Epidemiologist

Epidemiologist
Epidemiologists help with study design, collection and statistical analysis of data, and interpretation and dissemination of results (including peer review and occasional systematic review). Epidemiology has helped develop methodology used in clinical research, public health studies and, to a lesser extent, basic research in the biological sciences
Tampilkan postingan dengan label Male Circumcision Study (MCS). Tampilkan semua postingan
Tampilkan postingan dengan label Male Circumcision Study (MCS). Tampilkan semua postingan

Rabu, 08 Januari 2014

Male circumcision

Male circumcision is the surgical removal of the intact foreskin of the human penis.
Intact foreskin is one of the risk factors for HIV transmission from infected women to men
Circumcision is undertaken worldwide for religious, cultural, and social as well as medical reasons (Government of Uganda MOH 2010). Randomized clinical trials, conducted in sub-Saharan Africa; and South Africa (Auvert et al. 2005), showed that male circumcision protects against HIV as well as reduces the incidence of other sexually transmitted infections (STIs), including genital ulcers, human papilloma virus (HPV), and chlamydia in female partners of men.
 
These studies showed that circumcision reduced the risk of heterosexual HIV transmission from an infected woman to a circumcised man by more than 60%. Due to such evidence, in 2007 WHO/UNAIDS
recommended the adoption of male circumcision as part of the comprehensive strategy to reduce
heterosexually-acquired HIV infection in countries with high HIV prevalence and low levels of
male circumcision.
 
In 2010 Uganda launched the safe male circumcision (SMC) policy as part of the
comprehensive strategy on HIV prevention, in addition to the existing strategy of abstinence,
being faithful to one partner, and condom use (ABC). Prior to the launch of this policy, male
circumcision was mainly practiced for socio-cultural reasons as a rite of passage from childhood
to manhood among the Bagisu and Bakonjo ethnic groups; and also as a religious ritual among
the Moslems. The goal of the SMC policy is to contribute to the reduction of HIV and other STIs
through safe male circumcision services (Government of Uganda MOH 2010). In addition, one
of the key objectives of this policy is to establish a research agenda focusing on male
circumcision services for HIV prevention. This policy also recommends the integration of safe
male medical circumcision services in the HIV prevention and sexual and reproductive health
care services. The target population for this policy is all males, including neonates whose parents
and guardians consent to the procedure, while the recommended age for circumcision is before
puberty with a higher preference for age at circumcision below age 1, followed by age 2–9 and

age 10–17, respectively.

Selasa, 10 Desember 2013

"Penis length"

"Penis length" redirects here. For differences in penis length among non-human species. The most accurate measurement of the human penis comes from several measurements at different times since there is natural minor variability in size due to arousal level, time of day, room temperature, frequency of sexual activity, and reliability of measurement. When compared to other primates, including large primates such as the gorilla, the human penis is largest, both in absolute terms and in relative size to the rest of the body.

Measurements vary, with studies that rely on self-measurement reporting a significantly higher average than those with staff measuring. However, the mean of an erect human penis is approximately 12.9–15.0 cm (5.08–5.91 in) in length. Flaccid penis length is a poor estimate of erect length.
Most of human penis growth happens between infancy and the age of five, and between about one year after the onset of puberty and, at latest, approximately 17 years of age.[1]
A statistically significant correlation between penis size and the size of other body parts has not been found in research. Some environmental factors in addition to genetic, such as the presence of endocrine disruptors, can affect penis growth. An adult penis with an erect length of less than 7 cm or just under 3 inches, but otherwise formed normally, is referred to in medicine as a micropenis.

History

Perceptions of penis size are culture-specific. In Ancient Greece and in Renaissance art, an uncircumcised and small penis was culturally seen as desirable in a man, whereas a bigger or circumcised penis was viewed as comical or grotesque. Ancient Rome may have had a contrary view, and a larger penis size was preferred in medieval Arabic literature.[citation needed] Males may quite easily underestimate the size of their own penis relative to that of others, and many men who believe that their penis is of inadequate size have average-sized penises. The perception of having a large penis is often linked to higher self-esteem. Fears of shrinking of the penis in folklore have led to a type of mass hysteria called penis panic, though the penis legitimately can shrink in size due to scar tissue formation in the penis from a medical condition called Peyronie's disease. Marketers of penis enlargement products exploit fears of inadequacy, but there is no consensus in the scientific community of any non-surgical technique that permanently increases either the thickness or length of the erect penis that already falls into the normal range.
Studies on penis size

While results vary slightly across reputable studies, the consensus is that the mean human penis is in the range 12.9–15 cm (5.08–5.9 in) in length with a 95% confidence interval of (10.7 cm, 19.1 cm) or, equivalently (4.23 in, 7.53 in) — that is, it is 95% certain that the true mean is at least 10.7 cm but not more than 19.1 cm.

