At various points in history, a number of churches in Europe have claimed to possess Jesus's foreskin , sometimes at the same time. Various miraculous powers have been ascribed to it. All Jewish boys are required by Jewish law to be circumcised on the eighth day following their birth; the Feast of the Circumcision of Christ , still celebrated by many churches around the world, accordingly falls on January 1. Luke King James Version , reads: "And when eight days were accomplished for the circumcising of the child, his name was called JESUS, which was so named of the angel before he was conceived in the womb. Foreskin relics began appearing in Europe during the Middle Ages.
When you visit our websites, we and our third-party partners send cookies — small, removable data files French foreskin to your computer. BoxHarlan, IA J Urol. Urol Clin North Am. Lawrence held three caskets. Les hommes peuvent avoir les.
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Language: English French. To study the approaches to foreskin management of pediatric urologists in Canada. An online questionnaire comprising several survey questions and clinical vignettes. Diagnoses and management strategies for common foreskin conditions seen in consultation, including how many pediatric urologists perform neonatal circumcisions, patient costs, and the reasons for performing the surgery.
Management of asymptomatic physiologic phimosis is very conservative, with surgeons unlikely to intervene.
Our data support the hypothesis that pediatric urologists across Canada are very similar in their conservative approach to the management of common foreskin issues. Our goal is to improve the knowledge base among primary care providers and subsequently decrease patient and family anxieties. Questionnaire en ligne comportant diverses questions et vignettes cliniques. In , the Foetus and Newborn Committee of the Canadian Paediatric Society CPS published their position on prophylactic neonatal circumcision, stating that there was a lack of medical support for the procedure 1 ; this position was affirmed by the American Association of Pediatrics AAP.
This controversial position generated considerable opposition, 9 , 10 but both the AAP and CPS later reaffirmed their statements. The trend in infant circumcisions in Canadian hospitals appears to reflect the position of the CPS, with a substantial reduction in numbers performed after the consensus statements were released. In , the proportion of male infants circumcised was Because of the growing population of uncircumcised children, it is important that physicians, residents, and other health care practitioners be proficient at dealing with patient and family concerns about the proper care of the foreskin.
McGregor et al demonstrated that this was an area in need of improvement among primary care physicians and some subspecialists.
There are absolute indications for surgical or medical intervention for the care of the foreskin; however, there is diagnostic uncertainty as to what these indications are and how they present. We hope that this survey will serve as an educational tool for physicians and other health care providers with respect to care of the foreskin, as well as provide a foundation for patient and family education. Ethics approval was obtained from the University of Alberta Health Research Ethics Board, and a survey was created using the online survey generator SurveyMonkey.
It consisted of 12 multiple choice questions, which included topics relating to circumcision practices and costs, as well as several clinical vignettes with images of foreskin-related conditions. The vignettes incorporated conditions such as balanitis xerotica obliterans BXO , redundant foreskin, persistent phimosis, foreskin ballooning while voiding, and other issues.
The Internet-based survey allowed for high-quality photographs, which were used for several questions regarding foreskin pathology. The surveys and information sheets were mailed out electronically to the active members of the Pediatric Urologists of Canada, comprising 32 physicians nationwide. The first clinical question of the survey involved an asymptomatic 6-year-old boy unable to retract his foreskin.
The description was meant to portray a child with physiologic phimosis Figure 1. None of the urologists would recommend circumcision, nor would any promote aggressive methods of foreskin stretching. A healthy foreskin with physiologic phimosis. The distal ring is closed, but there is no evidence of scarring or BXO. The next question described a 5-year-old child with pathologic phimosis who likely had a case of BXO Figure 2.
These photographs depict 3 foreskins with the classic appearance of BXO. T he phimotic ring is closed, but the indurated, white scar is readily discernible from normal, healthy skin. We also asked the surgeons how they would treat an asymptomatic, year-old child who was still not able to retract his foreskin. One physician did not respond to the question. We believe that this reflects the consensus on a lack of medical benefit.
These circumcisions are likely to be associated with substantial costs for patients. The remaining questions were meant to deal with commonly encountered reasons for referral to pediatric urology clinics. The natural history of foreskin retraction requires the accumulation of epithelial debris ie, smegma to separate the prepuce from the glans and the force of penile erections to push through the distal ring.
Balanitis xerotica obliterans is a chronic dermatitis, resembling lichen sclerosis of the genital epidermis, which involves primarily the prepuce, but occasionally the glans and urethra. The incidence is unknown, but certainly accounts for a few phimosis referrals. Although relatively benign with respect to the pediatric prepuce, BXO of the meatal opening or urethra is associated with substantial morbidity and complex surgical reconstruction. This information suggests that physicians are in need of further education about this topic.
In , McGregor et al published an informative article meant to serve this purpose. Two of the questions in our survey pertained to phimosis in different age groups. As expected, none of the surgeons surveyed would perform a circumcision on a child with an asymptomatic physiologic phimosis, regardless of his age. This obvious difference speaks to the accuracy with which BXO is differentiated from physiologic phimosis.
Foreskin ballooning during voiding is another common complaint that brings families to the clinic for referrals. This phenomenon often causes anxiety among parents as well as concern among physicians about urine outflow obstruction.
In , Babu et al conducted a study that objectively assessed this concern. Further, maximum urinary flow rates of boys with ballooning were not significantly different from normal controls.
However, the Internet-based survey allowed for excellent-quality photographs, which were important to distinguish physiologic phimosis from BXO. This approach is in line with the published literature on the topic and with current recommendations; however, concerns over foreskin pathology still remain a common reason for referral.
Ideally, this article will help increase awareness of these views and decrease patient and family anxieties. Neonatal circumcision has decreased dramatically over the past decade, with pediatric urologists maintaining a conservative approach to foreskin management, despite consistent surgical referrals by family physicians.
