What problems can being uncircumcised cause?

Several problems can arise in people who have an uncircumcised penis. However, it is possible to avoid most of these issues by practicing good hygiene and safe sex.

The foreskin is a thin layer of skin covering the head of the penis. Circumcision is a surgical procedure to remove the foreskin. Some people undergo the procedure for religious or cultural reasons, but it can also be a way to reduce health risks.

People who are not circumcised and do not take proper care of their foreskin can experience some health-related complications. Keep reading to learn more about them.
1. Phimosis
Good hygiene and safe sex may help prevent problems in people with an uncircumcised penis.

Phimosis is where the foreskin is too tight around the penis, which prevents it from pulling back over the head of the penis.

The condition usually affects children and will improve as the foreskin loosens with age. In adults, it may result from a sexually transmitted infection (STI). It does not usually cause any symptoms or require medical attention.

However, in some cases, it might cause:

pain and tenderness around the tip of the penis
swelling of the penis
bleeding
scarring around the penis tip
difficulty controlling urination
infections

If phimosis is causing symptoms, a doctor will advise cleaning the area with lukewarm water daily. It is best to avoid using soaps or shampoos.

If there is inflammation, a doctor may also prescribe corticosteroid creams or ointments.
2. Paraphimosis

Paraphimosis occurs when the foreskin becomes stuck below the head and cannot pull back over the penis. The skin can become tight around the penis shaft, causing swelling and discomfort.

Paraphimosis can also cause fluid to build up around the area, worsening the swelling. Without treatment, paraphimosis can prevent blood from reaching the tip of the penis.

It is necessary to seek emergency medical attention for paraphimosis to avoid complications.

Doctors may use a local anesthetic to ease pain in the area. They can usually help restore the foreskin manually. However, in severe cases, they may have to make a small cut to loosen the skin.

3. Bacterial or fungal infection

Without regular cleaning of the penis, bacteria can build up on the foreskin and cause infections. Infections can also occur if there is a small cut or sore on the foreskin, as a break in the skin can allow microbes to enter.

Balanitis is an inflammation of the head of the penis, and it is a common result of an infection that affects the foreskin. About 3–11% of men will experience balanitis at some point in their lifetime.

The symptoms of balanitis can include:

a sore and itchy penis
swelling of the penis
pain during urination
discharge under the foreskin that is thicker than normal with a foul smell

Antibiotic medications are the best way to treat bacterial infections of the penis, whereas antifungal medications will be necessary in the case of a fungal infection. Both types of treatment will typically be in the form of creams or ointments that a person applies directly to the penis.

As poor hygiene is the primary cause of balanitis, it is important to clean the area regularly.

Read more about some possible infections of the penis here.

Read More…

Foreskin problems and circumcision | Healthy Male

What is balanitis?

Balanitis (bal-an-eye-tis) is a common infection that occurs at the head of the penis. It can happen at any age, but it’s more likely to develop if you have a foreskin.

What are the symptoms of balanitis?

Balanitis can cause the following symptoms:

• A foreskin that can’t be pulled back

• Itchiness or a rash

• Pain or tenderness at the head of the penis

• A red or swollen foreskin

• Discharge from the penis.

What causes balanitis?

Balanitis happens when you don’t keep the inside of your foreskin clean. This can be because your foreskin isn’t pulled back, or can’t be pulled back, when washing the penis. It’s common for the inflammation to be caused by bacteria or fungus.

Balanitis can also be caused by irritation from chemicals — the kinds found in household soap, clothing, washing powder, and the latex in condoms. Other causes include allergies to certain medicines, viruses such as HPV (human papillomavirus), and diabetes.

In adults, balanitis can be a sign of diabetes. Because diabetic people have increased levels of sugar in their urine, the combination of sugar and moisture can lead to bacterial or fungal growth if urine gets trapped under their foreskin. If you have a problem with recurring balanitis, it’s a good idea to ask your doctor about a test for diabetes.

What treatments are there for balanitis?

Usually, washing the penis and the inside of your foreskin with soap and warm water will help prevent balanitis. If balanitis is caused by an infection, you can use antibiotic or antifungal ointments/creams to treat it.

Uncircumcised Penis: 11 Things Everyone Should Know

If a person with an uncircumcised penis doesn’t clean themselves often enough, smegma—dead skin cells and oils that combine to form a white substance—can build up, Dr. Brahmbhatt says. (Yes, even doctors say “smegma.”)

If uncircumcised men or people with penises care about being clean in general, they’ll include that cleansing as part of their routine. “It becomes a natural thing,” says Dr. Brahmbhatt.

8. You’re not way more likely to get a sexually transmitted infection from someone with an uncircumcised penis than someone with a circumcised one.

Buckle up, because this is a little complicated.

In 2018, the Centers for Disease Control and Prevention (CDC) released guidance for health care providers trying to help uncircumcised people and parents of babies with penises learn about the health outcomes of circumcision.

Ultimately, the data show that, for the person with the penis, circumcision can reduce—but not fully remove—the risk of contracting HIV and some sexually transmitted infections like trichomoniasis during penile-vagina sex. But it doesn’t seem to carry that same benefit during anal sex, and experts haven’t yet determined how it may affect this risk during oral sex. (It’s really important to note that much of this evidence comes from studies in sub-Saharan Africa, the CDC says, which has a much higher rate of HIV than in the United States.)

Experts are still investigating whether or not circumcision may offer a protective effect if a circumcised person’s sexual partner has a vagina. The results don’t yet show a benefit when it comes to reducing the chance of contracting HIV if you have a vagina, but clinical trials show a decrease in transmission of sexually transmitted infections like trichomoniasis.

Beyond that, it seems as though circumcision lowers a person’s chances of getting urinary tract infections. These are pretty rare in people with penises, anyway, but experts theorize that an intact foreskin provides a better environment for potentially UTI-causing bacteria.

There’s also a possibility that circumcision makes it less likely that someone will experience penile cancer, which is already quite uncommon in the United States. (The American Cancer Society (ACS) estimates that about 2,320 people will be diagnosed with penile cancer in 2018.) The theory is that getting circumcised reduces penile cancer risk factors like…smegma. Yup, we’re circling back to this substance: Experts believe smegma might increase irritation and inflammation that can raise the risk of penile cancer and also make it harder to see signs of early cancer, according to the ACS. Researchers are still determining how much of a difference circumcision really makes here.

This kind of data is why the American Academy of Pediatrics’ official policy on circumcision, released in 2012 and endorsed by The American College of Obstetricians and Gynecologists, says that the benefits of circumcising babies in a safe, sterile way outweigh risks like the foreskin not healing properly. However, they emphasize, the choice is up to the parent or parents, and complications increase when people are circumcised after infancy.

9. You don’t automatically have to treat uncircumcised penises differently if you’re fooling around with someone who has a penis. Ask your partner what they like.

Uncircumcised penises are not terrifying sexual mysteries (at least, not any more than circumcised ones are). A penis is typically an easy-to-please body part no matter its circumcision status, not a fleshy Rubix cube. “When it comes to getting the job done, uncircumcised and circumcised penises work in the same way,” says Dr. Brahmbhatt.

10. That said, there is an interesting debate around whether uncircumcised or circumcised penises happen to be more sensitive.

Some hypotheses hold that circumcision results in a loss of sensitive tissue, along with the desensitization of the remaining exposed skin. There’s also the theory that since the head of the penis isn’t always exposed to the outside world the way it is with circumcised ones, uncircumcised penises don’t build up the same level of hardiness.

What is it, How is it Treated

Overview

What is a redundant prepuce?

The skin on the head of a penis is called the foreskin. Another name for foreskin is prepuce. A redundant prepuce means that there is an excess amount of foreskin – the foreskin completely covers the head of the penis when it is not erect. In some boys and men, this extra foreskin can sometimes lead to health problems if it can’t be fully drawn back from the head of the penis. In this case, the foreskin may need to be surgically removed.

What role does circumcision play?

Getting circumcised (surgical removal of the foreskin) is a procedure decided by the parents of a newborn son, or by the son himself if older. Circumcision can be a controversial procedure for some. The decision for circumcision or revision is best made by parents and/or male after a conversation with the surgeon.

Most male babies in the United States and the Middle East are circumcised (rates are much lower in Latin America, Europe, and Asia). Most of these procedures are done correctly. However, sometimes not enough of the foreskin is removed. When this happens, your child’s penis will look unusual since it is not fully circumcised or uncircumcised. You (the parents) or son (if older) may choose to have a second circumcision either to improve the appearance of the penis or to avoid (or lower the risk) of some of the problems that can occur in uncircumcised males. These problems include:

• A buildup of smegma (the substance that helps lubricate the penis).
• Inflammation of the head of the penis and foreskin.
• Infections, including urinary tract infections and sexually transmitted infections.
• Penile cancer.

What does a second circumcision involve?

Having a second circumcision is often called “circumcision revision.” It is uncommon but sometimes necessary.

Studies show that if a child has too much foreskin after a first circumcision, it is best not to wait too long to correct it. The problem typically will only get worse if not treated. Boys do not “grow into” a longer-than-usual foreskin.

Management and Treatment

Who performs circumcision revision?

Circumcision revision is most often done by a urologist (doctor who specializes in treating male reproductive organs) in a hospital. General anesthesia is usually needed.

How is circumcision revision done?

The sleeve surgical technique, in which the foreskin is removed from its pulled-back position, is most commonly used when males have too much foreskin. Other techniques may be used depending on the reason for the revision and the boy’s/man’s age. A urologist will be able to decide the type of revision that is best.

Outlook / Prognosis

What is the prognosis for males who have circumcision revision?

Circumcision revision usually is very successful. Your son’s urologist can review the benefits your son can expect to receive.

What care is needed after the circumcision revision?

The line of absorbable stitches (stitches that don’t need to be removed) is covered with an antibiotic ointment and covered with a sterile dressing. The dressing is usually left on for 24 to 48 hours. After that time, the dressing is removed and antibiotic ointment is continued to be used for the first seven to 10 days to prevent the stitches from sticking to diapers or underwear.

Urology | Types of Penile Conditions and Diseases

There are quite a few

types of penile conditions

. Some are minor and don’t cause many problems, and some are serious medical emergencies that require

immediate treatment or surgery

. Penile conditions can be congenital, which means they are present at birth, or they can develop over time.

Some of the more common disorders and conditions that affect the penis are:

Balanitis

Balanitis is inflammation of the glans (head) of the penis. If the foreskin is also inflamed, the condition is called balanoposthitis. Symptoms of balanitis can include penile pain, swelling and itching, a rash on the penis, and a strong-smelling discharge from the penis. The most common cause of balanitis is poor hygiene in uncircumcised males. If the penis isn’t properly cleaned underneath the foreskin, bacteria, sweat, dead skin cells, and debris can build up around the glans and lead to inflammation. If an uncircumcised male has phimosis (foreskin that is difficult to retract) and cannot clean under the foreskin, risk of inflammation increases. Other causes of balanitis include dermatitis and infection (yeast infection or sexually transmitted infection). If infection is the cause, treatment will include antibiotic or antifungal medication. If balanitis is severe or recurrent, circumcision may be the best treatment option.

