Harold:
Many thanks for forwarding this very compete article to the group. I really
appreciate having it.

Sincerely,

John Murray
--- In PROCIRCORG@yahoogroups.com, "Harold" <infos@...> wrote:
>
> Phimosis, Adult Circumcision, and Buried Penis
> Author: Richard A Santucci, MD, FACS, Chief of Urology, Detroit
> Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical
> Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital;
> Director, The Center for Urologic Reconstruction; Clinical Professor of
> Urology, Michigan State College of Medicine
> Coauthor(s): Ryan P Terlecki, MD, Clinical Instructor in Reconstructive
> Urology, Department of Urology, Division of Surgery, University of
> Colorado
> Contributor Information and Disclosures
>
> Updated: Apr 15, 2009
>
>     *  [Print This]  <http://emedicine.medscape.com/article/442617-print>
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>     * Overview     * Treatment
> <http://emedicine.medscape.com/article/442617-treatment>      *
> Follow-up <http://emedicine.medscape.com/article/442617-followup>      *
> Multimedia <http://emedicine.medscape.com/article/442617-media>
>
>     * References     * Keywords
>   Introduction
> Phimosis
> Phimosis is defined as the inability of the prepuce (foreskin) to be
> retracted behind the glans penis in uncircumcised males.
>
> Nearly all males are born with congenital phimosis, a benign condition
> that resolves in the overwhelming majority of infants as they transition
> into childhood. In 1949, Douglas Gairdner showed that only 4% of infants
> had a fully retractable foreskin at birth but that 90% did by age 3
> years. Contemporary work demonstrates that only 1% of males aged 17
> years still have an unretractable foreskin. Adult phimosis (ie,
> pathologic or true phimosis) may be caused by poor hygiene or an
> underlying medical condition (eg, diabetes mellitus).
>
> Uncomplicated pathologic phimosis is usually amenable to conservative
> medical treatment. Failure of medical treatment warrants surgical
> intervention, usually in the traditional form of a circumcision or
> preputioplasty.
>
> Although phimosis is the most common indication for adult circumcision,
> other reported indications include paraphimosis
> <http://emedicine.medscape.com/article/442883-overview> , balanitis
> without phimosis, condyloma, redundant foreskin, Bowen disease
> <http://emedicine.medscape.com/article/1100113-overview> , carcinoma
> <http://emedicine.medscape.com/article/446554-overview> , trauma
> <http://emedicine.medscape.com/article/456305-overview> , disease
> prophylaxis (eg, HIV infection), and patient choice.
>
> Buried penis
>
> Buried penis was described in the early 20th century as a penis of
> normal size that lacks an appropriate sheath of skin and is located
> beneath the integument of the abdomen, thigh, or scrotum. This condition
> is more common in children, usually presenting in neonates or obese
> prepubertal boys; however, it can also be seen in adults and has been
> observed in both circumcised and uncircumcised individuals. Marginal
> cases may not be diagnosed until adulthood, when increased fat
> deposition accentuates the problem.
>
> Several classification systems of buried penis have been proposed,
> although none has been universally adopted in the literature. Maizels et
> al (1986) differentiated among the terms concealed (before
> circumcision), trapped (cicatricial [scarred] after circumcision), and
> buried (associated with adolescence and obesity).1
>
> In most congenital pediatric cases, the buried penis is self-limited. In
> untreated adults, however, the condition tends to worsen as the
> abdominal pannus continues to grow.
>
>
>   History of the Procedure
> Circumcision <http://emedicine.medscape.com/article/1015820-overview>
> and adult circumcision
> Circumcision is one of the earliest elective operations known to man.
> Historically, this procedure has been performed for various religious
> reasons, social reasons, or both. The practice is considered a
> commandment in Jewish law and a rule of cleanliness in Islam, although
> it is not mentioned in the Quran. In biblical times, mothers were
> responsible for circumcising their newborn sons, with mohels gradually
> taking over. Priests in ancient Egypt would perform the procedure with
> their gold-impregnated thumbnail. Female circumcision, which is likely
> better termed "genital mutilation," has been practiced for centuries by
> some cultures but is an unacceptable practice and without medical
> benefit.
>
> Adult circumcision for phimosis is described in textbooks dating from
> the early 19th century. Alternative procedures for adult phimosis were
> described as early as 1900 by Cloquet. Surgical attempts to restore the
> prepuce are also well documented, going as far back as the Old
> Testament. However, potential psychological and surgical complications
> have led to closer scrutiny of routine neonatal circumcision. Currently,
> the American Academy of Pediatrics (AAP) neither recommends nor condemns
> routine neonatal circumcision.
>
> Studies suggest that circumcised boys are at a lower risk of urinary
> tract infections <http://emedicine.medscape.com/article/969643-overview>
> (UTIs). To put this in perspective, the approximate likelihood of a UTI
> occurring in the first year of life is 1 in 100 in uncircumcised boys
> and 1 in 1000 in circumcised boys. A lower risk of malignancy is also
> reported in studies of circumcised men, although the incidence is also
> rare in uncircumcised men. Of note, this decreased risk seems to be
> associated only with infant circumcision and not with adult procedures.
>
> The theory that circumcision contributes to prevention of sexually
> transmitted diseases (STDs) was encouraged by a 19th-century report of
> lower rates of syphilis
> <http://emedicine.medscape.com/article/229461-overview>  in Jewish men.
> Van Howe et al (1999), in an earlier literature review, found no clear
> evidence that circumcision prevents STDs.2 However, studies have
> demonstrated that human papillomavirus
> <http://emedicine.medscape.com/article/219110-overview>  (HPV)
> infection, including oncogenic HPV infection, is more prevalent in
> uncircumcised men, regardless of demographics and sexual history.3
> Citing a link between the intact prepuce and sexually transmitted
> infection, some authorities have gone as far as suggesting that
> circumcision protects against prostate cancer.4
> A recent meta-analysis of 3 randomized controlled trials in South
> Africa,5 Kenya,6 and Uganda7 has demonstrated that circumcision
> decreases the risk of HIV infection
> <http://emedicine.medscape.com/article/211316-overview>  among
> heterosexual men by nearly 60%.8 Data from a mathematical model suggest
> that routine circumcision in southern sub-Saharan Africa could prevent 2
> million HIV infections over 10 years.9 The results of the African
> randomized trials have sparked speculative interest in male circumcision
> to reduce HIV infection in the United States, especially in areas such
> as New York City.10 Pask et al (2008) have suggested that the protective
> benefit of circumcision against HIV infection may result from removal of
> Langerhans cells and that enhanced keratinization conferred by topical
> estrogen may therefore represent an alternative to circumcision.11
> Surgical correction of buried penis
>
> The first description of the buried penis was in 1919 by Keyes. The
> first attempted surgical correction of this problem was by Schloss in
> 1959; in 1968, successful correction was performed in an adult by Glanz.
> Since then, numerous techniques to correct buried penis have been
> developed.
>
>
>   Problem
> Phimosis
>
> Phimosis is defined as a condition in which the foreskin cannot be
> retracted behind the head of the penis. Depending on the situation, this
> condition may be considered either physiologic or pathologic.
>
> Physiologic, or congenital, phimosis is a normal condition of the
> newborn male. In 90% of cases, natural separation allows the foreskin to
> retract by age 3 years. However, phimosis persisting into late
> adolescence or early adulthood need not be considered abnormal.
>
> The entity of pathologic, or true, phimosis is far less common and can
> affect children or adults. This is associated with cicatricial scarring
> of the prepuce that is often white in appearance. Phimosis may occur
> after circumcision if redundant inner prepuce slides back over the
> glans, with subsequent cicatricial scarring and contraction.
>
> Buried penis
>
> Buried penis is a true congenital disorder in which a penis of normal
> size lacks the proper sheath of skin and lies hidden beneath the
> integument of the abdomen, thigh, or scrotum. The literature, on
> occasion, also refers to this condition as a hidden or concealed penis.
> Trapped penis is a condition in which the penis becomes inconspicuous
> secondary to a cicatricial scar, usually after overzealous circumcision.
> Webbed penis is characterized by obscuration of the penile shaft by
> scrotal skin webs at the penoscrotal junction. Micropenis (also known as
> microphallus <http://emedicine.medscape.com/article/923178-overview> )
> represents a penis less than 2 standard deviations below the mean in
> length when measured in the stretched state. Diminutive penis is a penis
> that is small, malformed, or both secondary to epispadias
> <http://emedicine.medscape.com/article/1014971-overview> , exstrophy
> <http://emedicine.medscape.com/article/1014971-overview> , severe
> hypospadias <http://emedicine.medscape.com/article/1015227-overview> ,
> chromosomal abnormalities, or intersex conditions.
>   Frequency
> Phimosis
>
> Nearly all males are born with physiologic phimosis. Data have shown
> that the foreskin is retractable in 90% of boys by age 3 years. Only 1%
> of boys have physiologic phimosis that persists until age 17 years.
> Thus, most healthy adult men should not have phimosis; the presence of
> the disorder in an adult male should raise the suspicion of balanitis
> (infection of the foreskin), balanoposthitis
> <http://emedicine.medscape.com/article/1124734-overview>  (infection of
> glans and foreskin), diabetes, or malignancy.
>
> Approximately 1 in 6 men in the world are circumcised. In the United
> States, circumcision is the fifth most common procedure; in 1992, the
> foreskin was removed in 62% of newborn males in the United States.
>
> Buried penis
>
> Congenital buried penis is uncommon. The incidence of buried penis in
> adulthood is unknown, but it is highly likely that many cases go
> unreported.
>   Etiology
> Phimosis
>
> Physiologic phimosis is the rule in newborn males. Formation of the
> prepuce is complete by 16 weeks' gestation. The inner prepuce and glans
> penis share a common, fused mucosal epithelium at birth. This epithelium
> separates via desquamation over time as the proper hormonal and growth
> factors are produced. Thus, neonatal circumcision is a surgical
> treatment of normal anatomy.
>
> Pathologic, or true, phimosis has several different etiologies. The most
> common cause is infection, such as posthitis, balanitis, or a
> combination of the two (balanoposthitis). Diabetes mellitus may
> predispose to such infections.
>
> Adult circumcision is most commonly performed to correct phimosis. When
> circumcision is performed for phimosis, 25%-46% of removed foreskins are
> histologically normal. Other indications for adult circumcision include
> balanitis xerotica obliterans
> <http://emedicine.medscape.com/article/1074054-overview>  (BXO),
> infection without phimosis; paraphimosis; Bowen disease; carcinoma;
> condylomas (warts
> <http://emedicine.medscape.com/article/1133201-overview> ); trauma;
> religious or social reasons; disease prophylaxis (eg, HIV infection);
> and personal preference.
>
> Buried penis
>
> Various etiologic factors have been proposed to explain congenital
> buried penis. Recent literature favors dysgenetic dartos tissue with
> abnormal attachments proximally and to the dorsal cavernosum. A
> prominent prepubic fat pad is also a common primary factor, in addition
> to dysgenetic dartos fascia. Secondary buried penis may be the result of
> an overzealous circumcision with subsequent cicatricial scar (trapped
> penis), a large hernia, or a hydrocele.
>
> Adults with buried penis are commonly obese and often have a history of
> trauma or surgery. Adults with this condition may have undergone
> abdominoplasty <http://emedicine.medscape.com/article/1271693-overview>
> with overzealous release of attachments between the Scarpa and dartos
> fasciae, penile-lengthening procedures, or other genitoinguinal
> surgeries.
>   Pathophysiology
> Phimosis
> The foreskin of an uncircumcised child should not be forcefully
> retracted. This may result in significant bleeding, as well as glanular
> excoriation and injury. Consequently, dense fibrous adhesions may form
> during the healing process, leading to true pathologic phimosis.
>
> Circumcision has been promoted as a means of reducing the risk of UTIs,
> which are more common in uncircumcised males younger than 6 months. The
> risk in circumcised infants is approximately 1 in 1000, whereas the risk
> in uncircumcised infants is about 1 in 100. Some researchers contend
> that the risk of UTI in these children is not high enough to warrant
> mandatory circumcision. Interestingly, nongonococcal urethritis
> <http://emedicine.medscape.com/article/438091-overview>  (NGU) may be
> more common in circumcised men. However, a multicenter study suggested
> that, if a child has associated vesicoureteral reflux
> <http://emedicine.medscape.com/article/439403-overview>  (VUR), the
> benefit of reduced infection risk may be valid support for surgery.12
>
> Another cited indication for circumcision is prevention of STDs.
> Numerous case-control studies concerning the relationship between the
> foreskin and HIV infection have been published, with inconsistent
> results and no definite link. Therefore, it seems that STD prevention is
> not a justification for routine circumcision. Of note, of the developed
> nations, the United States has one of the highest rates of STDs, HIV
> infection, and male circumcision.
>
> Infant circumcision seems to decrease the risk of penile cancer
> <http://emedicine.medscape.com/article/446554-overview> ,13 whereas
> later circumcision does not. Penile cancer is a rare disease in the
> United States, with an incidence of 1.5 per 100,000 people. In
> developing countries, the incidence is higher and accounts for up to 10%
> of malignancies in some African and South American nations. Although
> primarily a disease of older men, penile cancer has been reported in
> children. The lowest incidence has been reported in Jews, with a similar
> incidence in Muslims; both groups have high rates of neonatal
> circumcision.
>
> Daling et al performed a population-based case-control study in 2005
> that examined the importance of circumcision in patients with penile
> cancer. Preputial status was not found to be a statistically significant
> factor in penile cancer. The investigators concluded that the role of
> circumcision in penile cancer prevention is unclear.14 Several studies
> suggest that poor hygiene may be a stronger risk factor than
> circumcision status. Although smegma has been implicated as a
> carcinogenic agent, definitive evidence is lacking.
>
> Adult phimosis may be caused by repeated episodes of balanitis or
> balanoposthitis. Such infections are commonly due to poor personal
> hygiene (failure to regularly clean under the foreskin).
>
> Phimosis may be a presenting symptom of early diabetes mellitus. When
> the residual urine of a patient with diabetes mellitus becomes trapped
> under the foreskin, the combination of a moist environment and glucose
> in the urine may lead to a proliferation of bacteria, with subsequent
> infection, scarring, and eventual phimosis.
>
> Buried penis
>
> The penis is properly formed by 16 weeks' gestation. Congenital buried
> penis is caused by a developmental anomaly in which the dartos fascia
> has not developed into the normal elastic configuration to allow the
> penile skin to move freely over the deeper tissues of the penile shaft.
> Instead, the dartos layer is inelastic, which prevents the forward
> extension of the penis and holds it buried under the pubis.
>
> Other possible contributing factors to congenital buried penis include
> excess prepubic fat, scrotal webbing, deficient penile skin, loose skin,
> an abnormally low position at which the crura separate, abnormal
> attachments between the Buck fascia and the tunica albuginea, and
> insufficient attachment of dartos fascia and skin to the Buck fascia.
>
> The pathophysiology of buried penis in adults differs from that in
> children and includes iatrogenically induced scar contracture with
> concurrent descent of the abdominal fat pad. Because the penis is
> suspended from the pubis by the suspensory ligament, it remains fixed,
> unlike the prepubic fat. As fat descends over the penis, excessive
> moisture and bacterial overgrowth may occur. Chronic infection may lead
> to skin maceration and more scar contracture, further aggravating the
> problem. In many children, this condition is self-limited. However, in
> adults, total body fat content typically increases with age, causing the
> buried penis to worsen over time.
>
>
>   Presentation
> Phimosis
> Congenital or physiologic phimosis is clinically asymptomatic so is not
> a cause for concern. It is often associated with "ballooning" of the
> foreskin during voiding. This is a self-limited phenomenon that, in the
> absence of pathologic phimosis, does not indicate urinary tract
> obstruction <http://emedicine.medscape.com/article/438890-overview> .
> Pathologic, or true, phimosis is far less common. Symptoms include skin
> irritation, dysuria, bleeding, and occasionally enuresis or urinary
> retention. Physical examination usually reveals white cicatricial
> scarring at the preputial ring. Meuli et al (1994) devised the following
> scoring system to rate the severity of phimosis:15
>
>     * Grade I - Fully retractable prepuce with stenotic ring in the shaft
> * Grade II - Partial retractability with partial exposure of the glans
> * Grade III - Partial retractability with exposure of the meatus only
> * Grade IV - No retractability
>
> Pathologic phimosis may be due to BXO, a genital form of lichen
> sclerosus et atrophicus
> <http://emedicine.medscape.com/article/1123316-overview> . This
> condition affects both men and boys and represents an absolute
> indication for circumcision, which may be curative. The etiology of BXO
> is unknown, and it may represent a premalignant state. Clinically, it
> presents as severe phimosis and possibly meatal stenosis
> <http://emedicine.medscape.com/article/1016016-overview> , glanular
> lesions, or both.
>
> In older men, when the phimosis is severe, the distal foreskin often
> appears swollen and erythematous with cracked fissures (see image
> below). Men who are affected report pain and discomfort during sexual
> activity or when they attempt to retract the foreskin. Unlike in the
> pediatric population, lower urinary tract voiding symptoms are absent.
> In older men, acquired phimosis is often associated with poor hygiene
> but may be a product of diabetes mellitus.
>
>   [Phimotic foreskin. The distal foreskin is edemato...]   Phimotic
> foreskin. The distal foreskin is edematous, with cracked fissures. The
> patient was unable to retract the foreskin.   [ CLOSE WINDOW ]
> [Phimotic foreskin. The distal foreskin is edemato...]  Phimotic
> foreskin. The distal foreskin is edematous, with cracked fissures. The
> patient was unable to retract the foreskin.
>
>
>
> All uncircumcised adult men should have the foreskin retracted to
> exclude occult carcinoma as a part of a complete urologic examination.
> Squamous cell carcinoma of the penis
> <http://emedicine.medscape.com/article/1102225-overview>  may manifest
> as an ulcerated fungating mass of the glans or the prepuce.
> Alternatively, carcinoma in situ or penile carcinoma may appear as a
> velvety macular lesion of the glans (erythroplasia of Queyrat
> <http://emedicine.medscape.com/article/1100317-overview> ) or the penile
> shaft (Bowen disease).
>
> Buried penis
>
> Most pediatric cases of buried penis present in neonates or prepubertal
> boys. The most common age range of patients at presentation is 6 months
> to 1 year. Adolescents who present with buried penis are usually obese,
> and weight loss should be advised. Patients may be uncircumcised or
> circumcised; the latter complicates repair. One series found that 77% of
> children presenting with buried penis had been previously circumcised,
> emphasizing a need for pediatric urologists to educate primary care
> physicians.
>
> The reasons for presentation vary. Often, parents are concerned because
> they are unable to see the penis, which may also complicate proper
> hygiene. Occasionally, they may witness ballooning of the foreskin with
> voiding, and children may be persistently wet if they are voiding into
> the preputial sac.
>
> Adolescents may report dysuria, dribbling between voids, trouble
> directing their urinary stream because of difficulty holding the penis,
> or embarrassment in the locker room. Some patients have a history of
> balanitis and balanoposthitis, and some have undergone a radical
> circumcision or even multiple circumcisions.
>
> In addition to some of the symptoms seen in children, adults may present
> with sexual complaints. These include painful erection, sexual
> embarrassment, and difficulty with vaginal penetration, especially if
> the tip of the glans does not project past the male escutcheon. This
> condition may lead to the inability to void in a standing position and
> may cause the patient to soil himself while urinating in the seated
> position. Obesity and diabetes mellitus are commonly associated
> comorbidities.
>
> On physical examination, the penis may be concealed because it is buried
> in prepubic tissues; buried and enclosed in scrotal tissue (penis
> palmatus); trapped by phimosis, traumatic scar tissue, or
> postcircumcision cicatrix; or hidden secondary to a large hernia or
> hydrocele <http://emedicine.medscape.com/article/438724-overview> . A
> smooth transition from prepubic to penile skin indicates a buried penis.
> Trapped penis demonstrates a circumferential groove at the base of the
> penis. Only Maizels (1986)1 and Burkholder (1983)16 have noted an
> association between buried penis and renal anomalies. Other
> genitourinary anomalies have not been associated with this condition.
>
>
>   Indications
> Phimosis
> The main medical indication for circumcision in children is pathologic
> phimosis. In a prospective long-term study, 40% of boys treated for
> phimosis were found to have BXO, which has been linked to the
> development of penile squamous cell carcinoma (SCC).17 Although potent
> topical steroids may allow improvement and slow progression, total
> circumcision is the treatment of choice for BXO and may be curative.
>
> Recurrent balanoposthitis, which affects 1% of boys, is also considered
> a relative indication for circumcision. However, this condition tends to
> be self-limited, and even if balanoposthitis is recurrent,
> preputioplasty and topical steroids represent alternatives to
> circumcision.18,19,20,21 In patients with balanoposthitis who are
> sufficiently troubled to warrant surgical intervention, circumcision is
> always curative.
>
> Paraphimosis results from abuse or accident, not disease, of the
> foreskin and can be seen at any age. It represents the second most
> common indication for adult circumcision. Infants may present with
> paraphimosis if their parents have retracted the prepuce and failed to
> pull it forward thereafter. Reduction of the foreskin under sedation is
> almost always possible. However, in some situations, a dorsal slit or
> circumcision is required (see Paraphimosis
> <http://emedicine.medscape.com/article/442883-overview> ). Unrecognized
> chronic paraphimosis or delay in diagnosis may result in urinary
> retention or even penile autoamputation.
>
> Other indications for circumcision that are less common include small
> preputial tumors, multiple preputial cysts or condylomas, and penile
> lymphedema. A reasonable case may be made for circumcising boys with VUR
> who suffer from UTIs. In addition, the foreskin may be removed to
> perform a biopsy of lesions hidden under the prepuce or for definitive
> radiation therapy for penile cancer.
>
> Occasions arise in which urethral instrumentation—in the form of a
> cystoscopy or Foley catheterization—is necessary. This may be quite
> problematic in an adult affected by severe phimosis. In such instances,
> an emergency bedside dorsal slit can be performed safely and
> expeditiously. After being discharged, the patient may proceed to
> undergo formal circumcision.
>
> Many circumcisions are performed for social or religious reasons.
> Interestingly, only 1 out of 6 schools of Islamic law consider
> circumcision obligatory, whereas others feel it is to be recommended.
> Among religious Jews, circumcision is felt to be a commandment from
> their creator.
>
> In summary, common indications for circumcision include the following:
>
>     * Phimosis     * Paraphimosis     * Recurrent balanitis or
> balanoposthitis     * Social or religious reasons
>
> Buried penis
>
> The primary reason that children are referred for correction of the
> buried penis is cosmesis. In the neonate, observation seems to be a
> viable option. Children younger than 3 years have a 58% chance of
> spontaneous resolution. Some pediatric urologists insist that this
> condition is a developmental stage that will resolve by puberty and feel
> that correction should therefore be deferred. Evidence has shown,
> however, that spontaneous resolution does not always occur. Also, in men
> and adolescents, measures such as diet and exercise are unlikely to be
> effective.
>
> Other authors feel that, after age 3 years, buried penis requires
> correction. The primary reason cited is the importance of being able to
> void while standing during the period of toilet training. There are
> numerous other indications for repair. For example, a concealed penis
> can hamper proper hygiene, trap urine, and complicate voiding. This can
> lead to repeated infections, secondary phimosis, or even urinary
> retention. In addition, numerous investigators feel that children with
> buried penis are at risk for psychological and social trauma, even from
> an early age. Obese boys with a buried penis may be ostracized by their
> peers and withdraw socially. Surgery often relieves anxiety and may
> improve self-image.
>
> In adults, buried penis tends to worsen over time as they accumulate
> more fat. The cicatricial scar does not loosen on its own over time.
> Urinary and sexual complications can greatly affect daily life.
> Therefore, surgery is likely necessary in these patients.
>
>
>   Relevant Anatomy
> The penis is composed of paired corpora cavernosa, the crura of which
> are attached to the pubic arch, and the corpus spongiosum (see image
> below). The proximal portion of the corpus spongiosum is referred to as
> the bulb of the penis, and the glans represents the distal expansion.
> The urethra traverses the corpus spongiosum to exit at the meatus. The
> cavernosal bodies produce the male erection when they are engorged with
> blood.
>
>   [Cross-section through the body of the penis.]   Cross-section through
> the body of the penis.   [ CLOSE WINDOW ]  [Cross-section through the
> body of the penis.]  Cross-section through the body of the penis.
>
> The fascial layers of the penis are continuous with the fascial layers
> of the perineum and lower abdomen. Dartos fascia represents the
> superficial penile fascia. Deep to this lies the Buck fascia, which
> covers the tunica albuginea of the penile bodies. Proximally, the Buck
> fascia is in continuity with the suspensory ligament of the penis, which
> attaches to the symphysis pubis.
>
> The penis is supplied by a superficial system of arteries that arise
> from the external pudendal arteries and a deep system of arteries that
> stem from the internal pudendal arteries (see images below). The
> superficial blood supply lies in the superficial penile fascia and
> supplies the penile skin and prepuce. The internal pudendal artery,
> which arises from the hypogastric artery, gives rise to the penile
> artery. The penile artery then gives rise to the bulbourethral artery,
> the urethral artery, and the cavernous artery (deep artery of the penis)
> before terminating as the dorsal artery of the penis.
>
>   [The arterial blood supply of the penis arises fro...]   The arterial
> blood supply of the penis arises from the internal pudendal artery. The
> internal pudendal artery gives off branches to the bulbar artery,
> cavernosal artery, and dorsal penile artery. The bulbar artery continues
> on as the bulbourethral artery to supply the urethra. The cavernosal
> artery gives rise to the helicine arteries that are end arteries. The
> dorsal artery of the penis gives branches off to the circumflex
> arteries.   [ CLOSE WINDOW ]  [The arterial blood supply of the penis
> arises fro...]  The arterial blood supply of the penis arises from the
> internal pudendal artery. The internal pudendal artery gives off
> branches to the bulbar artery, cavernosal artery, and dorsal penile
> artery. The bulbar artery continues on as the bulbourethral artery to
> supply the urethra. The cavernosal artery gives rise to the helicine
> arteries that are end arteries. The dorsal artery of the penis gives
> branches off to the circumflex arteries.
>   [Dorsal view of the arterial and venous blood supp...]   Dorsal view of
> the arterial and venous blood supply of the penis.   [ CLOSE WINDOW ]
> [Dorsal view of the arterial and venous blood supp...]  Dorsal view of
> the arterial and venous blood supply of the penis.
>
>
>
> Somatic nerve supply to the penis comes by way of the pudendal nerves,
> which eventually produce the dorsal nerves of the penis on each side.
> Although cutaneous innervation to the penis is primarily from branches
> of the pudendal nerve, the proximal portion is supplied by the
> ilioinguinal nerve after it leaves the superficial inguinal ring. The
> prepuce has somatosensory innervation by the dorsal nerve of the penis
> and branches of the perineal nerve. The glans is primarily innervated by
> free nerve endings and has poor fine-touch discrimination.
>
>
>   Contraindications
> Circumcision is generally not performed in children born prematurely or
> those with blood dyscrasias
> <http://emedicine.medscape.com/article/1160261-overview> . It should not
> be performed in children with congenital penile anomalies such as the
> following:
>     * Hypospadias     * Epispadias     * Chordee     * Penile webbing
> * Buried penis
>
>
> More on Phimosis, Adult Circumcision, and Buried Penis
> [http://images.medscape.com/pi/global/ornaments/bg_nav_highlight2.gif]
> Overview: Phimosis, Adult Circumcision, and Buried Penis   Treatment:
> Phimosis, Adult Circumcision, and Buried Penis
> <http://emedicine.medscape.com/article/442617-treatment>   Follow-up:
> Phimosis, Adult Circumcision, and Buried Penis
> <http://emedicine.medscape.com/article/442617-followup>   Multimedia:
> Phimosis, Adult Circumcision, and Buried Penis
> <http://emedicine.medscape.com/article/442617-media>
>
>
> [Non-text portions of this message have been removed]
>