Another reputable source claims that the relaxed (flaccid, non-tumescent) human penis has an average length of only 4 inches (10 cm) and a diameter of 1.25 inches (3.2 cm) (which would result in a circumference of roughly 3.9 inches (9.9 cm) while fully erect ones have an average length of 6 inches (15 cm) and a diameter of 1.5 inches (3.8 cm), resulting in an erect circumference of 4.71 inches (12.0 cm).
The mean penis size is slightly greater than the median size.
Length
Flaccid length
One study found the mean flaccid penis length to be 3.5 inches (8.9 cm) (measured by staff). A review of several studies found average flaccid length to be 9–10 cm (3.5–3.9 in).[9] Length of the flaccid penis does not necessarily correspond to length of the erect penis; some smaller flaccid penises grow much longer, while some larger flaccid penises grow comparatively less.

The penis and scrotum can contract involuntarily in reaction to cold temperatures or nervousness, referred to by the slang term "shrinkage", due to action by the cremaster muscle. The same phenomenon affects cyclist and exercise bike users, with prolonged pressure on the perineum from the saddle, and the straining of the exercise causing the penis and scrotum to contract involuntarily. An incorrect saddle may ultimately cause erectile dysfunction (see crotch pressure for more information).

Stretched length
Neither patient age nor size of the flaccid penis accurately predicted erectile length. Stretched length most closely correlated with erect length.

Erect length
Several scientific studies have been performed on the erect length of the adult penis. Studies which have relied on self-measurement, including those from Internet surveys, consistently reported a higher average length than those which used medical or scientific methods to obtain measurements.
The following staff-measured studies are each composed of different subgroups of the human population (i.e. specific age range and/or race; selection of those with sexual medical concerns or self-selection) which could cause a sample bias.

In a study of eighty healthy males published in the September 1996 Journal of Urology an average erect penis length of 12.9 cm (5.1 in) was measured.[5] The purpose of the study was to “provide guidelines of penile length and circumference to assist in counseling patients considering penile augmentation.” Erection was pharmacologically induced in 80 physically normal American men (varying ethnicity, average age 54). It was concluded: “Neither patient age nor size of the flaccid penis accurately predicted erectile length.”

A study published in the December 2000 International Journal of Impotence Research found that average erect penis length in 50 Jewish Caucasian males was 13.6 cm (5.4 in) (measured by staff).[6] Quote: "The aim of this prospective study was to identify clinical and engineering parameters of the flaccid penis for prediction of penile size during erection." Erection was pharmacologically induced in 50 Jewish Caucasian patients who had been evaluated for erectile dysfunction (average age 47±14y). Patients with penis abnormalities or whose ED could be attributed to more than one psychological origin were omitted from the study.

A review published in the 2007 issue of BJU International showed the average erect penis length to be 14–16 cm (5.5–6.3 in) and girth to be 12–13 cm (4.7–5.1 in). The paper compared results of twelve studies conducted on different populations in several countries. Various methods of measurements were included in the review.

An Italian study of about 3,300 men concluded that stretched length was measured on average to about 12.5 centimetres (4.9 in). In addition, they also checked for correlations in a random subset of the sample consisting of 325 men. They found a few statistically significant Spearman's correlations: between flaccid length and height of 0.208, –0.140 with weight, and –0.238 with BMI, flaccid circumference and height 0.156, stretched length and height 0.221, weight –0.136, BMI –0.169. They also reported a few non-significant correlations.

