Urinary tract infections in uncircumcised men

UTI IN ADULTHOOD:

Based on a circumcision rate of 79% in the USA [Xu et al., 2007] it can be estimated that up to 44% of uncircumcised men, compared with 6% of circumcised men will get a UTI over their lifetime (J.H. Waskett and B.J. Morris, unpublished results – see diagram below).

 

Very high cumulative prevalence of urinary tract infections in uncircumcised males over their lifetime (from calculations by J.H. Waskett; unpublished).

UTI is the most costly (over $1 billion in men [Griebling, 2005]) and resource intensive urological condition in the USA, with 1.8 million physician visits [Litwin et al., 2005]. Circumcision may reduce this burden.

A report in 2010 identified the entire microbiome of the penis of 12 men before and after circumcision [Price et al., 2010]. Among the 42 unique bacterial families identified, Pseudomonadaceae and Oxalobactericeae were the most abundant irrespective of circumcision status. Circumcision was associated with a significant change in the overall microbiota (P = 0.007) and with a significant decrease in putative anaerobic bacterial families (P = 0.014). Two families in particular – Clostridiales Family XI (P = 0.006) and Prevotellaceae (P = 0.006) – were uniquely abundant before circumcision. Within these families the authors identified a number of anaerobic genera previously associated with bacterial vaginosis including: Anaerococcus spp., Finegoldia spp., Peptoniphilus spp., and Prevotella spp. The researchers concluded that the anoxic microenvironment under the foreskin may support pro-inflammatory anaerobes that can activate Langerhans cells to present HIV to CD4 cells in draining lymph nodes. They suggested that the reduction in putative anaerobic bacteria after circumcision may play a role in protection from HIV and other sexually transmitted infections

Circumcision: Survey results

The US National Health and Social Life Survey:

As far as performance during sex is concerned, the National Health and Social Life Survey (NHSLS) of 1,410 men in the USA found that uncircumcised men were more likely to experience sexual dysfunctions [Laumann et al., 1997]. This was slight at younger ages, but became quite significant later in life and included finding it twice as difficult to achieve or maintain an erection. It was also discovered that circumcised men engaged in a more elaborate set of sexual practices, i.e., enjoyed a more elaborate sexual lifestyle, and their female partners were more pleased with the esthetics of a circumcised penis over an uncircumcised one. Not surprisingly, in view of the findings above, circumcised men received more fellatio. However, they also masturbated more, a finding that contradicts the purported wisdom in Victorian times that circumcision would reduce the urge to masturbate. (In fact, as described in detail, with references, earlier, this is largely a myth, having little common currency at the time [Morris et al., 2006a]). Of course, circumcision would have prevented smegma and itching, so stopping males scratching their genitalia, a behavior that would have offended polite Victorian sensitivities.)

Australian survey of men:

A telephone-based survey of 10,000 men in Australia found circumcised men had fewer sexual difficulties for a month or more in the previous year [Richters et al., 2006]. This was greatest in men over 50, in whom 27% of uncircumcised, but only 15% of circumcised, men reported difficulty keeping an erection [Richters et al., 2006]. Physical pain during intercourse was also less common among circumcised men. (This contradicts part of the anti-circumcision mantra that claims the penis is an ‘internal organ’ [!] and the “lubrication” [?!] under the foreskin produces a gliding action during penetration. It is always good to compare such claims with scientific research findings, which, like most other claims of the anti-circumcision movement, are not supported, in fact here contradicted, by the evidence.) The Australian study observed no difference in premature ejaculation, nor masturbation. The circumcised men had significantly more liberal sexual attitudes, just as found above in the US study. Although this study, unlike the one in the USA, found uncircumcised men received as much fellatio as the circumcised, this finding did not indicate what type of penis women preferred. This presents an opportunity for further research in Australia such as conducted in the US and described in the next paragraph

A US survey of new mothers:

In a survey of new mothers in the USA, hygiene and appearance were the two major reasons for choosing to have their newborn son circumcised [Williamson & Williamson, 1988]. There was a strong correlation between their son’s circumcision status and the woman’s ideal male partner’s circumcision status for intercourse. Thus by being circumcised they thought that their sons would likewise be more attractive to a future sexual partner (with the implication that they would be at an advantage in passing on their, and therefore the mother’s, genes to the subsequent generation). Their own preference thus affected their choice for their sons.

In this US study, 92% said the circumcised penis was cleaner, 90% said it looked “sexier”, 85% it felt nicer to touch and 55% smelled more pleasant. Even women who had only ever had uncircumcised partners preferred the look of the circumcised penis. Only 2% preferred an uncircumcised penis for fel1atio, with 82% preferring the circumcised variety. Preference for intercourse for circumcised versus uncircumcised was 71% versus 6%, respectively; manual stimulation, 75% versus 5%; visual appeal, 76% versus 4%.

