domenica 30 ottobre 2011

Interventi Genitali al Femminile

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La chirurgia estetica dei genitali femminili

Nasce una nuova teoria sull’orgasmo femminile. Secondo una ricerca condotta dall’Indiana University, chi si vergogna dei propri genitali ha difficoltà a provare piacere. Gli ultimi dati: il 12% delle donne non ha mai provato l’orgasmo, il 33% non lo raggiunge durante la penetrazione e il 47% spesso lo finge. La colpa? Della vagina. Come spiega il sessuologo Marco Rossi, “Se durante il rapporto l’attenzione è più focalizzata sul tentativo di nascondere, piuttosto che di mostrare, l’inibizione impedisce di vivere le sensazioni piacevoli. In più, l’incapacità di provare l’orgasmo porta angoscia, frustrazione e senso di colpa” e questo, a volte, manda a rotoli la coppia. L’inibizione nasce dal fatto che molte donne hanno un rapporto così intenso con l’organo sessuale da vergognarsene se non è perfetto. La soluzione? La Chirurgia Estetica dei genitali femminili. Come rivela il documentario The Perfect Vagina, gli interventi di chirurgia plastica per ridurre le grandi e le piccole labbra e tonificare il clitoride rappresentano un trend che, negli ultimi anni, è aumentato del 300%, soprattutto nei paesi anglosassoni. Vivi in maniera disinibita e con totale serenità uno dei momenti più importanti della tua vita di coppia


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Cosa può fare una labioplastica

Il normale processo d’invecchiamento può alterare lentamente anche tutta la zona delle piccole labbra che possono apprire rilassate in maniera più o meno accentuata . Talvolta invece possono presenarsi ipertrofiche per ragioni congenite. Questa situazione può portare a degli inconvenienti più o meno accentuati che possono manifestarsi con sensazione di disagio quando ad esempio si praticano attività sportive tipo ciclismo o ippica. In casi estremi si possono produrre lacerazioni od infezioni.

La labioplastica rimuovendo l’eccesso di pelle e mucosa ridona armonia e comfort. L’intervento può essere eseguito in combinazione con altri interventi di ringiovanimento dei genitali femminili come lifting vulvare , il restringimento della vagina o l’imenoplastica.


In che cosa consiste una labioplastica

Durante una labioplastica viene rimossa con il bisturi la parte di pelle e mucosa eccedente. La quantità di pelle eliminata viene misurata con precisione per ottenere un risultato simmetrico su entrambe le labbra.


Quali risultati aspettarsi da una labioplastica

L’intervento alle piccole labbra lascia una finissima cicatrice appena visibile nella naturale piega delle stesse. L’intervento non influisce sul colore o lo spessore della pelle nè sulla sensibilità.


Anestesia e ricovero

Questo intervento può essere eseguito tranquillamente nell’ambulatorio del vostro chirurgo plastico. Vi sarà praticata un’anestesia locale con un’iniezione appena percepibile direttamente sui tessuti da trattare. Se lo desiderate avete la possibilità di associare l’anestesia a un sedativo, che vi aiuterà a rilassarvi fino ad uno stato di dormiveglia. Subito dopo l’intervento potrete farvi accompagnare a casa. Chi invece per motivi personali sceglie un’anestesia generale deve calcolare il ricovero in clinica e fare le visite necessarie e il colloquio con l’anestesista il giorno prima dell’intervento. Considerate che l’anestesia generale comporta sempre dei rischi maggiori.


Precauzioni prima dell’intervento

Per ridurre al minimo i rischi e le complicazioni osservate strettamente le indicazioni del vostro chirurgo sia prima e che dopo l’intervento. Comunicategli sempre se soffrite di allergie o di altre malattie croniche. Se vi vengono lividi con facilità o se sanguinate eccessivamente in caso di piccole ferite saranno necessarie alcune analisi per escludere difficoltà del vostro sangue a coagulare. Sono controindicati antidolorifici tipo aspirina durante le due settimane che precedono l’intervento perché il loro principio attivo interferisce con la coagulazione del sangue e può causare sanguinamenti eccessivi. E’ meglio evitare anche alcolici e sonniferi.


Come prepararsi all’intervento

Procuratevi delle compresse e due o tre piccoli elementi refrigeranti.Prima dell’intervento usate dei detergenti per l’igiene intima. Cercate di arrivare a digiuno riposati e possibilmente non durante il ciclo mestruale. La sera prima è bene assumere delle compresse di antibiotico che vi cerranno indicate dal vostro chirurgo.


Come viene eseguito l’intervento

Prima dell’intervento il chirurgo traccia con un pennarello finissimo le linee d’incisione per ottenere un risultato ottimale. Si esegue quindi l’anestesia locale per procedere poi alla rimozione della pelle in eccesso con molta delicatezza e precisione. Il grasso in eccesso che produccesse eventuali rigonfiamenti inestetici viene asportato.

