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Circumcision
Circumcision is a simple surgical procedure that removes the foreskin - a sleeve of skin covering the tip of the penis (Fig.1). Although infancy is the ideal time for a circumcision, many adult men and teens seek circumcision for medical, health, sexual, cultural, religious or cosmetic reasons. A man does not need to have a medical reason to have a circumcision. Personal preference or social reasons are perfectly valid. In order to make an informed decision, he must carefully consider the benefits and risks. Since the foreskin traps bacteria and other infectious agents, as well as accumulating malodorous smegma, its removal improves genital hygiene and reduces risk of diseases and other conditions over the lifetime of the man and his sexual partners.
Figure1: The uncircumcised vs circumcised.

  BENEFITS OF CIRCUMCISION
Eliminates the risk of phimosis, which affects 1 in 10 teenage boys and men. This condition refers to a tight foreskin that cannot be pulled back fully, so making cleaning under it, and passing urine, difficult and painful. Phimosis also increases the risk of penile cancer, and is a cause of foreskin and catheter problems in nursing homes. Circumcision also reduces the risk of paraphimosis (a tight retracted foreskin constricting the penis).
Reduces by 3-fold the risk of inflammation and infection of the skin of the penis. One in 10 uncircumcised men suffer from inflammation of the head of the penis and foreskin at some time in their lives. This rises to 1 in 3 if the uncircumcised man is
diabetic. (Diabetic men also have other severe problems when uncircumcised.) In contrast only 2% of circumcised men experience such inflammation.
Substantially reduces the risk of urinary tract infections and consequent renal complications.
Over 20-fold decrease in risk of invasive penile cancer, which has a high fatality rate. One in 600 uncircumcised men get penile cancer, which often requires penile amputation or disfiguring surgery leading to impaired penile function.


Figure 2: Anatomy of the penis.

Significant studies suggest that uncircumcised men have 1½ – 2 times the risk of prostate cancer, which affects 1 in 6 men.
Reduces by approximately 3- to 7-fold the risk of getting HIV (AIDS), during sex with an infected woman. HIV enters via the vulnerable inner lining of the foreskin of a healthy penis, but can also infect via sores anywhere on the penis (caused for example by genital herpes, balanitis or inflammation). The man’s risk, especially if uncircumcised, will be greater if he engages in unsafe sex with individuals at high risk for HIV infection. Condoms should always be used irrespective of circumcision status
  Circumcision also affords substantial protection against thrush, as well as sexually transmitted infections such as papilloma (wart) virus, syphilis and chancroid.
Circumcision reduces by up to 5 times the risk of the man’s female partner being infected by chlamydia and, similarly, by 5 times the risk of her getting cervical cancer (which is caused by human papillomavirus). The load of infectious bacteria and viruses that accumulate under the foreskin is delivered into the female genital tract during sex. Chlamydia has more than doubled over the past 5 years and can cause infertility (in both sexes), pelvic inflammatory disease, and ectopic pregnancy.
Up to 10% of males reaching adulthood uncircumcised will later require circumcision for medical reasons. Many are reluctant to go ahead with this or are incorrectly advised to ‘put up’ with the problem rather than have a circumcision. Early elective circumcision eliminates these problems before they occur
In general, sexual function and sensation is the same or better in circumcised men. The problem of overly tender sensitivity of the head of the penis experienced by many uncircumcised men is virtually eliminated
  RISKS AND RECOVERY AFTER CIRCUMCISION
All surgery involves some risk; however, circumcision is a very safe procedure with a complication rate of around 1%. Most complications are minor problems related to the wound and are self- limiting. Around 2-3% of men circumcised by experienced practitioners will have a minor complication such as bleeding or infection. Each circumstance is easily treated. Often patients may report what they perceive to be local infection; however, this is actually part of the normal healing process. The risk of serious injury is extremely rare.
Circumcision is not advised for men with a bleeding disorder such as hemophilia. If it is medically necessary, it will require a specialized team of physicians.
A local anaesthetic (plus a mild sedative) is usually preferable for a circumcision, but some surgeons will insist on a general anaesthetic, depending in part on the circumcision technique they use. An oral analgesic medication is often prescribed for pain relief after the anaesthetic wears off, but many men find it unnecessary. Often there is very little post-operative discomfort and normal activities generally can be resumed after 24 hours. The procedure is illustrated below (Fig. 3).

Figure 3: The procedure.

