Circular excision of the foreskin. Excision of the foreskin Uncircumcised foreskin
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phimosis- a condition characterized by the narrowness of the foreskin, which leads to a limitation of its mobility. Thus, the first, and often the only, sign of phimosis is the inability to expose the glans penis at rest and / or during an erection.
The foreskin or prepuce in men is called the skin fold covering the glans penis. The preputium is a specialized tissue, the structure of which in many ways resembles the structure of the eyelids of the eyes and labia in women. The foreskin consists of two sheets that are attached at coronal sulcus located at the base of the glans penis. The outer leaf is lined with a thin skin epithelium, and the surface of the inner leaf is a mucous membrane.
Additional fixation of the prepuce provides bridle, located on the underside of the head and limiting the shift of the foreskin towards the base of the penis. The structure of the frenulum of the foreskin is in many ways similar to the structure of the frenulum of the tongue.
As a rule, during an erection, the foreskin moves towards the base of the penis and exposes the glans penis. In the normal state, the prepuce completely covers the head, so that the inner surface of the foreskin forms a preputial cavity (preputial sac) - a narrow gap between the head and the foreskin.
Thus, the foreskin performs a protective function, protecting the mucous membrane of the glans penis from drying out and adverse external influences. It is for this reason that in the treatment of phimosis, doctors try to preserve this anatomical formation and resort to circumcision (removal of the foreskin) only in extreme cases.
How common is phimosis?
It should be noted right away that phimosis is a very common phenomenon and in many cases does not cause much concern to patients.
This is due to the fact that the head and foreskin during fetal development are formed from the same tissue. The development of the external genital organs continues until the end of puberty, so congenital physiological phimosis is observed in more than 95% of newborn male infants.
By the beginning of the second year of life, the glans penis opens only in 20% of babies, and by the beginning of the third - in 50%. As a rule, spontaneous elimination of physiological phimosis occurs at preschool age (3-6 years).
However, cases are far from unique when the glans penis opens for the first time during puberty, due to an increase in the level of sex hormones that help soften and stretch the skin of the foreskin.
In many peoples of the world, a gene of predisposition to the preservation of physiological childhood phimosis in adulthood is common. So, for example, in some countries of Southeast Asia, phimosis in adult men is considered the norm, except in cases where the narrowing of the foreskin leads to painful symptoms.
And in the culture of Ancient Greece, the long and narrow foreskin was not only not considered a pathology, but was also perceived as a sign of beauty and masculinity. The naked head of the penis was considered obscene because it reminded of circumcision. Ancient frescoes depict the custom of artificially gradually lengthening the foreskin.
For this, the ancient Greek youths used a special leather ribbon - kinodesma, one end of which was attached to the foreskin, and the other was tied around the waist. Wearing kinodesma was seen as a manifestation of special modesty and decency.
phimosis classification
Phimosis can be divided into two main classes:- associated with developmental features of the glans penis and foreskin physiological phimosis in children;
- pathological phimosis.
According to the mechanism of development, hypertrophic and atrophic phimosis are distinguished.
Hypertrophic phimosis characterized by a significant elongation of the foreskin (due to its very characteristic appearance, it is also called proboscis phimosis).
Statistically, hypertrophic phimosis is more common in obese boys, which is associated with both metabolic disorders and the accumulation of fatty tissue in the pubic area.
About atrophic form of phimosis they say in cases where the foreskin, on the contrary, is reduced in volume and tightly fits the head of the penis. At the same time, the preputial opening is narrowed and does not pass the head.
Causes of phimosis
Most common congenital phimosis, when physiological phimosis does not eliminate itself and the opening of the glans penis does not occur - neither in childhood, nor during puberty.The reasons for this anomaly have not yet been studied. The fact that phimosis is more common in some peoples than in others speaks in favor of the existence of a genetic predisposition to congenital phimosis.
Clinical studies have shown that congenital phimosis is often combined with other anomalies in the structure of the connective tissue and the musculoskeletal system, such as flat feet, scoliosis, and heart defects.
In children, a common cause of the development of pathological phimosis are injuries, including those received during gross violent attempts by parents to “fix” physiological phimosis in young boys.
In such cases, adhesions are formed between the mucous membranes of the glans penis and the foreskin, leading to a narrowing of the preputial cavity and the development of secondary pathological phimosis.
And finally, a fairly common cause of phimosis in children and adults is infectious and inflammatory processes in the preputial sac, leading to the formation of a characteristic cicatricial phimosis.
Degrees of pathological phimosis
Anatomically, there are four degrees of narrowing of the preputial ring.With phimosis first degree possible free removal of the glans penis in a calm state, during an erection, the exposure of the glans is difficult or painful.
ABOUT second degree phimosis is said when difficulties with exposing the head occur even at rest. During an erection, the head is either completely hidden under the foreskin, or only a small part of it is exposed, often swelling in the form of a ball.
At third degree phimosis, it is no longer possible to bring the glans penis beyond the preputial ring.
fourth degree phimosis is characterized by such a sharp narrowing of the foreskin, which causes difficulty in urination.
It should be noted that it is customary to talk about the first or third degrees of pathological phimosis when the patients are adults or adolescents. As for the fourth degree, normally in children's physiological phimosis, the preputial cavity has an opening sufficient for the free discharge of urine.
Therefore, such signs as the filling of the preputial sac during urination and / or narrowing of the urine stream, even if they occur in early infancy, clearly indicate a pathology and require emergency medical intervention.
Symptoms of pathological phimosis in adults
In cases where phimosis does not yet cause problems with urination, the most common complaints of patients are expressed to a greater or lesser extent inconvenience during sexual relations, such as:- soreness during intercourse (with phimosis of the first or second degree);
- premature ejaculation;
- decrease in the intensity of sexual sensations during intercourse;
- decrease in potency.
At the same time, it is not uncommon for men with severe phimosis to experience absolutely no problems sexually.
What is the danger of asymptomatic phimosis in adults
Today, one can meet opposing points of view regarding medical tactics in those cases of phimosis that are not accompanied by the appearance of any unpleasant symptoms. Indeed, is it worth correcting the "defect", which among many peoples was considered a sign of beauty?Unfortunately, phimosis poses a significant threat to the health of an adult male. The fact is that the cells of the mucous membrane of the inner leaf of the prepuce secrete a special secret that has a rather complex composition (fats, bactericidal substances, pheromones (exciting substances), etc.). This secret is the main part of smegma (translated from Greek as “sebum”), which also includes dead epithelial cells and microorganisms.
The activity of cells of the glandular epithelium of the foreskin increases by the period of puberty (the maximum smeg formation occurs at the age of 17-25 years) and progressively decreases in older men.
Normally, smegma protects the mucous membranes of the glans penis and the inner surface of the foreskin from drying out, and also acts as a natural lubricant during intercourse.
However, the secret of the glands of the mucous membrane of the inner leaf of the foreskin is an excellent living environment for many pathogens. Therefore, smegma stagnation in the preputial sac can cause the development of infectious and inflammatory diseases, such as balanitis (inflammation of the mucous membrane of the glans penis) and balanoposthitis (combined inflammation of the mucous membranes of the glans penis and the inner layer of the foreskin).
In addition, according to many studies, with prolonged stagnation of smegma, carcinogenic substances form and accumulate in it, which contributes to the development of oncological diseases in men (papillomas of the glans penis, penile cancer) and their sexual partners (cervical cancer).
In childhood, the cleansing of the preputial sac occurs independently, since the amount of smegma secreted is small. Adult men, in order to prevent the development of complications, must follow the rules of hygiene, that is, make a toilet every day, which consists in washing the foreskin and glans penis with warm water and soap.
With phimosis, this procedure is usually difficult. Thus, the narrowing of the foreskin in adults contributes to the accumulation of smegma in the preputial sac.
