Rwanda Investigating Adult Male Circumcision Without Anesthesia

Rwanda's government is studying a new nonsurgical method to circumcise males as part of its fight against HIV. The experimental PrePex device, manufactured by Circ MedTech, includes an elastic mechanism that is clamped on the penis foreskin in about four minutes, without anesthesia or sutures. With its blood supply cut, the foreskin dries up and it is removed after a week, and no blood is lost.

In March 2011, data on the first 40 patients in a safety and efficacy trial were presented at the 18th Conference on Retroviruses and Opportunistic Infections in Boston. All the men healed excellently, said researchers.

Participants took two ibuprofens to cope with an initial three-hour period of discomfort, said Agnès Binagwaho, permanent secretary of Rwanda's Ministry of Health. Newly circumcised males are counseled to forego sex for six weeks after the foreskin is removed.

"If we only circumcise newborns, the effects will start in 15 years," Binagwaho explained of Rwanda's aim of circumcising 2 million adult males by 2012. "We are offering, alongside counseling, testing and condom distribution, an additional means of lowering transmission. It's a comprehensive approach."

"There's absolutely no doubt that if one can perform male circumcision without anesthesia, you save time, money and it requires less expertise," said Kim Eva Dickson, senior advisor in WHO's HIV/AIDS department. "We saw it done, and when we spoke to people who went through the procedure they seemed satisfied and the cosmetics looked good."

A randomized controlled trial with 150 participants is ongoing; it will compare PrePex with conventional, surgical circumcision. Experts agree the device still has to be tested in expanded trials to ensure it is not associated with any rare adverse events.

For infants, World Health Organization-approved circumcision devices include the Morgen clamp, the Gomco clamp and the Plastibell.