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Journal ArticleDOI

Penile Measurements in Tanzanian Males: Guiding Circumcision Device Design and Supply Forecasting

TL;DR: To the authors' knowledge this is the first study in a sub-Saharan African population that provides sufficiently detailed glans and foreskin dimensions to inform voluntary medical male circumcision device development and size forecasting.
About: This article is published in The Journal of Urology.The article was published on 2013-08-01 and is currently open access. It has received 14 citations till now. The article focuses on the topics: Acquired immunodeficiency syndrome (AIDS).

Summary (2 min read)

INTRODUCTION

  • After three randomized control trials indicated male circumcision reduces heterosexual male HIV acquisition by ~60%, the World Health Organization (WHO) and the Joint UN Programme on HIV/AIDS recommended rapid scale-up of voluntary medical male circumcision (VMMC) programs in 14 African countries with low circumcision rates and high HIV prevalence.
  • Since 2009, the Ministry of Health has performed over 100,000 circumcisions in the Iringa and Njombe regions of Tanzania 76% of them in males ages 19 and younger.
  • Correct device fit and function are essential for safe and effective VMMC, both intra-operatively and postoperatively.
  • For disposable devices available in a range of sizes, manufacturing and supply forecasting are dependent on accurate predictions of device sizes required by target communities.
  • The authors main study objective was to provide detailed penile and foreskin dimensions to inform device development and size forecasting in a location where VMMC programs are being expanded.

Clinical and Measurement Procedures

  • Data collectors included five Tanzanian doctors and nurses with VMMC experience, who had a two-day orientation to the study.
  • The training established intra-individual reproducibility as well as utilized repeated measures of inter-rater reliability against a gold standard.
  • Participant’s age, height and weight were measured before surgery.
  • After manual reduction of any suprapubic fat, gentle traction was applied at the corona.
  • Length from the corona to the distal edge of the reduced foreskin (cm) in the relaxed state was measured using a ruler.

Statistical Analysis

  • For continuous variables, the mean, median, interquartile range (IQR) and standard deviation were calculated.
  • For categorical variables, percentages and frequencies were calculated.
  • Given estimated variation in pubertal onset, data from the younger two age categories were plotted in a similar fashion to a growth curve (measurements vs. age).
  • Participant height and weight were measured in order to examine correlations with penile parameters.
  • Scatterplots of continuous measurements were made with locally weighted scatterplot smoothing .

RESULTS

  • As expected, penile parameters varied widely among males ages 10–18 , given variability in age and sexual maturation.
  • Glans and foreskin measurements are critical to device fit.
  • A subset analysis of age and Tanner stage showed that 18-year-olds were more variable in Tanner staging than adults.

DISCUSSION

  • This study describes penile measurements of the foreskin and glans in Tanzanian VMMC clients in Iringa, Tanzania to inform device development and size forecasting for device-based VMMC programs.
  • These data augment currently available literature on penile dimensions, providing more detailed measurements than previously available in a population where VMMC is being scaled up.
  • 29 Tanzania’s 2010 Demographic and Health Survey found 52% of children under 5 were stunted, reflecting chronic under-nutrition.
  • The preponderance of young adults in the “adult” group magnifies any contribution of stunting or delayed sexual maturity discussed above.
  • Accurate device size forecasting will lead to more efficient use of resources for VMMC services as well as avoiding potential adverse clinical events from inappropriately sized devices.

Limitations

  • Results of this study are not necessarily generalizable.
  • Penile dimensions can vary based on age, race, and environmental factors.
  • The adult category was disproportionately comprised of younger males, reflecting the demographic seeking VMMC services.
  • Less physically mature adults may be overrepresented.
  • Age was based on self-report, since national IDs are not required.

CONCLUSIONS

  • Penile parameters measured in this study were more detailed than any previous evaluation in a rural/peri-urban sub-Saharan African population and will be useful for device design and supply forecasting.
  • Differences between this study and previous literature highlights the need to assess penile dimensions among target populations in the implementation plans of device-based VMMC programs.
  • Some somatometric measurements were found to be correlated with penile dimensions.
  • This finding may increase device-based VMMC program efficiency by providing an alternative nongenital method for estimating device size.
  • Penile measurements should be assessed in additional settings (urban locations, other countries, etc.) to establish generalizability.

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Citations
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Journal Article
TL;DR: Male circumcision significantly reduces the risk of HIV acquisition in young men in Africa and should be integrated with other HIV preventive interventions and provided as expeditiously as possible.