Con un filo sottilissimo ed invisibile esternamente si procede quindi a suturare le incisioni. L’intervento dura circa 1 ora.


Cosa succede dopo l’intervento

Subito dopo l’intervento bisogna aspettarsi gonfiori più o meno accentuati che si riassorbono dopo 1-2 giorni.. Potete togliere l’eventuale sangue lungo le linee di sutura con del cotone inumidito co della fisiologica. Attorno alle piccole labbra si presenteranno piccoli edemi che tenderanno a scomparire entro una settimana. I fili di sutura saranno tolti dopo circa 5 giorni. Le cicatrici si ridurranno a linee sottilissime appena o per niente visibili dopo circa 8 giorni.


Possibili complicazioni

Sanguinamenti sono estremamente rari ma possono avvenire 1 o 2 giorni dopo l’intervento.
In pazienti che hanno difficoltà a cicatrizzare, le linee di sutura potrebbero apparire arrossate e ruvide per più settimane. In questo caso il chirurgo può consigliare un trattamento adeguato.


Precauzioni dopo l’intervento

Non usate creme la settimana che segue l’intervento ma solo disinfettanti locali per l’igiene intima. E’ consigliabile evitare rapporti sessuali per almeno i 10 giorni successivi.

(Azienda Ospedaliera Italiana)


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Vaginal Tightening

Un intervento di chirurgia estetica di cui poco si è sentito parlare fino a poco tempo fa è certamente il vaginal tightening.

Si tratta di un’operazione chirurgica volta a modificare la conformazione delle pareti interne della vagina, rendendole più strette; l’unico motivo per cui essa viene praticata è quello di aumentare il piacere sessuale dovuto alla penetrazione nella donna.

Durante il primo parto, viene praticata un’incisione nella pelle e nelle fascie muscolari superficiali del perineo, nella parte posteriore della vagina, al fine di far passare più agevolmente il neonato e per evitare che si formino lacerazioni maggiori che comportino grosse perdite di sangue: tale tecnica viene denominata episiotomia; in seguito, non sempre avviene una corretta cicatrizzazione dell’incisione: l’apertura della vagina può risultare più ampia o addirittura asimmetrica; in tali casi, una corretta operazione di vaginal tightening può aiutare a ricostituire la normale morfologia della vagina, che, una volta tornata alle dimensioni originali, può dare maggiore piacere alla donna durante la penetrazione.

È importante sottolineare che il vaginal tightning non può risolvere problemi quali l’incontinenza o il prolasso uterino, anzi in tali casi è il chirurgi plastico a sconsigliare questo tipo di intervento chirurgico; durante l’operazione si preferisce sottoporre la paziente ad anestesia generale e non può essere eseguita in day hospital, ma è necessaria almeno una notte di ricovero in clinica onde scongiurare qualsiasi tipo di complicazione che, seppur raramente, può presentarsi. Il vaginal tightening è un’operazione piuttosto complicata ed ha un costo che parte dai quattromila euro; in seguito all’intervento sarà necessario recarsi più volte a visite di controllo e solo dopo almeno 6-8 settimane sarà possibile riprendere i rapporti sessuali.

FONTE: http://circoncisione.forumcommunity.net/?t=47737239

sabato 29 ottobre 2011

Urologist Renounces Infant Circumcision

Urologist Renounces Infant Circumcision; Discusses Risks, Harms, & Lack Of Benefits

Dr. Snyder, former president of the Virginia Urological Society, talks about the obvious ethical problems with performing an unnecessary procedure on a child that cannot consent.

He also de-bunks the myths that newborn circumcision can stop penile cancer (the rarest of all male cancers), urinary tract infections, or HIV.

Finally, Dr. Snyder addresses the real risks associated with circumcising infants, including:

- Death, usually by bleeding or infection
- Loss of the entire penis or parts of the glans (head)
- Various healing complications such as skin bridges
- Meatal stenosis (urethral strictures), which can prevent urination and damage the kidneys
- Sexual side effects from tight erections due to so much skin being cut off


Dr. Snyder was actually surprised that non-therapeutic circumcision continues to this day, seeing as most major U.S. medical associations have made it clear since the early 1970's that newborn circumcision is not a medically indicated procedure. He concludes that, with circumcision rates plummeting in the US, circumcision will likely fall completely out of favor in the US within a generation, as happened in other circumcising countries like the UK, New Zealand, and Australia decades ago.

Doctor Discusses Circumcision Controversy



James L. Snyder, M.D., F.A.C.S., Past President of the Virginia Urological Society discusses the controversy around infant circumcision.
Warning: Medical photos of circumcision harm.