Epispadias

Epispadias is a rare birth defect characterized by a urethra that doesn’t fully develop, which results in the inability to pass urine from the body properly. Both boys and girls can be born with epispadias. When it occurs in boys, they are normally born with a short, wide penis that is curved abnormally. Rather than the urethra opening at the tip of the penis, it may open on the top of side of the penis, or it may be open all along the length of the penis. Signs and symptoms of epispadias in males include an abnormal opening in the urethra, a widened pubic bone, an abnormally shaped penis or abnormally curved penis (chordee), reflux nephropathy (backward flow of urine into the kidney), urinary incontinence and urinary tract infections. Cases range from mild to severe. Mild cases may not require surgery, but most cases of epispadias will need to be surgically corrected. The goals of treatment are to maximize the function and length of the penis and to create a more normal appearance of the penis. In cases where the bladder is involved, surgery will also need to create a pathway for urine to pass normally and to help preserve fertility. There are two common surgical techniques to correct epispadias: the modified Cantwell technique and the Mitchell technique.

Hypospadias

Hypospadias is a birth defect in which the opening of the urethra develops on the underside of the penis instead of on the tip. The condition ranges in severity, depending on where the opening forms. Many times, the urethral opening is near the head of the penis. Some boys are born with the opening in the middle of the shaft or the base of the penis, and rarely, boys can be born with the urethral opening below the scrotum. Signs and symptoms of hypospadias include an abnormal urethral opening, chordee (a downward curve of the penis), abnormal spraying during urination and foreskin abnormalities that make the penis appear hooded. Hypospadias is a relatively common problem that has a straightforward diagnosis and treatment. Most men who were born with hypospadias experience normal sexual function as adults if they received treatment. Treatment involves surgical correction to reposition the urethral opening and, in some cases, to straighten the shaft of the penis. Surgery is most often done between the ages of three and 18 months.

Penile cancer

Cancer of the penis, also called penile cancer, almost always begins in the skin cells of the penis. There are five basic types of penile cancer: squamous cell carcinoma, melanoma, basal cell cancer, adenocarcinoma and sarcoma. About 95 percent of all cancers of the penis develop from squamous cells, which are flat skin cells. Cancer that develops from squamous cells is called squamous cell carcinoma. Squamous cell cancers tend to grow slowly, and they can usually be cured if they are found early. Carcinoma in situ, or CIS, is the earliest stage of squamous cell penile cancer. With CIS, cancer is only found in the top layers of the skin on the penis. Melanoma and basal cell cancer each make up less than 2 percent of all penile cancers, and sarcoma and adenocarcinoma, otherwise known as Paget disease of the penis, are even rarer. Penile cancer must be treated. If the cancer is found early, chances are good that the penis can be saved. However, if cancer has spread to deep tissues of the penis, a surgeon may have to perform a penectomy (removal of part or the entire penis) to remove the cancer. Learn more about penile cancer symptoms, causes, diagnosis and treatment.

Peyronie’s disease

Peyronie’s disease is a penile condition that develops when scar tissue, called plaque, forms inside the penis and causes erections to be curved and painful. Many men have a slight curve to their erect penis, and it doesn’t cause any problems. But when it is painful or the bend is significant, it can lead to erectile dysfunction and may even make sexual intercourse impossible. Signs and symptoms of Peyronie’s disease include scar tissue that can be felt under the skin of the penis, a significant bend or curve of the penis, difficulty getting or keeping an erection, pain in the penis, and shortening of the penis. Sometimes Peyronie’s disease is mild and doesn’t cause significant problems. In that case, treatment may not be necessary. There is also a chance it will improve or even go away on its own without treatment. However, if you have penile pain or the curve of your penis causes problems with sexual intercourse, call your doctor. You may need to take medication, have the scar injected with a medication or have surgery to correct the Peyronie’s.. Your doctor may prescribe other medications as well. If your disease is severe and isn’t improving on its own or with treatment, surgery may be an option.

Phimosis and paraphimosis

Phimosis is a condition that makes it difficult to retract the foreskin of the penis. Paraphimosis is a condition that makes repositioning the foreskin difficult. Both conditions can occur in boys and men who are uncircumcised (have not had their foreskin removed).

Phimosis is common in infants because their foreskin is still tight. In most cases, it resolves on its own as boys age. However, if boys cannot retract their foreskin by the time they are adolescents, they may need treatment. Treatments include applying steroid creams (to loosen the foreskin so it can be manipulated) and circumcision if steroid cream is unsuccessful.

Symptoms of paraphimosis include inability to return foreskin to its normal position, difficulty with ejaculation and urination, discoloration or bruising of the penis, and swelling of the penis.

Paraphimosis can be a medical emergency and should always be evaluated by a doctor right away for evaluation and treatment.

Treatment options include circumcision (if other treatments fail), manipulating and lubricating the foreskin to reposition it, and making a small incision in the foreskin to reduce swelling and/or bulging.

Priapism

Priapism is a persistent erection that lasts more than four hours and is not relieved by orgasm. Erections that occur with this condition can be painful and are not always related to sexual activity. Common causes include medications, alcohol and drug abuse (especially cocaine and marijuana), spinal cord problems and certain blood diseases.

Priapism is a medical emergency. If you have an erection that has lasted more than four hours, you should seek treatment at an emergency room.

Treatment usually involves draining blood from the penis. Medications to help shrink blood vessels may also be used. Rarely, surgery will be necessary to correct the problem and prevent permanent damage to the penis.

If you have

symptoms of penile conditions

or have been

diagnosed

with a penile condition and would like to talk with us about treatment options, call 800-633-7377 to make an appointment with a board certified urologist.

Learn more about penile conditions

Causes, Symptoms, Treatment and Prevention

By the time most uncircumcised boys are 10 years old, they can pull the foreskin back from the head of their penis. For some, it may not retract completely until they are about 17 years old. When this happens, it’s called phimosis.

Boys born with phimosis, and it can last through puberty. With time, the skin retracts off the head of the penis naturally. You need treatment only if it happens after your foreskin has become fully retractable. Or if, as a child, the head of the penis has redness, pain, or swelling.

When the foreskin gets stuck behind the head of the penis, in paraphimosis, circulation can get cut off. Men or boys of any age need to take this seriously and see a doctor or go to the hospital immediately.

Causes

Scar tissue. Infections can scar the foreskin, which might make the skin less stretchy. The tough tissue can make it hard to pull it back.

Pull and stretch. Don’t forcefully move your foreskin. Go easy on it. Even pulling or stretching it can cause tiny tears and inflammation that eventually lead to phimosis.

Aging. The same changes that happen on your face with age — wrinkles and looseness — happen to your foreskin. You are more likely to get it if you get fewer erections.

Medical conditions. If you have diabetes, you’re more likely to have balanitis, an infection of the tip of penis. Talk to your doctor about your complete medical history so they can treat you properly.

Why Paraphimosis Happens

Mishandled foreskin. Make sure to put your foreskin back after you, or your caregiver, washes it or inserts a catheter.

Piercings. Pain and swelling from penis piercings can make it difficult to put the foreskin in place after pulling it back.

During sex. You might pull your foreskin back to have sex. If it stays there too long, it might swell so much that the foreskin gets trapped behind the head.

Other penis conditions. Other ailments of the penis can lead to foreskin problems. For example, phimosis can lead to paraphimosis.

Symptoms

In both conditions, your foreskin will be stuck in one place, either over the tip of the penis or behind. With phimosis, you might also have the following signs:

• In the bathroom. Your foreskin will expand when you pee, like a balloon. It can be painful. You might see blood in the stream or in the toilet. The stream might seem weaker than normal.
• When you have sex. You might have pain with an erection.
• Infections. You may get urinary tract infections. Symptoms include blood in your urine, pain or burning when you pee, the urge to go even when your bladder is empty, and pain or pressure in your lower abdomen or back.
• Foreskin pain. You notice that your foreskin hurts. It might have discharge, too.
• White ring. The opening of your foreskin has a white ring that looks like scar tissue.

You may have painful swelling in the head of your penis or in the whole organ.

Diagnosis

Your doctor can usually figure out if you have one of these conditions by listening to you describe your symptoms and with an exam. They have probably seen cases like yours many times, so there’s no need to be embarrassed or shy.

Treatment

Phimosis. You can get treatment in an outpatient setting by a urologist. How they treat you depends on the severity of your condition. They will also consider the cause of the problem and ask what kind of solutions you prefer.

They may recommend:

• A steroid cream that you apply to your foreskin several times a day for several weeks. This can loosen the skin.
• A partial or full circumcision.

Paraphimosis. It’s often treated in the emergency room. The ways the doctors will provide relief include:

• A solution is applied to your penis to reduce the swelling. Then a doctor manually works the foreskin loose from its position.
• The doctor uses a needle to make several holes in the foreskin to allow fluids to escape. This reduces the swelling.
• You get fluids to help you release unneeded water to reduce swelling.
• Your doctor makes a small slit in your foreskin in order to loosen it.
• You get a circumcision.

Risks

If you have phimosis, you are more likely to get penile cancer. If left untreated, it can lead to increased swelling, and in extreme cases, gangrene, and eventually the loss of your penis.

Prevention

In most cases, these penis disorders are easy to prevent. The head and the foreskin need to be washed and dried regularly. Be gentle with the skin if you pull it back, and don’t forget to put it back in place when you finish.

If you have either of these conditions, consider getting circumcised to stop it from happening again.

Penile Inflammatory Skin Disorders and the Preventive Role of Circumcision

Balanitis

Clinical presentation and causes

Balanitis presents with mild burning, pruritis, itching, swelling, erythematous patches, and plaques or bullae involving the glans penis, satellite eroded pustules and moist curd-like accumulations[1] []. In uncircumcised men, the foreskin is often involved (balanoposthitis).[1] Balanitis has worse clinical presentation in diabetic and immunocompromised patients, with fulminating edema or ulcers in severe cases.[1]

Clinical presentation of balanitis. Reprinted from English et al.[1]

Poor hygiene is the most common cause. Irritant balanitis can result from exposure to medications, such as some common antibiotics, and to allergens, including latex condoms, propylene glycol in lubricants, some spermicides, and corticosteroids. Ammonia, released from urine by bacterial hydrolysis of urea, can induce inflammation of the glans and foreskin. Another common irritant responsible for contact dermatitis is frequent washing with soaps containing topical allergens or irritants.