Dear "Rood" from the 'Hood

This is Rene from the cafe,

I wouldn't jump to conclusions or draw inferences about women having more lichen
sclerosus than men unless you think about information already accessible to you.

Women's vulvas and labia are often moist.  Many do not wear cotton underwear
which is more absorbent, and their urine often splatters all over the place.

If you wish to compare and contrast, think of uncircumcised and undercircumcised
men (oh yes, them too).

A recommended treatment for lichen sclerosus in men is CIRCUMCISION for those
who have not had that, as this is often curative!

Skin is a very poor urinary conduit and subject to many irritative effects. 
Babies know of this first hand with diaper rashes.

For adults undergoing urological urethral reconstruction, skin has fallen into
disfavor.  Buccal (inner cheek) grafts are being used as buccal mucosa is
designed to handle moisture.

Who was it that said, once you've got past the smell, you've got it licked.


Rene (pro circ, what else)

(written on my Vaio at Cafe Oh Me, Oh Mio (Taco Bell, if you want to know the
truth) waiting for a plane, they wouldn't let me into Starbucks)




--- In PROCIRCORG@yahoogroups.com, "Rood" <korydon@...> wrote:
>
>
>
>
> John:  You might be advised not to jump to conclusions when it comes to
questions of health.   The good Doctor has said that he's not an expert in this
"area", which may account for the reason that many men suffering from this
condition have not contacted him.
>
> Poll men who do suffer from LS, and you will find many who had their foreskin
removed at birth.   Thus, the condition is not necessarily a consequence of
being intact.  Removing the foreskin, as in the case which you offered here,
from Britain, does not solve the problem.
>
> Lichen Sclerosis is a disease which affects body tissue, and it occurs most
often in women.  It may strike almost any area of the body, including the back
and shoulders.
>
> After reading your posts, however, it becomes evident that you are focusing
your interest not on this poor fellow's dilemma, but on an all consuming
fascination with circumcision.   That's not a terribly scientific way to study
or resolve the deleterious effects of disease. Choosing the solution before
diagnosing the source of the problem only complicates the situation.
>
> The medical establishment knows little or nothing about Lichen Sclerosus.  All
current treatments are blind experiments.  Sometimes they work, but most of the
time they don't.
>
>
>
>
>
>
>
> --- In PROCIRCORG@yahoogroups.com, "john m" <johnmurray499@> wrote:
> >
> > Hey, Harold:
> >
> > Thanks so much for the very useful info about lichen sclerosus. I was
particularly pleased that you brought forward the fact that you have never seen
this in circumcised men. Lichen sclerosus is such a destructive condition that
it seems to form yet another compelling piece of evidence for a well-perfromed
circumcison.
> >
> > Even the English should see the benefit of preventing this dreaded
condition.
> >
> > It was a plesure hearing from you.
> >
> > Cheers and beers,
> >
> > John M
> > --- In PROCIRCORG@yahoogroups.com, "Harold" <infos@> wrote:
> > >
> > > Hi again John,
> > >
> > > Campbell-Walsh's Urology (4 volume version, 2007) is the most up to date
reference source and probably weighs about 30 pounds. A few points, BXO is now
being called "lichen sclerosus." and reputedly could occur in circumcised men,
but I believe this may be a vestige from the uncircumcised state persisting. I
personally have not seen this in circumcised men. This process will invade the
opening of the urethra and may ingress well into the pendulous urethra.
Therefore if suspected cystoscopy and a urethrogram may be in order. Steroids
> > > and antibiotics have been recommended but surely do not work consistently.
Also clotrimazole 0.05% (think Lotrimin, antifugal cream) has been instilled.
BXO has also been described in "buried penis" and we saw a nasty case of that
about 4 months ago. Not sure which came first. Couldn't help but feel the dense
intraurethral scarring process may have contributed to inversion.
> > >
> > > For urethral reconstruction, a buccal graft is recommened as this seems to
be a process of genital skin. A buccal graft taken from the inside of the cheek
is of course unrelated. We are getting well away from using penile skin for
urethral reconstruction as we know only too well the effects of urine on penile
skin.
> > >
> > > In some instances, lichen sclerosus can progress to squamous cell
carcinoma (cancer for our lay friends).
> > >
> > > Again, thank you for introducing this excellent topic. I am not a real
expert in this area but I guess when no one has a good cure, there are not too
many experts out there.
> > >
> > > Cheers to you, and there will always be an England!
> > >
> > >
> > > Harold Reed, M.D.
> > >
> > >
> > > --- In PROCIRCORG@yahoogroups.com, john murray <johnmurray499@> wrote:
> > > >
> > > >
> > > > Hi, Harold:
> > > >
> > > >
> > > >
> > > > Thanks for the very complete answer. The man who e-mailed me is in the
U.K. and underwent a circumcision after years of foreskin problems. He informed
me that the frenulum was involved in the disease process and that his urologist
had to do a skin graft to the frenular area. This was a bit of a shock to this
young man, aged 28, after all those years of conservative treatment.
Furthermore, he has done extensive reading and , being aware that his glans has
a number of pale areas, he is querying whether he should also have other
treatments such as topical hormones.
> > > >
> > > >
> > > >
> > > > I told him I would contact you but, in the interim, I was quite sure
that surgery was the most definitive treatment and he has already had that. As a
retired G.P, I hate to sound too pompous to theses young guys but I keep
thinking what a pity it is that he did not a a well-done circumcision many years
ago
> > > > I really believe the Brits have gone way too far in the anti-circ
direction and that in the u.S. he would have received far better care(or in
Canada, for that matter, whcih is where I live.
> > > >
> > > >
> > > >
> > > > Thanks for listening to my rant , Harold.
> > > >
> > > >
> > > >
> > > > Have a onderful weekend
> > > >
> > > >
> > > >
> > > > Cheers
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > >
> > > > John
> > > >
> > > >
> > > >
> > > >
> > > >
> > > > > To: PROCIRCORG@yahoogroups.com
> > > > > From: infos@
> > > > > Date: Sat, 12 Dec 2009 12:09:21 +0000
> > > > > Subject: [PROCIRCORG] Re: BXO
> > > > >
> > > > > Hello John,
> > > > >
> > > > > Hardly a month goes by when we don't see a bonafide case of BXO.
> > > > >
> > > > > (from Wikipedia)
> > > > > Therapy focuses on prevention of disease progression.
> > > > > Shelley reported some success with long-term antibiotic therapy.
However, relapses were seen upon stopping treatment.
> > > > > Some success has been reported with topical steroids, when scarring is
minimal, though some have found this ineffectual.
> > > > > Moderate therapeutic results have been reported using etretinate.
> > > > > Some success has been reported in the use of carbon dioxide laser
therapy.
> > > > >
> > > > > Many authors report that circumcision is the treatment of choice, with
modifications if necessary. Pasieczny suggests testosterone ointment, however.
> > > > >
> > > > > Glansectomy may be required, but that would be unsuual. Invasion into
the urethra and urethral strictures (narrowing) is not uncommon. We have tried 5
FU cream in one patient, but if you read comments, there is no truly 100%
effective treatment.
> > > > >
> > > > > Could be a pre-malignant situation. Now that his glans is clearly
exposed, he should map out his glans with a ruler in millimeters and note any
changes in demarcation. If advancing, back to the urologist.
> > > > >
> > > > > Excision and letting the covered tissues see the light of day is still
our first line approach.
> > > > >
> > > > >
> > > > > Have a restful weekend,
> > > > >
> > > > >
> > > > > Harold M. Reed, M.D.
> > > > >
> > > > >
> > > > > --- In PROCIRCORG@yahoogroups.com, "john m" <johnmurray499@> wrote:
> > > > > >
> > > > > > Hello, Dr. Reed:
> > > > > >
> > > > > > I am one of several moderators on Inter-Circ. Today I had a post
from an adult who was circumcised for BXO. Because he has some distortion and
whitish areas on his glans and the frenaulr area, he is keen to find out
antyhing he can about the latest and most efficacious treatments for BXO.
> > > > > >
> > > > > > I wonder if you would care to comment about this or if I may refer
him to your group. CErtainly I can understand his concern over this very
distressing disorder.If this is accpetable to you, I should be pleased to
forward his original post to me.
> > > > > > Thanks in advance for your care and concern in perfroming excellent
adult circumcisions
> > > > > >
> > > > > > cheers,
> > > > > >
> > > > > > John M
> > > > > >
> > > > >
> > > > >
> > > > >
> > > > >
> > > > > ------------------------------------
> > > > >
> > > > > Yahoo! Groups Links
> > > > >
> > > > >
> > > > >
> > > >
> > > > _________________________________________________________________
> > > > Windows Live: Keep your friends up to date with what you do online.
> > > > http://go.microsoft.com/?linkid=9691815
> > > >
> > > > [Non-text portions of this message have been removed]
> > > >
> > >
> >
>