Erect circumference
Similar results exist regarding studies of the circumference of the adult fully erect penis, with the measurement taken mid-shaft.[citation needed] As with length, studies that relied on self-measurement consistently reported a significantly higher average than those with staff measuring. In a study of penis size where measurements were taken in a laboratory setting, the average penis circumference when erect was 4.8 inches (12.3 cm).

Size at birth
The average stretched penile length at birth is about 4 cm (1.6 in), and 90% of newborn boys will be between 2.4 and 5.5 cm (0.94 and 2.17 in). Limited growth of the penis occurs between birth and 5 years of age, but very little occurs between 5 years and the onset of puberty. The average size at the beginning of puberty is 6 cm (2.4 in) with adult size reached about 5 years later. W.A. Schonfeld published a penis growth curve in 1943.

Size with aging
Authors of a paper reviewing research on area of penis sizes conclude that "flaccid penile length is just under 4 cm (1.6 in) at birth and changes very little until puberty, when there is marked growth."
Age is not believed to negatively correlate with penis size. “Individual research studies have... suggested that penis size is smaller in studies focusing on older men, but Wylie and Eardley found no overall differences when they collated the results of various studies [over a 60 year period],”[9] however, there is some evidence to suggest that testicle size is getting progressively smaller with younger cohorts.
Variance in penis size

Micropenis
Main article: Micropenis
An adult penis with an erect length of less than 7 cm or 2.76 inches but otherwise formed normally is referred to in a medical context as having the micropenis condition.[18] The condition affects 0.6% of men. Some of the identifiable causes are deficiency of pituitary growth hormone and/or gonadotropins, mild degrees of androgen insensitivity, a variety of genetic syndromes, and variations in certain Homeobox genes. Some types of micropenis can be addressed with growth hormone or testosterone treatment in early childhood. Operations are also available to increase penis size in cases of micropenis in adults.

Environmental influence on penis size
It has been suggested that differences in penis size between individuals are caused not only by genetics, but also by environmental factors such as culture, diet, chemical/pollution exposure, etc. Endocrine disruption resulting from chemical exposure has been linked to genital deformation in both sexes (among many other problems). Chemicals from both synthetic (e.g. pesticides, anti-bacterial Triclosan, plasticizers for plastics, etc...) and natural (e.g. chemicals found in tea tree oil and lavender oil[) sources have been linked to various degrees of endocrine disruption. Both PCBs and the plasticizer DEHP have been associated with smaller penis size.DEHP metabolites measured from the urine of pregnant women have been significantly associated with the decreased penis width, shorter anogenital distance, and the incomplete descent of testicles of their newborn sons, replicating effects identified in animals.[28] Approximately 25% of US women have phthalate levels similar to those in the study. A 2007 study by University of Ankara, Faculty of Medicine has found that penile size may decrease as a result of some hormonal therapy combined with external beam radiation therapy.[29] In addition, some estrogen based fertility drugs like diethylstilbestrol (DES) have been linked to genital abnormalities and/or a smaller than normal penis (microphallus).
Perceptions of penis size

Historical perceptions
Fresco of Priapus from Pompeii. Depicted weighing his large erect penis against a bag of gold. Ancient Romans admired the large penis of Priapus.
According to Kenneth Dover's landmark study "Greek Homosexuality", Greek art had extreme interest in the genitals, but was not obsessed with size. The weekly Q&A column "The Straight Dope" deduces, based on pornographic Greek art work and Dover's aforementioned study, that in ancient Greece an uncircumcised and small penis was culturally seen as desirable in a man, whereas a bigger or circumcised penis was viewed as comical or grotesque, usually being found on "fertility gods, half-animal critters such as satyrs, ugly old men, and barbarians."

CBC Radio has suggested, based on several sources, that ancient Romans had a viewpoint contrary to that of the Greeks.This was also the case in medieval Arabic literature, where a longer penis was preferred, as described in an Arabian Nights tale called "Ali with the Large Member". As a witty satire of this fantasy, the 9th century Afro-Arab author Al-Jahiz wrote: "If the length of the penis were a sign of honor, then the mule would belong to the Quraysh" (the tribe which Muhammad belonged to and descended from).

Penis size is also alluded to in the Bible:
When she carried on her whoring so openly and flaunted her nakedness, I turned in disgust from her, as I had turned in disgust from her sister.Yet she increased her whoring, remembering the days of her youth, when she played the whore in the land of Egypt  and lusted after her lovers there, whose members were like those of donkeys, and whose issue was like that of horses. Ezekiel 23:18–20, English Standard Version.

