7 MYTHS ABOUT PHIMOSIS IN ADOLESCENTS AND ADULTS


​​The road to score 0 should be calm and serene, with common-sense and without alarmism in the case of some slight deviation of course. It should be.
Check-out 7 of the most commonly propagated myths - some of them, unfortunately, quite popular even among health professionals.

​1 - "PHIMOSIS CAUSES PENIS CANCER"​

FACT: first of all, penis cancer is extremely rare: in Europe, where the vast majority of men are intact (did not have their foreskin removed through circumcision), penile cancer corresponds to less than 1% of the tumors that affect the male population, and is manifested in approximately only 1 in every 100,000 men[1].

In any case, the main risk factors for this type of tumor are the ingestion of tobacco[2,3], which spreads carcinogens all over the body through blood flow, and the presence of the papilloma virus (HPV), which is transmitted by sexual relations[4]. The phimotic condition in a sexually active man who interacts with several partners without a condom can be considered a risk factor, since it hinders penile hygiene and increases the likelihood of HPV transmission. But the great villain of the story is not phimosis, but lifestyle and lack basic personal care.

2 - "THE FORESKIN IS JUST A FLAP OF SKIN..."​

FACT: the foreskin is the only moving part of human sexual anatomy. It is composed of very specific cells and tissues, whose collective purpose is to act as the frontier between the penis and the outer environment.

Because it is mobile, besides the external skin it is also composed of an "inner skin", which can be visualized only when the foreskin is retracted.
This inner skin, which due to the mobility of the foreskin also enters into contact with "the world" during sexual intercourse, is much more sensitive to stimuli than the external one[5], whose main function is protection. In addition, your frenulum is a functional tissue replete with nerve endings, being much more sensitive and specialized than any random piece of skin[6].

3 - "...AND WON'T BE MISSED"​

FACT: the foreskin is important to protect the glans from abrasions, keep it lubricated and sensitive to tactile stimuli. When it is removed through circumcision, the glans undergoes a process called keratinization, and becomes desiccated (dry) and desensitized[7] to compensate for the lack of natural protection.
Moreover, because the inner skin and the frenulum are intensely innervated and erogenous, their removal will also deprive you of important sensory stimuli. Such removal of nerve endings, associated with desensitisation of the glans, may have a significant impact on your sexual life[8,9,10,11,12].
But you are not the only one who may sorely miss the foreskin: due to the dryness of the keratinized glans, the circumcised penis will require more lubrication from your partner (or the use of some lubricant) so that she does not feel pain due to friction during sexual intercourse[13,14].

4 - "CIRCUMCISED MEN HAVE A LOWER RISK OF CATCHING SEXUALLY TRANSMISSIBLE DISEASES..."​

FACT: there are several mechanisms of natural immunological protection provided by the foreskin against infections[15]. Dried up mucous membranes are more susceptible to infection than those naturally humidified. In addition, subpreputial moisture contains lysozyme, an enzyme that attacks and destroys the protective layer of many bacteria. Statistical data studies have found no evidence for an alleged prophylactic role of circumcision[16]. The only effective way to prevent from sexually transmitted diseases (STDs) is the use of a condom.

5 - "...BECAUSE SMEGMA CAN CAUSE ILLNESSES"​

FACT: in its fresh state, smegma (that greasy substance that forms between the foreskin and the glans) is nothing more than a healthy and functional lubricant. But, when accumulated for a long time, it may present a rather unpleasant smell.
This alteration of odor, which occurs mainly after puberty, is due to the chemical fractionation of fats and the action of normally harmless germs. In addition, foreign material may have access to the smegma deposit in the form of dirt, dust or sand, or even urine and semen.
As with any other part of the body, the lack of basic care can cause small problems, odors, and infections which are usually (but not always) easily treatable. It is true that a penis with phimosis facilitates the accumulation of smegma and is difficult to be properly cleaned - this is one reason why it is important to resolve the phimotic condition after puberty. But the culprit is not smegma, but the lack of hygiene.