Rood, according to the National Institute of Arthritis and Musculoskeletal and
Skin Diseases
LS is rare in men.  But since it does mostly affect the genital areas, if it
occurs in men,
circumcision is a good option:

"Surgery is normally a good option for men. Circumcision (removing the
foreskin on the penis) is the most widely used therapy for men with
lichen sclerosus. The disease usually does not come back."

Here's the web site if you want to read the whole thing:

http://www.niams.nih.gov/Health_Info/Lichen_Sclerosus/default.asp

BTW, how do you know that if you "poll men who do suffer from LS, and you will
find many who had their foreskin removed at birth"?

--- On Sat, 12/19/09, Rood <korydon@...> wrote:

From: Rood <korydon@...>
Subject: [PROCIRCORG] Re: BXO
To: PROCIRCORG@yahoogroups.com
Date: Saturday, December 19, 2009, 5:08 AM







 













John:  You might be advised not to jump to conclusions when it comes to
questions of health.   The good Doctor has said that he's not an expert in this
"area", which may account for the reason that many men suffering from this
condition have not contacted him.



Poll men who do suffer from LS, and you will find many who had their foreskin
removed at birth.   Thus, the condition is not necessarily a consequence of
being intact.  Removing the foreskin, as in the case which you offered here,
from Britain, does not solve the problem.



Lichen Sclerosis is a disease which affects body tissue, and it occurs most
often in women.  It may strike almost any area of the body, including the back
and shoulders.



After reading your posts, however, it becomes evident that you are focusing your
interest not on this poor fellow's dilemma, but on an all consuming fascination
with circumcision.   That's not a terribly scientific way to study or resolve
the deleterious effects of disease. Choosing the solution before diagnosing the
source of the problem only complicates the situation.



The medical establishment knows little or nothing about Lichen Sclerosus.  All
current treatments are blind experiments.  Sometimes they work, but most of the
time they don't.



--- In PROCIRCORG@yahoogro ups.com, "john m" <johnmurray499@ ...> wrote:

>

> Hey, Harold:

>

> Thanks so much for the very useful info about lichen sclerosus. I was
particularly pleased that you brought forward the fact that you have never seen
this in circumcised men. Lichen sclerosus is such a destructive condition that
it seems to form yet another compelling piece of evidence for a well-perfromed
circumcison.

>

> Even the English should see the benefit of preventing this dreaded condition.

>

> It was a plesure hearing from you.

>

> Cheers and beers,

>

> John M

> --- In PROCIRCORG@yahoogro ups.com, "Harold" <infos@> wrote:

> >

> > Hi again John,

> >

> > Campbell-Walsh' s Urology (4 volume version, 2007) is the most up to date
reference source and probably weighs about 30 pounds. A few points, BXO is now
being called "lichen sclerosus." and reputedly could occur in circumcised men,
but I believe this may be a vestige from the uncircumcised state persisting. I
personally have not seen this in circumcised men. This process will invade the
opening of the urethra and may ingress well into the pendulous urethra.
Therefore if suspected cystoscopy and a urethrogram may be in order. Steroids

> > and antibiotics have been recommended but surely do not work consistently.
Also clotrimazole 0.05% (think Lotrimin, antifugal cream) has been instilled.
BXO has also been described in "buried penis" and we saw a nasty case of that
about 4 months ago. Not sure which came first. Couldn't help but feel the dense
intraurethral scarring process may have contributed to inversion.

> >

> > For urethral reconstruction, a buccal graft is recommened as this seems to
be a process of genital skin. A buccal graft taken from the inside of the cheek
is of course unrelated. We are getting well away from using penile skin for
urethral reconstruction as we know only too well the effects of urine on penile
skin.

> >

> > In some instances, lichen sclerosus can progress to squamous cell carcinoma
(cancer for our lay friends).

> >

> > Again, thank you for introducing this excellent topic. I am not a real
expert in this area but I guess when no one has a good cure, there are not too
many experts out there.

> >

> > Cheers to you, and there will always be an England!

> >

> >

> > Harold Reed, M.D.

> >

> >

> > --- In PROCIRCORG@yahoogro ups.com, john murray <johnmurray499@ > wrote:

> > >

> > >

> > > Hi, Harold:

> > >

> > >

> > >

> > > Thanks for the very complete answer. The man who e-mailed me is in the
U.K. and underwent a circumcision after years of foreskin problems. He informed
me that the frenulum was involved in the disease process and that his urologist
had to do a skin graft to the frenular area. This was a bit of a shock to this
young man, aged 28, after all those years of conservative treatment.
Furthermore, he has done extensive reading and , being aware that his glans has
a number of pale areas, he is querying whether he should also have other
treatments such as topical hormones.

> > >

> > >

> > >

> > > I told him I would contact you but, in the interim, I was quite sure that
surgery was the most definitive treatment and he has already had that. As a
retired G.P, I hate to sound too pompous to theses young guys but I keep
thinking what a pity it is that he did not a a well-done circumcision many years
ago

> > > I really believe the Brits have gone way too far in the anti-circ
direction and that in the u.S. he would have received far better care(or in
Canada, for that matter, whcih is where I live.

> > >

> > >

> > >

> > > Thanks for listening to my rant , Harold.

> > >

> > >

> > >

> > > Have a onderful weekend

> > >

> > >

> > >

> > > Cheers

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > John

> > >

> > >

> > >

> > >

> > >

> > > > To: PROCIRCORG@yahoogro ups.com

> > > > From: infos@

> > > > Date: Sat, 12 Dec 2009 12:09:21 +0000

> > > > Subject: [PROCIRCORG] Re: BXO

> > > >

> > > > Hello John,

> > > >

> > > > Hardly a month goes by when we don't see a bonafide case of BXO.

> > > >

> > > > (from Wikipedia)

> > > > Therapy focuses on prevention of disease progression.

> > > > Shelley reported some success with long-term antibiotic therapy.
However, relapses were seen upon stopping treatment.

> > > > Some success has been reported with topical steroids, when scarring is
minimal, though some have found this ineffectual.

> > > > Moderate therapeutic results have been reported using etretinate.

> > > > Some success has been reported in the use of carbon dioxide laser
therapy.

> > > >

> > > > Many authors report that circumcision is the treatment of choice, with
modifications if necessary. Pasieczny suggests testosterone ointment, however.

> > > >

> > > > Glansectomy may be required, but that would be unsuual. Invasion into
the urethra and urethral strictures (narrowing) is not uncommon. We have tried 5
FU cream in one patient, but if you read comments, there is no truly 100%
effective treatment.

> > > >

> > > > Could be a pre-malignant situation. Now that his glans is clearly
exposed, he should map out his glans with a ruler in millimeters and note any
changes in demarcation. If advancing, back to the urologist.

> > > >

> > > > Excision and letting the covered tissues see the light of day is still
our first line approach.

> > > >

> > > >

> > > > Have a restful weekend,

> > > >

> > > >

> > > > Harold M. Reed, M.D.

> > > >

> > > >

> > > > --- In PROCIRCORG@yahoogro ups.com, "john m" <johnmurray499@ > wrote:

> > > > >

> > > > > Hello, Dr. Reed:

> > > > >

> > > > > I am one of several moderators on Inter-Circ. Today I had a post from
an adult who was circumcised for BXO. Because he has some distortion and whitish
areas on his glans and the frenaulr area, he is keen to find out antyhing he can
about the latest and most efficacious treatments for BXO.

> > > > >

> > > > > I wonder if you would care to comment about this or if I may refer him
to your group. CErtainly I can understand his concern over this very distressing
disorder.If this is accpetable to you, I should be pleased to forward his
original post to me.

> > > > > Thanks in advance for your care and concern in perfroming excellent
adult circumcisions

> > > > >

> > > > > cheers,

> > > > >

> > > > > John M

> > > > >

> > > >

> > > >

> > > >

> > > >

> > > > ------------ --------- --------- ------

> > > >

> > > > Yahoo! Groups Links

> > > >

> > > >

> > > >

> > >

> > > ____________ _________ _________ _________ _________ _________ _

> > > Windows Live: Keep your friends up to date with what you do online.

> > > http://go.microsoft .com/?linkid= 9691815

> > >

> > > [Non-text portions of this message have been removed]

> > >

> >

>

























[Non-text portions of this message have been removed]

Phimosis, Adult Circumcision, and Buried Penis
Author: Richard A Santucci, MD, FACS, Chief of Urology, Detroit
Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical
Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital;
Director, The Center for Urologic Reconstruction; Clinical Professor of
Urology, Michigan State College of Medicine
Coauthor(s): Ryan P Terlecki, MD, Clinical Instructor in Reconstructive
Urology, Department of Urology, Division of Surgery, University of
Colorado
Contributor Information and Disclosures

Updated: Apr 15, 2009

     *  [Print This]  <http://emedicine.medscape.com/article/442617-print>
Print This <http://emedicine.medscape.com/article/442617-print>      *
[Email This]
<mailto:enter%20email%20address%20here?Subject=eMedicine%20Article%20-%2\
0Phimosis, Adult Circumcision, and Buried Penis&Body=I thought you might
be interested in this article from eMedicine.
You%20may%20either%20click%20on%20the%20following%20link%20or%20copy%20a\
nd%20paste%20it%20into%20your%20browser.%0Dhttp://emedicine.medscape.com\
/article/442617-overview%0D%0A%0D%0AeMedicine is the leading provider of
clinical medical information for medical professionals and consumers. To
explore eMedicine today, visit http://emedicine.medscape.com> Email This
<mailto:enter%20email%20address%20here?Subject=eMedicine%20Article%20-%2\
0Phimosis, Adult Circumcision, and Buried Penis&Body=I thought you might
be interested in this article from eMedicine.
You%20may%20either%20click%20on%20the%20following%20link%20or%20copy%20a\
nd%20paste%20it%20into%20your%20browser.%0Dhttp://emedicine.medscape.com\
/article/442617-overview%0D%0A%0D%0AeMedicine is the leading provider of
clinical medical information for medical professionals and consumers. To
explore eMedicine today, visit http://emedicine.medscape.com>

     * Overview     * Treatment
<http://emedicine.medscape.com/article/442617-treatment>      *
Follow-up <http://emedicine.medscape.com/article/442617-followup>      *
Multimedia <http://emedicine.medscape.com/article/442617-media>

     * References     * Keywords
   Introduction
Phimosis
Phimosis is defined as the inability of the prepuce (foreskin) to be
retracted behind the glans penis in uncircumcised males.

Nearly all males are born with congenital phimosis, a benign condition
that resolves in the overwhelming majority of infants as they transition
into childhood. In 1949, Douglas Gairdner showed that only 4% of infants
had a fully retractable foreskin at birth but that 90% did by age 3
years. Contemporary work demonstrates that only 1% of males aged 17
years still have an unretractable foreskin. Adult phimosis (ie,
pathologic or true phimosis) may be caused by poor hygiene or an
underlying medical condition (eg, diabetes mellitus).

Uncomplicated pathologic phimosis is usually amenable to conservative
medical treatment. Failure of medical treatment warrants surgical
intervention, usually in the traditional form of a circumcision or
preputioplasty.

Although phimosis is the most common indication for adult circumcision,
other reported indications include paraphimosis
<http://emedicine.medscape.com/article/442883-overview> , balanitis
without phimosis, condyloma, redundant foreskin, Bowen disease
<http://emedicine.medscape.com/article/1100113-overview> , carcinoma
<http://emedicine.medscape.com/article/446554-overview> , trauma
<http://emedicine.medscape.com/article/456305-overview> , disease
prophylaxis (eg, HIV infection), and patient choice.

Buried penis

Buried penis was described in the early 20th century as a penis of
normal size that lacks an appropriate sheath of skin and is located
beneath the integument of the abdomen, thigh, or scrotum. This condition
is more common in children, usually presenting in neonates or obese
prepubertal boys; however, it can also be seen in adults and has been
observed in both circumcised and uncircumcised individuals. Marginal
cases may not be diagnosed until adulthood, when increased fat
deposition accentuates the problem.

Several classification systems of buried penis have been proposed,
although none has been universally adopted in the literature. Maizels et
al (1986) differentiated among the terms concealed (before
circumcision), trapped (cicatricial [scarred] after circumcision), and
buried (associated with adolescence and obesity).1

In most congenital pediatric cases, the buried penis is self-limited. In
untreated adults, however, the condition tends to worsen as the
abdominal pannus continues to grow.


   History of the Procedure
Circumcision <http://emedicine.medscape.com/article/1015820-overview>
and adult circumcision
Circumcision is one of the earliest elective operations known to man.
Historically, this procedure has been performed for various religious
reasons, social reasons, or both. The practice is considered a
commandment in Jewish law and a rule of cleanliness in Islam, although
it is not mentioned in the Quran. In biblical times, mothers were
responsible for circumcising their newborn sons, with mohels gradually
taking over. Priests in ancient Egypt would perform the procedure with
their gold-impregnated thumbnail. Female circumcision, which is likely
better termed "genital mutilation," has been practiced for centuries by
some cultures but is an unacceptable practice and without medical
benefit.

Adult circumcision for phimosis is described in textbooks dating from
the early 19th century. Alternative procedures for adult phimosis were
described as early as 1900 by Cloquet. Surgical attempts to restore the
prepuce are also well documented, going as far back as the Old
Testament. However, potential psychological and surgical complications
have led to closer scrutiny of routine neonatal circumcision. Currently,
the American Academy of Pediatrics (AAP) neither recommends nor condemns
routine neonatal circumcision.

Studies suggest that circumcised boys are at a lower risk of urinary
tract infections <http://emedicine.medscape.com/article/969643-overview>
(UTIs). To put this in perspective, the approximate likelihood of a UTI
occurring in the first year of life is 1 in 100 in uncircumcised boys
and 1 in 1000 in circumcised boys. A lower risk of malignancy is also
reported in studies of circumcised men, although the incidence is also
rare in uncircumcised men. Of note, this decreased risk seems to be
associated only with infant circumcision and not with adult procedures.