Male self-perception
Males may quite easily underestimate the size of their own penis relative to that of others, because of the foreshortening obtained from looking down, due to repeated observation of atypical penises in pornography, or because of the accumulation of fat at the base of the penis. A survey by sexologists showed that many men who believed that their penis was of inadequate size had average-sized penises. Another study found sex education of standard penile measurements to be helpful and relieving for patients concerned about small penis size, most of whom had incorrect beliefs of what is considered medically normal. The perception of having a large penis is linked to higher self-esteem.

Among gay men
A study undertaken at Utrecht University found that the majority of homosexual men in the study regarded a large penis as ideal, and having one was linked to self-esteem. One study analysing the self-reported Kinsey data set found that the average penis of a homosexual man was larger than the average penis of their heterosexual counterparts (6.32 inches in length amongst gay men versus 5.99" in heterosexuals, and 4.95 inches circumference amongst gay men versus 4.80" in heterosexual men).

Anxiety about penis size
Widespread private concerns related to penis size have led to a number of folklore sayings and popular culture reflections related to penis size. Penis panic is a form of mass hysteria involving the believed removal or shrinking of the penis, known as genital retraction syndrome. The penis can significantly shrink due to scar tissue formation from a condition called Peyronie's disease which affects up to 10% of men.[40] Products such as penis pumps, pills, and other dubious means of penis enlargement are some of the most marketed products in email spam. At present there is no consensus in the scientific community of any non-surgical technique that permanently increases either the thickness or length of the erect penis that already falls into the normal range (4.5" to 7").

Penis size and size of other body parts
A statistically significant correlation between penis size and the size of other body parts has not been found in research. One study, Siminoski and Bain (1993), found a weak correlation between the size of the stretched penis and foot size and height; however, it was too weak to be used as a practical estimator. Another investigation, Shah and Christopher (2002), which cited Siminoski and Bain (1993), failed to find any evidence for a link between shoe size and stretched penis size, stating "the supposed association of penile length and shoe size has no scientific basis".

There may be a link between the malformation of the genitalia and the human limbs. The development of the penis in an embryo is controlled by some of the same Hox genes (in particular HOXA13 and HOXD13) as those that control the development of the limbs. Mutations of some Hox genes that control the growth of limbs cause malformed genitalia (Hand-Foot-Genital Syndrome).
Studies of size preferences among sexual partners

In a small study conducted by University of Texas–Pan American and published in BMC Women's Health, 50 undergraduate women were surveyed by two popular male athletes on campus about their perceptions of sexual satisfaction and it was concluded that the width of a penis feels better than the length of a penis, when subjects are asked to choose between the two (size was left unspecified). It was also concluded that this may show that penis size overall affects sexual satisfaction since women chose between the two options they were given.[47]
In a cover story by Psychology Today,[48][49] 1,500 readers (about 2/3 women) were surveyed about male body image. Many of the women were not particularly concerned with penis size and over 71% thought men overemphasized the importance of penis size and shape. Generally, the women polled cared more about width than men thought, and less about length than men thought, although the strength of caring for either among women showed a similar pattern.
Another study, conducted at Groningen University Hospital, asked 375 sexually active women (who had recently given birth) the importance of penis size and concluded: "Although clearly in the minority, a nevertheless considerable percentage of the women respondents attached substantial importance to the size of the male sexual organ".
A study[51] conducted at the Australian National University, published in early 2013, showed that penis size influences a man’s sex appeal, and the taller the man, the bigger the effect. The study showed 3D computer generated images at life size, altering the height and other physical attributes, with women typically registering preferences in under 3 seconds. A preference for taller men's larger penis size was notable.
The term size queen is slang for a gay or bisexual man who prefers his sexual partner(s) to have a larger-than-average penis.