Even in cases where phimosis is not manifested by any unpleasant symptoms, doctors advise taking care of eliminating the pathology, since, in addition to the risk of developing infectious, inflammatory and oncological diseases, one should also take into account the possibility of developing such a serious complication as paraphimosis.
Paraphimosis as a severe complication of phimosis in adults
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Caught in a tight ring of the narrowed foreskin, the head swells, while the pressure of the ring increases. Thus, a vicious circle is created: the violation of blood circulation caused by strong compression increases the swelling of the head, and the swelling increases the pressure on the head of the foreskin ring.
In adult men and adolescents, paraphimosis most often occurs during intercourse or masturbation. It should be noted that such a complication is typical only for phimosis of the first or second degree, since more severe forms of phimosis simply do not allow the possibility of exposing the glans penis.
Clinically, paraphimosis is manifested by acute pain, the head of the penis swells and acquires a bluish tint. Over time, the intensity of the pain syndrome decreases due to severe circulatory disorders. In advanced cases, the strangulated head becomes purple or black.
Severe and prolonged circulatory disorders can lead to deep necrosis (necrosis) of the tissues of the foreskin and the glans penis. Therefore, paraphimosis is an extremely dangerous complication that requires immediate help.
First aid for paraphimosis in men is to immediately seek specialized medical care. In the early stages of the development of paraphimosis, doctors can manually reduce the glans penis (this manipulation is very painful, therefore, it is performed after the administration of narcotic analgesics). In more severe cases, they resort to dissection of the ring of the foreskin.
Physiological phimosis in children
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At such a tender age, in most boys, the inner layer of the foreskin is soldered to the glans penis. It is for this reason that in no case should one try to forcefully expose the head - this will lead to erosion of the inner surface of the preputial cavity, the development of an inflammatory process and the occurrence of secondary pathological phimosis.
The well-known pediatrician Komarovsky rightly claims that in 99 cases out of 100, the complications of physiological phimosis in babies are associated with rude and illiterate intervention carried out by the parents themselves on the advice of relatives, neighbors and even, sadly, doctors.
If the boy is not bothered by anything (no problems with urination, pain, itching, etc.), no additional measures to correct phimosis should be taken. It is only necessary to make a regular toilet every day, washing the perineum and genitals with water. Soap is best used no more than once every three to four days, avoiding getting into the preputial sac.
Separation of the mucous membranes of the glans penis and the inner layer of the foreskin occurs due to the gradual desquamation of epithelial cells. This is a rather slow process that should not be artificially stimulated.
Desquamated epithelial cells form the basis of the so-called children's smegma, which, accumulating, slowly moves towards the exit and is excreted in the form of grains along with urine. Unlike adult smegma, children's smegma does not pose a danger in terms of developing infections and oncological diseases.
Physiological phimosis in itself performs an important protective function, it protects the delicate yet unformed epithelium of the glans penis and the inner layer of the foreskin from external aggressive agents.
Until what age can phimosis in a boy be considered a physiological phenomenon
To date, doctors have not agreed on the age at which phimosis in a boy should be considered a pathology, and when it is necessary to take special measures to eliminate it. Therefore, in the articles of specialists, you can see various figures - 2-3 years, 5-7 years, 7-10 years and even 14-17 years.If we focus on clinical data, then the probability of self-elimination of physiological phimosis in a five-year-old boy is 90%, at the age of 10 years - 83%, and by the age of thirteen it decreases to 33%.
Many pediatricians advise parents to take a wait-and-see approach until puberty: if there are no alarming symptoms, it is best to wait, since phimosis can be treated at an older age.
It should be noted that the persistence of phimosis by the age of 11-13 may be associated with a low blood level of male sex hormones, which have a beneficial effect on the process of softening and stretching the foreskin.
In addition, it is necessary to distinguish congenital physiological phimosis from secondary phimosis resulting from any infectious and inflammatory diseases.
Of course, only a specialist can make such a diagnosis. But in cases where the child has already observed the opening of the glans penis, and then there was a narrowing of the foreskin, we are most likely talking about pathological phimosis.
Can physiological phimosis cause problems in boys and what to do in such cases
Physiological phimosis in children rarely causes complications. Problems most often arise when basic hygiene rules are violated, as well as overheating and an increased tendency to allergic reactions.In cases where the severity of unpleasant symptoms is insignificant (itching, slight redness, anxiety of the child), you can try to fix the problem yourself. Many pediatricians recommend washing the preputial cavity with a warm solution of furacilin using a conventional ten-millimeter syringe.
The procedure is as follows:
- Draw a warm solution of furacilin or an ectericide into the syringe;
- Pull the skin up without exposing the head;
- Insert a syringe without a needle into the resulting gap (it is more convenient to carry out this manipulation together, so that one person pulls the foreskin, and the other performs actions with the syringe);
- Release the solution from the syringe under pressure, washing out the accumulated secretions.
With an increased tendency of the child to allergic reactions (exudative diathesis, atopic dermatitis, etc.), unpleasant symptoms may be associated with exposure to allergen substances excreted in the urine or with their contact effect on the skin.
- if possible, eliminate the alleged agent (revise the menu, medications taken, antibiotics, vitamins, used diapers, household chemicals, etc.);
- avoid exposure to chemicals on the skin;
- increase the amount of fluid you drink to speed up the “washing out” of allergens from the body.
Even in cases where the boy's phimosis was unconditionally recognized as physiological, you should immediately consult a doctor if the following alarming symptoms appear:
- there are problems with urination (difficulty urinating, soreness, etc.);
- there are pronounced signs of inflammation (swelling and redness in the foreskin area, pain syndrome).
Complications of phimosis in children requiring specialized medical care
Complications of phimosis in children requiring specialized medical care include the following pathological conditions:- balanoposthitis;
- paraphimosis;
- urinary retention.
Balanitis, fasting and balanoposthitis in children
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Balanoposthitis- combined infectious and inflammatory lesions of the glans penis and foreskin.
These diseases in boys are several times more common than in adult men. The latter circumstance is connected precisely with the physiological features of the structure of the children's male genital organ.
In addition to physiological phimosis, important predisposing factors for the development of inflammatory processes in the glans penis in children are:
- diabetes mellitus (high sugar in the urine contributes to the development of infection in the preputial cavity);
- obesity (violation of metabolic processes, deterioration of conditions for personal hygiene measures);
- avitaminosis (decrease in the overall resistance of the body).
- trauma resulting from a rough attempt to expose the head of the penis;
- acute allergic reaction (excretion of food or drug allergens in the urine or direct contact with the allergen (diapers, cosmetics, soap, washing powder, etc.));
- overheating;
- severe hypothermia, which can cause a sharp decrease in immunity;
- external injury, including uncomfortable clothing (too tight panties with a seam in the middle, snake injury, etc.).
Symptoms of the disease are quite typical:
- redness and swelling in the foreskin (fasting);
- through the hole you can see the hyperemic area of the head (balanitis);
- pain aggravated by urination (irritating effect of urine on the inflamed tissue of the head and foreskin);
- itching and discomfort;
- serous or serous-purulent discharge.
If you suspect an infectious inflammation of the glans penis and / or foreskin, you should immediately consult a doctor who will prescribe the necessary treatment.
In case of recurrence of the disease, as well as in the case of the formation of secondary phimosis, the question of surgical treatment may arise.
Paraphimosis in children
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The clinic and complications of phimosis in boys are the same as in adult men. A very strong pain syndrome, redness and rapidly progressive swelling of the glans penis is characteristic. Untimely or inadequate medical care can lead to irreparable consequences in the form of necrosis of the foreskin and penis.
First aid for paraphimosis in children. There are a lot of tips on the net for resetting the head on your own (applying cold to reduce swelling, using oil, etc.). Of course, much depends on the severity of paraphimosis (the severity of edema and pain) and the state of the child's mentality.