Two thoughts came to mind listening to Dr. Snyder speak:

First -- Of the thousands of US doctors who continue to perform or condone non-therapeutic circumcisions today, how many are actually giving parents honest disclosure on the harms, risks, and ethical problems of child circumcision? My hunch is that the answer is zero. Any ethical doctor capable of truthfully discussing these issues would surely have already stopped performing non-therapeutic circumcisions altogether. (All US doctors swear by the Hippocratic Oath to "First Do No Harm.")

Second -- Dr. Snyder's conclusions sound remarkably similar to the conclusions of a number of large international medical organizations: that non-therapeutic circumcision of children is harmful, risky, unnecessary (by definition), and a violation of a child's rights. Consider the conclusion of KNMG, the assocation representing over 40,000 Dutch medical professionals, from their 17-page report last year condemning circumcision:

The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications – bleeding, infection, urethral stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications.
As circumcision continues to fall out of favor in the US, I can't help but think that most intelligent, educated doctors in this country will reach the same conclusions regarding the unnecessary genital cutting of children, especially considering tomorrow's male doctors will most likely be intact.

During the transition period, I suspect that doctors who do continue to perform non-therapeutic circumcision on children will increasingly face lawsuits from both the children who are cut and the children's parents, who are so often being misled by the medical professionals they are supposed to trust.

www.barefootintactivist.com/

mercoledì 26 ottobre 2011

Foreskin Man-Volume 1




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martedì 25 ottobre 2011

Jew: My position on Circumcision

I'm a Physician, a Jew, a Father & Grandfather: My position on Circumcision

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Mark D. Reiss, M.D.
DoctorsOpposingCircumcision.org


I am a 72 year old retired physician, a Jew who is an active member of a Conservative synagogue, and a grandfather.


When I was in Medical School in the 1950s, almost all newborn males were circumcised. Despite the fact that prophylactic surgery was not generally performed, we were taught that circumcision was the correct and healthy thing to do. It was thought to control masturbation, decrease cancer risk, and help curtail sexually transmitted diseases. We learned nothing of foreskin anatomy and function. Infant nervous systems were thought to be undeveloped and their pain was so trivialized that it was almost ignored. As a young physician, I participated in many circumcisions. Over the years I’ve witnessed brit milah in the homes of friends and family. I was mildly uncomfortable with the practice, but like most physicians, and like most Jews, I said and did nothing to question circumcision.


Three years ago, as I was about to become a grandfather for the first time, my interest in the subject became more focused. I learned that more and more physicians now realize that any potential benefits of circumcision are far outweighed by its risks and drawbacks. The American Academy of Pediatrics has stated that “Routine circumcision is not necessary”. Whether done by a physician in the hospital, or a mohel in a ritual brit milah, the procedure has significant complication rates of infection, hemorrhage and even death. Mortality may actually be higher than thought since some of these deaths have not been attributed to circumcision, but listed only under their secondary causes, such as hemorrhage or infection. I’ve learned of the very important role the foreskin has in the protection of the head of the penis in the infant, and in sexual functioning in adulthood. It has also been shown that the newborn feels pain even more acutely than adults do, and that many of the infants who stop crying during circumcision are actually in a state of traumatic shock. To my amazement I learned that the USA is now the only country in the world routinely circumcising babies for non-religious reasons.


With these overwhelming reasons not to circumcise, I began to look at the practice of ritual circumcision in the Jewish community and I learned that: circumcision is not an identity issue. You do not need to be circumcised to be Jewish any more than the need to observe many other Jewish laws. The bottom line is this: if your mother is Jewish, you are Jewish, period. And in the Reform tradition, patrilineal descent is also accepted. Among Jews in Europe (only 40% of newborn Jewish boys in Sweden are being circumcised), South America, and even in Israel, circumcision is not universal. Growing numbers of American Jews are now leaving their sons intact as they view circumcision as a part of Jewish law that they can no longer accept. Alternative brit b’li milah or brit shalom ceremonies (ritual naming ceremony without cutting) are being performed by some rabbis. Increasing numbers of intact boys are going to religious school, having bar mitzvahs, and taking their place as young adults in the Jewish community.

As a Jewish grandfather, I want to assure young couples about to bring a child into the world, that there are other members of the Jewish “older” generation, including other Jewish physicians, and even some rabbis, who feel as I do. If your heart and instincts tell you to leave your son intact, listen!

(http://www.drmomma.org/2009/08/im-doctor-j...dfather-my.html)

domenica 23 ottobre 2011

Jewish on Circumcision

Jewish on Circumcision


Miriam Pollack, speaks frankly about her experiences and studies on circumcision.
For PART 2 go to:
www.youtube.com/watch?v=zAQdM2CxY5c

Why do/did you have foreskin?The foreskin occupies a prominent position on an important organ. The foreskins location and structure indicate that it is the most important sensory tissue of the penis. Its persistence over millions of years suggests that it has played a role in the propagation of the species.

