Phimosis: Difference between revisions

Circumcision: General revision.
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====Circumcision====
====Circumcision====
Circumcision (partial penile amputation) once was the classic treatment for phimosis, but has many disadvantages and drawbacks. [[Neurotomy]] is a feature of every circumcision and causes severe loss of [[erogenous sensation of the foreskin]]. [[Adolescent and adult circumcision| Circumcision]] is less performed today, because it is becoming outmoded by newer and better treatments.<ref name="shahid2012" />
Men who consult a [[urologist]] regarding non-retractile [[foreskin]] will usually receive a recommendation for [[adult circumcision]] because that surgery produces the [[Financial incentive| highest profit]] for the urologist. Circumcision (partial penile [[amputation]]) once was the classic treatment for phimosis, but has many disadvantages and drawbacks. [[Neurotomy]] is an unavoidable feature of every [[adult circumcision| circumcision]] and causes severe loss of [[erogenous sensation of the foreskin]]. [[Adolescent and adult circumcision| Circumcision]] is less performed today, because it is becoming outmoded by newer and better treatments.<ref name="shahid2012" />


* Circumcision is the most expensive treatment.<ref name="vanhowe1998" />
* Circumcision is the most expensive treatment.<ref name="vanhowe1998" />
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* Circumcision exposes the patient to the surgical risks of [[bleeding]], [[infection]], and surgical misadventure, which rarely can include loss of the [[glans penis]], loss of the [[penis]] or [[death]].
* Circumcision exposes the patient to the surgical risks of [[bleeding]], [[infection]], and surgical misadventure, which rarely can include loss of the [[glans penis]], loss of the [[penis]] or [[death]].


* Circumcision permanently and irreversibly amputates the [[Foreskin sensitivity| highly innervated]], erogenous [[foreskin]], so its [[Foreskin#Physiological_functions| multiple protective, immunological, sensory, and sexual physiological functions]] are destroyed and has many [[risks and complications]]. The sensitive head of the [[penis]] will be permanently exposed so the [[Glans penis| head]] will rub against clothing. Many men find this to be very painful.
* Circumcision permanently and irreversibly amputates the [[Foreskin sensitivity| highly innervated]], erogenous [[foreskin]], so its [[Foreskin#Physiological_functions| multiple protective, immunological, sensory, and sexual physiological functions]] are destroyed and has many [[risks and complications]]. The sensitive head of the [[penis]] will be permanently exposed, so newly [[circumcised]] men find it very painful when the [[glans penis]] is touched or rubs against clothing. The pain will persist until [[keratinization]] occurs.


* Most men report a permanent substantial loss of [[Sexual sensation of the foreskin| sexual sensation]].
* Most men report a permanent substantial loss of [[Sexual sensation of the foreskin| sexual sensation]].
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* Circumcision results in a permanent, usually two-toned, [[circumcision scar]].
* Circumcision results in a permanent, usually two-toned, [[circumcision scar]].


* Circumcision has a long, painful, and difficult recovery. Erections are painful. Post-circumcision [[lymphoedema]] caused swelling can last for many months. Recovery time is placed at six weeks. Erections may cause sutures to pull out, thus opening the surgical wound, causing [[wound dehiscence]]. Sexual and [[Psychological issues of male circumcision| psychological]] issues abound. As with other surgery, complications are surgical misadventure, hemorrhage, and [[infection]]. Loss of the penis and [[death]] are known.<ref name="shahid2012" /> <ref name="williams-kapila1993">{{REFjournal
* Circumcision has a long, painful, and difficult recovery. Erections are painful. Post-circumcision [[lymphoedema]] caused swelling can last for many months. Recovery time is placed at six weeks. Erections may cause sutures to pull out, thus opening the surgical wound, causing [[wound dehiscence]]. Sexual and [[Psychological issues of male circumcision| psychological]] issues abound. As with other surgery, complications are surgical misadventure, [[bleeding]], and [[infection]]. Loss of the [[penis]] and [[death]] are known.<ref name="shahid2012" /> <ref name="williams-kapila1993">{{REFjournal
  |last=Williams
  |last=Williams
  |first=Neville
  |first=Neville
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}}</ref>
}}</ref>


* Circumcision is irreverible amputation. Circumcision cannot be undone. [[Regret men]] are common.
* Circumcision is irreverible [[amputation]]. Circumcision cannot be undone. [[Regret men]] are common.


<b><u>[[Adolescent and adult circumcision| Circumcision]] should be the treatment of last resort, to be used only after conservative methods of treatment fail.</u></b>
<b><u>[[Adolescent and adult circumcision| Circumcision]] should be the treatment of last resort, to be used only after conservative methods of treatment fail.</u></b>


Kumar et al. (2017) graded phimosis from 0 to 5. They claimed that [[adult circumcision]] is necessary to treat grades 4 and 5,<ref name="kumar2017">{{REFjournal
Many men would prefer to live with phimosis in preference to losing one's [[foreskin]] to an [[adult circumcision]]. Phimosis is a condition, not a disease. Circumcision is usually an elective surgical [[amputation]]. Men who elect to be [[circumcised]] can only blame themselves, if they do not like the results. [[Regret men]] are common.
|last=Kumar
|first=
|init=JN
|author-link=
|last2=Neeraj
|first2=G
|init2=G
|author2-link=
|last3=Rajesh
|first3=L
|init3=L
|author3-link=
|last4=Kumar
|first4=
|init4=MS
|author4-link=
|etal=yes
|title=Phimosis: Nonsurgical Versus Surgical Management
|trans-title=
|language=English
|journal=Journal of Medical Science and Clinical Research
|location=
|date=2017-02
|volume=5
|issue=2
|article=
|page=
|pages=17556-60
|url=http://jmscr.igmpublication.org/v5-i2/57%20jmscr.pdf
|archived=
|quote=
|pubmedID=
|pubmedCID=
|DOI=
|accessdate=2021-01-14
}}</ref> however that is not certain. Many men would prefer to live with phimosis in preference to losing one's [[foreskin]] to an [[adult circumcision]]. Circumcision is usually an elective surgical amputation. Men who elect to be [[circumcised]] can only blame themself if they do not like the results. [[Regret men]] are common.


== Adult onset phimosis ==
== Adult onset phimosis ==