Microbiology of balanitis

Various bacterial species and yeasts under the foreskin have the potential to cause penile inflammatory conditions. C. albicans is the most frequent fungal isolate from the penis.[11] Fungi are normal flora, but overgrowth can occur in certain conditions, especially in diabetic patients with phimosis. Candida colonization was seen in 16% of men visiting a sexually transmitted infection (STI) clinic in Coventry, the UK.[12] Symptomatic infection due to C. albicans is more common in uncircumcised males.[3] Bacterial superinfection with Streptococci or Staphylococci increases pain.

Bacteria, especially Streptococcus spp., by themselves are the second most common cause of infectious balanitis. Less common are Haemophilus parainfluenzae, Klebsiella spp., Staphylococcus epidermidis, Enterococcus, Proteus spp., Morganella spp., and Escherichia coli.[1]

Chlamydia trachomatis, genital mycoplasmas, and bacterial STIs such as Neisseria gonorrhoeae, Haemophiluis ducreyi, and others can be associated with balanitis and balanoposthitis.[1] N. gonorrhoeae produces an endotoxin likely responsible for edema and erythrema of the foreskin.[13] Gardnerella vaginalis is responsible for symptomatic anaerobic-related balanitis in men; presentation includes a subpreputial “fishy”-smelling discharge similar to the odor from bacterial vaginosis in women.[1] The prevalence of G. vaginalis was 15% and 25% among heterosexual attendees at STI clinics in London[14] and Alabama,[15] respectively. Other causes of balanitis and balanoposthitis include viral STIs, such as high-risk human papillomavirus (HPV) types, and parasitic infections such as Trichomonas vaginalis and protozoa, all more common in uncircumcised men.[1]

Balanitis in boys

Approximately 4% of boys get balanitis, most commonly during the preschool years.[16] Balanitis is especially common in uncircumcised boys aged under 5 years with phimosis (25%) compared with those without phimosis (6%).[17] For males over 5 years of age, these figures are 24% versus 12%, respectively.[17] Ballooning was also more common in uncircumcised boys suffering from phimosis (34% vs. 2% and 20% vs. 4% for the respective age groups).[17] Overgrowth of yeasts as well as other microorganisms that favor development of balanitis can follow antibiotic treatment. Any factor that increases microorganisms substantially has the potential to contribute to balanitis in boys.

A major predisposing factor in boys is lack of circumcision, especially in those whose foreskin is partly or completely nonretractable.[16] An obvious medical reason for circumcision of boys is protection against balanitis and posthitis.[3] The incidence of balanitis in boys is over 2-fold higher in the uncircumcised.[18,19,20,21] Cases of balanitis caused by group A or B hemolytic Streptococcus spp. have been reported in prepubertal[22] and postpubertal[23] uncircumcised boys, respectively. Newer pyrosequencing methods (see subsection below) are needed to confirm and expand on findings in boys.

A study in India of 124 boys aged 6 weeks to 8 years swabbed before circumcision found that E. coli, Proteus spp., and Klebsiella spp., were the most common bacteria.[24] After circumcision, bacterial cultures were negative in 66%. Swabs of smegma from 52 uncircumcised Nigerian boys aged 1 week to 11 years identified 50 bacterial isolates, 58% being Gram-positive, and 42% Gram-negative; E. coli was the most common Gram-negative bacterium.[25] A Turkish study of 100 prepubertal boys swabbed before circumcision identified 72 organisms, 75% being Gram-positive bacteria, 24% Gram-negative bacteria, and 1% Candida spp.[26] Nine percent of boys had high-risk HPV genotypes. Most bacteria were multidrug resistant and included species capable of causing urinary tract infections. Another Turkish study, involving 78 boys aged 1 month to 14 years (mean 3.9 years), found bacterial growth in 72% before circumcision, but in only 10% after circumcision.[27] Bacterial growth was seen in all boys with phimosis; growth decreased progressively to approximately 50% for greater exposure of the glans. The most common organisms were Enterococcus (33%), Staphylococcus spp. (15%), E. coli (13%), Proteus spp. (7%), and Klebsiella spp. (3%).

C. albicans, but no other fungi, was found in 3.5% of 200 Iranian infants before circumcision.[28] In boys aged 8 months to 18 years (mean 6.4 years), fungus incidence was 44% in uncircumcised boys, compared to 18% in circumcised boys.[29] The fungal species were as follows: Malassezia globosa, Malassezia furfur, Malassezia slooffiae, C. albicans, Candida tropicalis, and Candida parapsilosis. All were present in uncircumcised infants, but none in circumcised infants. A gradual accumulation with age occurred to 37.5% by the age of 18 years in circumcised boys compared to the prevalence of 62.5% in uncircumcised boys.

Balanitis in adult males

Lack of circumcision has been consistently associated with balanitis in men.[30] Other causes include exposure to certain medications, allergens, and chemical irritants. Balanitis was reported in 11%–13% of uncircumcised men, but in only 2% of circumcised men.[20,21] A 3-year prospective review of men aged 16–95 years (mean age 47 years) at a multi-specialty penile dermatology clinic in Edinburgh, UK, diagnosed nonspecific balanitis in 22% of patients.[31] When circumcision status was documented, 53% were uncircumcised and 18% were circumcised. An STI clinic in Portugal found that the prevalence of balanitis in men (all uncircumcised) was 11%.[32] A large randomized controlled trial (RCT) involving young men found balanitis in 0.7% of the uncircumcised men over the 18 months of follow-up, but in none of the men who received circumcision.[33]

Diabetic uncircumcised men have a high (35%) prevalence of symptomatic balanitis.[20,21] Among men with acquired phimosis, 26% had a history of diabetes.[34] Phimosis increases the risk of infection of the foreskin and glans. During the period of 1942–1945 in World War II, there were 146,000 hospitalizations of US troops for balanitis, balanoposthitis, phimosis, and paraphimosis.[35] It was remarked that “the man-hours lost as a result of circumcisions and adjuvant therapy were expensive to the war effort and exasperated the commanding officers”.[35] “Time and money could have been saved had prophylactic circumcision been performed before the men were shipped overseas.”[35]

A study of 350 Indian men found that the uncircumcised men were more likely to harbor bacterial pathogens in the coronal sulcus; Gram-positive, Gram-negative, and any pathogen were 1.9, 2.4 and 2.8 times higher, respectively.[36]

Smegma, produced under the foreskin, consists of 27% fat and 13% protein, and contributes to the higher occurrence of Malassezia spp. in uncircumcised versus circumcised men (49% vs. 7%).[37] The frequency of yeast colonization was reduced from 11% to 1.3% (P < 0.008) by circumcision.[38]

The uncircumcised penis is an important niche for genital anaerobes associated with bacterial vaginosis in female partners.[39] Bacterial vaginosis risk to female partners is reduced by male circumcision.[40] The causative anaerobic genera significantly decreased by circumcision include Anaerococcus, Finegoldia, Peptoniphilus, and Prevotella.[41] These bacteria are exchanged between partners during sexual intercourse.[39]

Complete microbiome determined by pyrosequencing

Sophisticated 16S rRNA gene-based quantitative polymerase chain reaction (qPCR) and pyrosequencing, log response ratio, Bayseyan classification, nonmetric multidimensional scaling, and permutational multivariate analysis have been used in recent years to provide a much more complete picture of the penile microbiome than traditional clinical microbiological approaches.

A study in Rakai, Uganda, using this technology found a greater microbial diversity on coronary sulcus swabs of uncircumcised men before circumcision than 12 months after circumcision.[41] Anaerobic bacterial families decreased from 72 to 4.8 (P < 0.014) and facultative anaerobic families increased from 23 to 79 (P = 0.006), while abundance of aerobic bacteria did not differ significantly before and after circumcision (236 vs. 467). An RCT found significant reduction in prevalence, composition, and load of 12 anaerobic bacterial taxa 1 year after circumcision.[42] The prevalence and absolute abundance of 12 anaerobic bacterial taxa decreased significantly in the men who were circumcised. It was suggested that reduction in anaerobes might account in part for the ability of circumcision to reduce human immunodeficiency virus infection. An increase in the prevalence of two types of aerobic bacteria (Corynebacterium spp. and Staphylococcus spp.), which are skin commensals, was seen after circumcision.

A US study involving qPCR and pyrosequencing detected bacterial vaginosis-associated taxa (including Atopobium, Megasphaera, Mobiluncus, Prevotella, and Gemella) in coronal sulcus specimens of both sexually experienced and inexperienced males aged 14–17 years.[43] Porphyrmonas was higher in uncircumcised men (6.4% vs. 0.3%) and Prevotella spp. were found in abundance only in uncircumcised males. In contrast, Staphylococcus spp. were enriched in circumcised participants (27% vs. 5.5%).[39]

Pyrosequencing data are consistent with conventional clinical microbiology results, so adding to the reliability of conclusions drawn based only on the latter.

Meta-analysis of balanitis and circumcision status

shows a Forest plot from a meta-analysis of 8 relevant studies.[18,19,20,30,33,44,45,46] This found that prevalence of balanitis was 68% lower in circumcised versus uncircumcised males (odds ratio = 0.32; 95% CI 0.20–0.52)[47] i.e., was 3.1 times (95% CI 1.9–5.0) higher in uncircumcised males.

Meta-analysis of association of lack of circumcision with penile inflammation. Reprinted from Morris et al.[47]

Treatment of balanitis

Topical antifungals, if applied consistently until symptoms disappear, may be effective in treatment of sexually acquired balanitis.[48] Recurrence is frequent, however, especially in patients with risk factors such as phimosis or diabetes. Treatment of the partner is important to reduce the risk of relapse. Prevention entails good hygiene and circumcision during childhood.

Balanoposthitis

Overview

This condition only occurs in uncircumcised males. The prevalence is lower than balanitis.[16] The entire distal penis (foreskin and glans) presents as red, painful, and swollen, often accompanied by a foul-smelling, purulent discharge.[49] Balanophosthitis can involve a vicious cycle. After each infection, the foreskin will heal by fibrosis, in which there is thickening and scarring of connective tissue, and this will further shrink the tight foreskin. Balanoposthitis represents a strong medical indication for circumcision.

Balanoposthitis in boys

In childhood, balanoposthitis presents most commonly between ages 2 and 5 years,[16] which contradicts claims of soiled diapers, etc., as a major cause of penile inflammation. In young boys, balanoposthitis is often associated with phimosis and inability to clean under the foreskin because the foreskin is still lightly attached to the underlying penis.[49]

Balanoposthitis in men

This condition was found in 20% of 194 consecutive unselected UK men, all uncircumcised.[50] A Brazilian study of men presenting for prostate cancer screening identified balanoposthitis in 12%.[51] The prevalence was 58% higher in those with a history of nonspecific urethritis.[51] Balanoposthitis is especially common in uncircumcised diabetic men,[20,51,52] a dysfunctional, shrunken penis likely a contributing factor.[20] Not surprisingly, balanoposthitis in diabetic men adds to their frequent diabetic neuropathy and peripheral vascular disease, so contributing to their sexual dysfunction. Diabetes is common, inherited, and rising in incidence. Thus, in the opinion of the authors, family history of diabetes may add to considerations for circumcising a newborn infant.