6 - "if phimosis IS ASSOCIATED WITH INFLAMMATION OR INFECTION, YOU MUST OPERATE AS FAST AS POSSIBLE"​

FACT: when a patient has an inflammation or infection in any other region of the body, no reasonable doctor will propose the amputation of organic tissue without first trying to reverse the status with the use of medicines.

Most types of foreskin inflammation (posthitis) is of infectious nature and responds well to antibiotic or fungicide treatments[17]. On the other hand, pathologic phimosis due to whitish fibrous ring (lichen sclerosus) can in some cases be reversed with the application of ultrapotent corticoid cream, which should be the treatment of first choice for such condition[18]. If a urologist says that your skin disease is irreversible without trying to reverse the status with the use of medicines, be sure visit a good dermatologist to confirm the diagnosis.

7 - "PHIMOSIS CAN ONLY BE RESOLVED VIA SURGERY, SPECIALLY IN THE CASE OF ADULTS"​

FACT: physiological phimosis can be treated non-surgically[19,20], with or without the aid of corticoid ointments.

REFERENCES

  1. http://www.cirp.org/library/disease/cancer/
  2. Rogus BJ (1987). Squamous cell carcinoma in a young circumcised man. J of Urology, 138(4):861-2.
  3. Harish K, Ravi R (1995). The role of tobacco in penile carcinoma. British J of Urology, 75(3):375-377.
  4. Shingleton H, Heath Jr CW (1996). Letter to the American Academy of Pediatrics. American Cancer Society.​
  5. ​Taylor JR, Lockwood AP, Taylor AJ (1996). The prepuce: specialized mucosa of the penis and its loss to circumcision. British J of Urology, 77:291-5.
  6. McGrath K (2001). The frenular delta: a new preputial structure. Em: Denniston GC. Understanding Circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem. Nova Iorque: Kluwer/Plenum, 199-206.
  7. Sorrells ML, Snyder JL, Reiss MD, et al (2007). Fine-touch pressure thresholds in the adult penis. British J of Urology, 99:864-9.
  8. Denniston GC, Hill G (2004). Circumcision in adults: effect on sexual function. Urology, 64(6):1267.
  9. Kim D, Pang M (2007). The effect of male circumcision on sexuality. BJU Int, 99(3):619-22.
  10. Solinis I, Yiannaki A (2007). Does circumcision improve couple's sex life? Journal of Men's Health and Gender, 4(3):361.
  11. Frisch M., Lindholm M, Gronbaek M (2011). Male circumcision and sexual function in men and women: A survey-based, cross-sectional study in Denmark. International J of Epidemiology, 40(5):1367-1381.
  12. https://davidlouis77.wordpress.com/2010/05/08/adult-circumcision-my-experience-2-years-on/
  13. O’Hara K, O’Hara J (1999). The effect of male circumcision on the sexual enjoyment of the female partner. British J of Urology International, 83(1):79–84.
  14. Bensley GA, Boyle GJ (2003). Effects of male circumcision on female arousal and orgasm. NZ Medical J, 116(1181):595-6.
  15. Fleiss P, Hodges F, Van Howe RS (1998). Immunological functions of the human prepuce. Sexually Transmitted Infections (London), 74(5):364-7.
  16. Laumann EO, Masi CM, Zuckerman EW (1997). Circumcision in the United States. J of the American Medical Association, 277(13):1052-7.
  17. Edwards S, Bunker C, Ziller F, Meijden W (2014). 2013 European guideline for the management of balanoposthitis. International J of STD & AIDS, 25(9):615-626.
  18. Neill SM, Tatnall FM, Cox NH (2002). Guidelines for the management of lichen sclerosus. British J of Dermatology, 147:640-9.
  19. Dunn HP (1989). Non-surgical management of phimosis. Australian and New Zealand J of Surgery, 59(12):963.
  20. Ying H, Xiu-hua Z (1991). Balloon dilation treatment of phimosis in boys. Chinese Medical J, 104(6):491-3.