Il prepuzio occupa una posizione preminente su un importante organo. La posizione e la struttura prepuzi indicano che è il tessuto più importante sensoriale del pene. La sua persistenza nel corso di milioni di anni suggerisce che ha svolto un ruolo nella propagazione della specie.

A well-integrated organStructurally, the penis is highly integrated. The glans, foreskin and skin of the penile shaft function as a single unit, not as a collection of separate parts with entirely different functions. The functions of the glans and foreskin are similar, and overlapping, but come fully into their own at different times during intercourse.

Il glande, il prepuzio e la pelle che riveste il pene vanno viste come una singola unità, non come un insieme di parti distinte con funzioni completamente diverse.

Simple sensationsThe outer surface of the foreskin is specialized to detect feather-light touch and other sensations, including painful ones. The infamous zipper injury is an extreme example of the sort of damage the outer skin was designed to detect and prevent, long before the zipper posed a threat to the uninitiated.

Compared with the true (outer) skin of the foreskin, the glans is only feebly sensitive to light touch, pain, heat and cold. This is part of the reason we call the foreskin the primary sensory tissue of the penis. Without the foreskin, the end of the penis is numb to a host of sensations that tell the owner whether one of his most prized organs is in good company, or should move to safety.

Rispetto al vero (esterno) della pelle del prepuzio, il glande è solo debolmente sensibile alla luce tatto, dolore, calore e freddo. Il Prepuzio regola pure la temperatura e l'omeostasi interna dell'organismo nell'uomo.

Complex sensationsThanks to its ridged band, the inner lining of the foreskin is specialized sexual tissue. The ridged band readily expands and contracts and is obviously designed to detect stretching forces. When penile shaft skin tugs on the ridged band, special genital corpuscles in the peaks of the ridges detect movement and trigger ejaculation. Stretching of the ridged band may also trigger and sustain erection.

Electrical stimulation of the glans triggers nerve impulses that pass to the spinal cord and then to the muscle of ejaculation. Clearly the glans has much in common with the foreskin. Where foreskin and glans part company, functionally as well as physically, is in their sensitivity to light touch, pain and heat and cold. Contrary to common opinion, the glans is not highly sensitive to a broad range of stimuli.

Foreskin vs. glansIt is unclear whether the ridged band simply plays backup for the glans, or whether the two have different functions. The location of the retracted ridged band on the erect penile shaft suggests that the difference is one of timing. Possibly, the foreskin and its ridged band are designed to ensure that sexual reflexes are triggered when, and only when, these structures are stretched during intercourse. The biological importance of the ridged band to conception is self-evident, but there is still a major gap in our understanding of the relation between form and function of the penis.

Dartos musclePenile skin has two important characteristics, apparent only on erection. Firstly penile skin tenses, stiffens and shortens, firming up the connection between shaft skin and ridged band. This change allows for the transmission of movement from the base of the erect penis to the ridged band.

Secondly, penile skin undergoes a marked frictional change, brought about by stiff, forward-pointing skin folds. The mechanism is similar to that which raises goosebumps.

The changes in penile skin are brought about by contraction of the Dartos muscle. Between them, stiffening and frictionality ensure that the ridged band is instantly alerted to changes in position of the penis within the vagina.

Why two layers?The double-layering of the foreskin allows the delicate ridged band, which normally is safely hidden from view, to be deployed on the upper surface of the penile shaft during erection. There it stands a better chance of being activated. Double-layering also eases vaginal entry by offsetting the frictional resistance of erect shaft skin.

la Double-stratificazione, inoltre, facilita l'ingresso vaginale mediante compensazione con la resistenza d'attrito in erezione della pelle ad albero del pene.

SummaryThe various parts of the penis, including the foreskin, form a functional whole. The foreskin is the primary sensory tissue of the penis. The ridged band of the foreskin is built to trigger orgasm and ejaculation.

Le varie parti del pene, tra cui il prepuzio, formano un insieme funzionale. Il prepuzio è il tessuto sensoriale primario del pene. La "band increspate" del prepuzio è costruita per innescare l'orgasmo e l'eiaculazione.




Circumcision & Jewish Identity
http://youtu.be/zAQdM2CxY5c





Intactivist Laurie Evans talks about her reaction to circumcision.


Jewish Women Against Circumcision

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giovedì 20 ottobre 2011

Myth and Fact over Circumcision

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Myth and Fact over Circumcision


Myth – Circumcising baby boys is a safe and harmless procedure.
Fact – Surgically removing part of a baby boy's penis causes pain, creates immediate health risks and can lead to serious complications. Risks include infection, hemorrhage, scarring, difficulty urinating, loss of part or all of the penis, and even death. Circumcision complications can and do occur in even the best clinical settings.

