What to know about paraphimosis

By: Medically reviewed by Alana Biggers, MD on August 8, 2017 — Written by Kanna Ingleson
Source: Medical News Today
Website: https://www.medicalnewstoday.com/articles/318833

Paraphimosis is when the foreskin is pulled back behind the tip of the penis and becomes stuck there. The retracted foreskin and the penis become swollen, fluid can build up, and the foreskin is unable to return to its original position.

Paraphimosis should not be confused with phimosis, which is when the foreskin cannot be pulled back from the tip of the penis. Typically, this occurs in younger children and is not usually a serious condition.

Paraphimosis, on the other hand, is painful and a medical emergency that needs to be treated quickly. If ignored, it can affect blood flow to the tip of the penis. In rare cases, this may cause the penis tip to be damaged, or even lost.
Fast facts on paraphimosis:

Pain, swelling, and an inability to retract the foreskin are the main symptoms.14
Paraphimosis can usually be resolved manually. If not, minor surgical treatment may help.
Personal hygiene can go a long way towards preventing paraphimosis.
If treated quickly, the condition is not serious.

How is paraphimosis caused?
Paraphimosis should be treated quickly to avoid complications.

Paraphimosis can be caused by any of the following conditions or activities:

A foreskin that is left retracted long enough for swelling to occur. This can happen during a medical examination, after cleaning, or after urination.
A tight foreskin that is retracted, causing the penis to swell. This results in the foreskin not being able to move back to its natural position.
Vigorous sexual activity, penile piercing, and use of a constricting penile ring to enhance erection by compression.

Paraphimosis can also result from the following medical conditions or procedures:

Infection, due to various factors, including poor personal hygiene.
Scarring, caused by repeated infection of the foreskin, or by forced retraction of the foreskin in young boys.
A circumcision that has not be done correctly.
Swelling of the penis and foreskin, due to insect or spider bite.

Paraphimosis in older men is often due to one of the following:

Diabetes, causing chronic inflammation of the penis and foreskin. This makes paraphimosis more likely.
Catheterization that is done without the foreskin being returned to its natural position.

In children, the foreskin does not retract at all until about 2 years of age. Most boys will have a retractable foreskin by the age of 10, and forcibly pulling the foreskin back before it is ready to do so can cause scarring that can go on to cause paraphimosis.

 

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Benefits and risks of circumcision

By: Medically reviewed by Alana Biggers, M.D., MPH on April 24, 2020 New — Written by Tim Newman
Source: Medical News Today
Website: https://www.medicalnewstoday.com/articles/302234

Circumcision is an operation to remove a male’s foreskin. It is one of the oldest and most common surgical procedures. A male may undergo this procedure for religious, social, medical, or cultural reasons.

The Centers for Disease Control and Prevention (CDC) encourage male circumcision on the basis that it appears to reduce the risk of HIV infection during vaginal sex. However, not all health authorities agree, and the recommendations remain somewhat controversial.

Circumcision is fairly common in the United States. In fact, according to the CDC, 58.3% of U.S. newborns underwent circumcision in 2010.

It is less common in other Western countries, however. In the United Kingdom, for example, only around 8.5% of males are circumcised.

This article will discuss what to expect during the procedure itself, as well as some possible benefits and risks.

Circumcision involves the removal of the foreskin of the penis. The foreskin is the shroud of skin that, when gently pulled back, uncovers the head of the penis.13

The surgery is relatively simple. A healthcare professional will free the foreskin from the head of the penis and, in newborns, clip it off in a procedure that only takes a few minutes. In adults, they will remove the foreskin with a scalpel, and it takes around 30 minutes.

They will then either cauterize or stitch the wound with dissolvable sutures.
History

The first circumcisions may have taken place around 15,000 years ago. The procedure then slowly spread across a variety of cultures, especially in the Middle East.

It may have become popular in the ancient world as a public health measure and a way of preventing balanitis. Balanitis leads to swelling and pain in the head of the penis.

This condition might have been more common in ancient societies due to sand building up under the foreskin.

 

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Circumcised vs. uncircumcised: What's the difference?

