You may have heard that children in many western countries are circumcised at birth. Why don't the boys around us do this? So, does the child's foreskin need surgical circumcision? Besides tradition, what other medical problems are there? This article answers the questions that parents of boys are most concerned about.

Every boy's parents will face this problem, and most people are confused. Because prepuce is easy to grow in childhood, most of it is normal, and it will gradually improve with age, without surgery. There are some children who need surgery. This condition is called phimosis. Moreover, if phimosis surgery is needed and not done, it will affect the child's later life.

The foreskin has a protective function.

In the process of embryonic development, the foreskin will be closely connected with the glans penis with the growth of penis, which will wrap the glans penis and protect the genitals.

Therefore, the newborn baby boy will have a long foreskin, but it can protect the delicate glans, especially in the period when the baby is prone to diaper rash. If the foreskin is pulled behind the glans penis, it will often cause injuries and even leave scars, and the child will feel pain.

This physiological phimosis will gradually disappear before the boy is 3 years old, and the foreskin can be retracted or separated from the glans to form a soft quilt. At this time, it is easy to pull the foreskin behind the glans. Once the foreskin cannot be retracted after 3 years old, it is "phimosis".

What other problems will there be with boys' penises?

What is "foreskin clipping"

There is a kind of foreskin called "clamp foreskin", which means that the foreskin can't return to its normal position after returning to the coronary sulcus and is fixed, resulting in poor venous blood flow and edema, and the child feels severe pain in the glans penis. Sometimes parents find it earlier and can use lubricant to push the foreskin back to its normal position. If it is found late and the situation is serious, the foreskin will be removed.

1, the foreskin is easily inflamed.

If the foreskin of a baby boy is too long or too tight, it is often difficult to clean and even cause inflammation, which will have a negative impact on the baby's health. However, this infection is generally not serious, but it is easy to recur. "Inflammation of foreskin" most often happens when the glans wants to "satisfy" everyone, but it doesn't come out completely. At first, the baby's foreskin was well wrapped, but then the foreskin and glans slowly separated, and the glans had a chance to contact with the outside world for a long time, so bacteria could take advantage of it. However, because the foreskin is not completely separated from the glans penis, it cannot be thoroughly cleaned. At this time, the foreskin is red, swollen, painful and even suppurative.

2. Narrow foreskin opening

If the foreskin is often inflamed, it will stick to the opening of the foreskin, leading to stenosis. Stenosis may be congenital or caused by long-term inflammation. Its symptom is that the foreskin expands like a balloon when urinating. After urinating, the urine inside comes out slowly, sometimes it is difficult or painful to urinate.

3. Occasionally there will be scales

Sometimes, boys will have "skin scales", that is, they can see or touch some small white lumps through the foreskin. This is because phimosis makes some oily secretions accumulate between the foreskin and glans and cannot be discharged. But the scale itself will not go wrong, because as soon as the glans penis comes out, it will follow.

What kind of boys need phimosis surgery? How old can I do it?

There are usually three situations that require surgical treatment:

* Acquired phimosis with fibrous stricture ring at the foreskin;

* Recurrent glans dermatitis;

* After the age of five or six, the foreskin mouth is severely narrow and it is difficult to urinate. The foreskin can not be retracted to expose the penis head, and the conservative treatment effect is not ideal.

One of the first two conditions is that surgery is necessary.

If the boy does not have the above surgical indications, he can wait until the penis and penis head grow after puberty, and the foreskin of penis erection can contract upward and evert itself.

However, if there are indications for surgery without surgical treatment, the foreskin mouth will be repeatedly inflamed, resulting in scar contracture of the foreskin mouth, loss of skin elasticity and expansion ability, inability of foreskin to contract upward, and urethral stricture. If a narrow ring is formed, it will cause penile erection pain and affect adult sexual life.

Circumcision is not suitable.

Hidden penis

It is because the foreskin of the male baby is too short, the penis root is not fixed, and it is buried under the skin like a tent, so it looks very small, but it is actually normal. Once such a male baby is circumcised, it will cause more problems, and it should be based on foreskin plastic surgery.

hypospadias

If a boy suffers from hypospadias, his foreskin is the best material to repair the urethra and must not be easily removed.

Male circumcision is still controversial.

A few newspapers pointed out that male circumcision can reduce the possibility of penile cancer in adulthood, but a large-scale survey questioned the necessity of neonatal circumcision. In many western countries, for religious and cultural reasons, baby boys are circumcised. In the United States, it is believed that male boys after circumcision can reduce the chances of penile cancer, phimosis and balanitis in adulthood, and can also reduce urinary tract infections.

