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Guynemer
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Circumcision reduces the risk of penile cancer, and may also reduce the risk of certain STDs.
It most certainly provides health benefits.
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Asher
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Calgary, Alberta
Nov 1999
time: 22:26
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quote:
Originally posted by Guynemer
Circumcision reduces the risk of penile cancer, and may also reduce the risk of certain STDs.
It most certainly provides health benefits. |
Not to contradict a med student, but: http://www.cirp.org/library/disease/cancer/
quote:
The alleged relationship between "lack of circumcision" and genital cancers formerly implicated smegma or smegma-borne pathogens as the causative agent. Only two histologic studies of human smegma ever have been conducted, both of which found it to be perfectly harmless. Smegma is composed of secretions of ectopic sebaceous glands in the prepuce mixed with secretions of the prostate, seminal vesicles, mucin from the urethral glands, and desquamated epithelial cells.10,12
The hypothesis that human male smegma is carcinogenic was first formulated in 1932 by circumcision promoter Abraham L. Wolbarst, M.D.1. Wolbarst also believed that circumcision prevented epilepsy. (In the early part of the 20th Century, the paroxysm of masturbation in children was often misidentified as an epileptic seizure.) Wolbarst wrote: "[Circumcision] diminishes the tendency to masturbation, convulsions and other reflex phenomena of local irritation." Wolbarst's beliefs about circumcision were shared by other writers, such as Peter Remondino and Abraham Ravich.
No laboratory or clinical research had been done on the subject at the time. Regardless, Wolbarst's hypothesis about smegma and cancer found its way into early medical textbooks. In the 1950s a few experiments were done to test the hypothesis by injecting horse smegma into wounds made in the backs of mice. There were clinical studies that attempted to induce cancer by introducing smegma subcutaneously and intravaginally: No carcinomas could be induced.
The smegma hypothesis was finally disproven by an exhaustive study by Reddy2 in 1963. His results were: "The conviction that human smegma is a carcinogen could not be substantiated." |
And what's more:
quote:
Post-circumcision cancer may occur at the circumcision scar.13,19 The cause is unknown. One may hypothesize that the circumcision scar tissue is less resistant to penetration of HPV which then transfers DNA to the human cell and starting the growth of the neoplasm. More research is needed to determine the etiology of post-circumcision cancer. |
and
quote:
American Cancer Society. The American Cancer Society issued a five part advisory statement on penile cancer in June 1999. Circumcision is not considered to be beneficial in preventing or reducing the risk of penile cancer. |
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Guynemer
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All that proves is that smegma doesn't cause cancer. Whoop-de-doo.
According to every urologist I've talked to, circumcision still reduces the risk.
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Guynemer
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Fair enough; different medical groups often disagree on these things, I wasn't aware of the ACS's stance.
Let me clarify my position--it (possibly) reduces the risk of penile cancer. However, penile cancer is so rare that it is rather a moot point. On the other hand, there is no significant damage as a result of circumcision. (Anecdotally, if being uncut makes everything even more sensitive and whatnot, frankly, I'd never get anything useful done--the damn thing is too dangerous as it is.) So, really, it boils down to--who cares?
Female "circumcision", on the other hand...
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SuperSneak
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In the land of the one-eyed
Jun 2000
time: 21:26
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Here's a few more reasons to consider both sides of the issue. Being uncut seems to have a variety of potential liabilities:
quote:
Normal
The normal foreskin is adherent to the glans and is non-retractile in most newborns. Over time the adhesions disappear, the foreskin separates and becomes retractile. The proportion of boys with retractile foreskins is: 40% at 1 year, 90% at 4 years and 99% at 15 years.
Non-retractile foreskin is a normal variant and needs no intervention. It is different from true phimosis (see below).
The foreskin should never be forcibly retracted for cleaning. Once it becomes freely retractile naturally then the boy should retract it as part of routine bathing.
See parent leaflet on care of the normal uncircumcised penis.
Adhesions
Sometimes the normal process of separation is uneven and the foreskin becomes partially retractile but with a residual adhesion to the glans. This is normal and needs no intervention. It will resolve spontaneously by the time of puberty.
Sometimes the normal separation of an adhesion between the foreskin and glans will lead to a day or two of soreness and dysuria.
Smegma
Before the foreskin becomes separate and retractile, it is common for smegma to collect in small yellow / white lumps which may be visible or palpable through the foreskin. These are normal, and need no intervention.
Discharge of smegma from the foreskin opening is sometimes mistaken for pus.