The theory that circumcision contributes to prevention of sexually
transmitted diseases (STDs) was encouraged by a 19th-century report of
lower rates of syphilis
<http://emedicine.medscape.com/article/229461-overview>  in Jewish men.
Van Howe et al (1999), in an earlier literature review, found no clear
evidence that circumcision prevents STDs.2 However, studies have
demonstrated that human papillomavirus
<http://emedicine.medscape.com/article/219110-overview>  (HPV)
infection, including oncogenic HPV infection, is more prevalent in
uncircumcised men, regardless of demographics and sexual history.3
Citing a link between the intact prepuce and sexually transmitted
infection, some authorities have gone as far as suggesting that
circumcision protects against prostate cancer.4
A recent meta-analysis of 3 randomized controlled trials in South
Africa,5 Kenya,6 and Uganda7 has demonstrated that circumcision
decreases the risk of HIV infection
<http://emedicine.medscape.com/article/211316-overview>  among
heterosexual men by nearly 60%.8 Data from a mathematical model suggest
that routine circumcision in southern sub-Saharan Africa could prevent 2
million HIV infections over 10 years.9 The results of the African
randomized trials have sparked speculative interest in male circumcision
to reduce HIV infection in the United States, especially in areas such
as New York City.10 Pask et al (2008) have suggested that the protective
benefit of circumcision against HIV infection may result from removal of
Langerhans cells and that enhanced keratinization conferred by topical
estrogen may therefore represent an alternative to circumcision.11
Surgical correction of buried penis

The first description of the buried penis was in 1919 by Keyes. The
first attempted surgical correction of this problem was by Schloss in
1959; in 1968, successful correction was performed in an adult by Glanz.
Since then, numerous techniques to correct buried penis have been
developed.


   Problem
Phimosis

Phimosis is defined as a condition in which the foreskin cannot be
retracted behind the head of the penis. Depending on the situation, this
condition may be considered either physiologic or pathologic.

Physiologic, or congenital, phimosis is a normal condition of the
newborn male. In 90% of cases, natural separation allows the foreskin to
retract by age 3 years. However, phimosis persisting into late
adolescence or early adulthood need not be considered abnormal.

The entity of pathologic, or true, phimosis is far less common and can
affect children or adults. This is associated with cicatricial scarring
of the prepuce that is often white in appearance. Phimosis may occur
after circumcision if redundant inner prepuce slides back over the
glans, with subsequent cicatricial scarring and contraction.

Buried penis

Buried penis is a true congenital disorder in which a penis of normal
size lacks the proper sheath of skin and lies hidden beneath the
integument of the abdomen, thigh, or scrotum. The literature, on
occasion, also refers to this condition as a hidden or concealed penis.
Trapped penis is a condition in which the penis becomes inconspicuous
secondary to a cicatricial scar, usually after overzealous circumcision.
Webbed penis is characterized by obscuration of the penile shaft by
scrotal skin webs at the penoscrotal junction. Micropenis (also known as
microphallus <http://emedicine.medscape.com/article/923178-overview> )
represents a penis less than 2 standard deviations below the mean in
length when measured in the stretched state. Diminutive penis is a penis
that is small, malformed, or both secondary to epispadias
<http://emedicine.medscape.com/article/1014971-overview> , exstrophy
<http://emedicine.medscape.com/article/1014971-overview> , severe
hypospadias <http://emedicine.medscape.com/article/1015227-overview> ,
chromosomal abnormalities, or intersex conditions.
   Frequency
Phimosis

Nearly all males are born with physiologic phimosis. Data have shown
that the foreskin is retractable in 90% of boys by age 3 years. Only 1%
of boys have physiologic phimosis that persists until age 17 years.
Thus, most healthy adult men should not have phimosis; the presence of
the disorder in an adult male should raise the suspicion of balanitis
(infection of the foreskin), balanoposthitis
<http://emedicine.medscape.com/article/1124734-overview>  (infection of
glans and foreskin), diabetes, or malignancy.

Approximately 1 in 6 men in the world are circumcised. In the United
States, circumcision is the fifth most common procedure; in 1992, the
foreskin was removed in 62% of newborn males in the United States.

Buried penis

Congenital buried penis is uncommon. The incidence of buried penis in
adulthood is unknown, but it is highly likely that many cases go
unreported.
   Etiology
Phimosis

Physiologic phimosis is the rule in newborn males. Formation of the
prepuce is complete by 16 weeks' gestation. The inner prepuce and glans
penis share a common, fused mucosal epithelium at birth. This epithelium
separates via desquamation over time as the proper hormonal and growth
factors are produced. Thus, neonatal circumcision is a surgical
treatment of normal anatomy.

Pathologic, or true, phimosis has several different etiologies. The most
common cause is infection, such as posthitis, balanitis, or a
combination of the two (balanoposthitis). Diabetes mellitus may
predispose to such infections.

Adult circumcision is most commonly performed to correct phimosis. When
circumcision is performed for phimosis, 25%-46% of removed foreskins are
histologically normal. Other indications for adult circumcision include
balanitis xerotica obliterans
<http://emedicine.medscape.com/article/1074054-overview>  (BXO),
infection without phimosis; paraphimosis; Bowen disease; carcinoma;
condylomas (warts
<http://emedicine.medscape.com/article/1133201-overview> ); trauma;
religious or social reasons; disease prophylaxis (eg, HIV infection);
and personal preference.

Buried penis

Various etiologic factors have been proposed to explain congenital
buried penis. Recent literature favors dysgenetic dartos tissue with
abnormal attachments proximally and to the dorsal cavernosum. A
prominent prepubic fat pad is also a common primary factor, in addition
to dysgenetic dartos fascia. Secondary buried penis may be the result of
an overzealous circumcision with subsequent cicatricial scar (trapped
penis), a large hernia, or a hydrocele.

Adults with buried penis are commonly obese and often have a history of
trauma or surgery. Adults with this condition may have undergone
abdominoplasty <http://emedicine.medscape.com/article/1271693-overview>
with overzealous release of attachments between the Scarpa and dartos
fasciae, penile-lengthening procedures, or other genitoinguinal
surgeries.
   Pathophysiology
Phimosis
The foreskin of an uncircumcised child should not be forcefully
retracted. This may result in significant bleeding, as well as glanular
excoriation and injury. Consequently, dense fibrous adhesions may form
during the healing process, leading to true pathologic phimosis.

Circumcision has been promoted as a means of reducing the risk of UTIs,
which are more common in uncircumcised males younger than 6 months. The
risk in circumcised infants is approximately 1 in 1000, whereas the risk
in uncircumcised infants is about 1 in 100. Some researchers contend
that the risk of UTI in these children is not high enough to warrant
mandatory circumcision. Interestingly, nongonococcal urethritis
<http://emedicine.medscape.com/article/438091-overview>  (NGU) may be
more common in circumcised men. However, a multicenter study suggested
that, if a child has associated vesicoureteral reflux
<http://emedicine.medscape.com/article/439403-overview>  (VUR), the
benefit of reduced infection risk may be valid support for surgery.12

Another cited indication for circumcision is prevention of STDs.
Numerous case-control studies concerning the relationship between the
foreskin and HIV infection have been published, with inconsistent
results and no definite link. Therefore, it seems that STD prevention is
not a justification for routine circumcision. Of note, of the developed
nations, the United States has one of the highest rates of STDs, HIV
infection, and male circumcision.

Infant circumcision seems to decrease the risk of penile cancer
<http://emedicine.medscape.com/article/446554-overview> ,13 whereas
later circumcision does not. Penile cancer is a rare disease in the
United States, with an incidence of 1.5 per 100,000 people. In
developing countries, the incidence is higher and accounts for up to 10%
of malignancies in some African and South American nations. Although
primarily a disease of older men, penile cancer has been reported in
children. The lowest incidence has been reported in Jews, with a similar
incidence in Muslims; both groups have high rates of neonatal
circumcision.

Daling et al performed a population-based case-control study in 2005
that examined the importance of circumcision in patients with penile
cancer. Preputial status was not found to be a statistically significant
factor in penile cancer. The investigators concluded that the role of
circumcision in penile cancer prevention is unclear.14 Several studies
suggest that poor hygiene may be a stronger risk factor than
circumcision status. Although smegma has been implicated as a
carcinogenic agent, definitive evidence is lacking.

Adult phimosis may be caused by repeated episodes of balanitis or
balanoposthitis. Such infections are commonly due to poor personal
hygiene (failure to regularly clean under the foreskin).

Phimosis may be a presenting symptom of early diabetes mellitus. When
the residual urine of a patient with diabetes mellitus becomes trapped
under the foreskin, the combination of a moist environment and glucose
in the urine may lead to a proliferation of bacteria, with subsequent
infection, scarring, and eventual phimosis.

Buried penis

The penis is properly formed by 16 weeks' gestation. Congenital buried
penis is caused by a developmental anomaly in which the dartos fascia
has not developed into the normal elastic configuration to allow the
penile skin to move freely over the deeper tissues of the penile shaft.
Instead, the dartos layer is inelastic, which prevents the forward
extension of the penis and holds it buried under the pubis.

Other possible contributing factors to congenital buried penis include
excess prepubic fat, scrotal webbing, deficient penile skin, loose skin,
an abnormally low position at which the crura separate, abnormal
attachments between the Buck fascia and the tunica albuginea, and
insufficient attachment of dartos fascia and skin to the Buck fascia.

The pathophysiology of buried penis in adults differs from that in
children and includes iatrogenically induced scar contracture with
concurrent descent of the abdominal fat pad. Because the penis is
suspended from the pubis by the suspensory ligament, it remains fixed,
unlike the prepubic fat. As fat descends over the penis, excessive
moisture and bacterial overgrowth may occur. Chronic infection may lead
to skin maceration and more scar contracture, further aggravating the
problem. In many children, this condition is self-limited. However, in
adults, total body fat content typically increases with age, causing the
buried penis to worsen over time.


   Presentation
Phimosis
Congenital or physiologic phimosis is clinically asymptomatic so is not
a cause for concern. It is often associated with "ballooning" of the
foreskin during voiding. This is a self-limited phenomenon that, in the
absence of pathologic phimosis, does not indicate urinary tract
obstruction <http://emedicine.medscape.com/article/438890-overview> .
Pathologic, or true, phimosis is far less common. Symptoms include skin
irritation, dysuria, bleeding, and occasionally enuresis or urinary
retention. Physical examination usually reveals white cicatricial
scarring at the preputial ring. Meuli et al (1994) devised the following
scoring system to rate the severity of phimosis:15

     * Grade I - Fully retractable prepuce with stenotic ring in the shaft
* Grade II - Partial retractability with partial exposure of the glans
* Grade III - Partial retractability with exposure of the meatus only
* Grade IV - No retractability

Pathologic phimosis may be due to BXO, a genital form of lichen
sclerosus et atrophicus
<http://emedicine.medscape.com/article/1123316-overview> . This
condition affects both men and boys and represents an absolute
indication for circumcision, which may be curative. The etiology of BXO
is unknown, and it may represent a premalignant state. Clinically, it
presents as severe phimosis and possibly meatal stenosis
<http://emedicine.medscape.com/article/1016016-overview> , glanular
lesions, or both.

In older men, when the phimosis is severe, the distal foreskin often
appears swollen and erythematous with cracked fissures (see image
below). Men who are affected report pain and discomfort during sexual
activity or when they attempt to retract the foreskin. Unlike in the
pediatric population, lower urinary tract voiding symptoms are absent.
In older men, acquired phimosis is often associated with poor hygiene
but may be a product of diabetes mellitus.

   [Phimotic foreskin. The distal foreskin is edemato...]   Phimotic
foreskin. The distal foreskin is edematous, with cracked fissures. The
patient was unable to retract the foreskin.   [ CLOSE WINDOW ]
[Phimotic foreskin. The distal foreskin is edemato...]  Phimotic
foreskin. The distal foreskin is edematous, with cracked fissures. The
patient was unable to retract the foreskin.



All uncircumcised adult men should have the foreskin retracted to
exclude occult carcinoma as a part of a complete urologic examination.
Squamous cell carcinoma of the penis
<http://emedicine.medscape.com/article/1102225-overview>  may manifest
as an ulcerated fungating mass of the glans or the prepuce.
Alternatively, carcinoma in situ or penile carcinoma may appear as a
velvety macular lesion of the glans (erythroplasia of Queyrat
<http://emedicine.medscape.com/article/1100317-overview> ) or the penile
shaft (Bowen disease).

Buried penis

Most pediatric cases of buried penis present in neonates or prepubertal
boys. The most common age range of patients at presentation is 6 months
to 1 year. Adolescents who present with buried penis are usually obese,
and weight loss should be advised. Patients may be uncircumcised or
circumcised; the latter complicates repair. One series found that 77% of
children presenting with buried penis had been previously circumcised,
emphasizing a need for pediatric urologists to educate primary care
physicians.

The reasons for presentation vary. Often, parents are concerned because
they are unable to see the penis, which may also complicate proper
hygiene. Occasionally, they may witness ballooning of the foreskin with
voiding, and children may be persistently wet if they are voiding into
the preputial sac.

Adolescents may report dysuria, dribbling between voids, trouble
directing their urinary stream because of difficulty holding the penis,
or embarrassment in the locker room. Some patients have a history of
balanitis and balanoposthitis, and some have undergone a radical
circumcision or even multiple circumcisions.

In addition to some of the symptoms seen in children, adults may present
with sexual complaints. These include painful erection, sexual
embarrassment, and difficulty with vaginal penetration, especially if
the tip of the glans does not project past the male escutcheon. This
condition may lead to the inability to void in a standing position and
may cause the patient to soil himself while urinating in the seated
position. Obesity and diabetes mellitus are commonly associated
comorbidities.

On physical examination, the penis may be concealed because it is buried
in prepubic tissues; buried and enclosed in scrotal tissue (penis
palmatus); trapped by phimosis, traumatic scar tissue, or
postcircumcision cicatrix; or hidden secondary to a large hernia or
hydrocele <http://emedicine.medscape.com/article/438724-overview> . A
smooth transition from prepubic to penile skin indicates a buried penis.
Trapped penis demonstrates a circumferential groove at the base of the
penis. Only Maizels (1986)1 and Burkholder (1983)16 have noted an
association between buried penis and renal anomalies. Other
genitourinary anomalies have not been associated with this condition.


   Indications
Phimosis
The main medical indication for circumcision in children is pathologic
phimosis. In a prospective long-term study, 40% of boys treated for
phimosis were found to have BXO, which has been linked to the
development of penile squamous cell carcinoma (SCC).17 Although potent
topical steroids may allow improvement and slow progression, total
circumcision is the treatment of choice for BXO and may be curative.

Recurrent balanoposthitis, which affects 1% of boys, is also considered
a relative indication for circumcision. However, this condition tends to
be self-limited, and even if balanoposthitis is recurrent,
preputioplasty and topical steroids represent alternatives to
circumcision.18,19,20,21 In patients with balanoposthitis who are
sufficiently troubled to warrant surgical intervention, circumcision is
always curative.

Paraphimosis results from abuse or accident, not disease, of the
foreskin and can be seen at any age. It represents the second most
common indication for adult circumcision. Infants may present with
paraphimosis if their parents have retracted the prepuce and failed to
pull it forward thereafter. Reduction of the foreskin under sedation is
almost always possible. However, in some situations, a dorsal slit or
circumcision is required (see Paraphimosis
<http://emedicine.medscape.com/article/442883-overview> ). Unrecognized
chronic paraphimosis or delay in diagnosis may result in urinary
retention or even penile autoamputation.

Other indications for circumcision that are less common include small
preputial tumors, multiple preputial cysts or condylomas, and penile
lymphedema. A reasonable case may be made for circumcising boys with VUR
who suffer from UTIs. In addition, the foreskin may be removed to
perform a biopsy of lesions hidden under the prepuce or for definitive
radiation therapy for penile cancer.

Occasions arise in which urethral instrumentation—in the form of a
cystoscopy or Foley catheterization—is necessary. This may be quite
problematic in an adult affected by severe phimosis. In such instances,
an emergency bedside dorsal slit can be performed safely and
expeditiously. After being discharged, the patient may proceed to
undergo formal circumcision.

Many circumcisions are performed for social or religious reasons.
Interestingly, only 1 out of 6 schools of Islamic law consider
circumcision obligatory, whereas others feel it is to be recommended.
Among religious Jews, circumcision is felt to be a commandment from
their creator.

In summary, common indications for circumcision include the following:

     * Phimosis     * Paraphimosis     * Recurrent balanitis or
balanoposthitis     * Social or religious reasons

Buried penis

The primary reason that children are referred for correction of the
buried penis is cosmesis. In the neonate, observation seems to be a
viable option. Children younger than 3 years have a 58% chance of
spontaneous resolution. Some pediatric urologists insist that this
condition is a developmental stage that will resolve by puberty and feel
that correction should therefore be deferred. Evidence has shown,
however, that spontaneous resolution does not always occur. Also, in men
and adolescents, measures such as diet and exercise are unlikely to be
effective.