At present, doctors generally do not recommend circumcision for male babies. Although this operation is simple, does not require general anesthesia, and the baby has no fear, if the foreskin is too long, it is not an indication of surgery. Of course, if the foreskin causes problems, measures should also be taken, such as frequent inflammation, too small and too long opening, urinary retention, and even eczema and other skin inflammation.

If there is no such problem, parents only need to clean their babies frequently to reduce the chances of hiding evil people and accommodating evil people. It's not too late to have surgery after puberty.

What about phimosis surgery?

Phycosis surgery is simply to remove the long foreskin.

1. Does phimosis need general anesthesia or local anesthesia?

Surgical anesthesia is divided into four situations.

1. Simple penis root block anesthesia (local anesthesia, mainly suitable for older children who can cooperate with surgery)

2. Basic plus local anesthesia (basic anesthesia refers to the state of letting children sleep quietly)

3. General anesthesia (anesthetic enters the body by inhalation, intravenous, muscular or rectal perfusion, etc. , so that the patient's consciousness disappears, the whole body does not feel pain, nerve reflex and muscle activity are inhibited to varying degrees, or general anesthesia).

4. Epidural anesthesia (the epidural space is located outside the dural sac, and there are spinal cord and cerebrospinal fluid in the dural sac. The puncture needle enters the epidural space through the midline of the back, and can enter the epidural space through the neck, chest or waist for anesthesia. More used for sacral anesthesia in children)

If the child is older and can cooperate with the operation, you can choose local anesthesia. If the child is young, basic plus local anesthesia can be used.

Second, how long does the recovery period after the operation take? What problems should be paid attention to in nursing?

1. Take medicine and diminish inflammation according to the doctor's advice.

2. Parents should pay attention to whether there is bleeding in the wound after operation.

3. After the operation, the wound was fixed with absorbent gauze. After 3 days, take off the gauze, expose the wound, and clean it with antibiotic ointment and 4% boric acid water.

4. Short-term absorbable synthetic suture is generally used for surgery, and no needle is needed.

5. Postoperative penile edema is a normal phenomenon, and children should be paid attention to wearing some loose clothes to avoid rubbing the penis.

3. How long will the operation last? Do you need to be hospitalized? What preparations should be made before operation? Are there any requirements or restrictions on postoperative medication?

Generally, phimosis surgery takes 40~60 minutes, and healthy children can do it in the surgical clinic without hospitalization. But before the operation, you must take a bath and clean the penis and its surrounding skin. Take antibiotics orally after operation to prevent infection.

4. What are the cases that need special care without surgical indications? What should the family do?

1, children under 5 years old: If the child is under 5 years old, there is no dysuria, no infection, no serious phimosis, and no special treatment is needed.

For children with phalacrodermatitis, antibiotics should be used to control inflammation during infection, and the penis should be soaked in warm water or 4% boric acid water two or three times a day. After the inflammation subsides, first try to separate the foreskin, that is, go to the hospital to expand the foreskin mouth according to the doctor's method, and try to repeatedly turn the foreskin to expand the foreskin mouth, expose the penis head, remove scales, apply antibiotic ointment or liquid paraffin for lubrication, and then restore the foreskin. Parents will continue to use this method at home, but pay attention to the gentle inversion, otherwise the child will not cooperate. Most children can be cured with age.

Children over 2.5 years old: For boys over 5 years old who have asymptomatic phimosis, chronic manipulative treatment can be implemented: that is, after parents clean the child's vulva every day, they roll up the foreskin with their fingers and gradually expand the scope of upturning for several weeks, so that the foreskin mouth becomes bigger and looser, and basically the penis head is exposed on the foreskin. Pay attention to the extent of each upturn, so as to avoid pain and bleeding. Turn it down in time after each upturn to avoid incarceration of the foreskin. If the vulva can be cleaned with 4% boric acid solution after each cleaning, it will be better to apply a little chlortetracycline eye ointment or zinc oxide oil to the penis head and coronary sulcus after washing. When the foreskin mouth has been enlarged and loosened, it can be washed with clean warm water or in the bath. There is little bleeding at the beginning of treatment, so don't worry. Most children can be cured after treatment.

Common topics of foreskin and skin scales

What is the function of foreskin?

