, in Denmark, has found a link between autism spectrum disorder (ASD) and circumcision in boys aged 0 to 9 years. Though no specific mechanism has been established, the team speculates that a malformed stress response, stemming from the procedure, may alter or delay brain development.

Just within the last decade, ASD rates have more than doubled in the U.S. Without a single cause to pin it to, science has seen a rush to draw links between the disorder and a range of environmental, social, and genetic factors. The best that ASD researchers can surmise at this point is it comes from some mix of the three, though in which proportions and at what time still remains unknown.

“Our investigation was prompted by the combination of recent animal findings linking a single painful injury to lifelong deficits in stress response and a study showing a strong, positive correlation between a country’s neonatal male circumcision rate and its prevalence of ASD in boys,” said Professor Morten Frisch of the Statens Serum Institut, who led the research.

The team tracked more than 340,000 boys between 1994 and 2013. Nearly 5,000 cases of ASD were diagnosed during that time. Regardless of background, the team explains, “circumcised boys were more likely than intact boys to develop ASD before age 10 years.” What’s more, “risk was particularly high for infantile autism before age 5 years.”

Controversies surrounding circumcision are as fraught with uncertainty as the science behind the practice. Much of the data on circumcision is conflicting, as one study last year found the benefits outweighed the risks 100 to one and was, as the researchers put it, “equivalent to childhood vaccination.” A separate investigation put the chances of newborn boys getting a urinary tract infection at 50/50 if they stayed uncircumcised.

But while the U.S. circumcision rates are largely declining as the decades pass, worldwide the story is much different. Without access to the same anesthetics and trusted procedures, circumcision in foreign countries tends to earn a less favorable opinion among the public. By the World Health Organization’s most recent estimate, approximately 33 percent of the world’s males aged 15 years or older are circumcised. That number may be so low due to overwhelming beliefs that the practice equates to genital mutilation, while stateside it may be considered more comparable to dental braces.

In the latest study, Frisch and his colleague Jacob Simonsen relied on past research that suggests early pain in neonates has been shown to have long-lasting effects in pain perception, which crop up at greater rates in kids with ASD. “Possible mechanisms linking early life pain and stress to an increased risk of neurodevelopmental, behavioral, or psychological problems in later life remain incompletely conceptualized.” Frisch said. The findings are slightly complicated by earlier work that found autism emerges in utero, which suggests circumcision could only intensify a preexisting deficiency.

circumcision

At any rate, the findings may hold great promise for other countries to adopt formal anesthetic protocol to avoid, or at least minimize, the pain children experience. “Given the widespread practice of non-therapeutic circumcision in infancy and childhood around the world,” Frisch concluded, “our findings should prompt other researchers to examine the possibility that circumcision trauma in infancy or early childhood might carry an increased risk of serious neurodevelopmental and psychological consequences.”

Source: Frisch M, Simonsen J. Ritual circumcision and risk of autism spectrum disorder in 0- to 9-year-old boys: national cohort study in Denmark. JRSM. 2015.

RITUAL CIRCUMCISION: INCREASED RISK OF AUTISM?

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Research published today by the Journal of the Royal Society of Medicine suggests that circumcised boys are more likely than intact boys to develop autism spectrum disorder (ASD) before the age of 10. Risk is particularly high for infantile autism before the age of five. The research was carried out in Denmark among a cohort of all children born between 1994 and 2003. During the study over 340,000 boys were followed up to the age of nine between 1994 and 2013 and almost 5,000 cases of ASD were diagnosed. The study showed that regardless of cultural background circumcised boys may run a greater risk of developing ASD. The researchers also made an unexpected observation of an increased risk of hyperactivity disorder among circumcised boys in non-Muslim families.

Professor Morten Frisch of the Statens Serum Institut, Copenhagen, who led the research, said: “Our investigation was prompted by the combination of recent animal findings linking a single painful injury to lifelong deficits in stress response and a study showing a strong, positive correlation between a country’s neonatal male circumcision rate and its prevalence of ASD in boys.”

Today it is considered unacceptable practice to circumcise boys without proper pain relief but none of the most common interventions used to reduce circumcision pain completely eliminates it and some boys will endure strongly painful circumcisions. The researchers say that the pain associated with circumcision in very young babies is likely to be more severe during the operation and post-operatively.

Painful experiences in neonates have been shown in animal and human studies to be associated with long-term alterations in pain perception, a characteristic often encountered among children with ASD.

“Possible mechanisms linking early life pain and stress to an increased risk of neurodevelopmental, behavioural or psychological problems in later life remain incompletely conceptualised,” said Professor Frisch. “Given the widespread practice of non-therapeutic circumcision in infancy and childhood around the world, our findings should prompt other researchers to examine the possibility that circumcision trauma in infancy or early childhood might carry an increased risk of serious neurodevelopmental and psychological consequences.”

CDC Endorses Circumcision for Health Reasons

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U.S. health officials are poised to endorse circumcision as a means of preventing HIV and other sexually transmitted diseases.

The U.S. Centers for Disease Control and Prevention on Tuesday released its first-ever draft guidelines on circumcision that recommend that doctors counsel parents and uncircumcised males on the health benefits of the procedure.

The guidelines do not outright call for circumcision of all male newborns, since that is a personal decision that may involve religious or cultural preferences, Dr. Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, told the Associated Press.

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But “the scientific evidence is clear that the benefits outweigh the risks,” Mermin said.

Circumcision involves the surgical removal of the foreskin covering the tip of the penis. Germs can collect and multiply under the foreskin, creating issues of hygiene.

