Gentle Circumcision
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Benefits Benefits
The most common reason for deciding to circumcise is a desire to improve genital hygiene. Parents relate that inability to retract the foreskin and clean their infants and toddlers is frustrating. Furthermore, they find it difficult to monitor the older child  and his hygiene habits.

Hygiene issues are related to the presence of smegma, a natural lubricant produced by the inner layer of foreskin. It appears as a white to pale yellow material that can be wiped off the surface of the penis. However, when mixed with dirt and bacteria, it often has an offensive odor. Circumcision will eliminate the problem.


Inflammation of the glans (balanitis) or foreskin (posthitis) is a painful condition often seen in uncircumcised males. The moist, humid environment in the diaper area favors the growth of bacteria. Antibiotics given for unrelated conditions such as ear infections upset the balance of microorganisms on the skin surface leading to irritation and inflammation. These conditions are not uncommon in uncircumcised males.

The risk of bladder and kidney infections is 10-15 times greater in uncircumcised males in the first 6 months of life. It has been shown that bacteria normally found in feces can stick to the inner foreskin and eventually move up the urine outlet (urethra) and into the bladder to cause infection. If left untreated, the kidneys can also become infected leading to scarring and, in the worse cases, result in kidney failure. Circumcision significantly reduces the risk of these conditions.

It has been shown that the inner layer of the foreskin is subject to minor trauma during sexual intercourse leading to trapping of HIV under the foreskin and absorption into the skin and the bloodstream.

After reviewing studies of sexually transmitted infection throughout the world, the World Health Organization in 2007 concluded that male circumcision greatly reduces the risk of female to male transmission of the human immunodeficiency virus (HIV). Moreover, they recommended circumcision in infancy because of the ease of the procedure, lower risk and lower cost during this time.


Cancer of the penis is a rare condition where a cancerous growth develops on the glans or shaft of the penis, usually after the 5th decade of life. In the US population, Hispanic males have the highest incidence at 6.6 per million followed by blacks at 4 per million, Caucasian 3.9 per million and Asian males at 2.4 cases per million. This condition almost never occurs in circumcised males.

Phimosis is the inability to retract the foreskin over the glans of the penis. This is considered a normal condition to 3 years of age. In approximately 10% of boys, the foreskin can not be retracted by age 5 and will require evaluation. Since it is difficult to monitor the hygiene habits of young boys, irritation and inflammation is common and the unretractable foreskin often becomes red, swollen and painful. In sexually active adolescents and adults with phimosis, sexual intercourse may become unbearable. Although other treatments such as steroid creams can be used, circumcision is usually recommended.

Numerous studies have shown that women prefer circumcised males as partners. They believe the circumcised penis is cleaner, prefer the look of the circumcised penis and believe the circumcised male is less likely to transmit infection. In one study, only 16% of female respondents preferred uncircumcised male partners. Moreover in some cultures, particularly Afro-American, being uncircumcised can carry a social stigma evidenced by young boys relating being teased in shower rooms or young adult males experiencing uncomfortable feelings during initial sexual encounters.

Bleeding, usually minor and can occur in 1 in 1,000 circumcisions. Compression with gauze is all that is needed. Rarely, sudden bleeding into the surrounding skin (hematoma) may require release of the circumcision device and suturing by hand (stitches). Bleeding due to an unknown bleeding disorder, such as hemophilia may require a blood transfusion.

Local infections involving the surrounding skin can develop in 1 in 1,000 cases, which will be easily treated with antibiotic ointments. More serious infection, which can occur in 1 in 4,000 circumcisions, is treated with oral or injectable antibiotics.

Adhesions can occur between the rim of the glans and the healing area of the inner foreskin. This can be prevented by teaching parent(s) how to retract the skin from the glans daily while the circumcision heals.

Inclusion cysts develop from trapped smegma in the healing foreskin behind the corona (rim) of the glands. This can be avoided by removing all smegma while the area is exposed.

Circumcised penis retreats into a fat pad surrounding the base of the penis. While the surrounding skin continues to heal, the penis could become "trapped" resulting in scarring and the need for intervention and repair. Pushing down (retracting) on the fat pad at the 9 and 3 o'clock position will completely expose the penis and prevent the penis from becoming permanently trapped, As the infant grows, the fat pad will disappear and the penis will remain exposed.



WHAT ARE THE EXPERTS SAYING?

AIDS “…male circumcision – especially in Western Africa already protected more than eight million men from contracting the disease.”
Daniel Halpern, PhD – Assistant Professor of Medical Anthropology, University of California, San Francisco AIDS Research Institute

“The evidence is strong enough… to start trying to use circumcision as an intervention in AIDS.”
Anne Buve, M.D., Institute of Tropical Medicine, Antwerp, Belgium

"Now at least 37 studies show a highly significant effect for circumcision in reducing AIDS incidence. So far the international public health agencies have ignored this. "
Robert C. Bailey, PhD, MPH, professor of epidemiology and anthropology at the School of Public Health at the University of Illinois at Chicago

“The routine circumcision of newborn boys around the world may not only reduce HPV and cervical cancer [in women], but also HIV and other common sexually transmitted diseases.”
Xavier Castellsague, MD, PhD, of the International Agency for Research on Cancer

“Our ultimate goal should be to perform a painless circumcision for infants which will require the evaluation of more effective oral or injectable anesthetics.”
Jerome S. Pittman, M.D., Medical Director, Gentle Circumcision®

 
     
 
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