But it is wiser not to follow such advice. The reduction of the glans penis with paraphimosis is a very painful procedure that is performed under anesthesia in medical institutions (in pediatric practice, intravenous anesthesia is used, which implies a short-term, but complete loss of consciousness).
So it is best not to waste precious time and not to mock the child, but to seek medical help as soon as possible. Transportation of patients in such cases is carried out in the supine position with legs apart.
Difficulty urinating
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In addition, in such cases, children often complain of pain and discomfort during urination. They begin to avoid going to the toilet, which leads to the development of secondary enuresis (day and night).
Difficulties urinating in infants are manifested by restlessness, crying and severe straining when urinating.
This pathology leads to increased pressure in the urinary tract, which is fraught with serious complications. Therefore, difficulty in urination is an indication for emergency elimination of phimosis.
Medical tactics in the treatment of pathological phimosis
Today, along with surgical methods for the treatment of pathological phimosis, conservative methods are widely used, such as:- gradual daily manual stretching of the foreskin;
- the use of special devices that stretch the foreskin;
- drug treatment of phimosis (the use of steroid ointments that help soften and stretch the tissue of the foreskin).
Such a dismissive attitude was greatly facilitated by the fact that many patients self-medicate without consulting with professionals and often make gross mistakes that lead to serious complications (paraphimosis, infectious and inflammatory diseases of the foreskin).
In addition, it is often not taken into account that cicatricial forms of phimosis are an absolute contraindication to the use of conservative methods. The fact is that scar tissue does not stretch, so all attempts to eliminate phimosis are doomed to failure in advance.
Meanwhile, there is evidence of the effectiveness of conservative methods in many patients, even with the second or third degree of congenital phimosis.
An important positive aspect of all non-surgical treatments for phimosis is the “naturalness” of their impact, since they actually repeat the mechanism of physiological self-elimination of age-related phimosis.
In addition, conservative treatments for phimosis allow you to fully preserve the unconditionally important functions of the foreskin and avoid unpleasant side effects and complications.
Thus, in the absence of contraindications, conservative methods may well be used as a useful alternative. Of course, treatment should be carried out after consultation with a specialist and under the supervision of a physician.
However, in cases where it is necessary to achieve a quick and radical elimination of phimosis for medical reasons (for example, with phimosis of the fourth degree) or for personal reasons, it is better to give preference to surgical intervention.
Non-drug conservative treatment of phimosis. Tension methods.
Stretching methods came into use in the last years of the last century, when original statistical studies were carried out, showing that the risk of developing congenital phimosis depends on the method of masturbation.As a result, a hypothesis was put forward about the possibility of eliminating congenital phimosis by the method of gradual stretching of the foreskin and special methods for the conservative elimination of pathology were developed.
The general rules for these methods are:
- mandatory preliminary consultation with a professional and subsequent medical supervision;
- gradual stretching (in no case should pain be allowed);
- manipulation regularity.
There is evidence that it is possible to achieve elimination of phimosis of the first or second degree with the help of exercises to expose the head in three to four weeks.
Method stretching of the foreskin consists in the daily tension of the foreskin on the head of the penis during the morning shower, as well as after urination until pain occurs.
This method is often used to delay the self-elimination of phimosis in childhood. In such cases, it is quite effective, but the duration of the course of treatment largely depends on the type of phimosis and can reach 3-4 months with hypertrophic (proboscis) phimosis.
Method digital stretching consists in the careful introduction of the fingers into the preputial cavity and their gradual dilution.
According to some reports, the effectiveness of the methods described above in congenital phimosis reaches 75%.
Treatment of phimosis with ointments (drug treatment of phimosis)
Drug treatment of phimosis is a combination of the above methods of tension with the use of ointments containing corticosteroid drugs.- softening and increasing the elasticity of the foreskin;
- a decrease in the severity of inflammatory reactions (drugs in this group are called steroidal anti-inflammatory drugs).
Drug therapy is especially indicated for children and adolescents (recommended by the American Association of Pediatricians), since it is at this age that the most likely to achieve the elimination of congenital phimosis by conservative methods.
However, it should be borne in mind that such ointments are far from being shown to everyone. So, for example, a contraindication to the local use of corticosteroid drugs is the presence of a bacterial, viral or fungal infection - both acute and chronic.
Long-term use of drugs can cause unpleasant side effects (thinning of the skin, hyperpigmentation, disruption of the structure of superficial vessels), and with uncontrolled use, systemic effects of corticosteroids may occur, which is fraught with dangerous complications.
Therefore, ointments with corticosteroids can be used only after a thorough examination and consultation with a specialist who has sufficient experience in the treatment of congenital phimosis by this method.
Of course, an individual selection of the drug and the dose of the medicinal substance is necessary, as well as constant medical monitoring of the results of therapy.
Alternative methods of treating phimosis
It should be noted right away that traditional medicine, like homeopathy, is absolutely powerless in the fight against the narrowing of the foreskin.However, some of the favorite means of traditional healers are widely used as an aid. We are talking about decoctions of herbs that have anti-inflammatory, bactericidal and softening effects, such as:
- chamomile;
- calendula;
- succession.
Steaming the skin of the foreskin in a bath with a decoction of herbs for 15-20 minutes promotes effective, painless and safe stretching.
This kind of preliminary procedures is especially recommended for children and adolescents.
During the treatment of phimosis, you can alternate the decoctions of various medicinal herbs or use a collection of medicinal plants for the decoction.
The only contraindication to the use of traditional medicine as an adjuvant in the treatment of phimosis may be individual intolerance or allergies (very rare).
Surgical treatment of phimosis
Elimination of phimosis by a bloodless method
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First, a special probe is inserted into the preputial cavity, which separates the synechia (adhesions) formed between the glans penis and the inner leaf of the foreskin. To do this, the probe is carefully advanced inward to the coronary sulcus and slow movements are made in a clockwise direction.
Then the opening of the foreskin is expanded with the help of a Pean clamp: the ends of the clamp are inserted into the hole and the branches are parted.
Often two or three such manipulations are enough to completely eliminate phimosis. In cases where positive dynamics is not observed, more invasive surgical intervention is indicated.
After sessions of bloodless elimination of phimosis, it is necessary to follow all the recommendations of the surgeon in order to prevent the fusion of the mucous membranes of the foreskin and the glans penis.
Within a month, anti-relapse measures are shown: daily manual opening of the foreskin and washing the preputial cavity with a weak solution of potassium permanganate. If this manipulation is too painful or unpleasant for the child, it can be performed once every two to three days, but not less often.
Surgical interventions for phimosis
To date, a sufficiently large number of methods for the surgical correction of pathological phimosis have been developed. The choice of the method of the operation depends on the age of the patient, the type of phimosis (atrophic or hypertrophic, congenital or cicatricial), the severity of the pathology, as well as the qualifications of the operating surgeon and the capabilities of the clinic where they applied for help.Surgical interventions for phimosis are most often performed under local anesthesia, an indication for the use of general anesthesia may be:
- too young age of the patient;
- increased emotional lability;
- individual intolerance to drugs used for local anesthesia;
- patient's personal preference.
After the operation, discomfort in the area of the surgical wound is possible for several days, however, as a rule, it is possible to do without additional pain medication.
In cases where there is a need to remove sutures, this manipulation is performed 7-10 days after surgery. Before removing the stitches, it is necessary to make dressings every other day and make sure that urine does not get on the postoperative wound.
As a rule, within two weeks after the operation, the patient can have sex. Until this time, it is advisable to wear tight underwear that provides additional support for the penis.
Circular excision of the foreskin
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Circular excision of the foreskin, which in medicine is often called circumcision, and "in the world" - circumcision, is the most common operation to eliminate pathological phimosis.