Treatment of balanoposthitis

Local hygienic measures have been suggested for the treatment of nonspecific balanoposthitis.[53] If the condition is recalcitrant, antifungal and antibiotic creams can be used.[53] Circumcision is the definitive treatment for the prevention of future occurrence.[48,53] A study of 476 boys who were circumcised beyond the neonatal period found that balanoposthitis was the reason for performing the surgery in 23% of them.[54]

Other inflammatory conditions of penile skin

Other penile skin disorders include psoriasis, penile infections, LS, lichen planus, seborrheic dermatitis, and Zoon (plasma cell) balanitis, as described in extensive reviews.[1,21,55] These conditions are either much more common in, or totally confined to, uncircumcised males. A total of 34 different conditions, most commonly lichenoid conditions (24%), followed by nonspecific balanitis (22%), eczema and psoriasis (11%), Zoon/plasma cell balanitis (10%), malignancy/premalignant change (10%), and infective conditions (9%), were diagnosed over a 3-year period in 226 men in a clinic in Edinburgh.[31] Penile dermatoses in general have been reported in 20,[56] 5,[57] 3,[31] and 2[30] times as many uncircumcised as circumcised men. Data on several of the most prominent conditions follow.

A large series has shown that all patients with Zoon balanitis, Bowenoid papulosis, and nonspecific balanoposthitis were uncircumcised.[30] Bowenoid papulosis occurs mainly in young sexually active men.[55] One Zoon balanitis case has been reported in a circumcised man.[58] Typical symptoms of Zoon balanitis are erythrema (always), swelling (in 91%), discharge (in 73%), dysuria (in 13%), bleeding (in 2%), and ulceration (in 1%).[21] Mycobacterium smegmatis has been implicated in Zoon balanitis.[1] Zoon balanitis in 112 uncircumcised men aged 24–70 years involved lesions on the foreskin and glans of 59%, foreskin only in 23%, and glans only in 18%.[59] Lesions associated with Zoon balanitis improved after treatment with 0.1% tacrolimus ointment.[60] Erosive lichen planus is associated with increased mast cells, foreskin scarring, and phimosis in uncircumcised men.[61]

Lichen sclerosus

Overview

LS (previously termed either LS et atrophicus or balanitis xerotica obliterans) is a chronic, progressive, sclerosing inflammatory anogenital skin disease of uncertain etiology.[1] shows typical clinical appearance.[62] It is mostly anogenital. Only about 10% of patients have extragenital involvement. Because LS is among the most serious penile inflammatory condition, it has generated numerous publications.

Lichen sclerosus. (a) Appearance of foreskin and glans. (b) Meatal stricture which can result. Reprinted from Depasquale et al.[62]

Clinical presentation of lichen sclerosus

LS represents a challenge to urologists.[63] It presents as single or multiple erythematous papules, macules, or plaques that progress to sclerotic or atrophic white, ivory, or blue-white coalescent flat-topped papules and plaques.[1] Lesions commonly involve the glans and foreskin, although the frenulum, urethral meatus, and fossa navicularis may be involved as well. A sclerotic white ring at the tip of the foreskin is diagnostic of LS. Shaft and perianal involvement is rare. Serrous and hemorrhagic bullae, erosions, fissures, telangiectasia, and petechiae of the glans can occur. The foreskin may be adherent to the glans. As the disease progresses, the coronal sulcus and frenulum may be obliterated and the meatus gradually narrows. Progression of the disease through the entire urethra takes over 10 years,[64] resulting in significant urinary retention, followed by retrograde damage to the posterior urethra, bladder, and kidneys.[1] Eventual sloughing of the distal 0.5 cm of the urethra can occur.

LS can present at any age[65] and estimated prevalence is 1 in 300 to 1 in 1,000.[66] In prepubertal German boys, the prevalence was 0.1%–0.4%[67] and in Danish boys aged 1–17 years was 0.37%.[68]

LS is a common cause of phimosis in boys.[69,70] Early in its course, LS is often asymptomatic. Men may complain of phimosis, pruritis, burning, hypoesthesia of the glans, dysuria, urethritis with or without discharge, painful erections, and sexual dysfunction.[1] In a Swedish study, 56% of LS patients complained of an adverse effect on their sex lives.[71]

shows the penile sites affected by LS in a study of 66 men at a genitourinary clinic in Oxford, the UK.[65] Frequency was 64% for meatus (37% of these having meatal narrowing), 55% foreskin, 20% shaft, and 20% glans.[65] At the time of diagnosis, 30% of patients did not complain of symptoms related to LS. Nine percent had had a circumcision. A 2014 review of 40 reports found that LS affected the foreskin and glans in 57%–100% of cases, the meatus in 4%–37%, and urethra in 20%.[72] These studies found that disease progression may lead to phimosis and severe urethral stricture disease.[72] LS prevalence has generally been thought to peak in the fourth decade of life,[73] although a peak in the third decade has also been reported.[74] Foreskin biopsy after circumcision diagnosed LS histologically in 4%–19% of cases.[1,21] Because of the narrow foreskin opening, partial or complete urinary obstruction occurs. Both urethral stenosis and meatal stenosis is seen, so making LS a significant medical problem.[75,76]

The penile sites affected by lichen sclerosus and the frequency of each in a study of 66 cases in the UK. Redrawn and slightly modified from Riddell et al.[65]

Etiology of lichen sclerosus

LS may have an autoimmune origin, exacerbated by the warm and moist subpreputial environment,[67] but genetic and hormonal factors[77] and the isomorphic response[1] probably contribute. Lack of circumcision applies to 98% of LS patients.[30] Postpubertal circumcision has also been invoked.[78]

Lichen sclerosus in boys

Rather than being rare, and a disorder presenting in adulthood, LS is now regarded as common in boys.[75,79,80] In boys, average age of diagnosis is 9–11 years.[81] Atopic skin diathesis, seen in 25% of juvenile cases, may predispose to LS.[82] In contrast to a reported rate of 1%,[83] two UK studies found LS prevalence of 5% and 6% in uncircumcised boys under 18 and 15 years of age, respectively.[84,85] Histological examination of foreskins removed for various reasons revealed LS in 3.6%–19%.[86,87,88,89,90,91] A study in Plymouth, UK, of 422 boys aged 3 months to 16 years (mean 6 years) referred to a pediatric general surgical outpatient department with foreskin problems found 55.9% were normal, with the remainder (44.1%) undergoing surgery: 35% circumcision, 8% preputial adhesiolysis, and 0.1% frenuloplasty.[75] Histological abnormalities were seen in 85% of the foreskins removed by circumcision; chronic inflammation was seen in 47%, LS in 35%, fibrosis in 3%, and 13% were histologically normal.[75]

Global LS prevalence from 13 studies was 35% in foreskins from boys circumcised for any reason.[92] A prospective study in Budapest involving 1,178 boys who presented consecutively over the decade 1991–2001 and who underwent circumcision, identified LS in 40% of histological specimens, with peak prevalence of 76% at ages 9–11 years.[93] In this study, 19% had an early, 60% had an intermediate, and 21% had a late form of LS.

LS prevalence in acquired phimosis cases ranges from 10%[94] to 80%–90%[67] in more recent studies. LS can cause pathological phimosis as a result of secondary cicatrization of the foreskin orifice. In one study, LS was regarded as responsible for secondary phimosis in all pediatric patients requiring circumcision.[93] In another study, 37% of pediatric patients with severe phimosis had LS.[95] A further study found LS in 60% of boys with acquired phimosis and in 30% of those with congenital phimosis.[96] Foreskin inflammation was seen in 88% and 82%, respectively. The study also examined boys with congenital hypospadias, with 61% showing symptoms of inflammation and 15% having features consistent with LS. In a case series from Boston, of 41 pediatric patients with LS, 52% had been referred for phimosis, 13% for balanitis, and 10% for buried penis.[97]

Lichen sclerosus in adult males

An Italian study of men of mean age 46 years found LS in 85% of biopsies, LS of the foreskin being documented by histology in 93% of cases, of the meatus in 92% of cases, of the fossa navicularis in 84% and of the penile urethra in 71%.[64] A Hungarian study of men circumcised for phimosis found LS in 62%.[98]

In older patients, progressive LS or other inflammatory changes can lead to phimosis.[99] LS with phimosis can also cause lower urinary tract symptoms in elderly men.[100] Phimosis in older men is associated with 44%–85% of cases of penile cancer.[72,101] In men not circumcised in childhood, phimosis was strongly associated with invasive penile cancer, as was high-risk HPV.[102] Oncogenic HPV was seen in 23% of 92 Italian men aged on average 68 years who had LS, compared to 15% of men aged on average 58 years without LS, suggesting that LS causes slower clearance of HPV.[103] Among 226 males aged 16–95 years attending a penile dermatology clinic in Edinburgh, penile intraepithelia neoplasia was diagnosed in 6% and invasive penile cancer in 2%.[31] Penile cancer was seen in 1% of 771 Swedish men aged 48.6 years (range 22–92) diagnosed with LS during 1997–2007.[71] Another study found penile cancer in 4%–8% of men with LS.[104]

A random-effects meta-analysis of 8 studies found an association of phimosis with a 12-fold (95% CI 5.6–26) increase in penile cancer risk.[105] Lifetime prevalence of penile cancer is approximately 1 in 1000.[7,8,105] Among patients diagnosed with LS, penile cancer occurred in 2.3%–8.4% and mean time between diagnosis of LS and development of penile cancer is 12 years.[62,72,106]

LS represents an important, potentially preventable risk factor for this devastating cancer.

Treatment of lichen sclerosus in boys

The treatment of choice for LS in boys is circumcision.[62,93,94] Conservative treatment with topical steroids is considered “controversial.”[67,82] Because of significant side effects, steroid use should be avoided in children.[72] Preputioplasty is regarded by some as effective, although 13% of patients developed recurrent symptoms.[107] Preputioplasty or frenuloplasty are never a first choice. They are only an option when parents do not agree to circumcise. A Boston study found 46% of pediatric LS patients underwent curative circumcision.[97] In 27%, LS involved the meatus, so besides circumcision these patients had meatotomy or meatoplasty. In all, 22% required extensive plastic surgery of the penis, including buccal mucosa grafts, demonstrating a more severe and morbid clinical course. A study in Liverpool, UK, of 300 boys (mean age 9 years; range 4–16 years) circumcised after clinical diagnosis of LS, confirmed LS by histology in 80% and 1 in 5 required subsequent meatal dilatation or meatotomy for meatal pathology.[108]

Treatment of lichen sclerosus in men

Circumcision is curative in “nearly 100%” of LS cases.[109] Another study reported a cure rate of over 75%[73] and when confined to the foreskin, circumcision resulted in a long-term cure in 92% of LS patients.[62]

Steroid creams can limit disease progression but do not cure many LS cases.[73,110] Steroids lead to an improvement in 41%–76%, but a cure in only 50%–60% of cases in men.[73] In the second author’s experience, steroids are less effective than this. Recurrence of LS after steroid treatment may occur after 5 years.[109] In a Swedish study, 30% of men reported that outcome of local steroid treatment was “good,” while 37% said it was “medium” and 16% “poor” (17% failed to answer).[71] An Indian study of men aged 20–45 years with LS reported a preference by all for circumcision rather than use of steroid creams.[111] In another Indian study, 77% received circumcision for treatment.[63]

Progression to urethral involvement makes treatment much more difficult.[72] Treatment may include meatotomy or meatoplasty for meatal stenosis and urethroplasty for urethral involvement. Extensive disease affecting the full length of the urethra may require perineal urethrostomy.[72] In an Italian study of men of mean age 46 years, treatment included circumcision, meatotomy, navicularis uroplasty, extensive grafting procedures, and perineal urethrostomy.[64]

90,000 Male circumcision: context, criteria and culture (part 1)

February 26, 2007.