Myth – Circumcision is just a little snip.
Fact – Surgical removal of the foreskin involves immobilizing the baby by strapping him face-up onto a molded plastic board. In one common method, the doctor then inserts a metal instrument under the foreskin to forcibly separate it from the glans, slits the foreskin, and inserts a circumcision device. The foreskin is crushed and then cut off. The amount of skin removed in a typical infant circumcision is the equivalent of 15 square inches in an adult male.

Myth – Circumcision is routinely recommended and endorsed by doctors and other health professionals.
Fact – No professional medical association in the U.S. or anywhere else in the world recommends routine circumcision as medically necessary. In fact, leaving boys intact is now the norm in the U.S., with circumcision rates well below 40%.

Myth – The baby does not feel any pain during circumcision.
Fact – Circumcision is painful. Babies are sensitive to pain, just like older children and adults. The analgesics used for circumcision only decrease pain; they do not eliminate it. Further, the open wound left by the removal of the foreskin will continue to cause the baby pain and discomfort for the 7-10 days it takes to heal.

Myth – If I don't circumcise my son, he will be ridiculed.
Fact – Times have changed and so has people's understanding of circumcision. Today, although the popularity of circumcision varies across geographical areas, more than 70% of all baby boys born in the U.S. will leave the hospital intact. Most medically advanced nations do not practice child circumcision. Three quarters of the world's men are intact.

Myth – A boy should be circumcised to look like his father.
Fact – Children differ from their parents in many ways, including eye and hair color, body type, and (of course) size and sexual development. If a child asks why his penis looks different from that of his circumcised father (or brother), parents can say, "Daddy (or brother) had a part of his penis removed when he was a baby; now we know it’s not necessary and we decided not to let anyone do that to you."

Myth – Routine circumcision of baby boys cannot be compared to Female Genital Mutilation.
Fact – Rationales offered in cultures that promote female genital cutting – hygiene, disease prevention, improved appearance of the genitalia, and social acceptance – are similar to those offered in cultures that promote male circumcision. Whatever the rationale, forced removal of healthy genital tissue from any child – male or female – is unethical. Boys have the same right as girls to an intact body, and to be spared this inhumane, unnecessary surgery.

Myth – To oppose male circumcision is religious and cultural bigotry.
Fact – Many who oppose the permanent alteration of children's genitals do so because they believe in universal human rights. All children – regardless of their ethnicity or culture – have the right to be protected from bodily harm.

Myth – Circumcising newborn baby boys produces health benefits later in life.
Fact – There is NO link between circumcision and better health. In fact, cutting a baby boy's genitals creates immediate health risks. The foreskin is actually an important and functional body part, protecting the head of the penis from injury and providing moisture and lubrication. Circumcision also diminishes sexual pleasure later in life.

Myth – Male circumcision helps prevent HIV.
Fact – Claims that circumcision prevents HIV have repeatedly been proven to be exaggerated or false. Only abstinence or safe sex, including the use of condoms, can prevent the spread of sexually transmitted diseases, including HIV/AIDS.

da Intact America

martedì 18 ottobre 2011

Circoncisione: Metodi & Strumenti

Mogen clamp

In 1954, Rabbi Harry Bronstein, a Brooklyn mohel who'd previously invented the Nutech clamp - that's the one that looks like a hacksaw - invented the Mogen clamp. Mogen means shield (and in fact what we call in English the Star of David is Mogen David in Hebrew, the Shield of David.) It resembles a barzel, but one whose two blades are hinged together, and brought together with a cam.

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This is a step backward to straight-line cutting, but mohels like it because it's quick and resembles the traditional method. Unlike the barzel, it closes to crush the foreskin before it is cut. Described as "the least painful method" though there is no reason this should be so, and "able to be used without previous experience." With the glans below and completely out of sight, it can be trapped in the locked slit. And as Grossman points out, the meatal lips often project from the glans and into the clamp. It opens no wider than 3mm in order not to admit the glans - but it is not possible to see whether this has in fact happened: Varney's Midwifery - in a chapter written by a mohalet - says 'Using the Mogen clamp has the distinct disadvantage of making the circumcision a "blind" procedure. The glans of the penis cannot be seen (so anomalies may not be discovered until after the circumcision) and is thus at risk of being cut.'
This occurred in Florida in 2004, and the parents sued both the mohel and the Mogen company. They won $10.7 million, and the Mogen company went out of business.


Plastibell™

Come the 1950s, plastics and the age of disposables, and the Plastibell - developed out of the Ross Ring in 1950 - became the method of choice. Like the Gomco, it requires a dorsal slit and tearing of the foreskin from the glans before it can be fitted.

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Then the foreskin is pulled up over the bell, and the ligature tied to crush it into the groove. Everything distal to the ligature dies, and to stop this upsetting parents too much, it may be cut off first.
A grooved plastic dome (with a handle, designed to be broken off) placed under the foreskin (which must be slit and forcibly separated from the glans to allow entry). A ligature (thread) is tied tightly around the foreskin, crushing it into the groove, causing it to become necrotic (to die) and drop off. Varney's Midwifery, citing Gee and Ansell, says "the Plastibell has a higher incidence of infection."