Magazine surveys:

Many surveys have been carried out by women’s and men’s magazines over the years, and all report a preference by women for a man with a circumcised penis. One in Sydney by the magazine Men’s Health (July 2001 issue) found that only 16% of women preferred the uncircumcised penis, 46% preferred the circumcised, and 31% didn’t care (6% had never seen an uncircumcised penis and 1% had not seen a circumcised penis). A preference for the “cut” penis was reported in a survey by a female columnist of her female friends [Murray, 2008]. Comments they made were that “uncircumcised penises look like alien life forms”, that they look “like a woolly mammoth or something from the Stone Age”, that “the foreskin just gets in the way, especially during fellatio”, that “a cut penis gives both him and her more pleasure”, that “for those with their tackle intact, they’re likely to smell more”, and that the old adage “cleanliness is next to godliness ? goes for sex-godliness.”

Socio-Sexual aspects of circumcision

The Badger study in Australia:

University of Sydney biomedical scientist James Badger [Badger, 1989b; Badger, 1989a] (who used to regard himself as neutral on the issue of circumcision, but would now appear swayed by the evidence into adopting a ‘pro’ stance, not surprisingly for any scientist who follows the research findings). His study involved responses to a questionnaire placed in clinics of the Family Planning Association in Sydney. This led to 180 participants (79 male, 101 female) who were aged 15-60. The women were mainly (50%) in the 20-30 year-old age group cf. 25% of the men, more of whom (33%) were aged 30-40. It found that:

Highlights…

• Men who were circumcised as adults were very pleased with the result. The local pain when they awoke from the anesthetic was quickly relieved by pain killers (needed only for one day), and all had returned to normal sexual relations within 2 weeks, with no decrease in sensitivity of the penis and claims of “better sex”. (Badger’s findings are, moreover, consistent with every discussion the author has ever had with men circumcised as adults, as well as an enormous number of email messages received from many such men. The only cases to the contrary were a testimonial in a letter sent to the author from a member of UNCIRC and a very brief email message that didn’t say why.)

• Women with circumcised lovers were more likely to reach a simultaneous climax – 29% vs. 17% of the study population grouped across the orgasmic spectrum of boxes for ticking labeled “together”, “man first”, “man after” and “never come”; some ticked more than one box. (Could the superior response involve psychological factors? … Could it be that more circumcised men have a better technique? … Or could other factors be involved?)

• Women who failed to reach an orgasm were 3 times more likely to have an uncircumcised lover. (These data could, however, possibly reflect behaviors of uncircumcised males that might belong to lower socio-economic classes and/or ethnic groups whose attitudes concerning sex and women may differ from the better-educated groups in whom circumcision is more common.)

• A circumcised penis was favoured by women for appearance and hygiene. (Furthermore, some women were nauseated by the smell of the uncircumcised penis, where, as mentioned in another section earlier, bacteria and other micro-organisms proliferate under the foreskin.)

• An uncircumcised penis was found by women to be easier to elicit orgasm by hand.

• An circumcised penis was favoured by women for oral sex (fellatio).

Foreskin restoration

November 11, 2014

Dear Dr. Reed,

Like many boys in the US I was circumcised as a babyand had no say.  I am a vegan, naturalist, have a restorative mentality.

That is why I’d like some information on foreskin restoration.

Thank you for your help,

Nestor

Good afternoon Nestor,

Thank you for your interest in what we do.

Please review our informed consent: http://www.penisdoctor.com/concent-foreskin.pdf

If you have had an overly tight circumcision or short flaccid penile shaft skin length there is a possibility of still  inadequate skin to cover.

Be assured I will always be honest about our experience.  One thing I can advise regardless, if your glans is for example  is 1 1/4″ in length, you will need 2 times that amount for coverage (inside and outside) plus an additional  3/8″ to 1/2″ for the turn around and new skin margins.

Meaning if your flaccid shaft skin length is not at least 2 7/8″ to 3″ you may not have sufficient glans coverage.  Or said another way,  this is not a good procedure for men with short penises.

Spironolactone, a testosterone blocker, may be recommended to reduce erections during wound healing.

Again, many thanks for your inquiry.  Medicine doesn’t stand still, but rather is continuously in evolution.
Have  a restful weekend,

 

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America

305-865-2000

 

 

“Nervous in the service” about adult circumcision pain

November 1, 2014

Hi Dr. Reed,

Have a had phimosis for many years.  Tried steroids and stretching which has improved  for a while but always returns.  Am looking fo4eard to an adult circumcision with you.  Read reviews on the  web and also recommendations from several support groups.

Should I worry?

Not a wimp, just a worrier,

Austin

 

Good morning Austin,

My recommendation is to take Xanax 0.25 mg  the night before and on the morning of surgery  assuming you are staying at a nearby hotel within walking distance, and that you are not allergic to this type of medication.

After you office consultation  we’ll apply some EMLA to the skin so you will not feel the local  anesthesia needle stick.  Then a good squeeze helps the anesthetic to permeate through all the tissues.  After that is done, we wait  about 10 to 15 minutes.  Doubt you’ll feel anything.  You may wish to bring your spouse or partners into the operating room with you.  That helps to distract.

After completion and steri-strips are placed, we apply a 2 layered wrap which reduces swelling and bruising, the major causes of pain.