Important positive aspects of this surgical intervention are the rapid elimination of all unpleasant symptoms and the absence of relapses (this is the only surgical intervention for phimosis that provides 100% efficiency).
The only but significant drawback of the method is the complete elimination of the foreskin, and, consequently, the irretrievable loss of all its functions. However, it should be taken into account that millions of men in the world annually circumcise for religious reasons and do not suffer at all.
Circumcision is a non-alternative method for cicatricial phimosis, as well as for the fourth degree of phimosis, paraphimosis and recurrent balanoposthitis (the operation is performed after the elimination of the acute process).
Operations for plastic surgery of the foreskin in pathological phimosis
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So with preputioplasty, in contrast to the circular excision of the foreskin, the foreskin is not completely removed, since a much smaller incision is made.
Another common method of foreskin plasty is called the Schloffer method. During the operation, the surgeon does not make a straight, but a zigzag incision, and then stitches the edges in such a way as to significantly expand the opening, while preserving the foreskin. In addition, Roser's methods of foreskin plasty, spiral foreskin plasty, etc. are widely used.
The general disadvantages of such operations include a longer recovery period, the possibility of relapses and a relatively short list of indications. So, for example, operations with partial preservation of the foreskin cannot be performed in patients with severe cicatricial forms of phimosis.
phimosis laser treatment
Treatment of phimosis with a laser is such an operative intervention, when instead of a surgeon's scalpel, the energy of a laser beam is used.With the help of a laser, it is possible to perform both circular excision of the foreskin (laser circumcision) and plastic surgery that preserves the foreskin.
Laser surgery is characterized by highly precise incisions, so that damage to surrounding tissues is minimal.
In addition, laser beams cut the tissue, simultaneously cauterizing the vessels, and have a bactericidal effect.
Thus, laser surgery has the following advantages:
- safety (there is no risk of bleeding and infection of the surgical wound);
- less pronounced pain syndrome;
- short recovery period.
Compared to conventional surgery, the postoperative period with laser correction of phimosis is more comfortable (there is practically no tissue swelling, there is no need for dressings, removal of sutures, etc.) and lasts only three to four days. However, doctors do not advise starting sexual activity earlier than two weeks after the operation.
Circumcision of the foreskin (circumcision) is a surgical operation to partially or completely excise the foreskin of the penis. About half of the male population of the world is circumcised.
There are a number of diseases that require excision of the foreskin in men:
- Complete lesion of the genital organ with genital warts in men.
- Phimosis.
- Fusion of the foreskin with the head of the penis.
- Cancer of the foreskin.
- Hypertrophy of the foreskin.
- Chronic balanitis or balanoposthitis.
- Candidiasis of the glans penis (according to indications).
- premature ejaculation.
- Inflammation of the urinary tract in men.
- Prevention of sexually transmitted diseases, cancer and AIDS.
The indications for the operation are determined by the doctor, analyzing the anamnesis, laboratory data. Surgery in men during an exacerbation of the disease is not recommended.
Positive and negative points
Advantages of the circumcision procedure:
- easier to maintain hygiene;
- prevention of accumulation of smegma;
- prevention of inflammatory diseases;
- indications for the prevention of the development of cancer of the genital organ in men;
- prevention of venereal diseases and AIDS;
- an increase in the duration of sexual intercourse.
Examining the effects of circumcision calls into question some of the "pluses" listed above.
In countries where the risk of contracting AIDS is very high, WHO recommends circumcision to prevent the disease in men. Studies have shown that the roughened skin on the head of the penis after circumcision becomes less permeable to the penetration of the virus.
The physiological feature of development - phimosis in children under 3 years old then disappears. But there is a possibility (20%) that an operation will be required to prevent irritation of the head of the penis by the secret (smegma) accumulating under the foreskin and the occurrence of inflammation.
Conducted clinical studies have not confirmed a significant difference in the risk of penile cancer in circumcised and uncircumcised men. The opinion that smegma is carcinogenic has not been confirmed. Therefore, these "pluses" also raise reasonable doubts.
The current belief that the wives of circumcised men have a reduced risk of cervical cancer has not been confirmed.
The advantages of the operation, often cited in the argument, are the ease of maintaining hygiene. This argument is justified, especially in hot countries where water is scarce and the risk of infection due to poor hygiene is high.
There are such disadvantages:
- surgical intervention;
- violation of the natural physiological integrity;
- the risk of mechanical damage to the head and infection;
- formation of scars and scars;
- penis deformity;
- difficulty achieving orgasm;
- risk of bleeding and pain shock;
- frictional discomfort.
The foreskin and head of the penis is very sensitive due to the large number of nerve endings. Circumcision in babies often takes place without anesthesia, which can lead to pain shock.
Another disadvantage is that after the operation, the glans penis loses its natural lubrication. As a result, the epidermis dries out, threatening the formation of cracks, a decrease in sensitivity, and edema may develop.
The cons and risks of any surgical operation are clear, these are the risk of unskilled circumcision, postoperative complications, scarring. Deformation of the penis in men is a very rare pathology resulting from the formation of coarse connective tissue, retraction of the penis, or excessive removal of the foreskin. There is often tissue swelling after surgery. The bandage not only absorbs blood and secretions from the urethra, which can contribute to infection, it can be too tight, causing necrosis of the glans.
The risk of wound suppuration due to the proximity of the anal area and infection is complemented by the listed disadvantages of circumcision.
The foreskin is a natural defense and thanks to it the self-cleaning of the head is carried out. Some Muslims do circumcision at home, which threatens with infection of the wound, pain shock and large blood loss, the risk of severe swelling.
Another argument for performing the operation at home and without anesthesia for some devout Muslims and Jews is a test of fortitude and adherence to tradition.
There are statistics of deaths when using anesthesia in children, as well as how many children died after massive blood loss and shock.
It is not excluded the possibility of an additional complication - thrombosis of varying severity. Weighing the pros and cons of the operation, at a conscious age, every man must decide for himself whether he should do such a procedure if it is not due to medical indications.
Types of surgery
Complete or incomplete removal of the folds of the foreskin is carried out:
- Partial removal is indicated to facilitate exposure of the glans, which in the free state is completely covered by the foreskin, except for a small opening opposite the urethra.
- Minimal removal involves excision of a small part. The operation is performed if there is a circular scar or the foreskin is hypertrophied. After healing in a non-erect state, the genital organ does not outwardly differ from an uncircumcised one.
- Tight excision - the head is completely open due to the removal of all the foreskin.
- High removal - when part of the foreskin remains and its edge is located at a different distance from the base of the penis.
- Low excision - the postoperative suture passes along the coronal sulcus.
At the consultation, the doctor decides which method is preferable - complete or partial removal, if this is not dictated by the need for a medical technique, how much foreskin needs to be cut.
Partial removal is carried out with difficulty urinating, when the opening of the urethra is blocked by the foreskin.
Partial excision is most often used for phimosis when complete excision is not necessary. Partial and minimal circumcision is the most gentle, since most of the glans penis remains covered, which eliminates some of the disadvantages of a full circumcision - drying and coarsening of the epidermis of the glans.
The medical problem is solved, and visually the genitals look familiar. Types of surgery are due to both medical indications and cosmetic consequences. In some cases, it is worth going through a preliminary interview with a psychologist, especially if there is a medical reason, but circumcision may be contrary to some principles. In many clinics, the price of the operation does not depend on the type of excision of the foreskin in men.
Methods
The procedure is carried out both in a medical institution and at home.
One of the classic techniques is circumcision with a clamp or medical tweezers. The doctor injects an anesthetic into the coronary sulcus. The foreskin is then grasped with anatomical forceps, pulled back and excised over the forceps. After the operation, circular sutures are not applied, which prevents the development of postoperative phimosis, the formation of a rough scar, swelling and deformation of the organ.