By: Medically reviewed by Karen Richardson Gill, MD, FAAP, specialty in pediatrics, on July 10, 2019 — Written by Beth Sissons
Source: Medical News Today
Website: https://www.medicalnewstoday.com/articles/325713

Circumcision is a surgical procedure that removes the foreskin of the penis. In an uncircumcised penis, the foreskin remains. The main differences include appearance and hygiene practices.

People may have a circumcision for many different reasons, including:

religious reasons, such as if a person follows the Jewish or Muslim faith
cultural reasons
a family history of circumcision, so a person may decide to continue the tradition
personal preference
for health reasons, such as if a person is prone to frequent foreskin infections
Statistics
One 2016 study estimated that 37–39% of males across the world have a circumcision. The researchers estimated that 71.2% of males in the United States have a circumcision.

According to the American Urological Association, the areas of the world with the highest rates of circumcision are:

the Middle East
South Korea
the U.S.
The lowest rates of circumcision are in Europe, Latin America, and most of Asia.

According to the Centers for Disease Control and Prevention (CDC), in the U.S., rates of circumcision among newborn males decreased by around 10% between 1979 and 2010.6

Appearance
An uncircumcised penis retains the foreskin, which covers the head of a nonerect penis. When the penis is erect, the foreskin pulls back to reveal the glans.

A circumcised penis has no foreskin, which exposes the glans when the penis is both erect and nonerect.

Effects on sex
Studies have been inconclusive regarding penile sensitivity in uncircumcised and circumcised males.
Scientific studies have produced conflicting reports on the effect of circumcision on sex.

For example, one 2013 study looked at the sexual sensations of 1,059 uncircumcised males and 310 circumcised males. The group of circumcised males reported lower rates of sensitivity in the glans than the uncircumcised males.

A 2013 review looked at studies into the effect of male circumcision on sexual function and enjoyment. The review found that in the most accurate studies, circumcision had no negative effects on sexual function, sensitivity, pain, or pleasure during sexual intercourse.

However, one 2012 study found that there was not enough scientific evidence in some previous research to suggest that circumcision affects sexual function. The study concluded that circumcision has no negative long-term impact on sexual function.

A 2016 study compared the penis sensitivity of 30 circumcised males with that of 32 uncircumcised males ages 18–37. The study found that there was minimal difference between penile sensitivity in the uncircumcised and circumcised males

Techniques of Male Circumcision

By: Abdullahi Abdulwahab-Ahmed and Ismaila A. Mungadi
Source: PMC
Website: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888996/

Abstract

Male circumcision is a controversial subject in surgical practice. There are, however, clear surgical indications of this procedure. The American Academy of Pediatrics (AAP) recommends newborn male circumcision for its preventive and public health benefits that has been shown to outweigh the risks of newborn male circumcision. Many surgical techniques have been reported. The present review discusses some of these techniques with their merits and drawbacks. This is an attempt to inform the reader on surgical aspects of male circumcision aiding in making appropriate choice of a technique to offer patients. Pubmed search was done with the keywords: Circumcision, technique, complications, and history. Relevant articles on techniques of circumcision were selected for the review. Various methods of circumcision including several devices are in use for male circumcision. These methods can be grouped into three: Shield and clamp, dorsal slit, and excision. The device methods appear favored in the pediatric circumcision while the risk of complications increases with increasing age of the patient at surgery.
Keywords: Complication, dorsal slit, device, excision, male circumcision, public health benefit, technique
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INTRODUCTION

Circumcision is the surgical removal of the prepuce (foreskin) either in whole or in part. Religion, cultural, medical, and recently public health reasons[1,2] are known to be the major indications of the procedure. Usually, it is done in neonatal period but can be performed at any age. To maximize its health benefits,[1,2] to reduce procedural risks and cost,[2,3,4,5,6] however, it is advocated to be offered in neonatal period. Surgical approaches to circumcision are extremely varied.[7]

About 25-33% of the total world male population is circumcised.[8,9,10,11] In the US, an average of a million newborn males are circumcised yearly.[12] Circumcision rate in US is as high as 70%, while in Britain it is 6%.[12] In Nigeria, circumcision rate is estimated to be 87%.[8]