After the issues of male circumcision

After the issues of male circumcision and its relationship to HIV infection hit the headlines and sparked heated debate around the world, the first of three parts of the special See series, www.unaids.org on this issue, which goes into more detail on the historical, traditional and increasingly social reasons for the practice of male circumcision in various regions of the world.

Male circumcision is one of the oldest and most widespread surgical procedures and has traditionally been a sign of cultural identification or religious importance.

Historically, male circumcision was practiced by the ancient Semitic peoples, including the Egyptians and the peoples of the Jewish faith; the earliest records depicting circumcision were found in an Egyptian temple and in wall paintings dating from about 2300 BC.e.

As surgery developed in the 19th century and the mobility of the population increased in the 20th century, this procedure was introduced into some cultures that did not previously practice circumcision, for health or social reasons.

According to current estimates, about 30% of all men in the world – about 670 million men – are circumcised. Of these, about 68% belong to the Islamic faith, less than 1% to the Jewish faith, and 13% are non-Muslim or Jewish Americans.

“With recent evidence that male circumcision significantly reduces the risk of HIV infection for men, this practice is receiving renewed attention as the world struggles to understand what it will mean in terms of HIV prevention,” said Chief Scientific Adviser UNAIDS Dr. Katherine Hankins. “An analysis of the determinants of male circumcision and the acceptability of the practice in other communities provides a better way to see how these recent research findings can be used further.”

Religious Practice

In the Jewish religion, boys are traditionally circumcised on the eighth day of life, if there are no medical contraindications. The rationale given in the Hebrew holy book of Torah is that a covenant was established between Abraham and God, the outward sign of which is the circumcision of all male Jews. The Torah says: “This is my covenant, which you must keep between me and between you and your descendants after you: that all male sex may be circumcised among you” (Genesis 17:10).Male circumcision is still an almost universal practice among the Jewish people.

Islam is the largest religious group practicing male circumcision. As followers of the faith of Abraham, Islamic peoples practice circumcision as their relationship with God; they call this practice “takhera”, meaning purification. After the global spread of Islam since the 7th century AD. male circumcision began to be widely practiced among other peoples who had not previously used this practice.There is no clearly prescribed age for circumcision in Islam, although the Prophet Muhammad recommended circumcision at an early age and is said to have circumcised his sons on the seventh day after birth. Many Muslims perform this rite on this day, although a Muslim can be circumcised at any age from birth to puberty.

Coptic Christians in Egypt and Orthodox Christians in Ethiopia — two of the oldest forms of Christianity in existence — retain many of the traditions of early Christianity, including male circumcision.Circumcision is not prescribed by other forms of Christianity. In the New Testament, Saint Paul wrote: “for in Christ Jesus neither circumcision nor uncircumcision has power” (Galatians 5: 6), and in the Papal Bull of 1442 the Roman Catholic Church says that circumcision of men is optional: “Therefore, all who glorify on behalf of a Christian are strictly ordered not to practice circumcision either before or after baptism, since, regardless of whether they believe it or not, this rite cannot be observed without losing eternal salvation.”Focus group discussions on male circumcision in sub-Saharan Africa did not provide a clear consensus on the compatibility of male circumcision with the Christian faith. Some Christian churches in South Africa oppose the practice as a pagan ritual, while others, including the Nomian Church in Kenya, require circumcision for their members; focus group panelists in Zambia and Malawi noted similar beliefs that Christians should practice circumcision because Jesus was circumcised and the Bible preaches this practice.

Ethnic factors

Circumcision has been practiced for other, non-religious reasons, for millennia in sub-Saharan Africa, as well as in many ethnic groups around the world, including the Australasian, Aztec and Mayan aborigines in America. inhabitants of the Philippines and eastern Indonesia and various islands of the Pacific Ocean, including Fiji and the Polynesian Islands.

In most of these cultures, circumcision is an integral part of male initiation, although initially it may have been a test of courage and endurance.“Circumcision is also associated with factors such as masculinity, social cohesion with boys of the same age who were circumcised at the same time, self-identification and spirituality,” explains Dr. Hankins.

Ethnographer Arnold Van Gennep, in his Rites of Initiation (1909), describes the various initiation rites that are present in many circumcision rituals. They include three stages: separation from ordinary society; the period during which the new initiate undergoes transformation; and finally, reintegration into society in a new social role.

“The psychological explanation for this process is that the ambiguity of social roles creates tension, and as a person approaches the stage of transition from child to adulthood, a symbolic new classification is required. This is supported by the fact that many rituals give specific meaning to circumcision, which justifies its purpose in this context, ”says Dr. Hankins. For example, some ethnic groups, including the Dogon and Dawayo in West Africa and the Khosa in South Africa, believe that the foreskin is the feminine element of the male penis, and its removal (along with the passage of certain tests) transforms the child into a man.

For many ethnic groups, tradition plays an important role. Among ethnic groups in the Bendel State of southern Nigeria, 43% of men said they were motivated by tradition to circumcise. In some communities where circumcision is the norm, there is discrimination against uncircumcised men. For the Lunda and Luwale tribes in Zambia or the Bagisu tribes in Uganda, it is unacceptable to remain uncircumcised, and as a result, forced circumcision of older boys is not uncommon. Among the Khosa tribe in South Africa, uncircumcised men face extreme forms of punishment, including intimidation and beatings.

Circumcision as a social status

Social reasons for male circumcision are becoming more common. “Where most boys are circumcised, the desire to conform is an important motivation for circumcision,” says Dr. Hankins.

A study in Denver, USA, where circumcision is performed shortly after birth, found that parents, especially fathers of newborn boys, cite social reasons as the main factor in choosing circumcision (ex., unwillingness for the son to “look different” from the father).

In the Philippines, where circumcision is nearly universal and usually occurs between the ages of 10-14, a survey of boys found that two-thirds chose to be circumcised simply “so as not to be uncircumcised,” and 41% said it was “part traditions”. Social reasons were also cited as the main reason for circumcision in South Korea, where in one survey 61% of respondents indicated that they would be laughed at by their peers if they were not circumcised.

The desire to “be your own” is also a major factor explaining the high percentage of circumcision among men who immigrate to Israel from other countries where this practice did not exist (mainly from the former Soviet Union).

Socio-economic factors influence the prevalence of circumcision in a number of countries, especially in countries where the practice has emerged recently, such as in the English-speaking industrialized countries. When the practice of male circumcision first appeared in Britain in the late 19th and early 20th centuries, it was predominantly prevalent among the upper classes of society.In the United States, analysis of data for 4.7 million babies circumcised between 1988 and 2000 also indicated a significant relationship with private insurance and higher socioeconomic status.

Estimated Health and Sexual Benefits

In recent years, the proliferation of circumcision in men in the industrialized world has been driven by the idea of ​​improving hygiene and reducing the risk of infection.

In a 1983 US neonatal study, mothers indicated that hygiene was the most important factor in choosing circumcision for their sons; in Ghana, circumcision is considered to be the cleansing of a boy after birth. Improved hygiene was also reported by 23% of 110 circumcised boys in the Philippines and South Korea; the main reasons for circumcision were: “to improve sexual hygiene” and to prevent the development of genital cancer and the spread of sexually transmitted infections and HIV (71% and 78%, respectively).In Nyanza Province, Kenya, 96% of circumcised men and 97% of women, regardless of their attitudes toward male circumcision, said they found it easier for circumcised men to maintain hygiene.

The motive for circumcision can also be the concept of sex appeal and activity. In a survey of boys in the Philippines, 11% indicated that they believed women enjoy having sex with a circumcised man, and 18% of men in a study in South Korea noted that circumcision increased sexual pleasure.In Nyanza Province, Kenya, 55% of uncircumcised men believed women enjoy sex with circumcised men. Likewise, most women believed that sex with circumcised men was more attractive, although it is likely that most women in this province had never had sex with a circumcised man. In northwest Tanzania, young men believed that circumcision increased sexual pleasure for both men and women, and in Westonaria, South Africa, about half of men indicated that women preferred circumcised men.

Expected increase in demand

Global estimates for 2006 indicate that approximately 30% of men – about 670 million people – are circumcised.

With recent studies showing that circumcised men are significantly less likely to contract HIV, the demand for safe and affordable circumcision can be expected to increase rapidly.

“Since male circumcision is now considered effective in reducing the risk of HIV infection, it is important to ensure that both men and women correctly understand that this procedure does not provide full protection against HIV infection,” said Dr. Hankins, stressing that these The issues will be addressed during the international consultation on Male Circumcision and HIV Prevention: Implications for Policy and Programs, to be held in Montreux on March 6-8, 2007.“Male circumcision should be seen simply as part of a comprehensive HIV prevention package that includes correct and consistent use of male and female condoms, fewer sexual partners, delayed sexual debut and abstaining from penetrative sex. Just as combination treatment is the best strategy for HIV treatment, combination prevention is the best strategy to avoid getting or transmitting HIV, ”she added.

“Action is needed to improve the safety of circumcision practices in many countries and to ensure that providers and the public have the latest information on the health risks and benefits of male circumcision,” said Dr. Hankins.

References:

Read the three-part series on male circumcision:

Part 2 – Male circumcision and HIV: here and now
Part 3 – What lies ahead: UN policy and action on male circumcision
Part 4 – International experts review male circumcision

90,000 Circumcisia – a method of treatment

Circumcisia (circumcision) – a surgical operation aimed at excision of the foreskin in men and boys.In many countries, circumcision is a traditional practice dictated by religious customs and requirements. However, quite often the need for circumcision is not associated with belonging to a particular national or religious community, but is required for medical reasons.

The circumcision procedure is one of the most frequently performed surgical procedures and can be performed both in childhood and as an adult. Medical indications for circumcision can be congenital or acquired anatomical defects, and circumcision is also carried out for the prevention of diseases.

