Module 1: VMMC

and HIV Infection

1.1 Introduction
to VMMC: Part 1
 Introduction to VMMC:
Objectives
• Define terms related to VMMC.
• Describe who can perform male circumcision and where.
• List the key methods of male circumcision.
• List benefits and risks of VMMC.
• List some common myths about VMMC and explain
why they are not accurate.
Check Your Knowledge
 Testimonial: Tauanda Lúcio
• “Yeah, now I am clean!”
• “The pain was not very
strong.”
Fighting HIV with VMMC
 Defining our Terms
Male circumcision:
Surgical removal of foreskin,
the thin layer of skin covering the head of the penis

Traditional foreskin cutting

Medical male circumcision (MMC)

Early infant male circumcision (EIMC)

Voluntary medical male circumcision (VMMC)

Early Infant Male Circumcision
(EIMC)
 Methods
Conventional Surgery WHO Prequalified Devices
• Forceps-guided • PrePex™
• Dorsal slit • ShangRing.™
• Sleeve resection.
 WHO Prequalification
• Tested in clinical trials
• Found safe and effective when used
according to manufacturer’s instructions
• Properly manufactured
• Under continued monitoring.

Always consult the latest version of the device

manufacturer’s instructions for use!
 VMMC: The Healing Period
• Rest for 2-3 days
• Abstention from
sexual activity for
6-7 weeks
• Follow-up visits
according to
schedule.
Who Performs VMMC?
Where is VMMC Performed?
Requirements for VMMC?
• Counseling and
education
• Screening
• Informed consent
or assent.
End of Part 1
1.1 Introduction to VMMC
Part 2
 VMMC: Benefits for Men
• Reduced risk of HIV
• Reduced risk of some STIs: chancroid,
syphilis, HPV
• Reduced risk of penile cancer
• Prevention of conditions linked to foreskin:
phimosis, paraphimosis
• Easier to maintain penile hygiene.
VMMC: Benefits for Men Cont’d

Men report:
• Improved hygiene
• Improved sexual
pleasure
• Increased desirability.
 VMMC: Benefits for Women
Reduced risk of
contracting:
• HIV
• HPV, cervical cancer
• Other STIs.
 VMMC: Risks
• All medical procedures include risk.
• Majority of VMMC clients experience
no adverse events.
• Know risks and how to manage them.
• Adverse events are usually mild, treatable,
and resolved quickly.
• Accurate, timely identification of moderate
or severe events can limit their severity.
 VMMC: Risks (Cont)
• Pain
• Bleeding, haematoma formation
• Infection
• Injury to the penis (rare)
• Difficulty voiding (rare)
• Reaction to anaesthetic (very rare)
• Tetanus and Fournier’s Gangrene
(very rare).
 VMMC: Myths
A myth is a widely held but false belief.
Example:
FA
LS
Male circumcision is safest in the winter.
E!
Fact: Male circumcision can be performed
any time of the year as long as safety
guidelines are followed.
 VMMC: Myths
A man must stay off work for
weeks while he heals after VMMC.
VMMC reduces sexual pleasure
and performance.
VMMC is very painful.
VMMC is for a particular culture or
religion.
The penis becomes shorter after
VMMC.
Condoms are not necessary after
VMMC .
VMMC is a complicated operation.
Most men will miss 2-3 days of school or work. If a man
has a strenuous job, he may have to miss a few more
days.
Studies have found no negative effects of sexual function
or pleasure. Some Kenyan men report it is easier to reach
orgasm and their female partners find sex more
enjoyable after their partners were circumcised.
There is some pain, including the anaesthetic injection,
but it is temporary and painkillers are provided to control
it.
VMMC is not cultural or religious. It is a neutral medical
intervention.
VMMC only removes the foreskin of the penis.
VMMC provides only partial protection from HIV.
Condoms are still an important part of HIV prevention.
VMMC is minor surgery that usually takes less than
30 minutes.
 Conclusion
• MC: surgical removal of foreskin, the thin layer of
skin covering head of penis
• VMMC: programmes that offer and promote MC in
a package of services for HIV prevention
• MC performed through conventional surgery
or via a device method. Both require short
post-procedure healing period
• MC provides partial protection from female-to-male
transmission of HIV and certain other STIs
• VMMC has benefits and risks
• Myths exist about VMMC – Know the facts!
Test Your Learning