Foreskin management typically involves reassuring the patient and parent, educating the patient on self-care, and topical steroids. This article has been peer reviewed.
Drs Metcalfe and Elyas contributed to the concept and design of the study; data gathering, analysis, and interpretation; and preparing the manuscript for submission. Competing interests. National Center for Biotechnology Information , U.
Journal List Can Fam Physician v. Can Fam Physician. Peter D. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Open in a separate window. Figure 1. Figure 2. Footnotes This article has been peer reviewed.
Contributors Drs Metcalfe and Elyas contributed to the concept and design of the study; data gathering, analysis, and interpretation; and preparing the manuscript for submission.
Competing interests None declared. References 1. Available from: www. Accessed Jun Hinchley G. Is infant male circumcision an abuse of the rights of the child? LeBourdais E. Hutcheson JC. Male neonatal circumcision: indications, controversies and complications.
Urol Clin North Am. Severe complications of circumcision: an analysis of 48 cases. J Pediatr Urol. Epub Jun 9. Wright JE. Med J Aust. A tradeoff analysis of routine newborn circumcision.
Warner E, Strashin E. Benefits and risks of circumcision. Can Med Assoc J. Wiswell TE. Routine neonatal circumcision: a reappraisal. Am Fam Physician.
Discharge Abstract Database. Phimosis—a diagnostic dilemma? Can J Urol. Griffiths D, Frank JD. Inappropriate circumcision referrals by GPs. J R Soc Med.
Towards evidence based circumcision of English boys: survey of trends in practice. Why are children referred for circumcision? Gairdner D. The fate of the foreskin, a study of circumcision. Br Med J.
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Dorsal slit - Wikipedia
A dorsal slit often referred to in anthropology as superincision is a single incision along the upper length of the foreskin from the tip to the corona , exposing the glans without removing any tissue.
An ancient practice,  it has been a traditional custom among a number of peoples, particularly Filipinos and Pacific Islanders , probably for thousands of years.
In Western medicine it was used as an alternative to circumcision to relieve conditions such as failure of the foreskin to retract phimosis or failure to cover the glans penis paraphimosis , although a perception of poor appearance limited its popularity.
It is still used when circumcision or other measures are considered impractical or undesirable. Since superincision and circumcision are both forms of genital cutting that expose the glans, it can often be difficult to know which procedure is being described or depicted. Opinion is divided on whether a 4,year-old image from Egypt , often described as the first depiction of circumcision, may in fact be of a superincision.
Superincision has been widely practised by people of the Pacific , stretching from Hawaii  to the Philippines. Dorsal slit has a long history as a treatment for adult phimosis ,  since compared with circumcision it was relatively easy to perform, did not risk damage to the frenulum , and before the invention of antibiotics was less likely to become infected.
However, the literature often indicates that despite being "a simple operation" it was "not liked by some"  or refers to the "untidy apron-like appearance" it could produce. Standard guidelines suggest conservative approaches first and, should those fail, either circumcision or preputioplasty to both retain the foreskin and relieve the phimosis. In some cases the foreskin may become swollen as a result of paraphimosis foreskin trapped behind the glans or other conditions such as severe balanitis.
However, the Maasai operation is different in this: rather than a dorsal slit from the opening of the prepuce to the corona, a heart shaped "oval" is excised from the dorsum of the prepuce and the glans is pushed through this hole. Later the edges of the cut prepuce will heal. The prepuce is first cut off, leaving only a small part where the main veins are located, which is pulled down and the small hole through which the glans in pushed through is created. The remaining part is left hanging down, but the glans exposed.
Formerly tribes that copied the Maasai like the numerous Kikuyu of Kenya also practised the same form of circumcision.
Photos of the operation and result are numerously found in specialized African books, such as Carol Beckwith and Tepelit Ole Saitoti's Maasai. There are words for the resultant "prepuaial flap" in the Maa and Gikuyu languages, and possibly in other African tongues. In Gikuyu the word, now archaic, is likely to be ngwati. According to Goodwin, the dorsal slit operation may be reversed by suturing the cut ends together, which restores the tissue to its normal position and recreates the foreskin:.
One patient presented with a dorsal slit because of an acute infection during childhood. All of the normal preputial skin was still present and the patient wished the skin restored to a normal appearance. An inverted V-shaped incision was made where the dorsal slit had been and the two edges were sutured together, thus, reproducing the normal prepuce.
It could be that this might be an answer to some critics of circumcision. A simple dorsal slit can be performed in patients who have phimosis or severe recurrent infections. At a later date, if they wished restoration, reconstruction to the uncircumcised appearance would be simple .
From Wikipedia, the free encyclopedia. Sutureless prepuceplasty with wound healing by second intention: An alternative surgical approach in children's phimosis treatment. BMC Urology. PMC Milton Diamond incorrectly terms the procedure subincision, though it is clear superincision is meant. Pacific Health Dialog. Understanding circumcision: a multi-disciplinary approach to a multi-dimensional problem.
A ritual operation. Br Med J. Indications for infant circumcision. Text Atlas of Penile Surgery. Informa Healthcare; Emergency dorsal slit for balanitis with retention. Journal of the Royal Society of Medicine. April ;97 4 —6.
The Western Journal of Emergency Medicine. November ;10 4 —7. Benefits and risks of circumcision. Canadian Medical Association Journal. November ; 9 —76, Pathologic and physiologic phimosis: Approach to the phimotic foreskin. Canadian Family Physician. March ;53 3 —8. Uncircumcision: a technique for plastic reconstruction of a prepuce after circumcision. J Urol. Categories : Male genital modification Circumcision. Hidden categories: Webarchive template wayback links.