After surgery there is some swelling, which will resolve within a few weeks. Healing is not complete until the suture dissolves. This usually occurs within four weeks, after which sexual activity may be resumed. Final cosmetic appearance takes longer.
  IN CONCLUSION
Please note that circumcision is not a cure for HIV but rather has been shown (in a recent study) to reduce the risk of acquiring the infection. Circumcision is not a substitute for condoms and other means of protecting oneself against this virus. It is also important to note during the healing period following circumcision; sexually active men may be at a higher risk of HIV infection. Circumcision confers a lifetime of medical benefits. Many uncircumcised males are at greater risk of developing medical conditions leading to possible suffering and, in some extreme cases, death. In contrast, circumcision can reduce the risk of a number of these medical conditions. The surgical risk of circumcision in a modern setting is extremely low, while the long-term functional and cosmetic outcomes are generally excellent.

Men’s Clinic International offers the service of performing the circumcision procedure at a cost of R1160 (inclusive of VAT) and includes a circumcision pack for post-operative care (medication and dressings). An appointment can be arranged or additional information obtained by contacting 0860362867. Alternatively, you can SMS “cut” to 32110 and a representative will contact you to arrange an appointment.

Please find clinics offering this comprehensive service listed below:

Bloemfontein
Rondebosch (Cape Town)
East London
Evander
Isipingo (Durban)
Klerksdorp
Port Elizabeth
Polokwane
Pietermaritzburg
Pretoria (Hatfield)
Richards Bay
Rustenburg
Sandton

Vereenging

  REFERENCES
1. Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV Prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007; 369: 643-656.
2. Gerharz EW, Haarmann C. The first cut is the deepest? Medicolegal aspects of male circumcision. BJU International 2000; 86(3): 332.
3. Morris J. Brian. Why circumcision is a biomedical imperative for the 21st century. Bioessays 2007; 29: 1147-1158.
4. Moses S, Bailey RC, Ronald AR. Male circumcision: assessment of health benefits and risks. Sex Transm Infect 1998; 74: 368-373.
5. Waskett JH. Balanitis and the uncircumcised male. Pediatrics 2005; P3R Response (12June).
6. Wiswell TE. Circumcision circumspection. New England Journal of Medicine 1997; 336: 1244-1245.
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  DEFINITIONS
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Infancy
- An infant or baby is the very young offspring of humans. A newborn is an infant who is within hours, days, or up to a few weeks from birth
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Malodorous
An offensive smell.
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Smegma
Smegma is sometimes described as a "cheesy substance". Both females and males produce smegma. In males, smegma is produced and can collect under the foreskin.
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Catheter

A catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, injection of fluids, or access by surgical instruments.
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Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond
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Urinary tract infection
Urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. The main causative agent is Escherichia coli. Although urine contains a variety of fluids, salts, and waste products, it does not usually have bacteria in it. When bacteria get into the bladder or kidney and multiply in the urine, they may cause a UTI
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Renal complications
Kidney complications
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Penile cancer
Penile cancer is a malignant growth found on the skin or in the tissues of the penis
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Amputation
Amputation is the removal of a body extremity by trauma or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as gangrene
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Prostate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system
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Genital herpes,
Herpes simplex is a viral disease caused by both herpes simplex virus type 1 and type 2 and commonly manifests as sores on the penis (genital herpes).
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Balanitis
Balanitis is inflammation of the glans penis.
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Thrush
Thrush or candidiasis is a fungal infection of any of the Candida species (all yeasts). It is also commonly referred to as a yeast infection
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Syphilis
Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum. The route of transmission of syphilis is almost always through sexual contact.
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Chancroid

- Chancroid is a sexually transmitted infection characterized by painful sores on the genitalia. Chancroid is known to be spread from one to another individual through sexual contact.
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Chlamydia
Chlamydia infection is a common sexually transmitted infection (STI) in humans caused by the bacterium Chlamydia trachomatis
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Infertility
Infertility primarily refers to the biological inability of a person to contribute to conception
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Pelvic Inflammatory Disease
Pelvic Inflammatory Disease, (or Pelvic Inflammatory Disorder) is an infection and inflammation of the female uterus, fallopian tubes, and/or ovaries.
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Ectopic pregnancy
An ectopic pregnancy is a complication of pregnancy in which the pregnancy implants outside the uterine cavity.
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Haemophilia
Haemophilia is a group of genetic disorders that impair the body's ability to control blood clotting or coagulation, which is used to stop bleeding when a blood vessel is broken.
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Local anaesthetic
An anaesthetic is a drug that causes anaesthesia which is a reversible loss of sensation. These drugs are generally administered to facilitate surgery. Local anaesthetics cause a reversible loss of sensation for a limited region of the body while maintaining consciousness.
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General anaesthetic
An anaesthetic is a drug that causes anaesthesia which is a reversible loss of sensation. These drugs are generally administered to facilitate surgery. General anaesthetics cause a reversible loss of consciousness.
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Suture
Surgical suture is a medical device used to hold body tissues together after an injury or surgery.
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