1,692 citations

Journal ArticleDOI
01 Jun 2015-BJUI
TL;DR: To systematically review and create nomograms of flaccid and erect penile size measurements, a large number of errors were found in the previous studies.
Abstract: Objective To systematically review and create nomograms of flaccid and erect penile size measurements. Methods Study key eligibility criteria: measurement of penis size by a health professional using a standard procedure; a minimum of 50 participants per sample. Exclusion criteria samples with a congenital or acquired penile abnormality, previous surgery, complaint of small penis size or erectile dysfunction. Synthesis methods: calculation of a weighted mean and pooled standard deviation (SD) and simulation of 20,000 observations from the normal distribution to generate nomograms of penis size. Results Nomograms for flaccid pendulous [n = 10,704, mean (SD) 9.16 (1.57) cm] and stretched length [n = 14,160, mean (SD) 13.24 (1.89) cm], erect length [n = 692, mean (SD) 13.12 (1.66) cm], flaccid circumference [n = 9407, mean (SD) 9.31 (0.90) cm], and erect circumference [n = 381, mean (SD) 11.66 (1.10) cm] were constructed. Consistent and strongest significant correlation was between flaccid stretched or erect length and height, which ranged from r = 0.2 to 0.6. Limitations relatively few erect measurements were conducted in a clinical setting and the greatest variability between studies was seen with flaccid stretched length. Conclusions Penis size nomograms may be useful in clinical and therapeutic settings to counsel men and for academic research.

143 citations

Journal ArticleDOI
TL;DR: The findings add to previous reports and support the existence of PSSD, which may not be fully explained by alternative nonpharmacological factors related to sexual dysfunction, including depression and anxiety.
Abstract: Emerging evidence suggests that sexual dysfunction emerging during treatment with selective serotonin reuptake inhibitors (SSRIs) and/or serotonin-norepinephrine reuptake inhibitors (SNRIs) persists in some patients beyond drug discontinuation (post-SSRI sexual dysfunction [PSSD]). We sought to identify and characterize a series of such cases and explore possible explanatory factors and exposure-response relationship. Subjects who responded to an invitation in a forum dedicated to PSSD filled out a survey via online software. Case probability was defined according to the following 3 categories of increasing presumed likelihood of PSSD. Noncases did not meet the criteria for possible cases. Possible cases were subjects with normal pretreatment sexual function who first experienced sexual disturbances while using a single SSRI/SNRI, which did not resolve upon drug discontinuation for 1 month or longer as indicated by Arizona Sexual Experience Scale scores. High-probability cases were also younger than 50-year-olds; did not have confounding medical conditions, medications, or drug use; and had normal scores on the Hospital Anxiety and Depression Scale. Five hundred thirty-two (532) subjects completed the survey, among which 183 possible cases were identified, including 23 high-probability cases. Female sex, genital anesthesia, and depression predicted current sexual dysfunction severity, but dose/defined daily dose ratio and anxiety did not. Genital anesthesia did not correlate with depression or anxiety, but pleasureless orgasm was an independent predictor of both depression and case probability. Limitations of the study include retrospective design and selection and report biases that do not allow generalization or estimation of incidence. However, our findings add to previous reports and support the existence of PSSD, which may not be fully explained by alternative nonpharmacological factors related to sexual dysfunction, including depression and anxiety.

37 citations

Journal ArticleDOI
TL;DR: A nomogram of erect penile dimensions in a large sample of Middle Eastern men can be used as a standard when advising men with small penis anxiety to educate and reassure concerned men about the size of their penises.

19 citations

Journal ArticleDOI
TL;DR: With strict patient selection, this procedure is proved to be a plausible and reasonable option for patients with penile dysmorphophobia and provides a potential alternative procedure to current dominant methods and promotes the aesthetic results withpenile lengthening.
Abstract: BackgroundOur objective is to report on the efficacy and safety of dermal fat graft in augmentation phalloplasty performed on patients who presented complaining of “small penis,” and evaluate the cosmetic and psychological outcomes of it.MethodsFrom April 2010 and January 2015, 23 Chinese adult pati