Comparison to other primates

The human penis is both longer and thicker than that of any other primate, both in absolute terms and in relative size to the rest of the body.[54] (See also Implications of differences in penis length and morphology for hypothesized advantages involving group sex which may have led to the evolution of a larger penis size in humans, and factors which may account for differences in average penis size within the human species)
Penis size and condom use

One Australian study of 184 men looked at penis length and circumference in relationship to condom breakage or slippage. 3,658 condoms were used. The study found that when used correctly condoms had a breakage rate of 1.34% and, of slippage, 2.05%, with a total failure rate of 3.39%. Penile dimensions did not influence slippage, but penis circumference and broken condoms were strongly correlated, with larger sizes increasing the rate of breakage

Rabu, 06 November 2013

The PrePex™ device

The PrePex device



Developed in 2009/10 by Fuerst, Kilemnick & Shohat and marketed by a company called Circ MedTech Limited, this device is specifically aimed at the sub-Saharan market in Africa and is designed for use in non-sterile environments by minimally trained healthcare professionals. Possibly uniquely for modern clamps, it is suitable for routine use without anaesthesia. In common with many fit-&-wear clamps, it requires no sutures.

Circ MedTech is an ad-hoc private company incorporated in the British Virgin Islands. The CEO is Tzameret Fuerst; prior to the formation of Circ MedTech she was the Director of New Product Development at Keter Plastic (an Israeli company that is one of the world’s largest plastics manufacturers) and was a Strategic Planner at the advertising agency Geller-Nessis.

Photograph

Procedure: Something akin to an industrial grade 'O'-Ring is used to induce ischemic necrosis. Unsprung from the “placement ring”, the 'O'-Ring engages with a groove in the inner ring that has been pre-positioned under the foreskin. For several days, the wearer walks around with only the 'O'-Ring visible; the applicator has by then been removed. The foreskin dies off and, when it has, the device is removed by flicking the 'O'-Ring out of the groove of the component that is still out of sight, hidden in the sulcus.

Early criticism of the PrePex device suggested that a significant amount of inner foreskin would remain after circumcision, resulting in a failure to remove as many Langerhans cells as other methods. However, confidential images seen by Circlist show that the finalised design can produce a ‘low’ style if the device is correctly used.

The first results of Safety & Efficacy Trials appeared in the online version of JAIDS, the Journal of Acquired Immune Deficiency Syndromes, on 08.Sep.2011.

“Ramping Up” of numbers involved in the campaign of medical male circumcision in Rwanda, using the PrePex system, is described in an article published by Plus News on 9th January 2012. Also in January 2012, PrePex achieved the coveted FDA accreditation, opening the way for marketing in many countries that use the US yardstick as their determinant of medical device approval. In April 2012, PrePex won the Best Technology for Health Award and has also found favour with WHO’s Technical Advisory Group on Innovations in Male Circumcision. (See our news report dated 17.May.2012).

video illustrating the PrePex procedure is now available on the company’s website.



Questions and Answers about the PrePex device

Here are some questions raised in "Letters to the Editor" along with the answers given by Circ MedTech’s CEO:
  1. Q:  Why did Circ MedTech use military personnel as test subjects? They are not fully representative of the general population in several respects: Fitness, pain tolerance, diet, hygiene régimes, environmental factors that have infection control implications....

    A:  Only 5 patients out of 100 in the safety study were soldiers. In the comparison study currently underway (clinicaltrials.gov ID NCT01284088), all patients are civilians. Kanombe is a military and district hospital. The promising results of the Rwandan Government study will be public information very soon in prestigious conferences, in medical journals and on the circlist.com website.
  2. Q:  Is it really the case that the foreskin is NOT at first severed in a PrePex circumcision, but left intact for a week to necrotise 'in situ'?

    A:  Yes, it is true. The device is left in situ for 7 days, until the foreskin is fully necrotized. This is part of what makes the patent pending device and method safe and simple to use, with very little training (you don’t even have to be a nurse). This also enables a bloodless procedure (no cutting of live tissue!), a critical factor in rural settings. There is no anesthesia (so no needles!), no blood, no sutures and no sterile settings required, as the device comes in contact only with intact skin. There were no infections or complications throughout the whole study from anyone while the device was in situ, confirming the safety of the technique. From discussions with patients after the study, one of the key benefits raised was that the procedure had no blood.
  3. Q:  Adults only, or child sizes too?

    A:  For now, only adult sizes are readily available, but we will have child sizes too.

Why Male Circumcision?