Carrying out circumcision facilitates hygienic care, prevents the accumulation of secretions in the folds of the foreskin and reduces the risk of developing inflammatory diseases. Another goal – circumcision of the foreskin – is to adjust the sensitivity of the receptor apparatus of the glans penis. As a result of circumcision, sensitivity decreases, which acts as a preventive measure for premature ejaculation.

Circumcisia is performed in the following pathological conditions:

• Phimosis (including congenital physiological, cicatricial).Depending on the stage of development of the pathological process, the patient experiences difficulties with opening the glans of the penis, difficulty urinating, a decrease in sexual activity up to the complete impossibility of having sexual intercourse. The third and fourth stages of phimosis, when there is a risk of tissue necrosis, is an absolute indication for surgery.
• Circumcision is necessary for paraphimosis – infringement of the glans penis, most often as a result of unsuccessful attempts to displace the narrowed foreskin.
• The presence of a short frenum or its damage (complete or partial rupture. This defect causes pain, to eliminate the most effective circumcision of the foreskin.
• Often recurrent inflammatory diseases of the tissues of the foreskin and glans penis (balanitis, balanoposthitis, licheniosis) is quite successful

To the medical indications listed in the previous section in adults are added problems with the opening of the glans penis and trauma to the skin of the foreskin (frenulum) during erection and intercourse.In uncircumcised men, premature ejaculation is more common, which resolves after circumcision. Circumcisia is the first and most important stage in the treatment of phimosis in men with xerotic balanitis or licheniasis of the penis. This inflammation of the glans penis and foreskin of an insufficiently clear nature often causes scarring of the foreskin, the external opening and the distal part of the urethra. Circumcisia significantly reduces the likelihood of complications of xerotic balanitis or licheniosis.

Circumcisia is a surgical operation during which the foreskin is removed from a man. This type of intervention is one of the most common and consists in excision in a circle of the skin fold covering the head of the penis. If you believe the world statistics, doctors recommend that every 5th man do a circumcision. The operation was most widespread in countries where representatives of Muslim religions, Jews and Jews live.

Many men leave positive reviews about circumcision surgery.If you entrust its implementation to a qualified surgeon, you can permanently get rid of pathologies of the foreskin (including phimosis). The rehabilitation period after surgery does not last long, only 3-7 days.

If a man needs to have a circumcision, he needs to visit a urologist and get appropriate advice. Also, the primary counseling of patients with phimosis is carried out by a therapist. Having studied the circumstances of the problem, he refers the patient to a narrower specialist (surgeon, plastic surgeon, urologist, andrologist, venereologist).

Medical Center “Zvezda” holds an appointment with urologists and andrologists, including on the issue of circumcision (circumcision) for medical reasons. Our advantage is high qualification of specialists, convenient location and schedule. With us, you can pass all the necessary preceding operations analyzes and undergo the appointed instrumental examinations.

What every man should know about circumcision

Why did they start circumcision at all?

Circumcision is one of the oldest surgical practices that people still use today.The earliest records of her were found in an Egyptian tomb about 2,300 BC. e.

This procedure was done for different purposes. For example, the Jews, because it is written in the holy book of the Torah: “This is my covenant, which you must keep between me, and between you, and between your descendants after you [in their generations]: may all male sex be circumcised among you “(Genesis 17: 10-14).

And the Jews have been following this covenant to this day: almost all newborn Jewish men in Israel ^{are circumcised, about 99% in Great Britain and Northern Ireland and 98% in the USA .}

Christian men are also ordered by the Bible to be circumcised, but due to the debate about whether it is necessary to do this for the pagans who came to the Church, the rite gradually lost its meaning and was actually replaced by baptism.

Muslims also undergo circumcision as a confirmation of their relationship with God. And although the Qur’an does not say ^{about the need for a procedure, this is a mandatory requirement in order to perform the Hajj to Mecca .}

The Aztecs, Mayans, Indigenous Australians, various African peoples and other ethnic groups also practice circumcision as a rite of initiation ^{, although initially it could be a test of courage and endurance.}

Depending on the nationality, the procedure is performed either in infancy or when the social role changes: from boy to man.

For example, in Uganda, during the ceremony, a boy stands upright on his feet, his foreskin is cut off with several knives by other men. Naturally, everything is done without anesthesia, the boy should not show that he is in pain.

Some ethnic groups, including Dogon and Dowayo from West Africa, view the ^{foreskin as the female element of the penis, the removal of which (along with passing certain tests) displaces the child from the male .}

Got it. Why do they continue to do it now?

In general, the reasons remain the same. 62.1% of men are circumcised for religious reasons ^{, the rest – for cultural, medical, family reasons (parents circumcise babies). In total, about 39% of the world’s men are circumcised 90,212.}

In Russia this figure is much lower than in other countries – 11.8%. But even that is almost 8 million.

By comparison, 71.2% of men in the United States have been circumcised.This is the second most popular procedure for babies in the country. Vaccination comes first.

Medical circumcision has become very popular in the 21st century. It is even recommended by the American Academy of Pediatrics ^.

And what’s the catch?

There are many questions about circumcision for medical reasons.

The Egyptians also did this for medical purposes: in a drought it was difficult to observe all the necessary rules of hygiene, it was easier to get rid of the foreskin.

However, this is the catch: the current level of development of medicine and technology has changed significantly, there is much less sense in circumcision for medical reasons than is commonly believed. The foreskin is not the extra skin on the penis; it has its own functions.

What is the foreskin for?

It has many functions. The main three are protective, immune and erogenous.

The foreskin is a special erogenous zone. It contains a rich and complex network of nerves. Both the inner and outer folds of the foreskin have a denser distribution of nerve endings than the rest of the penis ^.

The rich innervation of the inner part of the foreskin contrasts sharply in sensations with the limited sensory capabilities of the glans penis. On it, the nerve endings are very close to the surface. This leads to the fact that the direct impact can feel unpleasantly rich or painful.

The double layer of the foreskin allows the skin of the penis to glide freely and smoothly over the glans. One of the functions of the foreskin is to facilitate movement between the surfaces of the mucous membranes of two partners.It allows the penis to slide into the vagina directly within its own sheath.

Conventional circumcision removes most of these sensitive areas, drastically weakens the penis and immobilizes all remnants of the foreskin.

Loss of protective self-lubricating mobile double-layer fold and gap for smooth friction leads to abrasion and injury ^{. Also, a circumcised man may need more intense action to achieve orgasm.For this reason, a circumcised penis is more likely to cause microcracks, abrasions and lacerations in the vagina or rectum, and through these, HIV in semen can come into contact with blood.}

The glands present on the foreskin secrete lubrication and protect against infections. The antibacterial enzyme lysozyme in these secretions acts against harmful microorganisms ^.

In fact, a circumcised penis is more prone to infections in the first years of a person’s life than an uncircumcised penis ^{.An eye without an eyelid will not be cleaner. It’s the same with the head of the penis.}

But does circumcision have advantages?

Yes, there is. But even with them, everything is not so simple. To understand the issue, we turned to Daria Chernysheva, urologist, member of the European Urological Association.

1. Reduces the risk of urinary tract infections

According to Chernysheva, if the procedure is performed on a newborn, circumcision significantly reduces the risk of urinary tract infections in boys under one year old – by almost 90%.It is another matter that in general there are not very many of these infections in boys, but the fact remains.

2. Phimosis and paraphimosis are excluded

Phimosis is a narrowing of the foreskin around the head of the penis, paraphimosis is an acute form of phimosis.

Obviously circumcised boys / men do not suffer from phimosis and even more so paraphimosis. In addition, they are less likely to get balanoposthitis. But it is important to understand that if the foreskin is handled correctly and hygiene is observed, all these diseases can be prevented without circumcision.

Daria Chernysheva

urologist

In addition, scientists recently came to the conclusion ^{that circumcision for the treatment of phimosis is not necessary in most cases. A condition in which the foreskin fits snugly against the head is the norm for boys up to almost 18 years of age and occurs in 96% of men .}

And only 2% of phimosis takes on an extreme form, when surgical intervention is required. For example, only in 11% of cases did doctors correctly identify the type of phimosis and circumcision was justified ^.

3. The likelihood of contracting squamous cell carcinoma of the penis decreases

“This cancer grows from the foreskin, and circumcision reduces the risk of its occurrence by almost 70%. No skin, no cancer. But there is one thing, – the urologist notes. – This type of cancer is very rare. To prevent one case, it is necessary to circumcise from 1,000 to 300 thousand boys just like that. At the moment, no one is sure if it is worth it. ”

4. Reduces the risk of HPV in partners

HPV is a family of viruses that cause warts, papillomas, dysplasia (abnormal development of tissues, organs or body parts) or cervical cancer in humans.

Circumcised men are less likely to carry HPV. So, under the condition of monogamy in the relationship, their partners are less likely to get cervical cancer.

5. Reduces the risk of contracting HIV and genital herpes

It is believed ^{that certain bacteria live under the foreskin that increase the risk of infection.}

The doctor explains how the foreskin can also increase the risk of infection.

Body fluids containing the virus stay in contact with the skin of the glans penis longer due to the foreskin.HIV penetrates relatively easily through this thin skin, which almost always contains microcracks or inflammations, and invades immune cells (HIV) or neurons (herpes). Together, this increases a person’s risk of becoming infected.

Daria Chernysheva

urologist

There are several reasons against this statement. First, herpes viruses are among the most common infections in humans, including oral herpes. 90% of people have it ^{, incurable and not dangerous to health: most infected people do not have any symptoms at all .}

Secondly, for orgasm, the circumcised penis needs to make more active movements, which lead to the appearance of cracks both on the head and in the vagina, and direct contact with an open wound also increases the risk of HIV infection. However, studies show ^{that circumcision reduces the risk of HIV infection by 60%. But a condom reduces it by 80% .}

In addition, circumcision in itself is not a guarantee of safe sex – contraceptives will still have to be used to protect against STDs and HIV.

Should you still be circumcised or not?

If we are talking about circumcision for religious reasons, this is only your choice. When it comes to surgery to prevent disease or simplify hygiene, it is worth soberly weighing all the chances of success.

Ask your doctor as many questions as possible about potential results, statistics and your analyzes. You may be more likely to become insensitive than to get cancer.

If it comes to your child, try to get the numbers from the doctors.For example, how many boys under one year old have urinary infections in your area.

This is not a routine procedure for getting rid of a useless skin area, but a full-fledged operation that should be performed exclusively by specialists. You must be aware of all the possible consequences, both positive and negative.

everything you need to know • musanews

In some religions such as Judaism and l’ Islam , circumcision of infants and young children is widespread .Even in the United States, where about 70 percent of men are circumcised, circumcision is routine . Here, more and more children were circumcised only at the end of the 19th century, because the topic of sex was taboo, and it was hoped that circumcision would prevent boys from masturbating in adolescence .