The next technique is circular excision of the foreskin. After the operation, a circular scar is formed, there is a threat of partial or complete amputation of the head, uneven excision of the sheets of the foreskin. The modern modernization of the method consists in pulling the foreskin away from the head, the doctor performs a circular excision without cutting the frenulum.
The vessels are tied up with catgut, after which a bandage is applied. In adults, the operation is performed under local or general anesthesia. One of the disadvantages of the operation is the need for general anesthesia in children.
The operation is also carried out using a device similar to a guillotine. The doctor pulls the foreskin as far as possible, fixes it in the guillotine and lowers the knife. In babies in the first months of life, the operation is performed without anesthesia, in older children - under general anesthesia, in men, a local anesthetic injection is used. Complications after this operation are due to the imperfection of the method, the impossibility of making an accurate incision.
As a result of any of these methods, complications can arise not only due to trauma, but also due to individual anatomical differences.
Currently, advanced techniques are operations performed with a radiosurgical knife or laser.
laser method
Laser surgery is mostly indicated in the treatment of children, as the method is non-traumatic, with a short rehabilitation period. Laser exposure allows you to make an accurate incision, which reduces the risk of cosmetic defects and amputation. There is no swelling after the operation, because the operation is completely sterile, it does not involve the application of tourniquets and pressure bandages. Coagulation of tissues in the place where the laser incision was made prevents the risk of bleeding. The operation is performed in a short time and under local anesthesia - both in babies and in adult men.
Before circumcision, the doctor must prescribe studies, including laboratory tests, examination, and a cardiogram is taken. If all tests are normal, then the operation can be performed on the day of treatment. After the operation, the patient may stay in the hospital for some time, where he will undergo therapeutic treatment for the fastest tissue regeneration and prevention of postoperative complications, if necessary according to indications.
In children, laser surgery causes less psychological stress than classical techniques.
In modern clinics, laser circumcision is performed not only for medical reasons, but also for religious reasons, for aesthetic purposes. The cost of the operation includes examination, consultation with a specialist, the operation itself. For men with urological or gynecological problems, treatment is additionally included in the price.
In some cases, after circumcision, plastic surgery of the foreskin is performed. All these individual characteristics and indications determine the prices of laser cutting operations. The price of the operation carried out by high-level specialists will be higher. If the procedure is not performed according to the indicated indications, then the patient has the right to decide for himself whether he should do laser or classical circumcision.
There is a wide range of costs. For example, in Kyiv, the average price starts from 3000 UAH. Maximum - reaches 13,000 UAH. How much does such an operation cost in Russia? In Moscow, the cost is about 50,000 rubles, and in the regions circumcision is done within 10,000 rubles.
Circumcision (circumcision) is a surgical intervention in which the skin covering the glans penis, the foreskin (prepuce) is excised.
It is assumed that the origins of this operation go back thousands of years. The operation to remove the skin of the foreskin began to be performed in Egypt, about fifteen thousand years ago.
Subsequently, in connection with the migration of the population, this operation spread throughout the world. According to rock paintings, Egyptian mummies, discovered in the 19th century, scientists judge the execution of circumcisions more than six thousand years ago.
Some scientists believe that circumcision of the foreskin began to be performed in different parts of the world without connection with the migration of the population.
Some peoples performed circumcision for hygienic reasons, while others used circumcision as a ritual of becoming a man, as a sign of cultural, ethnicity, sometimes as a sacrifice to the gods.
The circumcision ritual developed into a routine medical intervention in the late 19th century. It was assumed that performing circumcision could be associated with miraculous healing from many serious ailments. This is how cases of “cure” from hernias, paralysis, epilepsy, headaches, insanity, strabismus, asthma after circumcision were described.
In the United States, in the past two decades, the question of the advisability of performing routine circumcision in newborns has been raised.
Despite the large number of positive effects of surgery, there are always risks of postoperative complications. This operation requires the provision of full information to the parents of the child and the subsequent receipt of their informed consent.
Currently, scientists believe that in order to prove the feasibility of routine circumcision, it is necessary to conduct a full-fledged study of the effect of surgery on sexual function, penis sensitivity, the effect of surgery on the sexual partner, determining the exact indications for surgery, and establishing the effect of the age at which the operation is performed on the result.
Approximately 25-30% of the male population of the world underwent circumcision. In the US, circumcision among boys reaches 70%, while in the UK it is only 6%, and in Nigeria it is 87%.
In the countries of the post-Soviet space, where Christianity prevails, the frequency of male circumcision is low, and the operation is more often performed for medical reasons.
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1. What is the foreskin and why is it needed?
The foreskin (preputium) is a fold of skin covering the head of the penis, covered on the outside with keratinized epithelium, and on the inside with a mucous membrane.
A pocket is formed between the head of the penis and the foreskin, in which the desquamated epithelium can collect. In children, with a large accumulation of dead cells in this pocket, their aggregation, keratin "pearls" can form.
These "pearls" do not owe their formation to the inflammatory process. In a teenager, the desquamated epithelium mixes with the secretion of the glands, forming smegma. If the hygiene of the area of the skin pocket is violated, a large amount of smegma may accumulate and become infected.
The skin over the head of the penis protects it from drying out and keratinization. The foreskin has a complex system of innervation that affects the sexual function of an adult male.
2. Positive effects of circumcision
The advantages of circumcision of the foreskin include:
3. Is routine circumcision necessary in newborns?
Currently, the opinions of experts on the need to perform routine circumcision in newborns are divided.
A group of scientists, which denies the need to perform routine circumcision, justifies the refusal of the operation by a decrease in sensitivity during intercourse, as well as a violation of the natural functions of the foreskin for immunological and physical protection of the penis head.
After removal of the skin above the head, its keratinization (keratinization of the surface epithelium) occurs as a result of a long stay in the open state. As a result of keratinization, the nerve endings are closed and the sensitivity of the head is reduced.
4. Indications for circumcision
Indications for circumcision are divided into medical and non-medical.
- 1 Non-medical indications include cultural characteristics, attitudes towards a particular ethnic group, religion.
- 2 Often, parents decide to perform circumcision on a child for hygienic reasons, which is not an absolute indication for surgery.
- 3 Circumcision men have been found to have a lower risk of transmitting and contracting HIV and other STIs. Therefore, in regions with an increased incidence of HIV infection, circumcision surgery can be performed routinely for newborn boys.
Medical indications for circumcision:
- Phimosis. Phimosis is a condition in which, due to congenital / acquired pathological changes, the exposure of the head of the penis is impaired. - Absolute indication for surgery. In adults, the presence of phimosis can lead to severe violations during sex, infertility, recurrence of infections of the head of the penis and foreskin, and therefore may serve as a basis for performing an operation.
- Paraphimosis. Paraphimosis - infringement of the head at the base by a narrow ring of the foreskin, requiring emergency surgical intervention.
This condition develops as a result of the inability to return the foreskin to its original place after its removal. Infringement of the head is accompanied by its edema, swelling of the compressing skin ring and can turn into necrosis of the head of the penis.
Emergency circumcision in the case of paraphimosis is the last resort that a urologist can resort to. Initially, the doctor may try to eliminate paraphimosis in the least invasive way (manual reduction of the head, needle puncture of the head and removal of a small amount of blood from it in order to reduce swelling).
With the ineffectiveness of minimally invasive techniques, the urologist may resort to dissection of the skin stranglehold or to perform circumcision. If the head has been successfully reduced by conservative methods, then the circumcision operation can be performed as planned after some time.