Other authors feel that, after age 3 years, buried penis requires
correction. The primary reason cited is the importance of being able to
void while standing during the period of toilet training. There are
numerous other indications for repair. For example, a concealed penis
can hamper proper hygiene, trap urine, and complicate voiding. This can
lead to repeated infections, secondary phimosis, or even urinary
retention. In addition, numerous investigators feel that children with
buried penis are at risk for psychological and social trauma, even from
an early age. Obese boys with a buried penis may be ostracized by their
peers and withdraw socially. Surgery often relieves anxiety and may
improve self-image.

In adults, buried penis tends to worsen over time as they accumulate
more fat. The cicatricial scar does not loosen on its own over time.
Urinary and sexual complications can greatly affect daily life.
Therefore, surgery is likely necessary in these patients.


   Relevant Anatomy
The penis is composed of paired corpora cavernosa, the crura of which
are attached to the pubic arch, and the corpus spongiosum (see image
below). The proximal portion of the corpus spongiosum is referred to as
the bulb of the penis, and the glans represents the distal expansion.
The urethra traverses the corpus spongiosum to exit at the meatus. The
cavernosal bodies produce the male erection when they are engorged with
blood.

   [Cross-section through the body of the penis.]   Cross-section through
the body of the penis.   [ CLOSE WINDOW ]  [Cross-section through the
body of the penis.]  Cross-section through the body of the penis.

The fascial layers of the penis are continuous with the fascial layers
of the perineum and lower abdomen. Dartos fascia represents the
superficial penile fascia. Deep to this lies the Buck fascia, which
covers the tunica albuginea of the penile bodies. Proximally, the Buck
fascia is in continuity with the suspensory ligament of the penis, which
attaches to the symphysis pubis.

The penis is supplied by a superficial system of arteries that arise
from the external pudendal arteries and a deep system of arteries that
stem from the internal pudendal arteries (see images below). The
superficial blood supply lies in the superficial penile fascia and
supplies the penile skin and prepuce. The internal pudendal artery,
which arises from the hypogastric artery, gives rise to the penile
artery. The penile artery then gives rise to the bulbourethral artery,
the urethral artery, and the cavernous artery (deep artery of the penis)
before terminating as the dorsal artery of the penis.

   [The arterial blood supply of the penis arises fro...]   The arterial
blood supply of the penis arises from the internal pudendal artery. The
internal pudendal artery gives off branches to the bulbar artery,
cavernosal artery, and dorsal penile artery. The bulbar artery continues
on as the bulbourethral artery to supply the urethra. The cavernosal
artery gives rise to the helicine arteries that are end arteries. The
dorsal artery of the penis gives branches off to the circumflex
arteries.   [ CLOSE WINDOW ]  [The arterial blood supply of the penis
arises fro...]  The arterial blood supply of the penis arises from the
internal pudendal artery. The internal pudendal artery gives off
branches to the bulbar artery, cavernosal artery, and dorsal penile
artery. The bulbar artery continues on as the bulbourethral artery to
supply the urethra. The cavernosal artery gives rise to the helicine
arteries that are end arteries. The dorsal artery of the penis gives
branches off to the circumflex arteries.
   [Dorsal view of the arterial and venous blood supp...]   Dorsal view of
the arterial and venous blood supply of the penis.   [ CLOSE WINDOW ]
[Dorsal view of the arterial and venous blood supp...]  Dorsal view of
the arterial and venous blood supply of the penis.



Somatic nerve supply to the penis comes by way of the pudendal nerves,
which eventually produce the dorsal nerves of the penis on each side.
Although cutaneous innervation to the penis is primarily from branches
of the pudendal nerve, the proximal portion is supplied by the
ilioinguinal nerve after it leaves the superficial inguinal ring. The
prepuce has somatosensory innervation by the dorsal nerve of the penis
and branches of the perineal nerve. The glans is primarily innervated by
free nerve endings and has poor fine-touch discrimination.


   Contraindications
Circumcision is generally not performed in children born prematurely or
those with blood dyscrasias
<http://emedicine.medscape.com/article/1160261-overview> . It should not
be performed in children with congenital penile anomalies such as the
following:
     * Hypospadias     * Epispadias     * Chordee     * Penile webbing
* Buried penis


More on Phimosis, Adult Circumcision, and Buried Penis
[http://images.medscape.com/pi/global/ornaments/bg_nav_highlight2.gif]
Overview: Phimosis, Adult Circumcision, and Buried Penis   Treatment:
Phimosis, Adult Circumcision, and Buried Penis
<http://emedicine.medscape.com/article/442617-treatment>   Follow-up:
Phimosis, Adult Circumcision, and Buried Penis
<http://emedicine.medscape.com/article/442617-followup>   Multimedia:
Phimosis, Adult Circumcision, and Buried Penis
<http://emedicine.medscape.com/article/442617-media>


[Non-text portions of this message have been removed]

John:  You might be advised not to jump to conclusions when it comes to
questions of health.   The good Doctor has said that he's not an expert in this
"area", which may account for the reason that many men suffering from this
condition have not contacted him.

Poll men who do suffer from LS, and you will find many who had their foreskin
removed at birth.   Thus, the condition is not necessarily a consequence of
being intact.  Removing the foreskin, as in the case which you offered here,
from Britain, does not solve the problem.

Lichen Sclerosis is a disease which affects body tissue, and it occurs most
often in women.  It may strike almost any area of the body, including the back
and shoulders.

After reading your posts, however, it becomes evident that you are focusing your
interest not on this poor fellow's dilemma, but on an all consuming fascination
with circumcision.   That's not a terribly scientific way to study or resolve
the deleterious effects of disease. Choosing the solution before diagnosing the
source of the problem only complicates the situation.

The medical establishment knows little or nothing about Lichen Sclerosus.  All
current treatments are blind experiments.  Sometimes they work, but most of the
time they don't.







--- In PROCIRCORG@yahoogroups.com, "john m" <johnmurray499@...> wrote:
>
> Hey, Harold:
>
> Thanks so much for the very useful info about lichen sclerosus. I was
particularly pleased that you brought forward the fact that you have never seen
this in circumcised men. Lichen sclerosus is such a destructive condition that
it seems to form yet another compelling piece of evidence for a well-perfromed
circumcison.
>
> Even the English should see the benefit of preventing this dreaded condition.
>
> It was a plesure hearing from you.
>
> Cheers and beers,
>
> John M
> --- In PROCIRCORG@yahoogroups.com, "Harold" <infos@> wrote:
> >
> > Hi again John,
> >
> > Campbell-Walsh's Urology (4 volume version, 2007) is the most up to date
reference source and probably weighs about 30 pounds. A few points, BXO is now
being called "lichen sclerosus." and reputedly could occur in circumcised men,
but I believe this may be a vestige from the uncircumcised state persisting. I
personally have not seen this in circumcised men. This process will invade the
opening of the urethra and may ingress well into the pendulous urethra.
Therefore if suspected cystoscopy and a urethrogram may be in order. Steroids
> > and antibiotics have been recommended but surely do not work consistently.
Also clotrimazole 0.05% (think Lotrimin, antifugal cream) has been instilled.
BXO has also been described in "buried penis" and we saw a nasty case of that
about 4 months ago. Not sure which came first. Couldn't help but feel the dense
intraurethral scarring process may have contributed to inversion.
> >
> > For urethral reconstruction, a buccal graft is recommened as this seems to
be a process of genital skin. A buccal graft taken from the inside of the cheek
is of course unrelated. We are getting well away from using penile skin for
urethral reconstruction as we know only too well the effects of urine on penile
skin.
> >
> > In some instances, lichen sclerosus can progress to squamous cell carcinoma
(cancer for our lay friends).
> >
> > Again, thank you for introducing this excellent topic. I am not a real
expert in this area but I guess when no one has a good cure, there are not too
many experts out there.
> >
> > Cheers to you, and there will always be an England!
> >
> >
> > Harold Reed, M.D.
> >
> >
> > --- In PROCIRCORG@yahoogroups.com, john murray <johnmurray499@> wrote:
> > >
> > >
> > > Hi, Harold:
> > >
> > >
> > >
> > > Thanks for the very complete answer. The man who e-mailed me is in the
U.K. and underwent a circumcision after years of foreskin problems. He informed
me that the frenulum was involved in the disease process and that his urologist
had to do a skin graft to the frenular area. This was a bit of a shock to this
young man, aged 28, after all those years of conservative treatment.
Furthermore, he has done extensive reading and , being aware that his glans has
a number of pale areas, he is querying whether he should also have other
treatments such as topical hormones.
> > >
> > >
> > >
> > > I told him I would contact you but, in the interim, I was quite sure that
surgery was the most definitive treatment and he has already had that. As a
retired G.P, I hate to sound too pompous to theses young guys but I keep
thinking what a pity it is that he did not a a well-done circumcision many years
ago
> > > I really believe the Brits have gone way too far in the anti-circ
direction and that in the u.S. he would have received far better care(or in
Canada, for that matter, whcih is where I live.
> > >
> > >
> > >
> > > Thanks for listening to my rant , Harold.
> > >
> > >
> > >
> > > Have a onderful weekend
> > >
> > >
> > >
> > > Cheers
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > John
> > >
> > >
> > >
> > >
> > >
> > > > To: PROCIRCORG@yahoogroups.com
> > > > From: infos@
> > > > Date: Sat, 12 Dec 2009 12:09:21 +0000
> > > > Subject: [PROCIRCORG] Re: BXO
> > > >
> > > > Hello John,
> > > >
> > > > Hardly a month goes by when we don't see a bonafide case of BXO.
> > > >
> > > > (from Wikipedia)
> > > > Therapy focuses on prevention of disease progression.
> > > > Shelley reported some success with long-term antibiotic therapy.
However, relapses were seen upon stopping treatment.
> > > > Some success has been reported with topical steroids, when scarring is
minimal, though some have found this ineffectual.
> > > > Moderate therapeutic results have been reported using etretinate.
> > > > Some success has been reported in the use of carbon dioxide laser
therapy.
> > > >
> > > > Many authors report that circumcision is the treatment of choice, with
modifications if necessary. Pasieczny suggests testosterone ointment, however.
> > > >
> > > > Glansectomy may be required, but that would be unsuual. Invasion into
the urethra and urethral strictures (narrowing) is not uncommon. We have tried 5
FU cream in one patient, but if you read comments, there is no truly 100%
effective treatment.
> > > >
> > > > Could be a pre-malignant situation. Now that his glans is clearly
exposed, he should map out his glans with a ruler in millimeters and note any
changes in demarcation. If advancing, back to the urologist.
> > > >
> > > > Excision and letting the covered tissues see the light of day is still
our first line approach.
> > > >
> > > >
> > > > Have a restful weekend,
> > > >
> > > >
> > > > Harold M. Reed, M.D.
> > > >
> > > >
> > > > --- In PROCIRCORG@yahoogroups.com, "john m" <johnmurray499@> wrote:
> > > > >
> > > > > Hello, Dr. Reed:
> > > > >
> > > > > I am one of several moderators on Inter-Circ. Today I had a post from
an adult who was circumcised for BXO. Because he has some distortion and whitish
areas on his glans and the frenaulr area, he is keen to find out antyhing he can
about the latest and most efficacious treatments for BXO.
> > > > >
> > > > > I wonder if you would care to comment about this or if I may refer him
to your group. CErtainly I can understand his concern over this very distressing
disorder.If this is accpetable to you, I should be pleased to forward his
original post to me.
> > > > > Thanks in advance for your care and concern in perfroming excellent
adult circumcisions
> > > > >
> > > > > cheers,
> > > > >
> > > > > John M
> > > > >
> > > >
> > > >
> > > >
> > > >
> > > > ------------------------------------
> > > >
> > > > Yahoo! Groups Links
> > > >
> > > >
> > > >
> > >
> > > _________________________________________________________________
> > > Windows Live: Keep your friends up to date with what you do online.
> > > http://go.microsoft.com/?linkid=9691815
> > >
> > > [Non-text portions of this message have been removed]
> > >
> >
>

--- On Mon, 14/12/09, pat nybili <nybili@...> wrote:


From: pat nybili <nybili@...>
Subject: [PROCIRCORG] Fw: South Africa Zulus to revive circumcision to fight
AIDS ... [BBC news]
To: PROCIRCORG@yahoogroups.com
Date: Monday, 14 December, 2009, 6:11 PM


 



Compliments of Dr Morris.

pat

----- Forwarded Message ----
From: Brian Morris <brianm@medsci. usyd.edu. au>
To: brianm@medsci. usyd.edu. au
Sent: Tue, December 8, 2009 7:08:48 PM
Subject: South Africa Zulus to revive circumcision to fight AIDS ... [BBC news]

South Africa Zulus to revive circumcision to fight
AIDS ..
http://news. bbc.co.uk/ 2/hi/africa/ 8399487.stm

South Africa Zulus to revive circumcision to
fight AIDS
Zulu King Goodwill Zwelithini , file image
King Goodwill Zwelithini's region is one of the worst-affected by
Aids

The king of South Africa's Zulus has proposed reintroducing
circumcision - formerly practised as a ritual by Zulus - to help fight
the spread of HIV/AIDS.

The authorities are reportedly in talks with King Goodwill Zwelithini
on how to bring back the practice.

It was banned by King Shaka in the 19th Century because he said it
robbed him of young warriors for months at a time.

Some studies suggest circumcising men can halve their chances of
contracting the AIDS virus.

However, experts stress that the best way to avoid becoming infected
with HIV during sexual encounters is to use cond.oms.

Overall more than five million South Africans are infected with HIV -
the highest number of infections for a single country.

President Jacob Zuma recently announced major changes to the AIDS
policy which have been welcome by society and AIDS activists.

Positive reaction

Kwa-Zulu Natal Province has one of the highest HIV infection rates of
any South African province.

Addressing a Zulu festival, King Goodwill suggested his solution
to the problem.

"In the context of the fight against HIV and AIDS, I should
announce my intention to revive the practice of circumcision amongst
young men," Sapa news agency quoted him as saying.

Kwa-Zulu Natal's regional head Zweli Mkhize welcomed the king's
call.

"Circumcision will assist in the fight against the pandemic,
although on its own does not prevent the spread of sexual transmitted
diseases," Sapa quoted him as saying.

AFP news agency reported that the authorities in KwaZulu-Natal were in
talks with the king about the practicalities of reintroducing
circumcision.

The king's suggestion came as Zulu ceremonies were under scrutiny for
a different reason.

He was addressing Zulus gathered for the Ukweshwama ceremony - a
thanksgiving festival where young men kill a bull with their hands as
a rite of passage.

Animal Rights Africa bitterly criticised the practice as "cruel"
and "protracted" but the group lost a legal bid on Friday to
have the festival banned.

AIDS IN SOUTH AFRICA
5.2m people with HIV
17% of people aged 15-49 HIV-positive
1.5m adults need AIDS drugs in 2009
106,000 children under 15 need ARVs
413,000 new infections in 2009
59,000 of these are children

Source: Statistics South Africa
--

Brian J. Morris, PhD DSc
FAHA
Professor of Molecular Medical
Sciences
School of Medical Sciences and
Bosch Institute (F13)
Sydney Medical
School
The University of
Sydney
Sydney NSW 2006
Australia

DISCLAIMER: Any views or opinions
presented in this email are those of the author and do not necessarily
represent those of The University of Sydney unless explicitly stated
otherwise. In relation to University of Sydney policy, it should
be noted that if the subject matter of this email could relate
to a topic that the academic concerned is an expert on, that the
University of Sydney does not have a policy on every area of
academic interest, and that, as such, unless stated
specifically to the contrary, nothing in this email should be
deemed to represent a policy of The University of Sydney.

[Non-text portions of this message have been removed]









       The INTERNET now has a personality. YOURS! See your Yahoo! Homepage.
http://in.yahoo.com/

[Non-text portions of this message have been removed]

Compliments of Dr Morris.

pat



----- Forwarded Message ----
From: Brian Morris <brianm@...>
To: brianm@...
Sent: Tue, December 8, 2009 7:08:48 PM
Subject: South Africa Zulus to revive circumcision to fight AIDS ... [BBC news]

South Africa Zulus to revive circumcision to fight
AIDS ..
http://news.bbc.co.uk/2/hi/africa/8399487.stm


South Africa Zulus to revive circumcision to
fight AIDS
Zulu King Goodwill Zwelithini , file image
King Goodwill Zwelithini's region is one of the worst-affected by
Aids

The king of South Africa's Zulus has proposed reintroducing
circumcision - formerly practised as a ritual by Zulus - to help fight
the spread of HIV/AIDS.