Why Male Circumcision?


HIV has taken the lives of 25 million people at a rate of 2 million per year, with 2/3 of these deaths in Sub-Saharan Africa. In 2007, the World Health Organization and UNAIDS cited that voluntary medical male circumcision (VMMC) can reduce the risk of HIV infection by approximately 60% in high risk areas such as Sub Saharan Africa. The “ABCs” – Abstinence, Be Faithful and Condoms are crucial elements, but are not enough. The much anticipated HIV vaccines have been under development for nearly 20 years but are nowhere near market readiness. 

The US Government (USAID) underscores the impact of male circumcision if conducted rapidly in target countries. However, surgical male circumcision requires highly trained medical professionals and sterile surgery-type settings. While genuine attempts have been made by target countries to scale up surgery in the past years, the procedure is not geared for the volume required in Africa, especially in rural and resource limited areas. 

In December 2011, UNAIDS, in partnership with the US Government (PEPFAR) World Health Organization, Bill and Melinda Gates Foundation and the World Bank launched an accelerated action plan to reach 20M VMMC by 2015. Achieving this goal will save nearly 3.4M lives and 16.5 Billion USD in long term healthcare costs. View press release

The PrePex device (learn more) offers a safe, simple and scalable solution for scale up of adult male circumcision in resource limited settings for HIV prevention.

Sunat Cincin Bikin si Kecil Tak Menangis dan Cepat Sembuh

Sunat Cincin Bikin si Kecil Tak Menangis dan Cepat Sembuh


Sunat Cincin Bikin si Kecil Tak Menangis dan Cepat Sembuh
 Musim liburan telah tiba. Beberapa orangtua pun berniat mengkhitankan anak-anaknya. Sayang, banyak anak yang ketakutan ketika hendak disunat.
Jika Anda sebagai orangtua merasa bingung menyunatkan anaknya karena takut, tak ada salahnya mencoba metode sunat cincin, temuan dokter yang berpraktik di Rumah Sakit PKU Muhammadiyah, Merden, Banjarnegara, dr. Sofin Hadi.
Dilihat dari segi metodenya, sunat cincin mirip dengan sunat konvensional lainnya, hanya saja alatnya yang berbeda.
"Alatnya cincin biasa, seperti karet gitu," jelas dr. Sofin Hadi, saat diwawancarai Liputan6.com, yang ditulis Kamis (27/6/2013).
Alat yang digunakan untuk melakukan sunat cincin terdiri atas cincin karet dan penahan cincin yang terbuat dari plastik, yang digunakan untuk menjepit kulup (frenulum).
"Bentuk cincin ini seperti bentuk karet ban sepeda, sedangkan penahannya sebagai pelek, itu besi penahan ban," jelasnya.
Sebelum diberi cincin, daerah sekitar penis dibersihkan lalu dilakukan pembiusan. "Kulup yang menutupi penis yang akan disunat itu ditarik perlahan ke belakang. Setelah itu, baru ditarik penahan cincinnya," terang Sofin Hadi.
"Setelah dijepit, diamkan selama dua hari. Setelah itu, kembali lagi baru dilepas. Yah, kalau sunat pada umumnya, semacam lepas perban gitu," tambahnya.
Untuk biaya sunat cincin ini, dr Sofin Hadi membanderol dengan harga yang relatif murah, berkisar antara Rp 300 sampai 500 ribu.

