VMMC SELF CIRCUMCISION-AN EMERGING CHALLENGE IN THE ZIMBABWEAN VMMC PROGRAM

Case study

9 year old client who presented at a local health facility on 9/06/21 complaining of a 4 day history of
pain and penile swelling following an attempt to circumcise himself. This client was inspired to get
circumcised by a friend from the neighborhood who was circumcised in the national VMMC program.
Client could not access VMMC services because he has not yet reached the eligible age of 15 years
required in the national VMMC program.

Client used a string (shinda yesaga, intambo yesaka) as a tourniquet around the foreskin with the hope
that after some time the foreskin was going to fall off on its own. The mother noticed 4 days later that
client was having difficulties walking. Upon interrogation he admitted that he had tried to circumcise
himself. Client was then taken to the local health facility by his mother

O/E(under anesthesia)-stable, vitals within normal ranges, penis globally swollen, deep circumferential
cut noted around the coronal sulcus, tourniquet noted after exploration( client had indicated he had
removed the tourniquet and this was not true), he was voiding well with the urinary stream coming
through the urethral meatus, no urinary leaks.

Diagnosis- i. glans injury secondary to failed attempted self-circumcision.

Ii. Suspected urethrocutaneous fistula

Management: counselling done to both mother and son, wound cleaned with betadine and client
commenced on ceftriaxone iv 500mg bd, paracetamol po 500mg tds. Client referred to a urologist on
10/06/21. Further investigations by the urologist revealed that the glans and urethra were both intact,
WITH NO URETHROCUTANEOUS FISTULA.

The urologist performed a dorsal slit circumcision on 14/06/21 and client was happily discharged
following day. Several reviews were done by the local VMMC team and client has since completely
healed without any disabilities.

Questions:

i. Is this an AE related to VMMC?

ii. Was this AE avoidable/preventable and if so , how?
iii. Comment on the diagnosis and management of this client.
iv. Discuss impact of the shift in eligible age of circumcision on self-circumcisions
v. How widespread is the challenge of self-circumcisions in our communities?