Ringing the changes for circumcision(3)

Tian Long, director of the urology department in Chaoyang Hospital in Beijing, checks an X-ray. The department 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. Zhang Wei / China Daily

Although some private hospitals advertise "painless laser-scalpel 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 the US has been around 70 percent.

Li said the surgery is usually performed within a day or two of a baby's birth. However, doctors may 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.

Changing attitudes

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 of HIV and 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 Public Health at Tsinghua University. "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 term it could even prove to be of greater value than materials provided to support the continent as it changes. It's not just about today - it's also about the future."