Plastibell circumcision: A minor surgical procedure of major importance.

Samad A, Khanzada TW, Kumar B. Department of Surgery, Isra University, Hyderabad, Pakistan.

J Pediatr Urol. 2009 Jun 12.

OBJECTIVE: To determine ... the Plastibell impaction rate in various age groups.

...

RESULTS: ... The overall complication rate was 7.4%. Plastibell impaction [the Plastibell™ ring trapped by the swollen penis] was the commonest complication, encountered after 6.1% of procedures, and was managed by cutting the Plastibell. The impaction rate was only 2.3% for babies under 3 months, but gradually increased to 26.9% for children over 5 years.


One study of 2000 PlastibellTM circumcisions found a complication rate of 2.8%, "the most frequent being minor infection and hemorrhage. Other complications included a tight Plastibell ring that can cause constriction of the glans penis, irregular skin margin, inadequate skin excision and migration proximally [up the penis] of the Plastibell ring as the glans swells with venous engorgement. There have been isolated cases of necrotizing fasciitis, ruptured bladder, retention of urine secondary to glandular prolapse, and retention of the Plastibell device.


Preputome

A cross between the Circumcision Forceps and the Gomco was the Preputome, invented in 1945 by a Brooklyn doctor called Al Akl.
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(It was not actually a preputome, because it didn't cut. A better name would have been "prepustat".) It thoughtfully provided a hole through which the baby could urinate on the doctor. Since the bell pressed the glans downward, it could wedge some of the corona against the ring as the clamp was closed, allowing it to be cut along with the foreskin. The Preputome never became popular (especially not with babies).


Sheldon clamp II

The first of its two pairs of flat jaws grasps the acroposthion, the second set, the foreskin proper, ahead of the glans - if the boy is lucky. A straight cut is made between the two sets, resulting in a low circumcision similar to the tribal cut. Making the operator slice into a small aperture in the instrument almost guarantees an awkward cut. The Sheldon Clamp has reportedly been withdrawn because of lawsuits, but was still in use as late as 1994.

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Sheldon Clamp (showing how glans can be damaged)
The design seems simply unfortunate; it's hard to understand how it ever left the drawing- board.


Tibone Clamp

Even simpler was the Tibone clamp of 1944 This lost the leverage provided by the Gomco, and was more awkward to fit. Also, says Grossman, the side arm of the C was too close to the bell, and got in the way of the scalpel. (You'd have thought that was easy to fix). The device never gained any popularity.

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Improved Bloodless (Maryan) Clamp

Another variant on the Gomco was the Improved Bloodless Circumcision Clamp invented by a Dr H O Maryan in 1954:

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This had three interchangable bells, and supported the screw on a tiny lintel, like an early printing press, that pulled instead of pushing.


Glansguard

A doctor called Melges invented the Glansguard as late as 1972. It resembles a kitchen bag-sealer. It has a built in knife. It doesn't guard the glans, especially when it's put on upside down, hence the clear message, "This Side Up".


Turner clamp

So did the Turner Clamp of 1952, but it is operates in the reverse direction, the bell crushing the prepuce down on the aperture.
Both had the problem of the Tibone times two, the supports of the bell getting in the way of the scalpel on both sides. Neither eclipsed the Gomco.

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Leff clamp

Flat clamping continued with the Leff Clamp, invented in 1950, which looked like, and worked like, a large paper clip, used in conjuction with a barzel.

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Kantor clamp

In 1953, a Texas physician called Kantor merged a haemostat with a barzel.
Its linear cuts, as with all linear devices, resulte in crushed "dog ears" at the front and back of the penis.


Ross Rings

The first of the tourniquet devices was the metal Ross ring.

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In five sizes (reusable, as the handsome art deco walnut case implies), it included one groove for the ligature and one to catch the scalpel as it cut off the foreskin.

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Its tiny handle was on an angle, perhaps to align with the axis of the penis and follow the line of the sulcus. But in that case the small notch on the outside is on the wrong side to accommodate the frenulum, as one commentary suggests. (Its purpose may actually be to facilitate the knot.) An enclosed leaflet reportedly "Says the device is to be left in place for 24 to 72 hours."

