Prevalence of Preoperative Penile Abnormalities Among Voluntary Male Medical Circumcision Patients in Swaziland

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Circumcision has been found to be an effective strategy for lowering the transmission of HIV in Africa. The Luke Commission, a mobile hospital outreach program, has used this information to decrease the rate of HIV in Swaziland by performing voluntary male medical circumcisions throughout the country. During many of these circumcisions, genital medical conditions and penile abnormalities are simultaneously discovered and corrected.


The goal of our study was to evaluate the prevalence of penile abnormalities discovered and treated during voluntary male medical circumcisions performed by The Luke Commission (TLC) throughout rural Swaziland.

Basic procedures

We completed a retrospective analysis of all male patients who underwent voluntary male medical circumcision performed by TLC during a period from June–August, 2014. The penile abnormalities included: phimosis, paraphimosis, epispadias, hypospadias, ulcers, balanitis, torsion, and foreskin adherent to the glans.

Main findings

Of 929 total circumcisions, 771 (83%) patients had at least one pre-existing penile abnormality identified during their examinations and procedures, totaling 1110 abnormalities. Three specific abnormalities were detected – phimosis, adherent foreskin, and hypospadias. The 6–12 and 13–19 age groups had adequate sample sizes to yield precise estimates of prevalence (age group 6–12: 87% (95% confidence interval [CI] = 84–90%; age group 13–19: 79% (95% CI = 74–84%).

Principle conclusions

The Luke Commission is improving the lives of children and adults with limited access to healthcare through regular preoperative evaluations during male circumcision, and the organization is setting an example for other international healthcare groups.

Level of evidence

Type of Study: Prognostic Study, Level II.



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