- Balanitis and fasting. Balanitis - inflammation of the head of the penis, fasting - inflammation of the foreskin. Postitis is accompanied by swelling, redness of the skin above the head. With balanitis, the head of the penis swells, turns red, serous-purulent exudate may separate. Both conditions are most often the result of poor hygiene and respond well to topical and systemic antibiotic therapy. Recurrent postitis, balanitis is an indication for circumcision. The operation eliminates the skin pocket in which the infection most often originates.
- Recurrent infectious lesions of the organs of the urinary excretion system.
- The need for long-term continuous catheterization in newborns and adolescents.
5. Contraindications for surgery
Contraindications to performing circumcision are:
- 1 Anomalies in the development of the penis.
- 2 Hypospadias, epispadias.
- 3 Hidden penis.
- 4 Micropenis.
- 5 Pseudo-hermaphroditism.
- 6 Prematurity.
- 7 Relative contraindications to circumcision are disorders of hemostasis (congenital coagulopathy, such as hemophilia).
6. Principles of surgical treatment
The main goal of surgery for circumcision is to remove the skin covering the head and thereby prevent the development of phimosis and paraphimosis, reduce the likelihood of an inflammatory process.
Principles for performing circumcision:
- 1 Aseptic conditions.
- 2 Adequate excision of the outer and inner layers of the foreskin.
- 3 Reliable hemostasis.
- 4 Prevention of damage during the operation of the glans penis and urethra.
The operation can be performed under local or general anesthesia (in children, as a rule, mask anesthesia). During the operation, the patient lies on his back. After the onset of anesthesia, the foreskin can be excised using clamps, or using special plastic rings.
When using clamps, excess skin is pulled back and excised, followed by suturing the outer and inner leaves of the remnants of the foreskin.
To perform the operation of circumcision of the foreskin, many different techniques have been invented and implemented. Often in each clinic preference is given to any one of the generally accepted methods.
The choice of the method of operation depends on the age of the patient. In adult patients, preference is given to removing the prepuce with clamps, since most of the invented devices are adapted for pediatric circumcision.
7. Surgical options
7.1. Using a safety clamp (Morgan clamp)
During this operation, the skin of the foreskin is retracted distal to the head of the penis, a metal protection is installed on the retracted skin immediately after the end of the head. A scalpel is used to remove excess skin.
Thanks to the metal flap during the operation, the head and frenulum of the penis are protected from accidental damage by the scalpel. The inner leaflet of the prepuce can be retracted behind the head and excised.
With this intervention, the wound suture is not used; at the end of the operation, the penis is bandaged for the purpose of hemostasis. When using the Morgan method, the most common complication is bleeding in the early postoperative period.
Rice. 1 - Morgan clamp
7.2. plastic ring method
Plastibell is a plastic ring with a groove on the outer surface. The essence of the operation is the use of a plastic ring, which is inserted through the hole in the foreskin and retracts the head of the penis proximally (see Figure 2 below).
The ring, along with the remnants of the foreskin, falls off after a few days (usually after 7 to 10 days). The use of a ligature stops blood flow in the distal foreskin.
The most common complications are necrosis of the head of the penis and a delay in the falling off of the ring. Usually, these complications are caused by an incorrectly selected size of the injected plastic ring and a ligature that is not stretched over the skin. The advantage of this operation is the low risk of postoperative bleeding.
Rice. 2 - Plastibell circumcision. (Source - http://gethashtags.com/)
7.3. Gomco Method
A metal retractor ring is placed on the top of the penis head, the foreskin is brought over the head and covers the handle of the metal retractor.
For a better introduction of the foreskin on the retractor, a skin incision is made along the back surface. A metal plate is placed over the ring.
A tension bar is placed on the plate, which leads to sufficient retraction of the skin and retraction of the head. The foreskin is cut off along the metal ring, the entire structure is removed.
Of the possible complications, postoperative bleeding is more common, so the operation is often completed by applying hemostatic sutures to the wound.
Rice. 3 - Circumcision of the foreskin with the Gomco method (Source - http://www.circlist.com/)
7.4. Shang ring
Consists of three components: inner, outer rings and silicone gasket. A special ruler is provided with the ring to determine the required ring size.
The tape ruler is installed along the circumference of the penis shaft, just behind the head, the circumference of the penis shaft is measured. Further, on top of the skin, immediately under the base of the head, an inner ring is installed.
The skin of the prepuce is retracted from the head and everted over the already installed inner ring. In the presence of phimosis, before removing the skin from the head, a vertical incision is made in the preputium along the posterior surface.
On the wound skin, opposite the inner ring, the outer ring is placed and locked with the inner ring. The skin of the prepuce distal to the rings is excised with a scalpel.
After 7-10 days, the patient returns to have the ring removed. To do this, the lock fastening the two rings is opened and the outer ring is first removed, and then the inner ring is removed with a special clamp. The procedure does not require special skills and is easily performed by beginners. Due to the lack of protection of the head, there is a risk of amputation of the head of the penis.
Rice. 4 - Shang ring used for circumcision. (Source - https://german.alibaba.com)
7.5. Circumcision using clamps
The preputium is released from adhesion with the head and is pulled behind the head of the penis. The preputium is clamped with two clamps immediately after the end of the head.
The foreskin is cut off with a scalpel between the clamps. The proximal clamp serves to protect the head from damage during surgery. The leaves of the prepuce are sutured with separate interrupted sutures.
7.6. Dorsal Slit (section along the back surface of the prepuce)
Dorsal Slit (incision along the posterior surface of the prepuce) is a commonly used technique for excising the skin of the foreskin, it is preferable to use this technique in the presence of inflammation of the skin sheet.
The operation of circumcision by this method leads to the resolution of phimosis, paraphimosis. The course of the operation: the foreskin is freed from adhesions with the surface of the head, then the skin of the foreskin is captured by two clamps at 11 and 1 o'clock, a vertical skin incision is made at the middle of the distance between the clamps (at 12 o'clock) and stops a couple of millimeters from the base of the head.
The foreskin is excised circularly at the level of the end of the incision. After removal, careful hemostasis is performed (bleeding stops). The operation ends with the suturing of the remnants of the outer and inner layers of the foreskin with separate sutures.
Rice. 5 - Dorsal slit resection (Source - http://www.suggest-keywords.com)
7.7. Drain resection
The foreskin is retracted behind the base of the head, at the base of the head a circular incision is made in its inner leaf. Further, the foreskin returns to its original place, covers the head of the penis, and a circular incision is made in the same place on the outer skin sheet.
Two circular incisions are connected by a longitudinal incision. The selected area of the foreskin is removed. The inner and outer sheets are sutured with separate interrupted sutures. This method has a large number of modifications.
Rice. 6 - Drain resection (Source - http://kaitlinlindsay.pairserver.com)
8. Postoperative complications
The complication rate may be lower when the operation is performed by an experienced surgeon.
- The most common complication of circumcision surgery is postoperative bleeding. The frequency of bleeding after circumcision varies from 0.1 to 35% and depends on the method of surgical intervention, the thoroughness of hemostasis during surgery. Bleeding occurs in the early postoperative period and can often be stopped by simply applying pressure to the bleeding wound. If conservative measures are ineffective, it may be necessary to transport the patient to the operating room with subsequent hemostasis on the operating table.
- Infectious complications are the second most common in circumcised patients. Most often, infectious and inflammatory processes in the wound area respond well to systemic antibiotic therapy. The frequency of infectious complications ranges from 0.4% to 10% of cases.
- The most common long-term complication of circumcision is urethral stricture.
- Reducing the length of the penis due to its immersion in the suprapubic fatty tissue with the removal of only the outer sheet of the prepuce and insufficient excision of the inner sheet. In this case, the inner ring of the preputium leads to a mixture of the penis shaft into fatty tissue above the pubis.