18 citations

References
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Journal ArticleDOI
TL;DR: The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years.
Abstract: Objective To construct growth curves for school-aged children and adolescents that accord with the WHO Child Growth Standards for preschool children and the body mass index (BMI) cut-offs for adults. Methods Data from the 1977 National Center for Health Statistics (NCHS)/WHO growth reference (1–24 years) were merged with data from the under-fives growth standards’ cross-sectional sample (18–71 months) to smooth the transition between the two samples. State-of-the-art statistical methods used to construct the WHO Child Growth Standards (0–5 years), i.e. the Box-Cox power exponential (BCPE) method with appropriate diagnostic tools for the selection of best models, were applied to this combined sample. Findings The merged data sets resulted in a smooth transition at 5 years for height-for-age, weight-for-age and BMI-for-age. For BMI-for-age across all centiles the magnitude of the difference between the two curves at age 5 years is mostly 0.0 kg/m² to 0.1 kg/m². At 19 years, the new BMI values at +1 standard deviation (SD) are 25.4 kg/m² for boys and 25.0 kg/m² for girls. These values are equivalent to the overweight cut-off for adults (> 25.0 kg/m²). Similarly, the +2 SD value (29.7 kg/m² for both sexes) compares closely with the cut-off for obesity (> 30.0 kg/m²). Conclusion The new curves are closely aligned with the WHO Child Growth Standards at 5 years, and the recommended adult cut-offs for overweight and obesity at 19 years. They fill the gap in growth curves and provide an appropriate reference for the 5 to 19 years age group. Bulletin of the World Health Organization 2007;85:660–667.

6,037 citations


"Penile Measurements in Tanzanian Ma..." refers background or methods in this paper

  • ...The majority of males <19 fell beneath the 50 percentile of the WHO age-specific BMI curve.(25) Figure 2 shows age-specific BMI measurements....

    [...]

  • ...Thus they were placed in the pubertal for analysis which accords with WHO definitions for adolescents.(25) Thus, the three age categories used in this study were pre/peri-pubertal (10–13), pubertal (14–18), and adult (19–49)....

    [...]

Journal ArticleDOI
TL;DR: Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved in sub-Saharan Africa.
Abstract: Background Observational studies suggest that male circumcision may provide protection against HIV-1 infection. A randomized, controlled intervention trial was conducted in a general population of South Africa to test this hypothesis. Methods and Findings A total of 3,274 uncircumcised men, aged 18–24 y, were randomized to a control or an intervention group with follow-up visits at months 3, 12, and 21. Male circumcision was offered to the intervention group immediately after randomization and to the control group at the end of the follow-up. The grouped censored data were analyzed in intention-to-treat, univariate and multivariate, analyses, using piecewise exponential, proportional hazards models. Rate ratios (RR) of HIV incidence were determined with 95% CI. Protection against HIV infection was calculated as 1 � RR. The trial was stopped at the interim analysis, and the mean (interquartile range) follow-up was 18.1 mo (13.0–21.0) when the data were analyzed. There were 20 HIV infections (incidence rate ¼0.85 per 100 person-years) in the intervention group and 49 (2.1 per 100 person-years) in the control group, corresponding to an RR of 0.40 (95% CI: 0.24%–0.68%; p , 0.001). This RR corresponds to a protection of 60% (95% CI: 32%–76%). When controlling for behavioural factors, including sexual behaviour that increased slightly in the intervention group, condom use, and health-seeking behaviour, the protection was of 61% (95% CI: 34%– 77%).

2,483 citations

Journal ArticleDOI
TL;DR: In this article, a randomised controlled trial of 2784 men aged 18-24 years in Kisumu, Kenya was conducted to determine whether male circumcision had a protective effect against HIV infection, and to assess safety and changes in sexual behaviour related to this intervention.

2,075 citations

Journal ArticleDOI
TL;DR: Male circumcision reduced HIV incidence in men without behavioural disinhibition as well as in all sociodemographic, behavioural, and sexually transmitted disease symptom subgroups.

2,034 citations

Journal Article
TL;DR: Male circumcision significantly reduces the risk of HIV acquisition in young men in Africa and should be integrated with other HIV preventive interventions and provided as expeditiously as possible.

1,692 citations

Frequently Asked Questions (2)
Q1. What have the authors contributed in "Penile measurements in tanzanian males: guiding circumcision device design and supply forecasting" ?

This descriptive study provides penile measurements of males seeking VMMC services in Iringa, Tanzania. It is the first study in a sub-Saharan African population that provides sufficiently detailed glans and foreskin dimensions to inform VMMC device development and size forecasting. 

These correlations should be confirmed by future studies.