Minor inflammation
Minor redness / soreness of the tip of the foreskin is very common. A number of factors may contribute, including: irritation from wet / soiled nappies, inappropriate attempts at retracting the foreskin for cleansing, bubble bath, soap residue etc. Avoiding these factors, reassurance, and application of a napkin barrier cream to the tip of the foreskin will help. See also napkin rash guidelines.
Hydrocortisone 1% cream or ointment may help.
Balanitis
More severe inflammation of the glans penis +/- foreskin is often due to infection and is usually termed balanitis. It is common, affecting around 6% of uncircumcised and 3% of circumcised males.
Soaking in a warm bath with the foreskin retracted (if retractile and not too painful) will help with cleaning and urination may be easier in the bath. Topical hydrocortisone 1% cream or ointment may help in mild cases. Topical antibiotics creams are sometimes used but are of unproven efficacy.
Candida infection may be responsible in some infants. It is usually associated with more generalised napkin candidiasis and the presence of satellite lesions. Topical anti yeast creams (eg nystatin, clotrimazole, miconazole) will be helpful. See also napkin rash guidelines.
Bacterial infection
If there is significant cellulitis of the whole of the foreskin or the skin of the penile shaft then bacterial infection is likely and antibiotics should be given. Pain and swelling sometimes produce marked dysuria.
Streptococci (including Group A), staphylococci, and gram negative organism are most often responsible.
Swabbing the discharge is unhelpful because the normal foreskin is usually colonised with multiple organisms.
Most cases respond to oral antibiotics (eg Co-trimoxazole 4/20 mg/kg (max 160/800) 12 hourly or Amoxycillin 15 mg/kg (max 500 mg) 8hourly).
Analgesia is important, and sitting in a warm bath may ease dysuria.
Occasional cases require admission for parenteral antibiotics, and rarely urgent surgery (eg dorsal slit / circumcision) is indicated.Significant recurrent balanitis may be an indication for circumcision. Also, true phimosis may lead to recurrent balanitis and should be treated (see below).
Zipper Injury
The tip of the foreskin or other skin (eg scrotum) may become entrapped in the teeth of a zipper. This is painful.
Treatment options include:
Prior to these procedures, adequate analgesia +/- sedation should be given. See sedation Guidelines Liberal application of topical anaesthetic cream may work or local infiltration may be necessary (never use local agents with adrenaline on the penis).
If trapped between teeth below the slider (see figure):
Cutting the median bar of the zipper with wire cutters. The median bar is the part at the top of the slider which joins the front and back plates of the slider. Once cut, the slider falls off and the zipper can be separated (see figure).
Cutting through the material either side of the zipper below the entrapped skin and then cutting across the zipper with wire cutters / strong scissors. Then the zipper can then be separated from below (see figure).
If trapped between slider and teeth of zipper:
Liberal application of topical anaesthetic cream, then ease slider down.
Always check for injury to urethral meatus.
Phimosis
Non-retractile foreskin is a normal variation (see above). (Confusingly some refer to this as "physiologic phimosis").
True phimosis is when scar tissue is present in the distal foreskin and this prevents retraction. It may result from attempts to forcibly retract the foreskin before it has become naturally retractile.
Indicators of true phimosis (rather than simple non-retractile foreskin):
Foreskin not retractile by the time of established puberty.
Previously retractile foreskin becomes non-retractile.
Obvious ring of scar tissue visible at foreskin opening
Inability to visualise urethral meatus when foreskin opening is lifted away from glans.
Ballooning of foreskin on micturition, with pinhole foreskin opening, and very narrow urinary stream. (Note: minor ballooning may occur in normal non-retractile foreskin).
Treatment options:
Application of topical steroid creams: 0.05% betamethasone cream should be used twice daily for 2 to 4 weeks.
Gently retract foreskin without causing any discomfort and apply a thick layer of cream to the tightest part of the foreskin.
Steroid creams ofhigher potency may be tried if this fails.
Circumcision (if significant phimosis and steroid creams fail)
Paraphimosis
This occurs when the foreskin is left in the retracted position. The the glans and the foreskin distal to the tight area become oedematous and swollen. Pain and swelling make it difficult to return the foreskin to the non-retracted position.
Paraphimosis can usually be corrected without surgery:
Adequate analgesia +/- sedation should be given. Liberally covering the entire foreskin and glans in topical anaesthetic cream & Gladwrap for 1 hour may be effective. Local infiltration of anaesthetic is best avoided as it increases the swelling.
The swollen area is gently but firmly compressed within one hand, for a few minutes, to squeeze out the oedema fluid. The glans may then be pushed back and the foreskin returned to the normal position.