Circumcision is arguably the oldest surgical procedure in history.[13] Religious circumcision is practiced by the Jews; religious and cultural circumcision is also practiced by Muslims, Black Africans, Australian aborigines, and other ethnic groups in different parts of the world.[12] In Western societies, circumcision is mostly performed for medical reasons, the most common of which is phimosis.[7,12,13] Other medical indications are paraphimosis, balanitis (inflammation of the prepuce), posthitis (inflammation of the glans), localized condylomata acuminata, and localized carcinoma.[13,14,15]

Currently, the public health benefits of male circumcision are topic of interest particularly as regards human immunodeficiency virus (HIV) prevention.[1,2] It is shown to reduce the risk of transmission of HIV infection in heterosexuals.[16,17] Its benefits in reducing the risk of urinary tract infections in boys and reduction in transmission of other sexually transmitted infections are well documented.adult male circumcision[1,2,3,4,5,6]

Contraindications of this procedure include congenital abnormalities of the phallus such as hypospadias, epispadias, megalourethra, webbed penis, and any other condition in which prior circumcision renders treatment more difficult. Others are prematurity, bleeding problems, myelomeningocele, and anorectal anomaly.[12,14]
Embryology

Developmentally, during the third month of intrauterine life (65 mm fetus), a fold of skin develops at the base of the glans penis. This fold of skin grows distally from the glans penis and eventually becomes the prepuce. The dorsal aspect of the fold grows more rapidly than the ventral aspect, initially only the dorsum of the glans penis is covered by this fold.[18] As the glanular urethra fuses in the midline, it carries the ventral prepuce along with it. This ventral fusion of the prepuce is marked by the frenulum. Preputial formation is usually complete by the fifth month of intrauterine life (100 mm fetus). The inner surface of the prepuce and epithelium of the glans, are both stratified squamous epithelium in type, and both fuses together. Later, presumably under the influence of androgens, the squamous cells begin to keratinize and arrange themselves in whorls. The whorled cells then disintegrate so that clefts appear between the prepuce and the glans. These clefts eventually propagate and separate the inner preputial epithelium and the epithelium of the glans from each other. This process of separation is usually incomplete at birth and continues through childhood and sometimes to adult life.[14,18]
Techniques

The principles of circumcision are asepsis, adequate excision of outer and inner preputial skin layers, hemostasis, protection of the glans and urethra, and cosmesis. The goal of the procedure is to expose the glans sufficient to prevent phimosis or paraphimosis. Circumcision methods can be classified into one of three types or combinations thereof: dorsal slit, shield and clamp, and excision.[12,14] Many of the methods in use today fall in to one of these major classes. Shield and clamp adopts the use of device to effect circumcision obviating the use of knife in majority of cases. The device method is the commonly used method of circumcision in recent practice.
Anesthesia

The procedure is done under local anesthesia. There are many ways of achieving this: penile ring block, penile dorsal nerve block, and local anesthetic spray jet injector have all been described.[19,20,21] While the spray injector procedure requires an appliance that is uncommon and expensive (e.g., No-Needle MadaJet®),[20] penile dorsal nerve block and the ring penile block can be easily learned and carried out by all.[19,20]

Penile dorsal nerve block is a safe and appropriate anesthesia technique for circumcision procedure. The aim of the block is to deliver adequate local anesthetic agent at a dose of 1 ml + 0.1 ml/kg body weight around the main trunk of the dorsal nerve of the penis and its ventral branch.[19] This is easily accessible just below the symphysis pubis deep to the fascia and on either side of the penile suspensory ligament. Care is taken to avoid the midline where dorsal vessels that may be cause of hematoma and poor nerve block passes.

 

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What problems can being uncircumcised cause?

By: Medically reviewed by Cameron White, MD, MPH on February 10, 2020 — Written by Aaron Kandola
Source: Medical News Today
Website: https://www.medicalnewstoday.com/articles/uncircumcised-problems

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

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

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

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

The condition usually affects children and will improve as the foreskin loosens with age. In adults, it may result from a sexually transmitted infection (STI). It does not usually cause any symptoms or require medical attention.12

However, in some cases, it might cause:

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

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

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

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

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

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

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

 

3. Bacterial or fungal infection

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

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

The symptoms of balanitis can include:

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

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

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

Read more about some possible infections of the penis here.

 

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