Although American pediatricians today clearly state that the medical benefits of circumcision without a clear medical indication do not justify the risks of , this practice is still being pursued.

Is circumcision yes or no?

Everything is different with us: in Italy, circumcision is usually justified in terms of medical , for example, in the case of narrowing of the foreskin (phimosis) or problems with the urinary tract . However, there are also men who voluntarily undergo this operation because they expect improvement. aesthetics, firmness and hygiene But what are real benefits of circumcision for men? And what are they disadvantages of ?

What exactly is circumcision made of?

When performing circumcision , the foreskin of the glans penis eliminated completely or only partially .This practice is usually routine in some religions and is carried out during the childhood of the child.

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Sex and circumcision © iStock

Are there any health benefits?

Of course daily hygiene for men without foreskin is a little easier . However, over time, even an uncircumcised man will be able to cope with this. Also circumcised men should have 90,010 a lower risk of urinary tract infections , infections from Papilloma virus , the so-called HPV, that is, those viruses that can be precursors of cervical cancer in women, and sexually transmitted diseases .

Does circumcision change pleasure during intercourse?

Naturally, the question arises whether the glans penis would be much more sensitive without the protective foreskin. Researchers from the University of Sydney analyzed the results of 36 studies in which they participated in a total of 90,010 40,473 men 90,013. They found that, especially if circumcision occurred during childhood, there is little difference in sensitivity, arousal, or orgasmic ability .

However, there are studies that come to the opposite conclusion. Research from Denmark in 2011 found that circumcised men suffered from 90,010 orgasmic problems three times more often than 90,013 uncircumcised men.

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Sex and circumcision © iStock

Is it harder to get circumcised men aroused?

Unfortunately. The foreskin covers the glans of the penis and protects against external influences.It contains thousands of nerve endings where it is connected to the penis and is very sensitive . Thus, the foreskin plays an important role in the realm of male desires.

The sensitivity of the glans penis decreases with circumcision. Many women who have had experience with circumcised and uncircumcised men say the same thing. Often men are circumcised they cannot be stimulated so easily . In any case, to date has not been proven than men without foreskin can last longer than during intercourse, because they are less sensitive to stimulation.

There is no doubt that masturbation is more difficult for circumcised men because there is no way to push the foreskin back and forth. The more the area of ​​skin that is removed during circumcision is lengthened, the more unpleasant it can be to stimulate dryness of the head with your hands. Often this feeling becomes pleasant only lubricant .

The same precaution applies to us women: methods masturbazione or fellatio are just different, because circumcised men no longer have foreskin that can use as a stimulant .

Sex and Circumcision © iStock

How does a woman experience sexual intercourse with a circumcised man?

Many women do not notice the difference. However, in polls, the leaders of popularity are uncircumcised men. The problem that arises is this: if a lot of skin has been removed during circumcision, penetration during sex can be more inconvenient for both, because usually the presence of dermis contributes to the sliding of the penis reduces friction – which cannot be said for circumcised men.

Moisturizing or natural lubrication , the vagina cannot always fully compensate for this absence and therefore often need gods lubricants for some circumcised men.

All this means that without him there would be no reason for circumcision. cultural or medical needs . In any case, even circumcised men should not worry – many women even find them. is more aesthetically pleasing without foreskin, and the pleasure obtained from sex ultimately depends on this many different factors that you cannot focus on circumcision alone.

what is the difference between circumcised and uncircumcised member

Sex with a man with a circumcised and uncircumcised penis … what is the relish? Experienced women who have had contact with both types of manhood can talk about all the intricacies of intimacy and name the differences. If you have not had the opportunity to appreciate the features of a circumcised penis or you are intimidated by such an “adventure”, then you should definitely read our article.

How many myths and controversies have been generated by circumcision? Doctors, women and men do not get tired of discussing this topic and each side has its own opinion.Someone likes a circumcised penis (and this is not only about the hygienic side of the issue), someone considers such men to be incomplete. What do we think? Let’s speculate.

At rest, the head of the uncircumcised penis is covered with a thin fold of skin, which stretches during an erection and “disappears”. Usually, men do not experience any problems with the foreskin (well, except for hygienic ones – often dirt and various secretions accumulate under this skin, provoking the multiplication of bacteria and the release of an unpleasant odor.But this problem can be easily solved with daily washing).

Circumcised men do not care about the cleanliness of their intimate places even in the heat, because, due to the lack of skin, they do not accumulate anything, so they are always clean and fresh. This fact is often noted by partners. Agree, it’s nice when a man doesn’t smell like a horse.

In a tense state, the difference between a circumcised and an uncircumcised penis is clearly visible – for example, a bridle is not visible in a circumcised man, since it is no longer there.While in the uncircumcised one, the bridle is clearly visible and can be used in your sexual games.

Currently, circumcision is practiced in both Judaism and Islam. Modern Ukrainian and Russian men perform circumcision if indicated for medical reasons.

There is no fashion for circumcision, so few Christian men volunteer for this painful procedure.

Orgasm for circumcised and uncircumcised men

It is believed that after circumcision, the sensitivity of the glans penis increases.Doctors say that after this procedure, the nerve endings located in the bare area are exposed, so the head loses sensitivity and sex becomes longer. According to other sources, this argument is considered a myth.

There is no credible evidence that a circumcised guy is a better and more skillful lover than an uncircumcised one. It all depends solely on the experience of the partner, but not on circumcision.

Despite this fact and the possibility of its unreliability, women are attracted by the prospect of experiencing sex with a circumcised man in order to be convinced of this fact from personal experience.Only any sexologist can say with confidence that temperament, arousal, mood, the state of the body and the nervous system at the time of intercourse are important for a male orgasm. The same man in a different state and with different partners can feel the approach of orgasm in different ways.

Some seriously think that the circumcised penis will somehow magically become larger. Why on earth? They do not increase anything, but, on the contrary, shorten it.

The only thing is that the “placebo” effect can work and male dignity for women who do not meet men with a circumcised penis may visually appear longer.

But the circumcision did not add a difference in the form of real centimeters. If a woman wants to think that the penis after circumcision has become longer, you cannot convince her otherwise, besides, this is only for the man.

Girls should slow down with fantasies about enchanting sex with a circumcised man, because apart from the aesthetic appearance, their penis has not acquired anything else.

Yes, many men manage to turn their circumcised “friend” into a real sex machine and fetish for seducing beautiful ladies.

Only their skills, abilities and duration of sexual intercourse are the result of long and hard work aimed at satisfying women, but this has nothing to do with circumcision.

Circumcision is not equal to good, long-lasting sex. If you are tempted to try sex with a circumcised man, why not. At the same time, from your own experience, you will be able to compare the difference and say with precision what you liked and what did not. You just do not need to persuade your man to circumcision just to try sex with a circumcised man – this will only ruin your relationship.

Author : Svetlana Misnik

Materials on the topic:

90,000 What do those who circumcised when they were already adults

Chik-chik. Photo Phalinn Ooi

Thanks to my hippie parents, I have never been circumcised , although I grew up in the Midwest where circumcision is the de facto norm. Since this was a bit unusual for my place of residence, my sex partners often asked me what it was like to be uncircumcised.The answer, of course, is that I never knew what was different. There was no way I could compare my uncircumcised penis to an all-American circumcised penis because I never had one. My penis is my penis, it has always been uncircumcised, and always will be.

Since the procedure is usually done in infancy, there really isn’t any before or after to think about. I will never know what you experience with and without the foreskin, but some do. While the vast majority of uncircumcised people want to remain uncircumcised, there is no reason why they shouldn’t decide to change their penises as adults, and these men are the only ones who know what the true sensations before and after circumcision are.

There are three reasons why a person is circumcised at an older age: for cosmetic reasons, for medical reasons, or as part of a religious ceremony. A Los Angeles urologist I spoke with who performs 50-75 adult circumcisions per year confirmed that the procedure is sometimes performed for cultural reasons. In particular, Filipinos sometimes choose to circumcise their children at eight or ten years old, citing tradition, but this is quite rare.

Older circumcision is especially common among Jews who grew up in Soviet Russia, where the procedure was prohibited.So it was with Leo, who was circumcised at 13.

He learned that for the bar mitzvah he had to, in his words, “cut off the skin from the penis.”

Leo emigrated when he was four years old. After a Jewish aid organization helped him and his family settle in the United States, Leo began attending Sunday school and his family was given the opportunity to practice their religion.

“When I was eleven or twelve years old, my parents sat me down to talk,” he told me.“I hadn’t heard about circumcision – we didn’t have the Internet. I haven’t seen many members. To be honest, I didn’t have many erections and I didn’t masturbate until 14. ”

“They asked me if I would like to undergo a bar mitzvah ritual.” He wanted, but for this he had to, in his words, “cut off the skin from the penis.” His parents told him that if he did, they would give up pork as a sign of solidarity.

“I met the doctor,” Leo told me. “He told me that I would be under anesthesia.” “You will have stitches, you will feel strange, and then it will all go away in a week.”Leo then went through the procedure. “I can’t remember an erection before, so I don’t remember it hurting. The seams looked scary. The scar never went away. Pretty soon after that, I discovered masturbation. ” Everyone said that it was in the order of things.

Masturbation was more fun with the foreskin, it acts like an inline lubricant, but I like sex with a circumcised one because the head gets a stronger stimulus.

He said that immediately after the end of the circumcision, while he was still unconscious from anesthesia, his parents, sister and rabbi performed a festive dance around him, which he learned after the fact.Otherwise, it was a fairly standard medical procedure. And he says he has no regrets about it, that it helped him become “the Jew he wanted to be.”

After the surgery and the healing of his penis, Leo had a bar mitzvah. He never discussed circumcision with anyone. He says he felt a certain amount of shame about late circumcision, a feeling he attributed to a “shy and secretive person,” but he says it made him feel better after talking about it. Although he clearly remembered the process, he did not have a vision of how the foreskin affected his sex life.

Others know for sure. After a drunken sexual experience, 20-year-old Ryan tore his foreskin and a doctor recommended circumcision. When I spoke to him, he was still undergoing treatment after the procedure, which he had just four weeks ago. He described circumcision as painful but bearable, and although he still had to have sex while circumcised, he enjoyed it “much more than before.”

The worst was when a sudden erection occurred within a few days after the operation, which stretched the stitches.And after that, according to his description, the pain was like a sunburn. As he got closer to full recovery, he said he was just excited to be able to use his machine again and was looking forward to using his new penis.

“When he healed, there were scars around him. We named it Frankenpenis. ”

Medical circumcision is not always the result of a failed sexual act. Take Tom, 29, a Californian who was circumcised at 27 after years of struggling with phimosis, a narrowing of the foreskin of the head.Because of this, even an erection can be quite painful. The condition worsened dramatically when he was in his 20s and a half, to the point where his frenulum was regularly torn apart during sex and masturbation. After trying stretch marks and steroid creams, he decided he had enough pain and paid $ 1,500 for circumcision.