If manual reduction fails, consult surgical registrar immediately. Surgical options include needle puncture to release oedema fluid or incision of the tight band of the foreskin.Once reduced, a single episode of paraphimosis is not an indication for circumcision. If the child has significant phimosis then it should be treated as above. |
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SuperSneak
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In the land of the one-eyed
Jun 2000
time: 21:26
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And, of course, a recent article espousing circumcision as a way to reduce HIV transmission.
The jury is still OUT folks.
quote:
Circumcision may reduce HIV transmission
United Press International - June 1, 2002
Ed Susman, UPI Science News
--------------------------------------------------------------------------------
New cellular research suggests performing circumcision might help protect men -- and possibly their partners -- from contracting AIDS, researchers told United Press International.
The research examined laboratory specimens of healthy human foreskin -- the covering of the penis often removed in an operation, usually soon after birth -- and specimens of cervical tissue from women undergoing surgery. They searched for CD4 T-cells, macrophages and Langerhan's cells, all of which are targets for the human immunodeficiency virus, or HIV -- the virus that causes AIDS.
"We determined that the target cells that HIV infect are found in far greater numbers in the foreskin than in the cervix," said Dr. Carlos Estrada, a urologist at Rush-Presbyterian-St. Luke's Medical Center in Chicago. Estrada and colleagues presented a paper on their findings at the recent American Urological Association annual meeting in Orlando, Fla.
"Overall, the inner, mucosal surface of the foreskin had a seven-fold greater susceptibility to HIV infection than did cells in cervical tissue infected under the same conditions," Estrada said. The interactions between the cells were studied in culture dishes in the laboratory.
"The issue here is that epidemiologic data strongly suggests that circumcision protects against HIV," said Dr. John Krieger, professor of urology at the University of Washington at Seattle.
"These authors looked at pediatric and adult foreskins (and) ... found ... that foreskins have a lot of HIV target cells. So the increased risk of HIV infection in uncircumcised men is likely caused by large numbers of target cells in the foreskin. (Therefore circumcision) "is biologically plausible as a way to reduce HIV infection risk."
Estrada suggested reduced infection rates in men due to circumcision also should reduce HIV infections in women.
"There has been a lot of controversy over whether circumcision prevents infection with HIV or is simply a marker of more rigorous religious practices," Estrada told UPI.
"We think that our findings may show that the reason populations in Africa where Islam is practiced have lower HIV infections rates than in areas where circumcision is not practiced may be biological rather than faith-based."
Circumcision is routinely performed after birth in the United States and is required for males by Jewish and Muslim religious laws. Several studies have shown in African nations where Islam is predominant, rates of HIV infection can be one-tenth that of nations where circumcision is not practiced or its practice has been abandoned -- as in some of the nations of southern Africa, where AIDS has reached epidemic proportions.
In Nigeria, for example, where circumcision is routinely performed, United Nations AIDS Programme, or UNAIDS, data suggests the HIV infection rate is about 5 percent of adults. In Botswana, however, where circumcision is not widely practiced, the adult HIV infection rate has approached 40 percent.
Researchers and social commenters have been arguing both sides of this issue for some time. For example, at the 2000 World AIDS Conference, held in Durban, South Africa, some speakers argued the difference in rates has nothing to due with circumcision, but everything to do with religious requirements for general cleanliness and monogamy. Other speakers countered that even in heavily Islamic areas, adherence or non-adherence to religious prohibitions against sex outside of marriage parallels behavior in regions dominated by other faiths.
The new cellular research probably will not resolve the question. Dr. Thomas Brady, adjunct professor of urology at the University of Nevada-Reno, and chairman of the media committee of the AUA, said, "I'm not sure that I buy this explanation that more cells in the foreskin increase the risk of transmission of HIV. Just because there are more cells doesn't mean that there is a greater transmission risk."
Brady told UPI, however, he was not discounting the possibility circumcision could inhibit HIV transmission.
"I think it is far more logical to assume that during intercourse the penis suffers microabrasions and microscopic tears," he said.
In uncircumcized men, fluids that come in contact with the penis during intercourse can be trapped under the foreskin, which may make it easier for the virus to infect men through the organ's microscopic openings, Brady suggested.
020601
UP020601
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tandeetaylor
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Las Vegas
Apr 2001
time: 21:26
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To all the people who think that women won't sleep with you if they see your uncircumsized penis: If a woman is looking at your unerect penis, chances are you won't be sleeping with her anyway.
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