- Formation of a skin bridge. This complication is characterized by the formation of a skin bridge between the head and the shaft of the penis. Under the skin, smegma can accumulate in excess. During an erection, the skin bridge can lead to pain, discomfort, and curvature of the penis. The excision of the bridge leads to the elimination of the described symptoms.
- Urinary retention in the early postoperative period develops as a result of excessive tight bandaging of the wound.
- Urethral fistulas. Communication of the skin with the urethral canal is created with intraoperative damage to the urethra (injury with a clamp, stitching when restoring the frenulum, suturing the sheets of the prepuce).
- Partial/complete necrosis of the head and shaft of the penis. This type of complication is extremely rare and is the result of impaired blood supply against the background of infectious complications, excessive pressure of the dressing on the wound, the use of local anesthesia in combination with an adrenaline solution.
9. How long do I need to stay in the hospital after surgery?
In the absence of complications, the patient can be discharged for outpatient treatment the next day. On an outpatient basis, it is possible to perform dressings, remove sutures, rings.
- 1 Wound healing time after surgery 7-10 days.
- 2 Often in the postoperative period, pain may persist. For its relief, it is possible to take non-steroidal anti-inflammatory drugs for 3-5 days.
- 3 If there are sutures, they may need to be removed on the 9-10th day from the day of the operation.
- 4 If the operation was performed using a ring (Plastibell), and it has not fallen off after 7-10 days, then you need to contact a urologist for advice.
10. In what cases may an urgent medical examination be required after discharge?
- 1 Violation of urination within 12 hours after surgery.
- 2 Discharge from the wound with an unpleasant odor.
- 3 Bleeding from the wound.
- 4 The plastic ring does not fall off after 2 weeks from the operation.
Key points Key points Indications for circumcision can be medical and non-medical. Non-medical indications include the patient's religious, cultural, ethnic background. Newborns are more likely to undergo circumcision for non-medical reasons. Circumcision for medical reasons is intended to prevent possible complications of an existing pathology. Opinions of experts on the need to perform routine circumcision diverged. There are a large number of options for circumcision of the foreskin. Despite the relative ease of implementation, circumcision surgery can lead to severe and sometimes irreparable complications. Before the operation, the parents of the child/adult patients should be informed by the doctor about possible complications and give their informed consent to the operation.
Male circumcision, or circumcision, is a surgical procedure that involves removing all or part of the skin fold that covers and protects the glans penis. The procedure is performed by surgeons and urologists, they also advise the man before the intervention.
Collapse
The reason for such a procedure may be religious traditions, medical indications, or a desire to improve the appearance of the penis. According to various statistical sources, from 15% to 25% of men of different ages and nationalities underwent surgery to remove the foreskin. Some are still convinced that cutting off is the prerogative of Jews and Muslims, but in fact it is not. Nowadays, the procedure is widespread among the European population.
Circumcision may be performed for religious or medical purposes.
The first circumcision was performed in Egypt over 2000 BC. With the advent and spread of maternity hospitals, which only upper-class women had access to, the circumcised penis became an indicator of a man's status. Circumcision was performed on all newborn boys who were born in the hospital. For this reason, many husbands tried to find a place for their wife in the maternity hospital, so that the future heir would immediately receive a marker of belonging to a wealthy family.
Removal of the foreskin of the penis is done for various reasons. The procedure is traditional in the Muslim and Jewish religions. Catholics and Orthodox celebrate the day of the Circumcision of the Lord, which is traditionally celebrated on January 14th. Among the reasons not related to religious rites, the following can be distinguished:
- doctor's recommendation;
- reducing the likelihood of contracting a sexual infection;
- preventive measure.
According to their national tradition, the Jews perform circumcision of the foreskin of week-old babies. Muslims perform the procedure in age intervals from birth to 3 years and from 8 to 14 years. Among the adherents of this operation, there is an opinion that the intervention makes sense only if it is carried out before the age of 12: supposedly only before this age the operation can bring a positive result.
To understand why penis circumcision is part of the Jewish tradition, one has to look at the history and culture of the Jews. The procedure can be performed at any age, but most often it is performed on the eighth day of a boy's life. The ritual carries both physiological and social meaning at the same time: after the removal of the leathery fold, the baby is considered a full-fledged member of the Jewish community.
The tradition of circumcision arose among Muslims due to the fact that they were forced to live in sweltering heat.
For Muslims, the need for the operation arose at a time when they were forced to live in the sweltering heat of the desert. These conditions increase the risk of inflammation and infection of the genital organs. Circumcision of the penis as a preventive measure greatly simplified the intimate hygiene of Muslims.
The procedure can be carried out as prescribed by the doctor in those infant boys who suffer from voiceless phimosis. The space under the fold of skin around the head of the penis is an ideal place for the reproduction of pathogenic bacteria, and advanced phimosis can even lead to urinary incontinence, urethritis and other unpleasant consequences.
Removal of the foreskin significantly reduces the risk of contracting sexually transmitted diseases, and also reduces the secretion of smegma.
After circumcision, it is much easier to maintain hygiene of the genital organs.
After removing the skin, the head of the penis opens, and sex begins to bring new pleasant sensations. This is another reason why grown men get circumcised. The main thing is to choose an experienced competent surgeon and fully follow all his recommendations after the operation. In no case should you try to circumcise the foreskin yourself at home.
Benefits of circumcision
Circumcision has long been a popular intervention among men of all ages and nationalities. Like any procedure, it has advantages and disadvantages. The benefits of circumcision include the following:
- Although circumcision leaves a thin brown scar, the appearance of the penis becomes much better.
- An increase in the duration of sexual contact (the sensitivity of the head decreases slightly, so ejaculation does not occur longer).
- Intimate hygiene after skin removal becomes much easier.
- Reducing the likelihood of contracting AIDS. It is the mucous membrane of the foreskin that is most often injured, which facilitates the penetration of the virus into the body. The thing is that the mucous membrane, which is located on the inside of the foreskin, contains special cells called "Langerhans cells." This is the type of cell that is highly susceptible to infection by HIV infection.
- Reducing the likelihood of your partner contracting HPV (human papillomavirus) and sexually transmitted diseases. By the way, HPV can provoke the development of cancer.
- A preventive measure to prevent inflammation and diseases of the genitourinary system - the place under the foreskin is an excellent breeding ground for pathogenic microbes that penetrate the urethra into the prostate gland and provoke many diseases.
Some experts believe that circumcision is the prevention of cancer of the penis. However, this theory has no scientific confirmation.
In the 19th century, doctors believed that circumcision could cure anything from fever to paralysis. Of course, this method of healing has no scientific basis.
In addition to the advantages, the operation has a number of disadvantages:
- The need for a more careful approach to penis hygiene - the foreskin no longer protects the head.
- After the procedure, profuse bleeding may open. External infection of the wound surface and the occurrence of inflammation are possible.
- Some argue that circumcision is unnatural and contrary to human nature.
Many people think that the procedure is a bit unnatural.
Men often experience many fears before surgery. But if the surgeon has enough experience in such interventions, there is nothing to fear - the removal of the foreskin in men is absolutely safe.
The operation consists in excision of the foreskin along a circular contour. Before the procedure, it is necessary to pass general and biochemical blood tests, urinalysis, a test for hepatitis, HIV, syphilis and a coagulogram. The patient will also have an electrocardiogram.
The intervention is performed in the supine position and takes approximately one hour.
Both general and local anesthesia is used. With local anesthesia, the anesthesiologist will make injections at the site of the operation. This anesthesia is called "circular infiltration anesthesia".
The operation is performed in the supine position with general or local anesthesia.
The surgeon makes a circular skin incision at the level of the lower contour of the penis head. Clips are applied to the edge of the cut off flesh, which pull the skin to the periphery. After that, at the level of the edge of the head, the flesh is again excised in a circle, but already from the inside. The surgeon removes the severed skin.