Unlike Leo, Tom experienced sex and masturbation both before and after circumcision. He described it this way:

“Although the sensitivity level was higher before, I now have more sensitive areas.The pleasure is the same, maybe even more, because now I have no problems with the bridle. Masturbation was more fun with the foreskin, it acts like an inline lubricant, but I like the circumcised sex better because the head gets a stronger stimulus. I sometimes use lubricant now when I masturbate, which I have never done before, but it is not necessary. ”

Of course, since he regularly associated sex with pain, a sexual experience without breaking the frenum is obviously preferable.

Not all cuts go so smoothly. While the foreskin can appear to be “repaired” by stretching with weights , circumcision is not 100 percent reversible. And some men who have been circumcised deeply regret it.

Allan, a 37-year-old boy from Nova Scotia, was circumcised at 19. He experienced slight discomfort during sex due to an overly tight frenum. His partner at the time, being circumcised, advised him to be circumcised.The operation went badly.

“They had to cut it with a scalpel and stitch it. And it was terrible, those big old-fashioned seams around him. It hurt and it was uncomfortable, ”he told me. “After the operation, I was not interested in having an erection at all. When I got it, I tore the seam. I got an infection. It was a nightmare. When he healed, there were scars around him. We named it Frankenpenis. ”

Allan also claims that the sensitivity of his penis decreased significantly with circumcision.“It’s day and night,” he said. “The head was the zone of greatest enjoyment. There was a natural lubricant. It was fun. After that, I had to re-learn how to use my chick. Everything was lifted up. It was like learning to walk again. ”

Allan said that he was sorry for the connection and it would be better to just endure the pain. He thought about restoring the foreskin using weights, “but this seems to take a lot of effort and the results seem to be mixed.”

The urologist I spoke with was even less supportive of the restoration option.“This is voodoo,” he said. “They stretch their skin, but their foreskin won’t come back. In general, those people who are trying to rebuild their foreskin are fighting much larger demons. ”

Allan’s case is certainly not the norm. The urologist said complications associated with circumcision are extremely rare. He also noted that this operation in adulthood is much more complicated than for infants – “30 to 45 minutes compared to 30 to 45 seconds.” While performing selective cosmetic circumcision, he says he discourages patients from using it.“I always ask them:“ Why? ”. If you have lived well with it up to this point, so be it. ”

Circumcision is, to put it mildly, a controversial issue. After all, this permanent body change is usually carried out on those who cannot actually consent to the procedure. This point of contention is cited most often by active anti-circumcision activists , also known as “intactivists”, who claim that babies cannot consent to circumcision .

Opponents of circumcision tend to be tough. Holistic America, a well-known intactivist organization, refers to circumcision on its website as “a painful, risky, unethical surgery that deprives more than a million boys every year of healthy functional tissue.” MGM’s bill, presented to Congress in January 2014 by inactivists, was titled “Bill to End 90,010 Male Genital Mutilation in the United States.” (The feelings of opposition to circumcision are so strong that the urologist I spoke with, a specialist in infant circumcision, wished to remain anonymous.)Circumcision also has its staunch defenders.

The practice is revered as a cultural rite of passage in many societies; in Judaism, the practice goes back thousands of years. Modern health officials have also justified the spread of circumcision in terms of public safety. While the CDC (Centers for Disease Control and Prevention) stopped recommending circumcision by default, the organization noted in December 2014 that circumcision dramatically reduced men’s risk of getting 90,006 90,013 sexually transmitted diseases through heterosexual sex: HPV by 30 percent. genital herpes from 30 to 35 percent, and HIV infection from 50 to 60 percent.

This is a difficult debate, rest assured. And they’re pretty split: In 2007, the US circumcision rate fell to its lowest level in a decade, at only 55 percent of boys. Again, the American Pediatric Association began in 2012 to support this practice , saying there are “benefits” to child circumcision. Although they still advise that when it comes to amputation of the foreskin, the final word “should be with the parents.”

Leo, Ryan, Tom and Allan are all aware of life before and after circumcision.Their experience is different. But they are united by what unites every circumcised man: there is no turning back.

“If there was a way to get back to how it was before,” Allan told me, “hell, I would do it.”

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Men’s health – the most frequent problems / All Clinics and Medical Centers in Tashkent, Addresses and Phones

Men’s health – the most common problems

Male problems can affect all areas of life, causing stress and difficulty in relationships, disrupting sex life and fertility, and undermining self-confidence and usefulness.

To be able to maintain his health, a man needs to know the causes and symptoms of possible diseases. There are many factors that affect men’s health. We cannot change some factors, but others could be avoided.

For example:

1. Unprotected sex. Without using condoms, giving vent to emotions, and not to reason, a man can easily become a victim of a sexually transmitted disease.

2. Aggressive sex and masturbation. If the penis is suddenly and severely bent while erect, it can lead to injury – a fracture of the penis.

3. Diseases of blood vessels and diabetes mellitus. Impaired blood circulation in the small arteries of the penis caused by diabetes and atherosclerosis can lead to erectile dysfunction.

4. Some medicines. A number of medications can adversely affect men’s health. For example, long-term use of antibiotics sometimes turns into a fungal infection of the genitals.A side effect of beta blockers is a decrease in libido.

5. Surgical operations. Common surgery to remove the prostate gland (radical prostatectomy), which is done for prostate cancer, can cause urinary incontinence, soreness, and erectile dysfunction.

6. Smoking. Smoking has a bad effect on the state of blood vessels in general, including the vessels of the penis, which leads to erectile dysfunction.

7. The level of hormones.Hormonal imbalances such as testosterone deficiency or prolactin excess can lead to erectile dysfunction.

8. Psychological problems. Depression can cause a loss of libido. Moreover, after one or two failures, the man will be determined to “fail” in the future. And this contributes to further sexual and psychological problems. Childhood trauma (abuse) is also associated with sexual failure in adulthood.

9. Neurological diseases.Stroke, spinal cord injuries, multiple sclerosis, and dementia can interfere with the conduction of impulses from the brain to the genitals. The result is sexual problems.

10. Aging. As men age, testosterone levels gradually drop. This leads to loss of sexual interest, weakening of erections, and impaired fertility.

11. Piercing. Penetration of the skin on the genitals is fraught with skin infections and impaired arousal in the future.

12. Hypothermia.Men who stay in the cold for a long time, especially in a motionless sitting position (drivers), often become victims of chronic prostatitis. This disease affects potency, fertility, affects the general health and quality of life of a man.

Most common male health problems

1. Prostatitis.

Inflammation of the prostate gland, often in a chronic form, affects hundreds of millions of men around the world.Acute prostatitis is characterized by impaired urination, pain in the perineum, sometimes accompanied by fever and body aches. Acute inflammation of the prostate requires urgent consultation with a urologist, otherwise the disease can become chronic. In chronic prostatitis, the symptoms of the disease are erased, patients complain of pain and discomfort in the perineum and genital area, frequent urination, dripping of urine, frequent urge at night, pain during ejaculation, weakening of erection, etc. The consequence may be male infertility or erectile dysfunction.

2. Erectile dysfunction and ejaculation.

The most common and terrible problem for men is erectile dysfunction. It is defined as the inability to achieve and maintain an erection for full intercourse. Another disorder, priapism, is an unusually long and painful erection that may not even be triggered by sexual stimulation. Ejaculation disorders are not uncommon. Anejaculation is the inability to ejaculate.Premature ejaculation, painful ejaculation, and retrograde ejaculation are also possible, in which semen is thrown into the bladder rather than exiting. All these violations can talk about a variety of diseases, therefore, in each of these cases, you need to be examined by a doctor.

3. Sexually transmitted diseases (STDs).

There are many STDs that can manifest in different ways. Among them are gonorrhea, chlamydia, syphilis, genital herpes, etc.The most common signs of an STD are blisters or sores on the penis, painful urination, discharge, and itching in the genital area. Any unusual manifestations require urgent medical attention. Do not under any circumstances self-medicate.

4. Problems with the foreskin.

The disease of phimosis is widely known, in which the foreskin of uncircumcised men does not allow exposing the glans of the penis. Phimosis is treated with surgery. Paraphimosis occurs when a man manages to roll back his foreskin, but fails to bring it back.In this condition, urgent help may be required, because blood circulation in the penis is impaired.

5. Other diseases.

A fungal infection (candidiasis) can cause redness and white patches on the glans of the penis. Inflammation of the head of the penis (balanitis) is a serious condition that causes urethral discharge and pain. Peyronie’s disease is a chronic condition in which abnormal scar tissue develops in the penis.Sometimes men develop penile cancer, which usually begins with a sore on the foreskin or head.

Symptoms of diseases of the male genital area

Consult your doctor as soon as possible if you have:

• Disrupted ejaculation.

• Blood is visible in the ejaculate.

• A burning sensation while urinating.

• There is an unusual discharge from the urethra.

• Pain and itching in the genital area.

• Increased urination.

• Delayed urination.

• There are dark spots on the penis.

• There is a rash, sores, redness in the genital area.

• There was an injury during sex, after which the penis hurts a lot.

Prevention of diseases of the male genital area

Each of us can take simple steps to improve our health:

• Be responsible.Use condoms or maintain a monogamous relationship with a reliable partner to avoid STDs.

• Get vaccinated. If you are under 26 years old, American doctors recommend getting the human papillomavirus (HPV) vaccine. This will insure you against genital warts, a very unpleasant and contagious disease.

• Maintain physical activity. Moderate physical activity can significantly reduce the risk of cardiovascular disease, atherosclerosis, diabetes, and problems with potency.Plus, exercising well will keep you energized all day. • Follow good hygiene practices. If you are not circumcised, wash the space between the glans and foreskin daily with soap and water.

• Know all about your medications. Review all the medications you have to take to be aware of their possible side effects and how they should be taken.

• Take care of your psyche. Treat depression and other mental problems in time. Minimize the impact of work and household stress on your psyche.

• Limit alcohol intake

• Be sure to give up cigarettes. Nicotine in any form, even chewing tobacco, is bad for our vessels. As a result, the heart, brain, lungs, and even the vessels of the penis suffer. The results of smoking are known to everyone: stroke, heart attack, several types of cancer, impotence, etc.

• Avoid hypothermia. This will reduce the likelihood of genitourinary infections and prostate problems.

• Use what you have regularly.Regular sex life is a must for any healthy man. Lack of sex is bad for the condition of the prostate and the health of men in general.

Remember, some male diseases cannot be prevented. However, regular visits to your doctor can help you identify these conditions at an early stage, which means successful treatment. Every man should regularly check his genitals for signs of any disease. Visiting a urologist at least 1-2 times a year will help identify serious diseases such as prostate cancer at an early stage.

Don’t forget to take time for your health!

If you have any questions, you can contact the leading urologists in Tashkent at the “Urologic Complex” clinic.