Ring­ing the changes for cir­cum­ci­sion

A Chi­nese in­ven­tion may pro­mote the pro­ce­dure at home, and help in the battle against HIV/AIDS over­seas, as Yang­Wanli re­ports.

China Daily (Canada) - - FRONT PAGE -

On April 4, 2012, Bill Gates vis­ited Stan­ford Uni­ver­sity for a ques­tion and an­swer ses­sion with stu­dents. Dur­ing a brief pre­sen­ta­tion on the in­no­va­tions that are help­ing African coun­tries, the bil­lion­aire Mi­crosoft boss showed off an in­ge­nious in­ven­tion from China. It was small, pink, and con­sisted of two con­cen­tric plas­tic rings. “It’s a fan­tas­tic devel­op­ment. It’s just plas­tic, so it’s very cheap,” he said. “It re­duces the pain in­volved. It re­duces the cost in­volved. It’s very straight­for­ward.”

Fast-for­ward al­most three years. It’s Jan­uary, and an elec­tri­cian is in­stalling bulbs to meet light­ing stan­dards on the pro­duc­tion line at Wuhu Sn­nda Med­i­cal Treat­ment Ap­pli­ance Tech­nol­ogy Co in EastChina’s An­hui prov­ince. If the in­ven­tion Gates dis­played at Stan­ford passes the World Health Or­ga­ni­za­tion’s pre­qual­i­fi­ca­tion process in the next few­months, WuhuSn­nda will begin full pro­duc­tion.

The de­vice, called the Shang Ring af­ter its in­ven­tor, Shang Jianzhong, is the lat­est de­vel­op­mentin cir­cum­ci­sion— the sur­gi­cal re­moval of the fore­skin, there­tractable­fold­oftis­suethat cov­ers the head of the pe­nis.

Shang al­ways laughs when he re­calls the cir­cum­ci­sion he had 13 years ago to treat an ail­ment, but the 60-year-old’s ex­pe­ri­ence was far from hu­mor­ous. The surgery, per­formed at a clinic in An­hui, took 30 min­utes as the sur­geon snipped the fore­skin and then stitched the wound in the clas­sic pro­ce­dure that’s per­formed ev­ery day in some part of the world. Af­ter the op­er­a­tion, Shang was put on a drip and given oral an­tibi­otics to pre­vent in­fec­tion. He was also banned from tak­ing a shower for seven days.

A month later, how­ever, the re­sults were un­sat­is­fac­tory. The surgery had left sev­eral prom­i­nent scars, and “even more em­bar­rass­ing was that the sur­geon had cut the fore­skin a lit­tle more than nec­es­sary, and my erec­tion be­came shorter than be­fore”, Shang said. Ex­perts say th­ese “de­fects” may be un­avoid­able with con­ven­tional surgery; the scars are caused by the stitches, and the length of the fore­skin al­ways de­pends on the in­di­vid­ual sur­geon’s tech­nique.

In light of the prob­lems he’d en­coun­tered, Shang, who spent eight years as a mold­maker be­fore work­ing as a sur­veyor at a map­ping in­sti­tute, de­cided to put his tech­ni­cal skills to good use and de­sign a de­vice to aid cir­cum­ci­sion.

The re­sult was the Shang Ring, a dis­pos­able de­vice con­sist­ing of two con­cen­tric rings that clamp to­gether and ex­pose the fore­skin so it can be re­moved sur­gi­cally, but with min­i­mal bleed­ing. The ring is re­moved seven days af­ter the surgery when the wound has healed. Be­cause the pro­ce­dure doesn’t re­quire stitches, the pa­tient is al­lowed to bathe and only re­quires oral an­tibi­otics. The use of the ring also cuts the pro­ce­dure time to about three to five min­utes from about 30 be­fore.

“Peo­ple may be sur­prised to learn that such an in­no­va­tive idea was nur­tured in China, where the cir­cum­ci­sion rate is ex­tremely low,” Shang said.“My re­ply is this: No mat­ter how many cir­cum­ci­sions have been done in a coun­try, each one is ex­tremely im­por­tant to the man con­cerned, to his health and self-con­fi­dence. A safer, semi-sur­gi­cal de­vice will en­cour­age­morepeo­ple to learn about cir­cum­ci­sion, and­maybe choose to have the pro­ce­dure.”

The World Health Or­ga­ni­za­tion es­ti­mates that about 30 per­cent of all males aged 15 and older world­wide are cir­cum­cised, and about 70 per­cent of them are Mus­lim or Jewish. Although the prac­tice is most preva­lent in Ju­daism and Is­lam, and is car­ried out dur­ing child­hood oraround­pu­berty as part of a rite of pas­sage, it’s also com­mon among Chris­tians in Egypt, Syria and a small num­ber of other coun­tries. In­China, the male cir­cum­ci­sion rate is lower than 5 per­cent.

In 2007, WHOand UNAIDS, the Joint United Na­tions Pro­gram on HIV/AIDS, is­sued guide­lines on us­ing med­i­cal male cir­cum­ci­sion as an ad­di­tional strat­egy to pre­vent HIV in­fec­tion. Ac­cord­ing to the US Cen­ters for Dis­ease Con­trol and Pre­ven­tion, clin­i­cal tri­als have demon­strated that cir­cum­ci­sion re­duces the risk of con­tract­ing HIV/AIDS by 50 to 60 per­cent. The pro­ce­dure also re­duces the chances of con­tract­ing her­pes and hu­man pa­pil­loma virus, two pathogens be­lieved to cause can­cer of the pe­nis, by 30 per­cent.

How­ever, cir­cum­ci­sion is still al­most un­known in China, ac­cord­ing to Zhou Xiaozheng, a pro­fes­sor of so­ci­ol­ogy at Ren­min Uni­ver­sity of China. “Few Chi­nese men have a re­li­gious back­ground that pro­motes cir­cum­ci­sion. In ad­di­tion, surgery on the male gen­i­tals re­mains un­think­able. In the minds of the Chi­nese peo­ple, the only equiv­a­lent widely known surgery is the cas­tra­tion of eu­nuchs, which can be traced back to the Qin Dy­nasty (221-206 BC),” he said.

Ac­cord­ing to Zhu Jichuan, direc­tor of the An­drol­ogy Cen­ter at Pek­ingUniver­si­tyHospi­tal, the tra­di­tional no­tion that “only a pa­tient needs surgery” is deeply rooted. “Most men choose to be cir­cum­cised be­cause of a skin in­flam­ma­tion that re­sults from hav­ing an over­long fore­skin, rather than to pre­vent dis­ease. How­ever, surgery is an op­tion that must be open to them,” he said.

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