Policy amp Programming Other Benefits for Men and Women Knowledge Check Answer the following questions to see how much you know about this topic Male circumcision includes which of the following health benefits Select ALL that apply ID: 239084
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Slide1
Male Circumcision: Policy & Programming
Other Benefits for Men and WomenSlide2
Knowledge Check
Answer the following questions to see how much you know about this topic.
Male circumcision includes which of the following health benefits? Select ALL that apply.
Less frequent human papillomavirus in circumcised men
Cervical cancer and bacterial vaginosis less prevalent in women whose partners are circumcisedDecreased risk of urinary tract infections in male infantsDecreased risk of syphilis, chancroid, and invasive penile cancer in circumcised menFindings from a study of FEMALE PARTNER satisfaction in Rakai, Uganda, suggest that male circumcision DECREASES female satisfaction.TrueFalse
All of the following statements about male circumcision (MC) are true EXCEPT:
MC is currently recommended for HIV-positive men as an intervention to reduce HIV transmission to women.
Men who test positive for HIV at an MC clinic should be linked to HIV care and treatment.
An HIV-positive man with a compromised immune system may have increased complication rates following MC.
A study of self-reported sexual satisfaction and function among MALES in Rakai, Uganda, concluded that adult male circumcision adversely affects:
Sexual satisfaction in men
Clinically significant sexual function in men
a and b
None of the above
Male circumcision INCREASES the risk of HSV-2 (the most common cause of genital herpes).
True
FalseSlide3
MC Has Other Important Health Benefits for Men and Women.
For example:
Human papillomavirus
(HPV), is less frequent in circumcised men.
The circumcised penis is easier to keep clean.Circumcision prevents the growth of bacteria under the foreskin and this, in turn, protects male infants from urinary tract infections.Associations have been reported between the uncircumcised foreskin and the presence of anaerobes (bacteria that grow where there is no oxygen). In female partners of uncircumcised men, these anaerobic bacteria can lead to bacterial vaginosis, which is associated with pre-term delivery of low-birth-weight infants. (Hiller et al. 1995)Slide4
MC Benefits for Men
MC reduces risk of:
HSV-2
(the most common cause of genital herpes)
HPV infections (which can lead to penile cancer)Genital ulcer diseaseUrinary tract infections (in male infants)Syphilis, chancroid, and invasive penile cancerPenile injuries (e.g., soreness during intercourse, abrasions/scratches/cuts during intercourse, soreness after intercourse)
In addition, MC prevents:
Inflammation of the glans (
balanitis
) and the foreskin (
posthitis
)
Health problems associated with the foreskin such as
phimosis
(an inability to retract the foreskin) or
paraphimosis
(swelling of the retracted foreskin causing inability to return it to its normal position)Slide5
Important Indirect Benefits of MC for Women
Even though MC has not currently been shown to protect against male-to-female HIV transmission, MC does provide important indirect benefits for women.
For example, in women whose partners are circumcised, MC reduces:
Bacterial vaginosis,
Trichomonas infection, and genital ulcer diseaseThe prevalence of cervical cancer
The prevalence and incidence of HPV infections (persistent high-risk HPV infection is a prerequisite for cervical cancer)
Sources
: Gray et al. 2009; Agarwal et al. 1993; Wawer et al. 2011Slide6
Sexual Function and Satisfaction for Men Following MC
Sources
: Krieger et al. 2008; Kigozi et al. 2008a
Some concerns have been raised that MC may impair sexual function and satisfaction.
These studies found that:Integrating MC with programs to reduce HIV risk is unlikely to adversely affect male sexual function. (Kisumu)
Adult MC does not adversely affect sexual satisfaction or clinically significant function in men. (
Rakai)
Two studies (an assessment in Kisumu, Kenya, and an investigation of self-reported sexual satisfaction and function in Rakai, Uganda) were conducted, within the context of randomized controlled trials (RCTs), to investigate these concerns.Slide7
Female Partner Sexual Satisfaction:
Rakai, Uganda
However, in a study of 455 women partners of men circumcised in the Rakai RCT, the overwhelming majority of women (97.1%) reported either no change (57.3%) or improved sexual satisfaction (39.8%) after their male partner was circumcised.
These findings suggest that MC does NOT decrease female sexual satisfaction.
Source: Kigozi et al. 2009
There is not a wide body of literature that examines the effect of MC on female sexual satisfaction.Slide8
Should HIV-Positive Men Be Circumcised?
There is no evidence that documents a reduction in HIV among HIV-positive men who are circumcised. And an HIV-positive man with a compromised immune system may have increased complication rates following surgery.
According to the WHO and UNAIDS conclusion and recommendations (WHO and UNAIDS 2007b),
promoting circumcision for HIV-positive men is not recommended
. Did You Know?To maximize MC's benefits, priority may be given to HIV-negative men of any age who are at higher risk for HIV (e.g., men presenting with STIs, or HIV-negative men in discordant relationships). Slide9
Should HIV-Positive Men Be Circumcised? (continued)
If an HIV-positive man resumes sexual activity before certified MC wound healing, his likelihood of transmitting HIV may increase.