Sunatan massal menggunakan metode sunat cincin
Saat berbincang dengan Liputan6.com, Sofin Hadi mengaku dirinya baru saja melangsungkan sunatan massal yang dilakukan di daerah Klaten, Yogyakarta.
Pasiennya pun, cukup banyak, sekitar 100 orang anak. Waktu yang dibutuhkan untuk menyunatkan anak-anak itu, pun cukup cepat.
"Kemarin waktu sunatan massal hanya butuh waktu 3,5 jam untuk 100 orang anak. Kecepatan per anaknya hanya 2,5 menit. Habis dipasang cincinnya itu, anak-anak itu diizinkan pulang," jelasnya.
Ada yang lucu ketika menyunat anak-anak di sana. Ada 1 anak usia 13 tahun ketakutan. Sementara anak-anak lain, yang usianya jauh lebih muda tersebut, justru kesenangan.
"Anak-anak yang lain ingin cepat-cepat disunat, pas tahu cara sunatnya tidak menyakitkan," pungkasnya.
Enaknya sunat menggunakan metode sunat cincin
Sofin Hadi menjelaskan, banyak efek menyenangkan ketika seorang anak disunat menggunakan metode ini. Pertama, cara kerjanya cukup mudah dan tidak menyakitkan. "Habis dipasang cincin, diizinkan pulang, 3 hari berikutnya lepas," jelasnya
Yang kedua, seorang anak yang disunat menggunakan metode ini, selesai disunat bisa langsung mandi. Jika dibandingkan dengan sunat metode lain, belum tentu bisa langsung mandi.
"Soalnya kan kalau metode lain diperban. Jadi nggak boleh mandi dulu, nanti basah perbannya," terang Sofin Hadi.
Menurut Sofin Hadi, justru yang diperban itu rada tidak menyehatkan. Bayangkan saja, ketika yang disunat akan buang air kecil, dan mengenai perbannya, mau nggak mau perban itu harus diganti. Belum lagi kalau air seninya berserakkan ke mana-mana.
Efek Samping
Ada pun efek samping yang dihasilkan dari sunat cincin ini relatif lebih sedikit dari sunat konvensional lainnya.
"Dilihat dari pendarahannya, kalau sunat metode lainnya dari 10 orang yang sunat, 1 orang yang pendarahan. Kalau sunat cincin ini, dari 500 orang yang sunat, hanya 1 orang yang mengalami pendarahan," tutupnya lagi.

General foreskin care – babies and young boys

Foreskin care is important for babies, boys and men. The foreskin is the sheath of skin that covers the head (glans) of the penis. Circumcision is sometimes recommended for older boys and men who have ongoing foreskin problems, such as infection, that don't respond to other forms of treatment. Circumcision usually requires epidural or general anaesthesia and about six weeks of recovery.

The foreskin is the sheath of skin that covers the head (glans) of the penis. At birth, the foreskin is fully attached to the penis. In time, the foreskin separates and can be retracted (pulled back). This can usually be done by the age of about two. Sometimes, the foreskin separates later. Occasionally, the foreskin doesn’t separate evenly and areas remain stuck to the glans. These attachments almost always resolve by puberty.

Circumcision is a surgical procedure to remove the foreskin. In Australia today, less than 10 per cent of boys are circumcised. The procedure is mostly performed on babies for family, religious or cultural reasons. Circumcision is sometimes recommended for older boys and men who have ongoing foreskin problems, such as infection, that don’t respond to other forms of treatment.

General foreskin care – babies and young boys


Foreskin care is important and young boys should be taught how to care for their penis. Suggestions include:
  • Treat a baby’s penis like any other body part when you give him a bath. Don’t worry about cleaning under the foreskin. Simply wash the penis with soap and rinse.
  • Do not forcibly pull back a baby’s foreskin. Doing so may cause pain, bleeding, infection or scarring.
  • Change your son’s wet or dirty nappies as soon as possible to reduce the risk of infection.
  • Retract the foreskin for cleaning once it has separated. Wash with soap and rinse well. Roll the foreskin back over the glans afterwards.
  • Teach your son how to clean underneath his foreskin.

General foreskin care – teenagers and men


Taking care of your foreskin should become a habit. Make sure you:
  • Clean underneath the foreskin. Without regular cleaning, a build-up of a whitish-yellow substance known as ‘smegma’ can occur under the foreskin. Smegma can look like pus to the untrained eye.
  • See your doctor if you have any concerns.

