To a sur­geon, cir­cum­ci­sion is a ... chal­leng­ing op­er­a­tion, not be­cause it’s com­pli­cated but be­cause it re­quires an ex­quis­ite tech­nique.”

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That re­luc­tance is also a re­sult of the de­fects of con­ven­tional surgery, be­cause scars and the risks re­lated to bleed­ing are in­evitable, Zhu said. “More im­por­tant, the amount of fore­skin re­moved can’t be tar­geted by the mil­lime­ter, so some men may be con­cerned that their erec­tions will be shorter af­ter surgery,” he said.

What­ever their con­cerns, the pa­tients have high ex­pec­ta­tions. The urol­ogy depart­ment at Chaoyang Hos­pi­tal in Bei­jing per­forms about 1,000 cir­cum­ci­sions ev­ery year, and most pa­tients opt for the Shang Ring, even though it costs 1,200 yuan ($192) to 1,300 yuan, dou­ble that of con­ven­tional surgery, ac­cord­ing to Tian Long, direc­tor of the depart­ment.

“Peo­ple ex­pect more nowa­days. Not just in terms of safe re­moval of the fore­skin, but also in terms of good ap­pear­ance and per­fect func­tion,” Tian said. “To a sur­geon, cir­cum­ci­sion is ac­tu­ally a chal­leng­ing op­er­a­tion, not be­cause it’s com­pli­cated, but be­cause it re­quires an ex­quis­ite tech­nique.”

Although some pri­vate hos­pi­tals advertise “pain­less laser­scalpel surgery” to en­cour­age peo­ple to have the tra­di­tional op­er­a­tion, the dif­fer­ences are min­i­mal. “They just re­volve around the type of anes­the­sia and sur­gi­cal in­stru­ments; the pro­ce­dure is fun­da­men­tally the same,” he said.

Philip S. Li, as­so­ciate re­search pro­fes­sor of urol­ogy at the Weill Cor­nell Med­i­cal Col­lege of Cor­nell Uni­ver­sity, said that in the past three years, the male cir­cum­ci­sion rate in theUS has been around 70 per­cent.

Li said the surgery is usu­ally per­formed within a day or two of a baby’s birth. How­ever, doc­tors­may also sug­gest cir­cum­ci­sion for older pa­tients who are experiencing prob­lems, such as in­flam­ma­tion of the fore­skin, or phi­mo­sis, dif­fi­culty in re­tract­ing the fore­skin.

Tian, from Chaoyang Hos­pi­tal, said the cir­cum­ci­sion of new­borns is al­most un­known to most Chi­nese par­ents, but an in­creas­ing num­ber of the younger gen­er­a­tion is em­brac­ing the prac­tice. In re­cent years, stu­dents have ac­counted for nearly 50 per­cent of all sur­gi­cal cases at Chaoyang Hos­pi­tal and Pek­ing Uni­ver­sity Hos­pi­tal dur­ing the win­ter and sum­mer va­ca­tions.

Ac­cord­ing to Tian, an­other siz­able pa­tient group con­sists of men aged about 30 who are about to marry, and choose to have the surgery to re­duce the risk of the bride con­tract­ing a bac­te­rial in­fec­tion.

Zhou Junchen, 32, opted to be cir­cum­cised at the age of 20 af­ter read­ing on the In­ter­net that the op­er­a­tion would re­duce the risk of in­fec­tion and also pro­vide bet­ter-qual­ity sex. “Dozens of men were hav­ing the op­er­a­tion that morn­ing, and the sur­geon was sur­prised when I lay on the op­er­at­ing ta­ble. He said he rarely treated younger pa­tients who had cho­sen to have the surgery vol­un­tar­ily for health rea­sons. Most of his cases in­volved older men with in­flam­ma­tions,” he said.

Things have changed in the in­ter­ven­ing 12 years, though. Zhou said young peo­ple have a more open-minded at­ti­tude to­ward cir­cum­ci­sion, and want to learn more about it. “Although the benefits haven’t been widely pub­li­cized in China, peo­ple now have greater ac­cess to health in­for­ma­tion. I be­lieve peo­ple of my gen­er­a­tion will con­sider this as an op­tion for their kids,” he said.

The Shang Ring has been adopted by a num­ber of hos­pi­tals around China, and some ex­perts be­lieve that the growth of the mar­ket will ben­e­fit an in­creas­ing num­ber of peo­ple, who will in turn en­cour­age oth­ers to learn about cir­cum­ci­sion.

“More im­por­tant, the Shang Ring could vastly in­crease ac­cess to male cir­cum­ci­sion in coun­tries hard­est hit by the HIV epi­demic,” said Cor­nell’s Li. The sig­nif­i­cance of cir­cum­ci­sion has al­ready been shown in some Africa coun­tries, be­cause the surgery has been grad­u­ally pro­moted across the con­ti­nent in the past decade.

In 2011, a UNAIDS re­port showed a decline in the num­ber of new cases of HIV in 33 coun­tries — 22 of them in south­ern Africa — be­tween 1997 and 2010. Although med­i­cal in­ter­ven­tions, such as the in­tro­duc­tion of an­tiretro­vi­ral ther­a­pies, were the main rea­sons for the fall, the re­port said cir­cum­ci­sion had also played an im­por­tant role in the pre­ven­tion ofHIVand other sex­u­ally trans­mit­ted dis­eases.

“The Shang Ring is a great con­tri­bu­tion that China has made to global health,” said Cheng Feng, pro­gram direc­tor of the Re­search Cen­ter for Pub­licHealth atTs­inghuaUniver­sity. “Once it passes the WHO’s pre­qual­i­fi­ca­tion process, the United Na­tions could pur­chase it for large-scale use in Africa, where there are so few med­i­cal staff. That could mean a lot for African coun­tries— in the long ter­mit could even­prove­to­beof greater value than ma­te­ri­als pro­vided to sup­port the con­ti­nent as it changes. It’s not just about­to­day— it’s al­soabout­the fu­ture.” Con­tact the writer at yang­wanli@chi­

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