If—following in-depth counseling on MC risks and benefits—an HIV-positive man wants MC for reasons other than HIV prevention, MC should not be withheld unless it is medically contraindicated.
Men who test HIV-positive in an MC clinic should be linked to HIV care and treatment and should refer their partner(s) for HIV testing and counseling.Slide10
Policy and Programming Opportunities
You Decide . . .
As a program manager, implementing an MC for HIV prevention program, what strategies would you use to reach men and their partners with information about – and services that address – HIV risk reduction, gender equity, contraception, and shared decision making?Slide11
MC and Family Planning Synergies in Zimbabwe
An MC operating room integrated with a family planning (FP) clinic recovery room.
Highlights:
A Win-Win Strategy for Public Health
Offering MC at FP clinics can potentially increase uptake of FP and other health services.Slide12
Knowledge Recap
Answer the following questions to see how much you know about this session.
Male circumcision includes which of the following health benefits? Select ALL that apply.
Less frequent human papillomavirus in circumcised men
Cervical cancer and bacterial vaginosis less prevalent in women whose partners are circumcisedDecreased risk of urinary tract infections in male infantsDecreased risk of syphilis, chancroid, and invasive penile cancer in circumcised menMale circumcision REDUCES Trichomonas infection in female partners. TrueFalse
Findings from a study of FEMALE PARTNER satisfaction in
Rakai
, Uganda, suggest that male circumcision DECREASES female satisfaction.
True
False
A
study of self-reported sexual satisfaction and function among MALES in
Rakai
, Uganda, concluded that adult male circumcision adversely
affects:
Sexual satisfaction in
men
Clinically
significant sexual function in
men
a and
b
None
of the
aboveSlide13
Knowledge Recap (continued)
Male circumcision INCREASES the risk of HSV-2 (the most common cause of genital herpes).
True
False
A study from Kisumu, Kenya, raises concerns that integrating male circumcision with programs to reduce HIV risk may adversely affect male sexual function.TrueFalse
All of the following statements about male circumcision (MC) are true EXCEPT:
MC
is currently recommended for HIV-positive men as an intervention to reduce HIV transmission to women.
Men
who test positive for HIV at an MC clinic should be linked to HIV care and treatment.
An
HIV-positive man with a compromised immune system may have increased complication rates following MC
Answer the following questions to see how much you know about this session.Slide14
Other Benefits for Men and Women
Knowledge
Recap Answer Key
Please note that the questions and answers match those in the
Knowledge Recap. The number and order of questions in the Knowledge Check may differ.Male circumcision includes which of the following health benefits? Select ALL that apply.Less frequent human papillomavirus in circumcised menCervical cancer and bacterial vaginosis less prevalent in women whose partners are circumcisedDecreased risk of urinary tract infections in male infantsDecreased risk of syphilis, chancroid, and invasive penile cancer in circumcised mena, b, c, and d ALL apply
Male circumcision REDUCES Trichomonas infection in female partners.
True
Findings from a study of FEMALE PARTNER satisfaction in Rakai, Uganda, suggest that male circumcision DECREASES female satisfaction.
b.
False: The overwhelming majority of women reported either no change or improved sexual satisfaction after their male partner was circumcised. Findings from this study suggest that male circumcision does NOT decrease female sexual satisfaction.
A study of self-reported sexual satisfaction and function among MALES in Rakai, Uganda, concluded that adult male circumcision adversely affects:
d.
None of the above: A study of self-reported sexual satisfaction and function among males in Rakai, Uganda, concluded that adult male circumcision DOES NOT ADVERSELY AFFECT sexual satisfaction OR clinically significant function in men. Slide15
Other Benefits for Men and Women
Knowledge Recap Answer Key (continued)
Male circumcision INCREASES the risk of HSV-2 (the most common cause of genital herpes).
b.
False: Male circumcision DECREASES the risk of HSV-2 (the most common cause of genital herpes). A study from Kisumu, Kenya, raises concerns that integrating male circumcision with programs to reduce HIV risk may adversely affect male sexual function.b. False: The study from Kisumu concluded that integrating male circumcision with programs to reduce HIV risk is UNLIKELY TO ADVERSELY AFFECT male sexual function. All of the following statements about male circumcision (MC) are true EXCEPT: a.
MC is currently recommended for HIV-positive men as an intervention to reduce HIV transmission to women.
Based on current available evidence, MC is not recommended for HIV-positive men as an intervention to reduce HIV transmission to women. There is no evidence that documents a reduction in HIV among HIV-positive men who are circumcised. In addition, if an HIV-positive man resumes sexual activity before certified wound healing, his likelihood of transmitting HIV may increase.
Please note that the questions and answers match those in the
Knowledge Recap
. The number and order of questions in the
Knowledge Check
may differ.