Reference:(For instruments from 1920-1980) Grossman E. The Evolution of Circumcision Technique. In Circumcision: A Pictorial Atlas of its History, Instrument Development and Operating Techniques. Great Neck: Todd & Honeywell 1982]

lunedì 17 ottobre 2011

Study confirms male circumcision is genital mutilation

A new study in the British Journal of Urology International shows that men with normal, intact penises enjoy more sexual sensitivity – as much as four times more – than men who have been circumcised. Circumcising slices off more of a male’s sensitivity than is normally present in all ten fingertips. Circumcision removes the most sensitive portions of the penis. Thi news study demonstrates what we have suspected for decades, that circumcision’s result, if perhaps not its intent, is reduced sexual pleasure for men. As such, it is a violation of a male’s right to bodily integrity. In large part, female circumcision does the same: even the mildests forms remove the most sensitive portions of the female genitalia. Females in the USA and many other countries are protected by law from all forms of genital cutting. Because circumcision has such a drastic effect on sexuality later in life, no infant or child should ever experience a non-therapeutic circumcision. Parents should not be allowed to control their son’s level of sexual sensitivity, just as no parent should be allowed to request for their son or daughter any other sensitivity-reducing surgery; for example, eye surgery that would limit vision from color to black-and-white.

In addition, circumcised men, with one-fourth the sensitivity of intact men, might decline to wear further-desensitizing condoms, increasing their and their partner’s risk to infectious diseases.

Adult men who want circumcision for themselves should be advised per proper informed consent that penile sensitivity will be reduced on average by a factor of four.
    Sorrells ML, Snyder ML, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS. Fine-touch pressure thresholds in the adult penis.

Circoncisione: Metodi & Strumenti

Methods of circumcision

Tribal

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Tribal circumcision has common in Africa. The commonest method is to pull out the foreskin and chop with a spear or slice with a knife against some hard substrate. The terror and pain of this seems to be part of its appeal (to the adults).


Barzel and Izmel

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The izmel (Hebrew for scalpel) is a double-bladed knife, to ensure that a nervous mohel can not choose the wrong side and thereby cause (additional) pain to the baby. You might think that the wrong side could be marked, coloured or otherwise indicated quite easily, reducing both that risk and the risk of cutting some other part of the baby or the mohel himself with the back blade.

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The barzel (Hebrew for iron) also known as a mogen (Hebrew for shield) s a slotted shield to protect the glans, which it may or may not do, depending on the glans' size and conformation. This one is gold-plated silver.


Forceps guided

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A basic surgical method before the invention of the various medical clamps - widespread in the British Commonwealth when it was still believed to do some good. The foreskin was pulled through a pair of bonecutters, which (usually) protected the glans, and the exposed foreskin cut along the clamp's edge.


Sleeve resection

Two circular cuts and one lengthwise one are made in the shaft and a cylinder of skin is removed, then the cut ends pulled together and stitched. The outcome depends on where along the penis the cuts are made, and how far apart they are. In Japan, though it is rarely done at all, proximal cuts (close to the body, are reportedly favoured, keeping the inner mucosa and ridged band, but possibly interfering with their innervation.

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This image is from a study that found 10 immediate and 8 late complications, and 20 adhesions, in 68 sleeve circumcisions.


Scissors

When non-religious circumcision of adults became a commonplace, Sir Frederick Treves used scissors.

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The problem with using no clamping method was, how to keep even tension on the foreskin to give a straight cut? As the cut proceeds, the same amount of tension is concentrated in less and less skin, "so the incision at the frenulum was often deeper and uneven." (Grossman)


Smartklamp™

A non-reusable circumcision device made of plastic, similar to the Tara KLamp. Works by cutting off circulation to the foreskin, using a plastic ring clamped in place over a tube. Available in sizes up to adult.

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Tara KLamp™

A non-reusable circumcision device made of plastic. Works by cutting off circulation to the foreskin, using a plastic ring clamped in place over a tube (to allow urination). Available in sizes up to adult, recently developed in Malaysia. (Capital, Kuala Lumpur = K.L., hence KLamp)

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S Afr Med J. 2009 Mar;99(3):163-9,
High rate of adverse events following circumcision of young male adults with the Tara KLamp technique: a randomised trial in South Africa.

Lagarde E, Taljaard D, Puren A, Auvert B.

Abstract

BACKGROUND: The Tara KLamp (TK) device has been claimed to enable circumcisions to be performed safely and easily in medical and non-medical environments. Published evaluation studies have been conducted among young children only.

METHODS: Following a randomised controlled trial (RCT) on 3 274 participants on the impact of male circumcision on HIV transmission, 69 control group members participated in this male circumcision methods trial and were randomised to a forceps-guided (FG) group and a TK group, and circumcised.