The authorities are reportedly in talks with King Goodwill Zwelithini
on how to bring back the practice.

It was banned by King Shaka in the 19th Century because he said it
robbed him of young warriors for months at a time.

Some studies suggest circumcising men can halve their chances of
contracting the AIDS virus.

However, experts stress that the best way to avoid becoming infected
with HIV during sexual encounters is to use cond.oms.

Overall more than five million South Africans are infected with HIV -
the highest number of infections for a single country.

President Jacob Zuma recently announced major changes to the AIDS
policy which have been welcome by society and AIDS activists.

Positive reaction

Kwa-Zulu Natal Province has one of the highest HIV infection rates of
any South African province.

Addressing a Zulu festival, King Goodwill suggested his solution
to the problem.

"In the context of the fight against HIV and AIDS, I should
announce my intention to revive the practice of circumcision amongst
young men," Sapa news agency quoted him as saying.

Kwa-Zulu Natal's regional head Zweli Mkhize welcomed the king's
call.

"Circumcision will assist in the fight against the pandemic,
although on its own does not prevent the spread of sexual transmitted
diseases," Sapa quoted him as saying.

AFP news agency reported that the authorities in KwaZulu-Natal were in
talks with the king about the practicalities of reintroducing
circumcision.

The king's suggestion came as Zulu ceremonies were under scrutiny for
a different reason.

He was addressing Zulus gathered for the Ukweshwama ceremony - a
thanksgiving festival where young men kill a bull with their hands as
a rite of passage.

Animal Rights Africa bitterly criticised the practice as "cruel"
and "protracted" but the group lost a legal bid on Friday to
have the festival banned.


AIDS IN SOUTH AFRICA
5.2m people with HIV
17% of people aged 15-49 HIV-positive
1.5m adults need AIDS drugs in 2009
106,000 children under 15 need ARVs
413,000 new infections in 2009
59,000 of these are children

Source: Statistics South Africa
--



Brian J. Morris, PhD DSc
FAHA
Professor of Molecular Medical
Sciences
School of Medical Sciences and
Bosch Institute (F13)
Sydney Medical
School
The University of
Sydney
Sydney NSW 2006
Australia



DISCLAIMER: Any views or opinions
presented in this email are those of the author and do not necessarily
represent those of The University of Sydney unless explicitly stated
otherwise. In relation to  University of Sydney policy, it should
be noted that if the subject matter of this email could  relate
to a topic that the academic concerned is an expert on,  that the
University of Sydney does not have a policy on  every area of
academic  interest, and that, as such, unless stated
specifically  to the contrary, nothing in this email should be
deemed to represent a policy of The University of Sydney.




[Non-text portions of this message have been removed]

Compliments of Joshua Amos

pat



----- Forwarded Message ----
From: the_joshua_a <joshua_amos@...>
To: unashamedly_procirc@yahoogroups.com
Sent: Sat, December 12, 2009 7:15:46 AM
Subject: [unashamedly_procirc] DOES CIRCUMCISION AFFECT MALE'S PERCEPTION OF
SEXUAL SATISFACTION?


Arch Esp Urol. 2009 Nov;62(9):733- 736.

DOES CIRCUMCISION AFFECT MALE'S PERCEPTION OF SEXUAL SATISFACTION?

[Article in English, Spanish]
Cortés-González JR, Arratia-Maqueo JA, Martínez-Montelongo R, Gómez-Guerra
LS.
Urology Department. Hospital Universitario "Dr. Jose E. Gonzalez" UANL.
Monterrey NL. Mexico.

OBJECTIVES: To evaluate the effect of circumcision on sexual satisfaction
perception in males with stable sexual partners.

METHODS: Twenty two heterosexual male adults, sexually active with a stable
partner, scheduled for circumcision for medical (MR) or esthetic reasons (ER) at
our clinic between June 2005 and June 2006 were included in this study. Men with
severe erectile dysfunction (ED) were excluded from the study. These men were
surveyed to assess erectile function, penile sensitivity, esthetical pen1s'
appearance, sexual activity and overall satisfaction before the procedure and 12
weeks after. Categorical scores were evaluated with Chi square.

RESULTS: Surgical indications were: Phimosis 50%, balanitis 18.2%, condyloma
13.6% and esthetics 13.6%. After the procedure 82% of patients reported an
increase in the quality of their sexual intercourse, 4.5% reported it diminished
and 13.5% reported no change at all. 95.5% of the patients felt better with the
appearance of their pen1s. Almost all areas of sexual satisfaction weren't
statistical significant except for the improvement in erectile function (p =
0.0007) and perception of sexual events (p = 0.04). This improvement on erectile
function was reported as shifts from mild to normal on International Index of
Erectile Function 5 scores. Premature ejaculation was observed in 31.8%(7)
before the procedure and diminished to 13.6%(3).

CONCLUSION: Because of our statistic limitations and mixed indications for
circumcision in the study, we cannot conclude that circumcision might bring
certain benefit on sexual satisfaction by itself but it certainly does not bring
about deleterious effects and, when dissatisfaction is associated with local
problems, some benefit could be expected.

PMID: 19955598 [PubMed - as supplied by publisher]







[Non-text portions of this message have been removed]

I will second John's remark.

Pat




________________________________
From: John Public <johnpublic77@...>
To: PROCIRCORG@yahoogroups.com
Sent: Fri, December 11, 2009 9:02:16 AM
Subject: Re: [PROCIRCORG] Re: Adult Circumcision



Stu, I was circ'd as an adult and couldn't wait to get rid of that nasty
foreskin.
It's been over 30 years and I couldn't be more delighted.
I think you will find a lot of happily circ'd guys here.

Also check out Inter-Circ@yahoogro ups.com.  There are a lot of guys circ'd
as adults telling their stories.

Good luck.

j

--- On Mon, 12/7/09, Abnobaco <abnobaco@yahoo. com> wrote:

From: Abnobaco <abnobaco@yahoo. com>
Subject: [PROCIRCORG] Re: Adult Circumcision
To: PROCIRCORG@yahoogro ups.com
Date: Monday, December 7, 2009, 1:13 PM



Stu,

I don't think you are going to like my advice,  I am turning 40 this year and
had a circumcision when i was 25.  I was very happy with the results until the
beginning of this year, and had a wonderfull sex life to.

But since January, I started loosing sensation to the point that I could not
feel anything during intercourse up until I am ejaculating.

After a lot of research, I have found that the head dries out and even cracks
because of the irritation that your clothes cause, the skin thickens to protect
the nerve endings.

I would suggest that you talk to some guys that were cut as adults and had it
for more that 15 years.

And this happens to most of us.  I would suggest before you go through with the
procedure.  Go and read this:

http://www.newfores kin.biz/members/ framesetMain. htm

I am 3 months into restoring my foreskin just to have a normal sex life again.

--- In PROCIRCORG@yahoogro ups.com, "S" <stu5678@... > wrote:

>

> Hi,

>

> I am in my late 40s an UK based in the west. I have always wanted to be
circumcised. This is just for personal reasons, cosmetic and hygiene.

>

> I have for many years worn my foreskin permanently back so to all intent and
purposes this is just making the current situation permanent.

>

> I am well aware that there are a number of experienced doctors in the London
area who perform circumcisions. I have heard of a clinic in Cardiff
www.circumcisioncli nic.net run by Mr. Khan a surgeon in the NHS. This would be
much more convenient for me.

>

> I have spoken to him on the phone and he has confirmed to me that he would be
prepared to undertake the procedure on me for personal reasons.

>

> Do any UK based members have any experience of this clinic. I believe he does
a proper sleeve resection rather than using forceps or a clamp and he did tell
he could place the scar as I wanted.

>

> Any advice would be most welcome.

>

> Stu

>

[Non-text portions of this message have been removed]







[Non-text portions of this message have been removed]

I will be having my circ done soon with Dr. Reed, and plan
to recover during the holidays.

Dag

Hey, Harold:

Thanks so much for the very useful info about lichen sclerosus. I was
particularly pleased that you brought forward the fact that you have never seen
this in circumcised men. Lichen sclerosus is such a destructive condition that
it seems to form yet another compelling piece of evidence for a well-perfromed
circumcison.

Even the English should see the benefit of preventing this dreaded condition.

It was a plesure hearing from you.

Cheers and beers,

John M
--- In PROCIRCORG@yahoogroups.com, "Harold" <infos@...> wrote:
>
> Hi again John,
>
> Campbell-Walsh's Urology (4 volume version, 2007) is the most up to date
reference source and probably weighs about 30 pounds. A few points, BXO is now
being called "lichen sclerosus." and reputedly could occur in circumcised men,
but I believe this may be a vestige from the uncircumcised state persisting. I
personally have not seen this in circumcised men. This process will invade the
opening of the urethra and may ingress well into the pendulous urethra.
Therefore if suspected cystoscopy and a urethrogram may be in order. Steroids
> and antibiotics have been recommended but surely do not work consistently.
Also clotrimazole 0.05% (think Lotrimin, antifugal cream) has been instilled.
BXO has also been described in "buried penis" and we saw a nasty case of that
about 4 months ago. Not sure which came first. Couldn't help but feel the dense
intraurethral scarring process may have contributed to inversion.
>
> For urethral reconstruction, a buccal graft is recommened as this seems to be
a process of genital skin. A buccal graft taken from the inside of the cheek is
of course unrelated. We are getting well away from using penile skin for
urethral reconstruction as we know only too well the effects of urine on penile
skin.
>
> In some instances, lichen sclerosus can progress to squamous cell carcinoma
(cancer for our lay friends).
>
> Again, thank you for introducing this excellent topic. I am not a real expert
in this area but I guess when no one has a good cure, there are not too many
experts out there.
>
> Cheers to you, and there will always be an England!
>
>
> Harold Reed, M.D.
>
>
> --- In PROCIRCORG@yahoogroups.com, john murray <johnmurray499@> wrote:
> >
> >
> > Hi, Harold:
> >
> >
> >
> > Thanks for the very complete answer. The man who e-mailed me is in the U.K.
and underwent a circumcision after years of foreskin problems. He informed me
that the frenulum was involved in the disease process and that his urologist had
to do a skin graft to the frenular area. This was a bit of a shock to this young
man, aged 28, after all those years of conservative treatment. Furthermore, he
has done extensive reading and , being aware that his glans has a number of pale
areas, he is querying whether he should also have other treatments such as
topical hormones.
> >
> >
> >
> > I told him I would contact you but, in the interim, I was quite sure that
surgery was the most definitive treatment and he has already had that. As a
retired G.P, I hate to sound too pompous to theses young guys but I keep
thinking what a pity it is that he did not a a well-done circumcision many years
ago
> > I really believe the Brits have gone way too far in the anti-circ direction
and that in the u.S. he would have received far better care(or in Canada, for
that matter, whcih is where I live.
> >
> >
> >
> > Thanks for listening to my rant , Harold.
> >
> >
> >
> > Have a onderful weekend
> >
> >
> >
> > Cheers
> >
> >
> >
> >
> >
> >
> >
> > John
> >
> >
> >
> >
> >
> > > To: PROCIRCORG@yahoogroups.com
> > > From: infos@
> > > Date: Sat, 12 Dec 2009 12:09:21 +0000
> > > Subject: [PROCIRCORG] Re: BXO
> > >
> > > Hello John,
> > >
> > > Hardly a month goes by when we don't see a bonafide case of BXO.
> > >
> > > (from Wikipedia)
> > > Therapy focuses on prevention of disease progression.
> > > Shelley reported some success with long-term antibiotic therapy. However,
relapses were seen upon stopping treatment.
> > > Some success has been reported with topical steroids, when scarring is
minimal, though some have found this ineffectual.
> > > Moderate therapeutic results have been reported using etretinate.
> > > Some success has been reported in the use of carbon dioxide laser therapy.
> > >
> > > Many authors report that circumcision is the treatment of choice, with
modifications if necessary. Pasieczny suggests testosterone ointment, however.
> > >
> > > Glansectomy may be required, but that would be unsuual. Invasion into the
urethra and urethral strictures (narrowing) is not uncommon. We have tried 5 FU
cream in one patient, but if you read comments, there is no truly 100% effective
treatment.
> > >
> > > Could be a pre-malignant situation. Now that his glans is clearly exposed,
he should map out his glans with a ruler in millimeters and note any changes in
demarcation. If advancing, back to the urologist.
> > >
> > > Excision and letting the covered tissues see the light of day is still our
first line approach.
> > >
> > >
> > > Have a restful weekend,
> > >
> > >
> > > Harold M. Reed, M.D.
> > >
> > >
> > > --- In PROCIRCORG@yahoogroups.com, "john m" <johnmurray499@> wrote:
> > > >
> > > > Hello, Dr. Reed:
> > > >
> > > > I am one of several moderators on Inter-Circ. Today I had a post from an
adult who was circumcised for BXO. Because he has some distortion and whitish
areas on his glans and the frenaulr area, he is keen to find out antyhing he can
about the latest and most efficacious treatments for BXO.
> > > >
> > > > I wonder if you would care to comment about this or if I may refer him
to your group. CErtainly I can understand his concern over this very distressing
disorder.If this is accpetable to you, I should be pleased to forward his
original post to me.
> > > > Thanks in advance for your care and concern in perfroming excellent
adult circumcisions
> > > >
> > > > cheers,
> > > >
> > > > John M
> > > >
> > >
> > >
> > >
> > >
> > > ------------------------------------
> > >
> > > Yahoo! Groups Links
> > >
> > >
> > >
> >
> > _________________________________________________________________
> > Windows Live: Keep your friends up to date with what you do online.
> > http://go.microsoft.com/?linkid=9691815
> >
> > [Non-text portions of this message have been removed]
> >
>

Hi again John,

Campbell-Walsh's Urology (4 volume version, 2007) is the most up to date
reference source and probably weighs about 30 pounds. A few points, BXO is now
being called "lichen sclerosus." and reputedly could occur in circumcised men,
but I believe this may be a vestige from the uncircumcised state persisting. I
personally have not seen this in circumcised men. This process will invade the
opening of the urethra and may ingress well into the pendulous urethra.
Therefore if suspected cystoscopy and a urethrogram may be in order. Steroids
and antibiotics have been recommended but surely do not work consistently. Also
clotrimazole 0.05% (think Lotrimin, antifugal cream) has been instilled. BXO has
also been described in "buried penis" and we saw a nasty case of that about 4
months ago. Not sure which came first. Couldn't help but feel the dense
intraurethral scarring process may have contributed to inversion.

For urethral reconstruction, a buccal graft is recommened as this seems to be a
process of genital skin. A buccal graft taken from the inside of the cheek is of
course unrelated. We are getting well away from using penile skin for urethral
reconstruction as we know only too well the effects of urine on penile skin.

In some instances, lichen sclerosus can progress to squamous cell carcinoma
(cancer for our lay friends).

Again, thank you for introducing this excellent topic. I am not a real expert in
this area but I guess when no one has a good cure, there are not too many
experts out there.

Cheers to you, and there will always be an England!


Harold Reed, M.D.