All men have foreskins on their penises, but the foreskins are different in length. Like other human organs, the foreskin is born in the uterus and grows on the penis from infancy to death, which is a normal physiological structure of men. The foreskin can protect the glans from trauma and insect bite and keep the glans smooth, delicate and sensitive.

What is the standard of foreskin length?

Excessive prepuce means that after puberty, the prepuce still covers the urethral orifice. If the foreskin retreats from the urethral orifice or the penis head can extend out of the foreskin orifice in the state of penile erection, it should not be regarded as too long foreskin. The key to the difference between long foreskin and long foreskin lies in the word "country". Too long prepuce does not necessarily require surgery, but too long prepuce requires surgery.

When is circumcision done?

Babies or children with long foreskin do not need to be circumcised prematurely as long as it does not affect urination. Because children's penis still has a development process, most children have more outdoor activities in childhood and more opportunities for penis trauma. Premature circumcision will lose the function of protecting glans. Generally speaking, the foreskin will not affect the development of the penis, and it is most appropriate to remove the long foreskin after the male sexual development is mature. Therefore, even if the foreskin is too long, it should be removed after puberty or before marriage.

What is phimosis? What should I do?

Phycosis means that the glans penis is attached to the foreskin and the foreskin cannot be turned over. There are complete adhesion and partial adhesion of phimosis, and some phimosis are closely adhered and need surgical separation; Some phimosis are loosely adhered or partially adhered. Without inflammation, the foreskin can be turned up. If the adhesion gradually leaves the glans penis, the foreskin can turn to the coronal groove. For phimosis with narrow prepuce mouth, when manual foreskin turnover and foreskin expansion are ineffective, operation should be performed to separate adhesion and remove foreskin.

Who wants to be circumcised?

The indications of circumcision are redundant prepuce, recurrent dermatitis, tight adhesion of phimosis, narrow prepuce mouth and prepuce cyst. It is particularly important to point out that patients with repeated inflammation of prepuce, prepuce cyst, phimosis adhesion and prepuce stenosis should be treated by surgery as soon as possible, regardless of their age.

What kind of operation is good for circumcision?

Circumcision is one of the simplest operations in urology. The surgical method includes excision with common instruments, which has the advantages of neat incision, less bleeding and quick healing. Laser knife resection, little or no bleeding, but healing later; Electrosurgical resection, etc. No matter what method is used to remove the foreskin, the inner and outer plates of the foreskin must be stitched to facilitate healing. Several surgical methods have their own advantages and disadvantages. As long as the surgeon is skilled, both methods can be used.

What is the function of foreskin secretion?

There are foreskin glands in the coronal groove of the inner foreskin plate, which have the same secretory function as sebaceous glands and sweat glands of the human body. Excessive secretion of the foreskin remains in the foreskin cavity, which will form bean dregs-like scale after absorbing water. The foreskin secretion is serous and weakly alkaline, and consists of water, trace salt and lipoprotein. It has the functions of keeping glans smooth, avoiding scratches and preventing bacterial invasion.

Is it necessary to circumcise on a large scale?

Men have a small amount of foreskin secretion from birth to old age, and there are more foreskin secretions in youth, which decreases after entering middle-aged and elderly people. The secretion of foreskin is the normal secretion of male foreskin, not a carcinogen. Otherwise, why did the "Creator" grow foreskin glands in the male foreskin when he created human beings? Is it just to get penile cancer? Because the foreskin secretion contains lipoprotein, when it accumulates too much in the foreskin cavity, it will be decomposed by some enzymes and resident bacteria in the human body, forming a kind of white material similar to bean dregs, and has a special sense of shame, which is what people usually call skin scale. Men don't have to worry about skin scale, as long as they are cleaned in time and kept hygienic, and they don't have to cut off the foreskin that is not too long to eliminate skin scale.

Special reminder:

Don't follow the small advertisement. Never follow small advertisements. As long as you pay a little attention, you will find small advertisements for treating redundant prepuce, dermatitis, narrow prepuce, urinary tract infection and sexually transmitted diseases posted everywhere in the streets. As long as you turn on the TV, all kinds of "new technologies" and "new means" to treat this kind of disease, as well as images of circumcision with laser knives and ionization knives, will appear from time to time. Are the people who make these advertisements really thinking about what patients think and are anxious about what patients are anxious about? Don't! The answer is simple, that is, a money word is waving there. Some "doctors" wearing white coats also lobby patients from time to time: "In some countries, children are circumcised after birth" and regard foreskin as a redundant structure of men.