Think you’ll be fine.

Have a restful weekend,

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America

305-865-2000

Penile skin bridge or tunnel, will there be a scar after surgery

October 25, 2014

Hi Dr. Reed,

What can I expect as a result will there be a scar?

Denver

Good morning again Denver,

A skin bridge is like any bridge with a pedicle on either side.  The pedicle is usually relatively small a few millimeters.  We may oversew the base or if small just cauterize it and allow it to heal like any small abrasion.  I’m sure if you looked hard enough with a magnifying glass you might see a little change in pigment after healing but I’ve never had a patient call back about this.  Underneath the tunnel is usually normal skin.

Take a look at our web-site http://www.penisdoctor.com/photo-circumcision.htm#17  figures 17 and 18 (penile skin tunnels) and I think you will be reassured.

Sincerely,

Harold M. Reed, M.D.
305-865-2000

Penile skin bridge, penile skin tunnel

October 25, 2014

I sent you an email a little over a year ago asking about a skin bridge I have. After my in depth description of my bridge you replied that I had a preputial bridge.I would like to have this bridge removed for hygienic reasons as well as cosmetic, as its not very attractive. I guess my question is what would something like this cost approximately? I would like to have this procedure done in the very near future. I would appreciate any info you can give me.  Thank you.

Denver

Good afternoon Denver,

We see skin bridges frequently.  They occur most often when a bell clamp is used because the doctor cannot see what’s going  on underneath the bell before he/she applies the clamp.  This would not happen on a “sleeve” resection done on an older patient.  Underneath there may be chronic inflammation, and of course as you know occasional discharge.

Thanks for your continued interest in what we do.  Fees are as follows, consultation $250 and surgery for preputial bridge $500.

Have a safe and restful weekend,

Harold M. Reed, M.D.
305-865-2000

Pearly pink papules (PPP)

October 12, 2014

 I have pearly penile papules (PPP) and I’d like them removed. What’s involved?

Lester

Good morning Lester,

Glad we talked.

Pearly penile papules (PPP) are considered a normal variant of penile anatomy and appear as minute little somewhat flat pink skin tags on the rim of the glans.  They occur somewhat more frequently in uncircumcised men, and usually once formed remain stable in number and appearance.  They will not hurt you or your partner and in no way are communicable.

They are easily treated in our practice with local anesthesia and pin point needle electro-desiccation.  You will have numerous little black spots where they formerly existed and that is a crust which falls off in a few days.  You will not have pain once the anesthetic wears off and no dressing is required.

We would prefer not to zap a long contiguous line of these as leaving some healthy skin on either side facilitates wound healing.  Within a week to 10 days, you should look very well.  Gentle sex is possible in about 12 days.  If some residual lesions are left, we’ll tackle those in about a month.

To review consultation 250, removing most if not all papules 250.  If you elect circumcision revision which could be as high as 1750, PPP removal is free, including followup care. When patients are having a circumcision, they are removed gratis.

With kindest regards,

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America

305-865-2000

Mr. D seeks adult circumcision revision for aesthetic reasons. Remove frenulum?

October 4, 2014

Dear Dr. Reed,

I was never circumcised and seek adult circumcision now.  Will I encounter any pain?

Mahmood

 

Good morning Mahmood,

We start out by applying numbing cream to the penis so you do not feel
the local anesthesia.  We don’t rush, this gives the anesthesia a chance
to work.  If you have a loved one who wants to be present, we would welcome that.

Patients smile as they leave the office, and by and  large remain free of serious discomfort
as evidenced by our  followup contact with them.  The best investment you can provide yourself
to reduce discomfort is to be on  bed rest for 2 days afterwards.

After seeing so many circumcised men who look very  much like they were done later in life, because
of large suture tracts, and irregularly meeting  skin, I developed perhaps a unique approach to
be sure this did not happen to my patients,  and have found no need to vary over the past 15
years.

If there is further interest please call and ask  for Anne our amiable office manager who
will assist with arrangements.

We hope to have the pleasure of serving you  whenever your travel plans include the South
Florida area.

With kindest regards,

Harold M. Reed, M.D.
305-865-2000

P.S.   Take a look at this unsolicited web-site
constructed by a patient of mine.  Is this
what you have in mind?  Especially the
photos taken 60 days post-op.

http://www.circlist.com/considering/davids_freehand_circumcision.html

Also view:  http://www.circlist.com/considering/findphysician.html
and read several unsolicited recommendations.


 

Wrinkles after a circumcision

October 3, 2014

Dear Dr. Reed,

Had an adult circumcision few years ago but have longitudinal wrinkles distal to the incision.  Is this normal and can it be corrected.

Candido

Good morning Candido,

You are not alone.  Remember the foreskin may be very loose and its circumference may be larger than shaft skin.This is why we have a hand held mirror in the operating room for our patients. If you can see it, I can see it.

The remedy it to cut a strip of skin out from the underside and redo perhaps the lower half of your circumcision.  The recovery should be a lot easier this time.

Hoping this is of help.

Harold M. Reed, M.D. FICS

Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America
305-865-2000