--- In PROCIRCORG@yahoogroups.com, john murray <johnmurray499@...> wrote:
>
>
> Hi, Harold:
>
>
>
> Thanks for the very complete answer. The man who e-mailed me is in the U.K.
and underwent a circumcision after years of foreskin problems. He informed me
that the frenulum was involved in the disease process and that his urologist had
to do a skin graft to the frenular area. This was a bit of a shock to this young
man, aged 28, after all those years of conservative treatment. Furthermore, he
has done extensive reading and , being aware that his glans has a number of pale
areas, he is querying whether he should also have other treatments such as
topical hormones.
>
>
>
> I told him I would contact you but, in the interim, I was quite sure that
surgery was the most definitive treatment and he has already had that. As a
retired G.P, I hate to sound too pompous to theses young guys but I keep
thinking what a pity it is that he did not a a well-done circumcision many years
ago
> I really believe the Brits have gone way too far in the anti-circ direction
and that in the u.S. he would have received far better care(or in Canada, for
that matter, whcih is where I live.
>
>
>
> Thanks for listening to my rant , Harold.
>
>
>
> Have a onderful weekend
>
>
>
> Cheers
>
>
>
>
>
>
>
> John
>
>
>
>
>
> > To: PROCIRCORG@yahoogroups.com
> > From: infos@...
> > Date: Sat, 12 Dec 2009 12:09:21 +0000
> > Subject: [PROCIRCORG] Re: BXO
> >
> > Hello John,
> >
> > Hardly a month goes by when we don't see a bonafide case of BXO.
> >
> > (from Wikipedia)
> > Therapy focuses on prevention of disease progression.
> > Shelley reported some success with long-term antibiotic therapy. However,
relapses were seen upon stopping treatment.
> > Some success has been reported with topical steroids, when scarring is
minimal, though some have found this ineffectual.
> > Moderate therapeutic results have been reported using etretinate.
> > Some success has been reported in the use of carbon dioxide laser therapy.
> >
> > Many authors report that circumcision is the treatment of choice, with
modifications if necessary. Pasieczny suggests testosterone ointment, however.
> >
> > Glansectomy may be required, but that would be unsuual. Invasion into the
urethra and urethral strictures (narrowing) is not uncommon. We have tried 5 FU
cream in one patient, but if you read comments, there is no truly 100% effective
treatment.
> >
> > Could be a pre-malignant situation. Now that his glans is clearly exposed,
he should map out his glans with a ruler in millimeters and note any changes in
demarcation. If advancing, back to the urologist.
> >
> > Excision and letting the covered tissues see the light of day is still our
first line approach.
> >
> >
> > Have a restful weekend,
> >
> >
> > Harold M. Reed, M.D.
> >
> >
> > --- In PROCIRCORG@yahoogroups.com, "john m" <johnmurray499@> wrote:
> > >
> > > Hello, Dr. Reed:
> > >
> > > I am one of several moderators on Inter-Circ. Today I had a post from an
adult who was circumcised for BXO. Because he has some distortion and whitish
areas on his glans and the frenaulr area, he is keen to find out antyhing he can
about the latest and most efficacious treatments for BXO.
> > >
> > > I wonder if you would care to comment about this or if I may refer him to
your group. CErtainly I can understand his concern over this very distressing
disorder.If this is accpetable to you, I should be pleased to forward his
original post to me.
> > > Thanks in advance for your care and concern in perfroming excellent adult
circumcisions
> > >
> > > cheers,
> > >
> > > John M
> > >
> >
> >
> >
> >
> > ------------------------------------
> >
> > Yahoo! Groups Links
> >
> >
> >
>
> _________________________________________________________________
> Windows Live: Keep your friends up to date with what you do online.
> http://go.microsoft.com/?linkid=9691815
>
> [Non-text portions of this message have been removed]
>

Hi, Harold:



Thanks for the very complete answer. The man who e-mailed me is in the U.K. and
underwent a circumcision after years of foreskin problems. He informed me that
the frenulum was involved in the disease process and that his urologist had to
do a skin graft to the frenular area. This was a bit of a shock to this young
man, aged 28, after all those years of conservative treatment. Furthermore, he
has done extensive reading and , being aware that his glans has a number of pale
areas, he is querying whether he should also have other treatments such as
topical hormones.



I told him I would contact you but, in the interim, I was quite sure that
surgery was the most definitive treatment and he has already had that. As a
retired G.P, I hate to sound too pompous to theses young guys but I keep
thinking what a pity it is that he did not a a well-done circumcision many years
ago
I really believe the Brits have gone way too far in the anti-circ direction and
that in the u.S. he would have received far better care(or in Canada, for that
matter, whcih is where I live.



Thanks for listening to my rant , Harold.



Have a onderful weekend



Cheers







John





> To: PROCIRCORG@yahoogroups.com
> From: infos@...
> Date: Sat, 12 Dec 2009 12:09:21 +0000
> Subject: [PROCIRCORG] Re: BXO
>
> Hello John,
>
> Hardly a month goes by when we don't see a bonafide case of BXO.
>
> (from Wikipedia)
> Therapy focuses on prevention of disease progression.
> Shelley reported some success with long-term antibiotic therapy. However,
relapses were seen upon stopping treatment.
> Some success has been reported with topical steroids, when scarring is
minimal, though some have found this ineffectual.
> Moderate therapeutic results have been reported using etretinate.
> Some success has been reported in the use of carbon dioxide laser therapy.
>
> Many authors report that circumcision is the treatment of choice, with
modifications if necessary. Pasieczny suggests testosterone ointment, however.
>
> Glansectomy may be required, but that would be unsuual. Invasion into the
urethra and urethral strictures (narrowing) is not uncommon. We have tried 5 FU
cream in one patient, but if you read comments, there is no truly 100% effective
treatment.
>
> Could be a pre-malignant situation. Now that his glans is clearly exposed, he
should map out his glans with a ruler in millimeters and note any changes in
demarcation. If advancing, back to the urologist.
>
> Excision and letting the covered tissues see the light of day is still our
first line approach.
>
>
> Have a restful weekend,
>
>
> Harold M. Reed, M.D.
>
>
> --- In PROCIRCORG@yahoogroups.com, "john m" <johnmurray499@...> wrote:
> >
> > Hello, Dr. Reed:
> >
> > I am one of several moderators on Inter-Circ. Today I had a post from an
adult who was circumcised for BXO. Because he has some distortion and whitish
areas on his glans and the frenaulr area, he is keen to find out antyhing he can
about the latest and most efficacious treatments for BXO.
> >
> > I wonder if you would care to comment about this or if I may refer him to
your group. CErtainly I can understand his concern over this very distressing
disorder.If this is accpetable to you, I should be pleased to forward his
original post to me.
> > Thanks in advance for your care and concern in perfroming excellent adult
circumcisions
> >
> > cheers,
> >
> > John M
> >
>
>
>
>
> ------------------------------------
>
> Yahoo! Groups Links
>
>
>

_________________________________________________________________
Windows Live: Keep your friends up to date with what you do online.
http://go.microsoft.com/?linkid=9691815

[Non-text portions of this message have been removed]

Hello John,

Hardly a month goes by when we don't see a bonafide case of BXO.

(from Wikipedia)
Therapy focuses on prevention of disease progression.
Shelley reported some success with long-term antibiotic therapy. However,
relapses were seen upon stopping treatment.
Some success has been reported with topical steroids, when scarring is minimal,
though some have found this ineffectual.
Moderate therapeutic results have been reported using etretinate.
Some success has been reported in the use of carbon dioxide laser therapy.

Many authors report that circumcision is the treatment of choice, with
modifications if necessary. Pasieczny suggests testosterone ointment, however.

Glansectomy may be required, but that would be unsuual.  Invasion into the
urethra and urethral strictures (narrowing) is not uncommon.  We have tried 5 FU
cream in one patient, but if you read comments, there is no truly 100% effective
treatment.

Could be a pre-malignant situation.  Now that his glans is clearly exposed, he
should map out his glans with a ruler in millimeters and note any changes in
demarcation.  If advancing, back to the urologist.

Excision and letting the covered tissues see the light of day is still our first
line approach.


Have a restful weekend,


Harold M. Reed, M.D.


--- In PROCIRCORG@yahoogroups.com, "john m" <johnmurray499@...> wrote:
>
> Hello, Dr. Reed:
>
> I am one of several moderators on Inter-Circ. Today I had a post from an adult
who was circumcised for BXO. Because he has some distortion and whitish areas on
his glans and the frenaulr area, he is keen to find out antyhing he can about
the latest and most efficacious treatments for BXO.
>
> I wonder if you would care to comment about this or if I may refer him to your
group. CErtainly I can understand his concern over this very distressing
disorder.If this is accpetable to you, I should be pleased to forward his
original post to me.
> Thanks in advance for your care and concern in perfroming excellent adult
circumcisions
>
> cheers,
>
> John M
>

There's more to penile hygiene, minimizing acquiring STD, etc. than removal of
the frenulum.  Take care of little Richard and have a properly performed
cosmetic circumcision.

Harold M. Reed, M.D.
infos@...
305-865-2000

--- In PROCIRCORG@yahoogroups.com, "idlethree" <idlethree@...> wrote:
>
> Hi I just became a member of this group in hopes of obtaining some more info
on getting circ'd as an adult. I recently had a frenuloplasty done but the
result hasn't made life any more enjoyable as my foreskin is still causing
problems. Getting circumcised has been on my mind for several years now so
hopefully I can make a final decision soon. However, I live in western canada
and I'm not sure how long the waitlist is or who I should talk to first. Any
thoughts or suggestions would be greatly appreciated.
>
> Thanks
>

Could you please tell me step by step how you got that look.

Glove leather is my favorite, but chamois is OK too.  I am sure a lot of folks
would like to touch you.


Hazelton



--- In PROCIRCORG@yahoogroups.com, "energizerbunnywabbit30"
<energizerbunnywabbit30@...> wrote:
>
> I was circumcised a few years ago............and it was the worst decision I
ever made............mine was too tight and the head got like leather and I had
what looked like skin peeling constantly........until I restored my foreskin to
cover the head when I am flaccid..........
>
> --- In PROCIRCORG@yahoogroups.com, "S" <stu5678@> wrote:
> >
> > Hi,
> >
> > I am in my late 40s an UK based in the west. I have always wanted to be
circumcised. This is just for personal reasons, cosmetic and hygiene.
> >
> > I have for many years worn my foreskin permanently back so to all intent and
purposes this is just making the current situation permanent.
> >
> > I am well aware that there are a number of experienced doctors in the London
area who perform circumcisions. I have heard of a clinic in Cardiff
www.circumcisionclinic.net run by Mr. Khan a surgeon in the NHS. This would be
much more convenient for me.
> >
> > I have spoken to him on the phone and he has confirmed to me that he would
be prepared to undertake the procedure on me for personal reasons.
> >
> > Do any UK based members have any experience of this clinic. I believe he
does a proper sleeve resection rather than using forceps or a clamp and he did
tell he could place the scar as I wanted.
> >
> > Any advice would be most welcome.
> >
> > Stu
> >
>

Rabbits should not be circumcised.  I can tell you that atraight out.
Their skin will turn to leather and will peel like an onion.  If you were born
in the year of the rabbit, look for a hare.  If you see one, please let the
waiter know.

Donald Duck


--- In PROCIRCORG@yahoogroups.com, "energizerbunnywabbit30"
<energizerbunnywabbit30@...> wrote:
>
> I was circumcised a few years ago............and it was the worst decision I
ever made............mine was too tight and the head got like leather and I had
what looked like skin peeling constantly........until I restored my foreskin to
cover the head when I am flaccid..........
>
> --- In PROCIRCORG@yahoogroups.com, "S" <stu5678@> wrote:
> >
> > Hi,
> >
> > I am in my late 40s an UK based in the west. I have always wanted to be
circumcised. This is just for personal reasons, cosmetic and hygiene.
> >
> > I have for many years worn my foreskin permanently back so to all intent and
purposes this is just making the current situation permanent.
> >
> > I am well aware that there are a number of experienced doctors in the London
area who perform circumcisions. I have heard of a clinic in Cardiff
www.circumcisionclinic.net run by Mr. Khan a surgeon in the NHS. This would be
much more convenient for me.
> >
> > I have spoken to him on the phone and he has confirmed to me that he would
be prepared to undertake the procedure on me for personal reasons.
> >
> > Do any UK based members have any experience of this clinic. I believe he
does a proper sleeve resection rather than using forceps or a clamp and he did
tell he could place the scar as I wanted.
> >
> > Any advice would be most welcome.
> >
> > Stu
> >
>

You must be unique I was circumcised 36 years ago and my glans is still
sensitive and works well. I would never want a foreskin back!
Neville in England
PS My Circumcision was the best decision I ever made
----- Original Message -----
From: "energizerbunnywabbit30" <energizerbunnywabbit30@...>
To: <PROCIRCORG@yahoogroups.com>
Sent: Monday, December 07, 2009 12:56 AM
Subject: [PROCIRCORG] Re: Adult Circumcision


>I was circumcised a few years ago............and it was the worst decision
>I ever made............mine was too tight and the head got like leather and
>I had what looked like skin peeling constantly........until I restored my
>foreskin to cover the head when I am flaccid..........
>
> --- In PROCIRCORG@yahoogroups.com, "S" <stu5678@...> wrote:
>>
>> Hi,
>>
>> I am in my late 40s an UK based in the west. I have always wanted to be
>> circumcised. This is just for personal reasons, cosmetic and hygiene.
>>
>> I have for many years worn my foreskin permanently back so to all intent
>> and purposes this is just making the current situation permanent.
>>
>> I am well aware that there are a number of experienced doctors in the
>> London area who perform circumcisions. I have heard of a clinic in
>> Cardiff www.circumcisionclinic.net run by Mr. Khan a surgeon in the NHS.
>> This would be much more convenient for me.
>>
>> I have spoken to him on the phone and he has confirmed to me that he
>> would be prepared to undertake the procedure on me for personal reasons.
>>
>> Do any UK based members have any experience of this clinic. I believe he
>> does a proper sleeve resection rather than using forceps or a clamp and
>> he did tell he could place the scar as I wanted.
>>
>> Any advice would be most welcome.
>>
>> Stu
>>
>

Stu, I was circ'd as an adult and couldn't wait to get rid of that nasty
foreskin.
It's been over 30 years and I couldn't be more delighted.
I think you will find a lot of happily circ'd guys here.

Also check out Inter-Circ@yahoogroups.com.  There are a lot of guys circ'd
as adults telling their stories.

Good luck.

j

--- On Mon, 12/7/09, Abnobaco <abnobaco@...> wrote:

From: Abnobaco <abnobaco@...>
Subject: [PROCIRCORG] Re: Adult Circumcision
To: PROCIRCORG@yahoogroups.com
Date: Monday, December 7, 2009, 1:13 PM







 









       Stu,



I don't think you are going to like my advice,  I am turning 40 this year and
had a circumcision when i was 25.  I was very happy with the results until the
beginning of this year, and had a wonderfull sex life to.



But since January, I started loosing sensation to the point that I could not
feel anything during intercourse up until I am ejaculating.



After a lot of research, I have found that the head dries out and even cracks
because of the irritation that your clothes cause, the skin thickens to protect
the nerve endings.



I would suggest that you talk to some guys that were cut as adults and had it
for more that 15 years.



And this happens to most of us.  I would suggest before you go through with the
procedure.  Go and read this:



http://www.newfores kin.biz/members/ framesetMain. htm



I am 3 months into restoring my foreskin just to have a normal sex life again.



--- In PROCIRCORG@yahoogro ups.com, "S" <stu5678@... > wrote:

>

> Hi,

>

> I am in my late 40s an UK based in the west. I have always wanted to be
circumcised. This is just for personal reasons, cosmetic and hygiene.

>

> I have for many years worn my foreskin permanently back so to all intent and
purposes this is just making the current situation permanent.

>

> I am well aware that there are a number of experienced doctors in the London
area who perform circumcisions. I have heard of a clinic in Cardiff
www.circumcisioncli nic.net run by Mr. Khan a surgeon in the NHS. This would be
much more convenient for me.

>

> I have spoken to him on the phone and he has confirmed to me that he would be
prepared to undertake the procedure on me for personal reasons.

>

> Do any UK based members have any experience of this clinic. I believe he does
a proper sleeve resection rather than using forceps or a clamp and he did tell
he could place the scar as I wanted.

>

> Any advice would be most welcome.

>

> Stu

>

























[Non-text portions of this message have been removed]

Hi I just became a member of this group in hopes of obtaining some more info on
getting circ'd as an adult. I recently had a frenuloplasty done but the result
hasn't made life any more enjoyable as my foreskin is still causing problems.
Getting circumcised has been on my mind for several years now so hopefully I can
make a final decision soon. However, I live in western canada and I'm not sure
how long the waitlist is or who I should talk to first. Any thoughts or
suggestions would be greatly appreciated.

Thanks

There are devices that can be bought to stretch the opening...........and there
are exercises that you can do using your fingers to help stretch the
opening...........try googling foreskin and see what it gives
you.............that may help

--- In PROCIRCORG@yahoogroups.com, "otisarnell" <otisarnell@...> wrote:
>
> New to the group.  Unable to retract to see the head for years.
>
> Can a cut be made to open up the constriction?  And avoid full
> circumcsion.
>
> Otis
>

Hello, Dr. Reed:

I am one of several moderators on Inter-Circ. Today I had a post from an adult
who was circumcised for BXO. Because he has some distortion and whitish areas on
his glans and the frenaulr area, he is keen to find out antyhing he can about
the latest and most efficacious treatments for BXO.

I wonder if you would care to comment about this or if I may refer him to your
group. CErtainly I can understand his concern over this very distressing
disorder.If this is accpetable to you, I should be pleased to forward his
original post to me.
Thanks in advance for your care and concern in perfroming excellent adult
circumcisions

cheers,

John M

Stu,

I don't think you are going to like my advice,  I am turning 40 this year and
had a circumcision when i was 25.  I was very happy with the results until the
beginning of this year, and had a wonderfull sex life to.

But since January, I started loosing sensation to the point that I could not
feel anything during intercourse up until I am ejaculating.

After a lot of research, I have found that the head dries out and even cracks
because of the irritation that your clothes cause, the skin thickens to protect
the nerve endings.

I would suggest that you talk to some guys that were cut as adults and had it
for more that 15 years.

And this happens to most of us.  I would suggest before you go through with the
procedure.  Go and read this:

http://www.newforeskin.biz/members/framesetMain.htm

I am 3 months into restoring my foreskin just to have a normal sex life again.