RESULTS: Of the 166 men asked to participate, 97 declined, most (94) refusing circumcision by the TK technique; 34 men were randomised to the FG group and 35 to the TK group, and 32 and 24 patients were circumcised by the FG and TK methods respectively, of whom 29 and 19 respectively attended the post-circumcision visit. All 12 adverse event sheets corresponded to the TK group (p<0.001) and circumcisions by the TK method. Less favourable outcomes were associated with the TK method, including any sign of an adverse event (37% v. 3%; p=0.004), delayed wound healing (21% v. 3%; p=0.004) and problems with penis appearance (31% v. 3%; p=0.001). Participants randomised to the TK method were significantly more likely to report bleeding (21% v. 0%; p=0.02), injury to the penis (21% v. 0%; p=0.02), infection (32% v. 0%; p=0.002), swelling (83%/ v. 0%; p<0.001), and problems with urinating (16% v. 0%; p=0.056). The mean score of self-estimated pain was 9.5 for participants circumcised by TK compared with 6.1 for other participants (adjusted p=0.003).

CONCLUSION: This study provides compelling evidence that strongly cautions against use of the TK method on young adults.



Sunathrone

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The Sunathrone, made in Malaysia, described as "the Superb Bio-Engineering Innovation Envisioned and Derived from Aerospace Technology" offers "non-invasive circumcisions" - which would be quite a feat. It replaces the suture of the Plastibell with a hard outer clamp that is applied with a plier-like device called a Sunalever and locks shut like a handcuff. The chess-queen-like cone is broken off after the foreskin has been cut away.


Kirve Clamp

The Kirve clamp resembles the Shang ring, but with a placement device with a handle and a bayonet fitting so that it can be removed from the inner ring after placement and cutting.

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Kirve is Turkish for "uncle".


PrePex

Very similar to an Elastrator, the PrePex system cuts off circulation and kills the foreskin with an elastic ring that crushes it into a grooved ring. Claimed to be bloodless and not to require anaesthetic or a sterile environment. Being tested in Rwanda in 2011.

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Ismail Clamp

The Ismail clamp uses a screw to apply pressure instead of levers.

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It claims to be "readily removable" which means it can be re-used, with a risk of cross-contamination.


Ali's Clamp

Ali's clamp is the only devide to recognise that the cut is on an angle to the axis of the penis, and hence not circular.

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It makes the slightly less inaccurate simplifying assumption that the penis then has an elliptical cross-section.


Ecraseur

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In Paris in 1920, Doyen used what he called an écraseur or crusher on both adults and babies.


Circumcision forceps

Invented by a Dr Moskovich in 1920, apparently for adult circumcision, but they look more as though they should be used to blow bubbles.

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The top ring was introduced into the preputial cavity - somehow - and the foreskin fanned out between the two rings. After cutting round it, seven sutures could be made in the notches. It had the obvious problem of the place where the forceps attach to the rings. The rings also left a collar of skin round the glans. Less obvious, it can't apply much pressure over so large an area, but it was the first circumcision device to acknowledge that the prepuce is, more or less, circular.


Harris Clamp

The Harris Clamp (1932) certainly didn't consider the actual shape of the foreskin. It looks as though you'd need two thumbs to work it.

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The third arm, C, drives a blade up through a slit in both the haemostat arms. The problem with that is that the blade gets blunt with repeated use.


Gomco™ clamp

A device invented in 1934 by Hiram S. ("Inch") Yellen, M.D. and Aaron A. Goldstein (and reportedly based on the tyre-lever used for Model T Fords, according to Julian Wan's sickeningly worshipful history of the device). It consists of a metal bell placed over the glans (requiring a slit in the foreskin first) and a flat plate with a hole in it placed over both, to define the position of the cut. They are brought together by a screw to apply circular crushing and fusing force (of 8000 to 20,000 pounds, according to Wan) at the position of excision. It leaves a characteristic dark line at the excision scar.

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Varney's Midwifery says its disadvantages are that "it involves more parts, requires more steps in the procedure, and it takes more time." Under that enormous pressure, a groove wears in the bell with prolonged use, making it ineffective. The clamp is made in a set with different-sized bells and rings and there is a danger of mixing parts of different sizes. In 2001, the FDA issued a warning against clamp injuries. A video for the rival Accu-circ demonstrates how these injuries can occur.

In 2009, Dr David Tomlinson endeavoured to reduce this risk by adding coded holes to the lever and corresponding studs on the plate, and differently sized shafts on the bells, matched to differently sized notches on the lever.

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The bell has been found to develop grooves and nicks following repeated use with surgical blades. There have been reports of the bell breaking where it presses against the baseplate as pressure is applied. A ring of metal breaks off and is left inside the preputial cavity and the clamp is rendered useless. There have also been reports of glans injury if the scalpel cuts through the bell.
The Gomco can obviously not be left on the penis, in fact it is removed as soon as the skin is cut off, giving a risk of bleeding.


Nutech Clamp
This is even more true of its offspring, the Nutech Clamp invented by Rabbi Harry Bronstein, which looks like a hacksaw, but is actually held the other way around:

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Circumstat

A more obvious descendent of the Gomco is the Circumstat, invented by Rabbi Irving Grossman in 1962.

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The cam is apparently quicker and simpler than the screw of the Gomco.