International AIDS Society

Shang Ring for Circumcision Is Safe If Left on for More Than 7 Days

Author: Mark Mascolini

10 July 2012

A nonsurgical device for male circumcision, the Shang Ring, usually detaches itself safely if left in place for more than the recommended 7 days, according to results of a 50-man study in Kenya. The ring proved effective and acceptable, as in earlier studies.

Three randomized trials found that circumcision lowered the risk of HIV acquisition about 60% in heterosexual African men.

“The Shang Ring consists of two concentric plastic rings that lock together over the foreskin, and is then removed and disposed of 7 days later,” PR Newswire reports. Surgical circumcision takes 20 to 40 minutes in a single visit, but it requires more training than Shang Ring placement and it can cause bleeding and other complications.

The Shang Ring should be removed after 7 days, but some men may not be able to return to clinic for removal in 7 days. To see if longer Shang Ring placement causes problems, researchers randomly assigned 50 HIV-negative men to device removal at 7 days (15 men), 14 days (15 men), or 21 days (20 men).

Circumcision was successful in all men, and the device was removed without significant problems. Time for circumcision to occur averaged 6.5 days (standard deviation 2.4), and time for device removal averaged 2.5 minutes (standard deviation 0.8).

Among men who wore the Shang Ring for more than 7 days, complete detachment occurred in 22 (66.7%). Seven men (14%) in whom the ring partially detached requested removal 8 to 14 days after circumcision because of pain or discomfort.

Healing progressed normally in all men, and cumulative probability of complete healing was similar in the three groups. Removal time had little effect on wound healing. There were no severe or serious adverse events in any men, and acceptability was high in all men.

Providers rated Shang Ring circumcision “very easy” compared with the forceps-guided procedure.

The researchers believe these findings should “help allay concerns about men not returning for ring removal and expand the evidence base suggesting the Shang Ring could facilitate rapid male circumcision rollout in sub-Saharan Africa.”


Mark A. Barone, Quentin D. Awori, Philip S. Li, Raymond O. Simba, Mark A. Weaver, Jairus O. Okech, Alex O. Aduda, Peter Cherutich, Nicholas Muraguri, John Masasabi Wekesa, Jared Nyanchoka, Paul Perchal, Puneet Masson, Richard Lee, Marc Goldstein, Jackson Kioko, Ojwang' Lusi, David C. Sokal. Randomized trial of the Shang ring for adult male circumcision with removal at one to three weeks: delayed removal leads to detachment. JAIDS. 2012; 60: e82-e89.

PRNewswire. Study affirms safety and acceptability of Shang ring for reducing HIV risk among men. 28 June 2012.

For the study abstract

(Downloading the complete article requires a subscription to JAIDS or an online payment; the abstract is free.)

For the PRNewswire article

For a YouTube video on the Shang Ring