--- In PROCIRCORG@yahoogroups.com, "S" <stu5678@...> wrote:
>
> Hi,
>
> I am in my late 40s an UK based in the west. I have always wanted to be
circumcised. This is just for personal reasons, cosmetic and hygiene.
>
> I have for many years worn my foreskin permanently back so to all intent and
purposes this is just making the current situation permanent.
>
> I am well aware that there are a number of experienced doctors in the London
area who perform circumcisions. I have heard of a clinic in Cardiff
www.circumcisionclinic.net run by Mr. Khan a surgeon in the NHS. This would be
much more convenient for me.
>
> I have spoken to him on the phone and he has confirmed to me that he would be
prepared to undertake the procedure on me for personal reasons.
>
> Do any UK based members have any experience of this clinic. I believe he does
a proper sleeve resection rather than using forceps or a clamp and he did tell
he could place the scar as I wanted.
>
> Any advice would be most welcome.
>
> Stu
>

I was circumcised a few years ago............and it was the worst decision I
ever made............mine was too tight and the head got like leather and I had
what looked like skin peeling constantly........until I restored my foreskin to
cover the head when I am flaccid..........

--- In PROCIRCORG@yahoogroups.com, "S" <stu5678@...> wrote:
>
> Hi,
>
> I am in my late 40s an UK based in the west. I have always wanted to be
circumcised. This is just for personal reasons, cosmetic and hygiene.
>
> I have for many years worn my foreskin permanently back so to all intent and
purposes this is just making the current situation permanent.
>
> I am well aware that there are a number of experienced doctors in the London
area who perform circumcisions. I have heard of a clinic in Cardiff
www.circumcisionclinic.net run by Mr. Khan a surgeon in the NHS. This would be
much more convenient for me.
>
> I have spoken to him on the phone and he has confirmed to me that he would be
prepared to undertake the procedure on me for personal reasons.
>
> Do any UK based members have any experience of this clinic. I believe he does
a proper sleeve resection rather than using forceps or a clamp and he did tell
he could place the scar as I wanted.
>
> Any advice would be most welcome.
>
> Stu
>

Otis
This should never be allowed to happen !   Everybody who is uncut should be
able to retract their foreskin fully ! However do you manage to keep it
clean ?????

Go for a full circumcision it is best and you will never regret it
Good Luck Neville in England
----- Original Message -----
From: "otisarnell" <otisarnell@...>
To: <PROCIRCORG@yahoogroups.com>
Sent: Sunday, December 06, 2009 11:13 AM
Subject: [PROCIRCORG] Cannot retract to see the head


> New to the group.  Unable to retract to see the head for years.
>
> Can a cut be made to open up the constriction?  And avoid full
> circumcsion.
>
> Otis
>
>
>

Hi,

I am in my late 40s an UK based in the west. I have always wanted to be
circumcised. This is just for personal reasons, cosmetic and hygiene.

I have for many years worn my foreskin permanently back so to all intent and
purposes this is just making the current situation permanent.

I am well aware that there are a number of experienced doctors in the London
area who perform circumcisions. I have heard of a clinic in Cardiff
www.circumcisionclinic.net run by Mr. Khan a surgeon in the NHS. This would be
much more convenient for me.

I have spoken to him on the phone and he has confirmed to me that he would be
prepared to undertake the procedure on me for personal reasons.

Do any UK based members have any experience of this clinic. I believe he does a
proper sleeve resection rather than using forceps or a clamp and he did tell he
could place the scar as I wanted.

Any advice would be most welcome.

Stu

New to the group.  Unable to retract to see the head for years.

Can a cut be made to open up the constriction?  And avoid full
circumcsion.

Otis

[Non-text portions of this message have been removed]

  Now this is clear  government  intervention.... I take it you are  
opposed to  this   ? 
 


(prayer for peace and prosperity)
--- On Wed, 2/12/09, pat nybili <nybili@...> wrote:


From: pat nybili <nybili@...>
Subject: [PROCIRCORG] Fw: SA male circumcision plan almost there
To: "circlist" <CIRCLIST@googlegroups.com>,
mothersandcircumcision@yahoogroups.com, unashamedly_procirc@yahoogroups.com,
PROCIRCORG@yahoogroups.com
Date: Wednesday, 2 December, 2009, 7:34 PM


 



Compliments of Dr Morris.

Pat

SA male circumcision plan almost
there
http://www.health- e.org.za/ news/article. php?uid=20032580

SA male circumcision plan almost
there
24.11.2009 Anso Thom
South Africa has moved swiftly to develop a male
circumcision plan that would have buy-in from all stakeholders and
will go beyond being a purely medical intervention, ideally also
engaging men on among others HIV prevention, gender issues and alcohol
abuse.

Men have traditionally been disinclined to access health services
via the South African state healthcare system while women find it
simpler as they easily and more frequently engage with the system when
attending ante-natal care once pregnant or taking sick children to
health institutions.
Many groups in Africa circumcise men, usually in late childhood or
early adolescence, and this is an important part of their cultural
identity. In other ethnic groups, men are not circumcised. This is
similar in South Africa where the isiXhosa circumcise as part of a
coming of age initiation rite while the isiZulu do not
participate.
By the late 1980s, researchers noticed that HIV infection rates were
lower in those groups where men were circumcised. But it was not clear
whether it was circumcision itself or some other difference in
behaviour between the groups that gave some protection to the
circumcised men against getting HIV.
Researchers in Orange Farm, Johannesburg wanted to find out whether
circumcising men could reduce their chance of becoming infected by
HIV. They offered young, sexually active, heterosexual, uncircumcised
men the chance to have the operation. They explained that half of
those who came forward would be circumcised right away (the
"treatment group") and the other half would be circumcised 21 months
later (the "control group").
Some 3 000 men joined the study. The group that each man was put into
was decided at random. The plan was that all the men would visit the
research clinic four times during this 21-month period, and that they
would be tested for HIV each time. However, after 14 months, the
number of new infections in the control group (49) was so much greater
than the number in the treatment group (20) that it was considered
unethical to continue the study as the result showed unequivocally
that there was great benefit in being circumcised. The men in the
control group were told they could be circumcised without any further
delay.
Infections were 60% fewer in the treatment group, which seemed to
indicate that circumcised men were much less likely to become infected
with HIV when having sex with infected women. These findings have been
confirmed by studies in Uganda and Kenya.
It is now widely accepted that in communities where HIV is common,
circumcision may prove to be a valuable tool for reducing men's risk
of getting infected. It is important to note that circumcised men can
still become infected, even though the risk might be lower and that
they should still take other steps to prevent themselves from getting
HIV.
South African stakeholders have been pushing since 2005 to have
the government engage the issue of male circumcision, however the
former health minister Dr Manto Tshabalala-Msimang was outspoken in
her opposition to medical male circumcision and believed that it was
best left in the hands of traditional leaders.
"Nothing happened until Barbara Hogan became the health minister (in
2008)," said Dr Dirk Taljaard, one of the lead researchers of the
Orange Farm study. "Suddenly everything came to life and with the
new health minister Dr Motsoaledi taking over things are carrying on,"
he said.
Soul City's Senior Executive Dr Sue Goldstein believes that other
factors have also caused the delay. "The scientific evidence is
clear, but I believe many people don't understand the science and
their criticism is often not well informed," she said.
Goldstein said the biggest opposition has been from the women and
traditional leader section. The women's sector has expressed concern
that the introduction of medical male circumcision would impact on
condom distribution and move resources away from interventions aimed
at protecting women. She believes the traditional leader sector is
worried about their area being sidelined by the medical
intervention.
Taljaard believes the resistance from traditional leaders has been
exaggerated: "I have spoken to a lot of these leaders and they have
no real problem with us doing the cutting bit as long as they can
continue with the other initiation rites. In Orange Farm they have
shown that they are quite keen to work with us," said Taljaard.
President of the Southern African HIV Clinicians Society, Dr Francois
Venter cautions that medical male circumcision would not be simple to
implement within South Africa's buckling health system. "It's
do-able, but quite difficult and would require dedicated human
resources for a shattered health system. It is an amazing opportunity
to get hold of men and get the relevant messaging in there. It would
be a shame if it was only an HIV intervention, " he said.
Venter said he would like to see one country in Africa "going
massive", spreading the intervention across multiple provinces and
he believes South Africa has the potential to lead the way.
Responding to the concerns of the women sector that male circumcision
would undermine efforts to protect women, Venter said there was no
doubt that women would benefit from the circumcision intervention.
"If less men are infected, it means that less women would be
infected. So, of course women would benefit. Perhaps it is time that
these sectors make themselves more relevant and not try to hold up the
one intervention that could really work at this stage to reduce the
rate of infection. They need to climb in and rather make sure that
issues such as the messaging around gender violence is included,"
said Venter.
A key stakeholder driving South Africa's formulation of a policy has
been Professor Helen Rees of the Wits Reproductive Health and HIV
Research Unit. Rees is also co-chair of the South African National
AIDS Council's Programme Implementation Committee and Chair of the
Prevention Sector Research Sub-committee.
Rees revealed there would be a report back at the next SANAC plenary
meeting in November. "At the last SANAC plenary meeting there was an
agreement to continue the engagement with the traditional leadership,
and that the National Department of Health would undertake a
feasibility and costing exercise on expanding medical male
circumcision services within the public health system." Medical male
circumcision is already available within the public health system, but
on a limited scale.
Rees said there was agreement that it needed to be part of the wider
integrated package of male sexual and reproductive health care which
could include STI treatment, HIV counseling and testing, con.dom
distribution and alcohol and gender issues. Rees said research has
also shown that the introduction of male circumcision would not
undermine con.dom use thereby increasing the risk of infection.
"Speaking as a researcher and a clinician I believe that if we
are successful in developing this intervention it would be a real
triumph for SANAC. We would have succeeded in engaging a wide range of
stakeholders and achieving a consensus viewpoint. If we manage to do
this while taking into account all these different inputs we should
see national buy-in to the programme," said Rees.

************ ********* *********
Jeffrey D. Klausner, MD, MPH

PRETORIA, SOUTH AFRICA

DrKlausner@hotmail. com


--

Brian J Morris, PhD DSc
FAHA
Professor of Molecular Medical
Sciences
School of Medical Sciences and
Bosch Institute (Bldg F13)
Sydney Medical
School
The University of
Sydney
Sydney NSW 2006
Australia
Email:
brianm@medsci. usyd.edu. au



DISCLAIMER: Any views or opinions
presented in this email are those of the author and do not necessarily
represent those of The
University of Sydney unless explicitly stated otherwise. The
University of Sydney recognized that its academic staff are experts in
a wide diversity of areas and does not have a policy on every
topic that an academic staff member is an expert on.

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       The INTERNET now has a personality. YOURS! See your Yahoo! Homepage.
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[Non-text portions of this message have been removed]

Compliments of Dr Morris.


Pat





SA male circumcision plan almost
there
http://www.health-e.org.za/news/article.php?uid=20032580

  SA male circumcision plan almost
there
24.11.2009 Anso Thom
South Africa has moved swiftly to develop a male
circumcision plan that would have buy-in from all stakeholders and
will go beyond being a purely medical intervention, ideally also
engaging men on among others HIV prevention, gender issues and alcohol
abuse.

Men have traditionally been disinclined to access health services
via the South African state healthcare system while women find it
simpler as they easily and more frequently engage with the system when
attending ante-natal care once pregnant or taking sick children to
health institutions.
Many groups in Africa circumcise men, usually in late childhood or
early adolescence, and this is an important part of their cultural
identity. In other ethnic groups, men are not circumcised. This is
similar in South Africa where the isiXhosa circumcise as part of a
coming of age initiation rite while the isiZulu do not
participate.
By the late 1980s, researchers noticed that HIV infection rates were
lower in those groups where men were circumcised. But it was not clear
whether it was circumcision itself or some other difference in
behaviour between the groups that gave some protection to the
circumcised men against getting HIV.
Researchers in Orange Farm, Johannesburg wanted to find out whether
circumcising men could reduce their chance of becoming infected by
HIV. They offered young, sexually active, heterosexual, uncircumcised
men the chance to have the operation. They explained that half of
those who came forward would be circumcised right away (the
"treatment group") and the other half would be circumcised 21 months
later (the "control group").
Some 3 000 men joined the study. The group that each man was put into
was decided at random. The plan was that all the men would visit the
research clinic four times during this 21-month period, and that they
would be tested for HIV each time. However, after 14 months, the
number of new infections in the control group (49) was so much greater
than the number in the treatment group (20) that it was considered
unethical to continue the study as the result showed unequivocally
that there was great benefit in being circumcised. The men in the
control group were told they could be circumcised without any further
delay.
Infections were 60% fewer in the treatment group, which seemed to
indicate that circumcised men were much less likely to become infected
with HIV when having sex with infected women. These findings have been
confirmed by studies in Uganda and Kenya.
It is now widely accepted that in communities where HIV is common,
circumcision may prove to be a valuable tool for reducing men's risk
of getting infected. It is important to note that circumcised men can
still become infected, even though the risk might be lower and that
they should still take other steps to prevent themselves from getting
HIV.
South African stakeholders have been pushing since 2005 to have
the government engage the issue of male circumcision, however the
former health minister Dr Manto Tshabalala-Msimang was outspoken in
her opposition to medical male circumcision and believed that it was
best left in the hands of traditional leaders.
"Nothing happened until Barbara Hogan became the health minister (in
2008)," said Dr Dirk Taljaard, one of the lead researchers of the
Orange Farm study. "Suddenly everything came to life and with the
new health minister Dr Motsoaledi taking over things are carrying on,"
he said.
Soul City's Senior Executive Dr Sue Goldstein believes that other
factors have also caused the delay. "The scientific evidence is
clear, but I believe many people don't understand the science and
their criticism is often not well informed," she said.
Goldstein said the biggest opposition has been from the women and
traditional leader section. The women's sector has expressed concern
that the introduction of medical male circumcision would impact on
condom distribution and move resources away from interventions aimed
at protecting women. She believes the traditional leader sector is
worried about their area being sidelined by the medical
intervention.
Taljaard believes the resistance from traditional leaders has been
exaggerated: "I have spoken to a lot of these leaders and they have
no real problem with us doing the cutting bit as long as they can
continue with the other initiation rites. In Orange Farm they have
shown that they are quite keen to work with us," said Taljaard.
President of the Southern African HIV Clinicians Society, Dr Francois
Venter cautions that medical male circumcision would not be simple to
implement within South Africa's buckling health system. "It's
do-able, but quite difficult and would require dedicated human
resources for a shattered health system. It is an amazing opportunity
to get hold of men and get the relevant messaging in there. It would
be a shame if it was only an HIV intervention," he said.
Venter said he would like to see one country in Africa "going
massive", spreading the intervention across multiple provinces and
he believes South Africa has the potential to lead the way.
Responding to the concerns of the women sector that male circumcision
would undermine efforts to protect women, Venter said there was no
doubt that women would benefit from the circumcision intervention.
"If less men are infected, it means that less women would be
infected. So, of course women would benefit. Perhaps it is time that
these sectors make themselves more relevant and not try to hold up the
one intervention that could really work at this stage to reduce the
rate of infection. They need to climb in and rather make sure that
issues such as the messaging around gender violence is included,"
said Venter.
A key stakeholder driving South Africa's formulation of a policy has
been Professor Helen Rees of the Wits Reproductive Health and HIV
Research Unit. Rees is also co-chair of the South African National
AIDS Council's Programme Implementation Committee and Chair of the
Prevention Sector Research Sub-committee.
Rees revealed there would be a report back at the next SANAC plenary
meeting in November. "At the last SANAC plenary meeting there was an
agreement to continue the engagement with the traditional leadership,
and that the National Department of Health would undertake a
feasibility and costing exercise on expanding medical male
circumcision services within the public health system." Medical male
circumcision is already available within the public health system, but
on a limited scale.
Rees said there was agreement that it needed to be part of the wider
integrated package of male sexual and reproductive health care which
could include STI treatment, HIV counseling and testing, con.dom
distribution and alcohol and gender issues. Rees said research has
also shown that the introduction of male circumcision would not
undermine con.dom use thereby increasing the risk of infection.
"Speaking as a researcher and a clinician I believe that if we
are successful in developing this intervention it would be a real
triumph for SANAC. We would have succeeded in engaging a wide range of
stakeholders and achieving a consensus viewpoint. If we manage to do
this while taking into account all these different inputs we should
see national buy-in to the programme," said Rees.

******************************
Jeffrey D. Klausner, MD, MPH

PRETORIA, SOUTH AFRICA

DrKlausner@...


--


Brian J Morris, PhD DSc
FAHA
Professor of Molecular Medical
Sciences
School of Medical Sciences and
Bosch Institute (Bldg F13)
Sydney Medical
School
The University of
Sydney
Sydney NSW 2006
Australia
Email:
brianm@...



DISCLAIMER: Any views or opinions
presented in this email are those of the author and do not necessarily
represent those of The
University of Sydney unless explicitly stated otherwise. The
University of Sydney recognized that its academic staff are experts in
a wide diversity of areas and does not have a policy on  every
topic that an academic staff member is an expert on.




[Non-text portions of this message have been removed]