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Unnecessary circumcisions and the “phony” phimosis diagnosis

Here in the US circumcision is an extremely common practice right after birth, and thus most people tend to associate it to newborns. In many parts of the world, however, newborn circumcision is virtually nonexistant, and young boys from various ages are the ones who get their foreskins removed – often due to a condition called phimosis.

Phimosis is a relatively vague term. In accordance to general usage, it means any condition in which the prepuce or foreskin ­of the penis cannot be rolled away.

Most babies come to this world with a foreskin that will not retract. This really is the norm rather than an exception!

“True” phimosis—better termed preputial stenosis, because phimosis has so many diverse definitions it now can be devoid of any valuable meaning—occurs in less than 2 out of 100 intact men.

Besides, about 90% of men with true phimosis will successfully respond to topical steroids. Of those who fail this kind of treatment, most will still respond to stretching routines. The arithmetic is pretty straightforward: at most, only 7 boys out of 10,000 may need a surgical procedure for preputial stenosis. Maybe this is why the Canadian Paediatric Society calls circumcision a great “obsolete” procedure!

There happen to be several alternatives to the amputation of the foreskin (circumcision) which preserve the function of the prepuce and bring about less complications. After all, for what reason would anyone want to lose all those sensory corpuscles, nerve endings and protective shelter to keep the glans lubricated?

Child care

It is essential to notice that the premature foreskin of any child does not need to be forced back for “cleaning” or for virtually any other reason, because this can cause damage to the developing tissues. The kid should be instructed that his foreskin will, sooner or later, spontaneously become retractable. The first person to retract the foreskin ought to be the child himself.

A number of medical reports from places like the UK and Brazil (where phimosis is called “fimose”), for example, indicate that pediatricians, general practitioners and even urologists are not properly trained to differentiate between normal developmental unretractable prepuce in boys and pathological phimosis. This kind of results in cases of misdiagnosis of normal developing preputial tightness as pathological phimosis, and dramatically increases the rate of surgical interventions performed as “treatment” to something that does not even needed to be treated in the first place. Rickwood and Walker found that the quantity of circumcisions performed in the UK in 1988 was 8 times more than actually required, but this number has been probably reduced since then. The amount of unnecessary circumcisions performed in Brazil is unknown.

Rickwood and partners give a particular therapeutic meaning of phimosis: true phimosis is tight non-retractable foreskin brought on by Balanitis Xerotica Obliterans (BXO) and is distingished by a whitish ring of solidified sclerotic skin at the tip of the prepuce (histologic examination by a pathologist is important to affirm the diagnosis). If BXO is not present, then genuine phimosis is not present.

Conclusion

As a consequence of misdiagnosis and confusion of normal developing narrowessness and non-retractablity with pathological phimosis, many unneeded circumcisions are performed.

Circumcision is presently suggested just in affirmed instances of phimosis brought on by balanitis xerotica obliterans (BXO), however more current medications might dispose of the requirement for circumcision. Shankar and Rickwood found a low frequency of just 0.4 of 1000 young men for every year, and just 6 in 1000 by age 15. Different instances of non-retractile foreskin react to moderate, non-dangerous, non-traumatic, less expensive treatment.