Common foreskin problems


Conditions that may affect the foreskin include:
  • Inflammation – sore and red foreskin. Common causes include forced retraction, irritants such as bubble baths or dirty nappies.
  • Infection – the most common include posthitis and balanitis. Posthitis is infection of the foreskin, usually caused by fungus thriving in the hot and moist conditions. Balanitis is infection of the foreskin and glans, and is usually caused by poor hygiene. Smegma encourages the growth of infection-causing germs.
  • Chronic infections – for some males, posthitis or balanitis tends to recur. A complication of chronic infections is scar tissue, which could stick the foreskin to the glans and make retraction impossible. Chronic infections of the penis and foreskin also increase the risk of urinary tract infections. Repeated kidney infections can affect kidney function.
  • Phimosis – the foreskin is abnormally tight, which prevents it from retracting. This can cause recurrent balanitis because good hygiene is difficult or impossible. An erection may cause the foreskin to split and bleed. The tight foreskin can also hinder urination – in some cases, the foreskin fills up with urine like a little balloon. Phimosis is the most common reason for circumcision after infancy.
  • Paraphimosis – permanently retracted foreskin. The foreskin gathers like a tight rubber band around the penis, causing swelling and pain. This condition is the second most common reason for adult circumcision.
  • Tumour – rarely, abnormal growths develop on the foreskin. In some cases, the tumour is cancerous. Penile cancer is extremely rare in circumcised men.
  • Zipper trauma – the foreskin (or other parts of the genitals, commonly the scrotum) gets caught in a zipper. Wearing underpants is the best prevention.

Diagnosis of foreskin problems


Tests used to diagnose foreskin problems may include:
  • Medical history
  • Physical examination
  • Swab test (to check for infection).

Treatment of foreskin problems


Treatment depends on the condition but may include:
  • Inflammation – avoid irritants such as bubble bath lotion or harsh soaps. Wash gently under the foreskin. Nappy rash cream or hydrocortisone ointment may be recommended.
  • Infection – the doctor may prescribe antifungal or anti-inflammatory creams, oral antibiotics and pain-killing drugs. Try soaking in a warm bath to relieve painful or difficult urination (dysuria). In severe cases, intravenous antibiotics are needed.
  • Chronic infections – the doctor may recommend circumcision as a permanent solution.
  • Phimosis – the doctor may suggest that you attempt to stretch your foreskin by retracting it regularly, such as when showering and every time you urinate. The stretching process may take a few weeks. Regular use of steroid creams may also help. If the foreskin remains tight, you may need circumcision. For men who are opposed to circumcision for ethical or political reasons, it may be possible to keep the foreskin but surgically widen it. The cut made along the topside of the foreskin is called a ‘dorsal slit’.
  • Paraphimosis – the doctor attempts to manually roll the foreskin over the glans. This may involve the application of anaesthetic cream and compression of the penis head (by the doctor’s hand or with a tight wrapping of cling film) to reduce the swelling. If this fails, the doctor may puncture the penis with a needle (to drain the fluid and reduce swelling) or cut the band of foreskin, or both. If paraphimosis tends to recur, you may need circumcision.
  • Tumour – the first line of treatment for a tumour is surgical removal. Cancer treatment may include chemotherapy or radiotherapy.
  • Zipper trauma – the doctor will apply anaesthetic cream to the foreskin. The foreskin is freed by either opening the zipper or cutting the zipper with scissors.

Circumcision for older boys and men


Circumcision is a common treatment for many foreskin problems. The procedure in newborns is simple and fast, but it is much more complicated in older boys and men. After the first few weeks of life, circumcision usually requires epidural or general anaesthesia and about six weeks of recovery. Complications are uncommon, but can include bleeding, allergic reactions to anaesthesia or infection.

Adult circumcision for non-medical reasons


American research suggests that about five per cent of adult men seeking circumcision don’t have foreskin problems. Instead, they wish to have the surgery for cosmetic reasons or to enhance sexual feeling.

Sometimes, a man has nothing against his foreskin but his partner prefers a circumcised penis – in these situations, doctors advise caution. The decision to have cosmetic surgery should be yours and yours alone. If your foreskin is healthy and doesn’t cause you emotional distress, you should keep it (and perhaps consider finding yourself a new partner who can love you – and your uncircumcised penis – unconditionally).

Where to get help

Things to remember

  • The foreskin is the sheath of skin that covers the head (glans) of the penis.
  • Without regular cleaning, a build-up of a whitish-yellow substance known as ‘smegma’ can occur under the foreskin, which may cause infection.
  • Circumcision is a surgical procedure to remove the foreskin and is a common treatment for many foreskin problems.

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This page has been produced in consultation with and approved by:

Urological Society of Australia and New Zealand
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Fact sheet currently being reviewed.
Last reviewed: October 2011
Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.