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Aim of Surgery |
Treatment for:
· Repeated infection and inflammation (balanitis). In spite of adequate hygiene one may suffer from persistent or recurrent soreness, itching or redness of the inner aspect of the foreskin and penis head. Balanitis may also occur before the prepuce has fully separated from the glans in childhood. Recurrent attacks may lead to scarring of the foreskin (phimosis). Similarly, inflammation affecting the glans may heal with scarring and narrowing of the water pipe opening (meatal stenosis). If passing water becomes difficult an operation (meatotomy) to enlarge the opening may be necessary. A variety of germs will flourish under a damp prepuce and they are difficult to permanently eradicate until the area is rendered permanently dry by circumcision. Thrush or Monilia, a fungus infection, is quite common in the vagina of women on 'the pill' and their male consorts are liable to get 'thrush balanitis'. Due to the presence of sugar in their water diabetics are also prone to balanitis. Similarly warts under the prepuce, which are caused by a virus infection, are difficult to cure until circumcision is performed.
· Phimosis: After infancy the foreskin should be loose enough to be drawn back so as to completely expose the whole penis head and to be pulled forward again without pain or difficulty. In the mature youth this action should be possible with the penis erect. If it cannot be retracted at all (phimosis), washing is not possible and smegma accumulates. Phimosis also makes sexual intercourse unsatisfactory and low deposition of semen in the vagina due to poor penetration may cause infertility. Occasionally the opening becomes so small that even passing water becomes difficult. Phimosis may follow injury (e.g. zip-fastener!), inflammation (see below), or it may be a developmental abnormality. Parents are often surprised to learn that their teenager needs a circumcision, having been assured he was perfectly normal earlier in life. The explanation is that before puberty the opening in the prepuce was large enough to allow the glans to pass through but during the rapid growth of the penis after puberty only that part of the foreskin which covers the glans enlarges. In consequence, the tip of the prepuce which lies beyond the glans does not grow, the opening stays the same size and the much enlarged glans will no longer pass through (puberty phimosis). A tight prepuce cannot be cured by stretching at any age because this only causes little splits which heal with scarring making the condition worse than before.
· Paraphimosis: If a tight prepuce is forcibly drawn back (e.g. during intercourse) it may become jammed and incapable of being pulled forward again (paraphimosis). In this painful condition the foreskin strangulates the glans and emergency treatment is necessary. So heed the warning signs that paraphimosis is going to occur when you are no longer able to draw the foreskin forward after sexual intercourse until the erection subsides or when painful little splits appear in the tip of the prepuce during sexual intercourse.
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