Clinical trials, many done in sub-Saharan Africa, have demonstrated that circumcision reduces HIV infection risk by 50 percent to 60 percent, the CDC guidelines note. The procedure also reduces by 30 percent the risk of contracting herpes and human papilloma virus (HPV), two pathogens believed to cause cancer of the penis.

The guidelines do point out that circumcision has only been proven to prevent HIV and sexually transmitted diseases in men during vaginal sex. The procedure has not been proven to reduce the risk of infection through oral or anal sex, or to reduce the risk of HIV transmission to female partners.

The scientific evidence is mixed regarding homosexual sex, the guidelines say, with some studies having shown that circumcision provides partial protection while other studies have not.

Circumcision does reduce the risk of urinary tract infections in infants, according to the CDC guidelines.

The most common risks associated with the procedure include bleeding and infection.

Male circumcision rates in the United States declined between 1979 and 2010, dropping from almost 65 percent to slightly more than 58 percent, according to a CDC report issued last year.

The new draft guidelines mirror an updated policy on circumcision released by the American Academy of Pediatrics in 2012.

“The American public should take confidence that these are pretty much converging guidelines. There is no doubt that it [circumcision] does confer health benefits and there is no doubt it can be performed safely, with a less than 1 percent risk of complications,” Dr. Susan Blank, chair of the task force that authored the AAP policy statement, said Tuesday. “This is one thing a parent can do to protect the future health of their children.”

In its policy statement, the AAP declared that the health benefits are great enough that infant male circumcision should be covered by insurance, which would increase access to the procedure for families who choose it, said Blank, who is also assistant commissioner of STD Control and Prevention at the New York City Department of Health and Mental Hygiene.

“The push from the academy’s point of view is to really have providers lay out for parents what are the risks, what are the benefits, and give the parents the information they need to make a decision,” Blank said. “And the academy feels strongly that since there are proven health benefits, the procedure should be covered by insurance.”

The guidelines are expected to spur a response from anti-circumcision groups.

Malignant and premalignant lesions of the penis.

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  • Penile cancer has potentially devastating functional and psychological consequences for the patient
  • Penile cancer is thought to be associated with foreskin and genital infection with human papillomavirus types 16 and 18
  • Most patients present with a penile lump (47%), ulcer (35%), or erythematous lesion (17%)
  • Carcinoma in situ of the penis is treated initially with topical chemotherapy or lasers; surgery is reserved for unresponsive cases and men with extensive premalignant changes
  • In invasive penile cancer, penile preserving surgery minimises voiding and sexual dysfunction and psychological sequelae; more radical penile surgery is reserved for advanced cases
  • Metastatic inguinal lymph node involvement is the most important prognostic factor

Penile cancer can have devastating mutilating and psychological consequences for those affected. It is important for clinicians to be aware of the condition. Differentiation of benign genital dermatoses from premalignant penile lesions and early stage penile cancer, with prompt specialist referral, usually prevents progression, improves prognosis, and results in improved functional and cosmetic outcomes for affected men. A retrospective single centre study of all penile cancer cases in a specialist unit over five years found that general practitioners initiated most referrals, but that about 20% of patients were initially referred to specialties other than urology, such as genitourinary medicine, dermatology, or plastic surgery.1This error delayed diagnosis by up to six months and potentially adversely affected quality of life, prognosis, and survival. Our article, written for the non-specialist, aims to provide an evidence based review of the causes and current trends in the diagnosis and management of premalignant and malignant penile lesions.

 

Source:BMJ

 

 

Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women

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Randomised trials show that male circumcision reduces the prevalence and incidence of high-risk human papillomavirus (HPV) infection in men. We assessed the efficacy of male circumcision to reduce prevalence and incidence of high-risk HPV in female partners of circumcised men.
METHODS: In two parallel but independent randomised controlled trials of male circumcision, we enrolled HIV-negative men and their female partners between 2003 and 2006, in Rakai, Uganda. With a computer-generated random number sequence in blocks of 20, men were assigned to undergo circumcision immediately (intervention) or after 24 months (control). HIV-uninfected female partners (648 of men from the intervention group, and 597 of men in the control group) were simultaneously enrolled and provided interview information and self-collected vaginal swabs at baseline, 12 months, and 24 months. Vaginal swabs were tested for high-risk HPV by Roche HPV Linear Array. Female HPV infection was a secondary endpoint of the trials, assessed as the prevalence of high-risk HPV infection 24 months after intervention and the incidence of new infections during the trial. Analysis was by intention-to-treat. An as-treated analysis was also done to account for study-group crossovers. The trials were registered, numbers NCT00425984 and NCT00124878.
FINDINGS: During the trial, 18 men in the control group underwent circumcision elsewhere, and 31 in the intervention group did not undergo circumcision. At 24-month follow-up, data were available for 544 women in the intervention group and 488 in the control group; 151 (27.8%) women in the intervention group and 189 (38.7%) in the control group had high-risk HPV infection (prevalence risk ratio=0.72, 95% CI 0.60-0.85, p=0.001). During the trial, incidence of high-risk HPV infection in women was lower in the intervention group than in the control group (20.7 infections vs 26.9 infections per 100 person-years; incidence rate ratio=0.77, 0.63-0.93, p=0.008).
INTERPRETATION: Our findings indicate that male circumcision should now be accepted as an efficacious intervention for reducing the prevalence and incidence of HPV infections in female partners. However, protection is only partial; the promotion of safe sex practices is also important.
FUNDING: The Bill & Melinda Gates Foundation, National Institutes of Health, and Fogarty International Center.

source: lancet