Bleeding is stopped and sutures are placed to connect the outer and inner sheets of the foreskin. There is no need to remove sutures, as absorbable sutures are most often used. The doctor applies a sterile bandage to the penis. Full recovery occurs within a couple of weeks.
The duration of healing and recovery after surgery may vary. As a rule, doctors recommend abstaining from intimacy for one to two months to eliminate the risk of infection and injury to the penis.
But to be afraid that the seams can disperse is not at all worth it. The level of modern medicine practically excludes such a possibility. If the healing of the wound surface is normal, then the bandage is removed after 10-14 days. In the event of edema, you will have to make special baths, which are prepared from a glass of oxen and a teaspoon of salt. At the time of healing, the doctor will prescribe the use of special drugs that are designed to speed up the process of healing the wound.
The doctor will prescribe the necessary drugs that promote speedy healing
If an ichor appears, the penis is washed with a weak solution of potassium permanganate and a special ointment is applied. In such a situation, it is necessary to bandage several times a day until the symptoms of inflammation pass. After the healing goes at a normal pace, the dressing is done once a day.
Before removing the bandage, the bandage must be thoroughly soaked in warm water. Dried bandages, when removed, can damage the healing suture and cause pain.
After a successful surgical intervention, it is necessary to carefully follow all the recommendations of the doctor. Following these rules will help to significantly speed up the wound healing process:
- bed rest for 7 days;
- meticulous hygiene of the penis;
- exclusion of sports training for 2-5 months;
- wearing special underwear made of natural cotton fabric that does not constrain the genitals.
Sexual intercourse is prohibited for two months. After healing, it is recommended to use a condom for a couple more months until the penis is completely healed.
If any alarming symptoms appear, you should immediately consult a specialist in order to exclude the development of complications.
The medical term "circumcision" is probably not familiar to most of our men. It is much clearer when they talk about circumcision, excision of the foreskin. This small operation is an essential ritual in many cultures and religions, it has long become the norm for the stronger sex in the US and Europe.
You can literally write volumes about the history of circumcision, because this type of surgical intervention has been known since the time of Ancient Egypt (for example, a statue of a pharaoh is exhibited in the Cairo Museum, which is distinguished by this feature). In many African tribes, circumcision was one of the elements of initiation - the initiation of a boy into a "husband". Probably, there is a practical explanation for this - in hot countries it was easier to maintain intimate hygiene.
As for statistics, there are a wide variety of figures. For example, data on what percentage of gentlemen who have undergone removal of the foreskin worldwide is rather vague - a value from 17 to 40% is given. The procedure was most widely used in the Middle East, Central Asia, and North Africa. And Americans and Europeans in the recent period have begun to resort to intervention not so much for reasons of hygiene, but for aesthetic ones, believing that this way the penis looks much more attractive.
It is noteworthy that the validity of this intervention in the intimate "sphere" for medical reasons has long been proven. But the benefits of the procedure for prevention are still controversial.
There are indications
The list of medical indications for the procedure is small, but the reasons for deciding to excise the foreskin are quite serious. For an adult male, this is:
Anatomy of the male genital organ
- Pointed warts. The appearance of these genital warts is provoked by the human papillomavirus (HPV), and in the representatives of the stronger sex - only some of its strains. The disease in the vast majority of cases is transmitted through sexual contact, extremely rarely through household contact. In fact, condyloma is a skin outgrowth, “planted” on a thin leg. The color of the neoplasms varies, they can be either barely pink or purple. Condylomatosis is usually referred to as precancerous conditions. With extensive lesions of the foreskin with warts, circumcision is considered the most effective method.
- Phimosis. This term is understood as a pathology of the foreskin, in which it is impossible to completely expose the head of the penis. In addition to difficulties with maintaining hygiene, the disease also leads to discomfort in the intimate area (painful sensations during sexual intercourse). There are four degrees of illness. If on the first one it is problematic to expose the head of the penis only in an erect state, then on the fourth one it is basically unrealistic, which leads to impaired urination. Surgery is considered the most effective treatment. Circumcision of the foreskin in men relieves the patient of phimosis at any stage.
- premature ejaculation. This state of affairs is caused by both psychological factors and physiological characteristics. The most accessible, simple way to solve the problem is circumcision. After the operation, the head of the penis is constantly in contact with the underwear, its sensitivity is reduced.
- Contusion, injury to the foreskin.
In order to prevent
As for circumcision for preventive purposes, there are a number of pros. So, after cutting:
- Facilitates the care of the head of the penis, carrying out hygiene procedures;
- The risk of infections of the genitourinary system is reduced tenfold;
- Significantly drop the chances of contracting STIs - syphilis, herpes, trichomoniasis, chlamydia, HIV. Based on the results of various studies, scientists suggest that the skin on the glans penis becomes rougher after circumcision, microcracks appear much less often, which are the "gateway" for viruses, infections;
- Reduces the chance of getting prostate cancer in the future.
Preparation stage
Before the operation, the patient will have to undergo an examination and consultation with the surgeon. This will help determine whether there are contraindications to the intervention, which technique will be used. The doctor should talk about the principles of the procedure, its cost, at this stage the type of anesthesia is also discussed.
Before the operation, you should undergo all the necessary examinations
You will also need to undergo a preliminary examination. It includes, in particular,
- Blood tests (general, biochemistry, coagulogram), urinalysis,
- Tests for hepatitis, HIV, Wasserman reaction,
- Electrocardiogram
Additional research may be needed. So, if during examination on the glans penis, foreskin, signs of inflammation (redness, purulent discharge) are found, and during the interview it turns out that the patient is worried about itching, pain, the man will have to take a smear from the urethra for pathogenic microorganisms (Trichomonas, gonococcus, i. P). You will also need to sow secretions, urine for microflora, its sensitivity to antibacterial drugs. Depending on the results, it will be necessary to drink antibiotics, anti-inflammatory, antifungal drugs before the operation.
If, with phimosis, a seal on the head is felt during palpation under the foreskin, cytology, ultrasound diagnostics or MRI of the organ are necessary
Simple operation
Technically, circumcision is considered a fairly simple operation. Its duration is usually fifteen to forty minutes. The procedure is performed under local anesthesia. They do anesthesia like this - they inject an anesthetic with a thin needle on both sides of the penis at the level of the pubic symphysis (this term means the area in front of the bladder, above the ligament holding the penis). So they block the nerves going to the organ. Often they make a circular chipping so that the effect is stronger. Sometimes intravenous administration of sedatives is additionally practiced. General anesthesia is used at the request of the man himself, or when the patient is in a strong emotional arousal, and there is no certainty that he will remain motionless.
Having achieved the effect of "freezing", the doctor, using two clamps, pulls back the sheets of the foreskin. If they are significantly fused with the head, they are separated using a probe or scissors. After the foreskin is stretched, excised in a circle.
The operation may cause bleeding. The fact is that there are many blood vessels in the penis area. For a while, it is stopped by applying clamps, and then the vessels are tied up with catgut (or other self-absorbable suture material). Finally, a sterile bandage is applied to the intervention area.
Circumcision happens:
- complete. In this case, the head of the penis is “exposed” completely.
- partial. The surgeon will leave a portion of the foreskin that may half cover the glans penis. Usually such an operation is done for medical necessity.
Recovery period
After the procedure, the penis will be bandaged for some time. The bandage is usually removed in the hospital after two to three days. Then it will be possible to wash the penis (very carefully, with warm water and soap). The doctor may also recommend the use of antibacterial ointments, warm baths with various solutions (usually potassium permanganate).
The stitches will either dissolve on their own (in about a month), or they will be removed in a medical facility (in ten days). Patients return to sexual activity in 2-3 weeks.
Possible Complications
Most often, after the operation, complications such as:
2
Book a doctor now and do not postpone the problem for later.