CIRCUMCISION

Definition: 

Male circumcision taken from Latin Word circumcidere, meaning "to cut around” is the surgical removal of the foreskin (prepuce) from the human penis.

Prevalence: 

Approximately one-third of males worldwide are circumcised, most often for reasons other than medical indication. 

It is commonly practised between infancy and the early twenties. 

The WHO estimated in 2007 that 664,500,000 males aged 15 and over are circumcised (30% global prevalence), almost 70% of whom are Muslim. 

History: 

Circumcision is the world's oldest planned surgical procedure, suggested by anatomist and historian Grafton Elliot Smith to be over 15,000 years old, predating recorded history. 

There are different theories how it came to be practised worldwide. One theory is that it began in one geographic area and spread from there. Another is that several different cultural groups began its practice independently. 

In his book, History of Circumcision, physician Peter Charles,suggested that it began as a less severe form of emasculating a captured enemy. 

The practice of circumcision is followed mainly through the cultures and peoples in two separate regions.,The procedure was practised by the ancient Egyptians and then by the Jews and Muslims, with whom the practice travelled to and was adopted by the Bantu Africans.

The earliest historical record of circumcision comes from Egypt, in the form of an image of the circumcision of an adult carved into the tomb of Ankhmahor at Saqqara, dating to about 2400–2300 BC 

Circumcision was done by the Egyptians possibly for hygienic reasons, but also was part of their obsession with purity and was associated with spiritual and intellectual development 

No well-accepted theory explains the significance of circumcision to the Egyptians, but it appears to have been endowed with great honour and importance as a rite of passage into adulthood. 

Performed in a public ceremony emphasizing the continuation of family generations and fertility. It may have been a mark of distinction for the elite.

Preparing for a Jewish ritual circumcision with a Mogen shield (on the table, next to the scalpel) 

For the Jews of the time, circumcision was not as much a spiritual act as it was a physical sign of their covenant with God, and a prerequisite for the fulfillment of the commandment to produce offspring. 

Circumcision is very important to Judaism, with over 90% of adherents having the procedure performed as a religious obligation. The basis for its observance is found in the Torah of the Hebrew Bible. 

Jewish circumcision is part of the brit milah ritual, to be performed by a specialist ritual circumciser (a mohel) on the eighth day of a newborn son's life (with certain exceptions for poor health). 

Jewish law requires that the circumcision leave the glans bare when the penis is flaccid. Converts to Judaism must also be circumcised. 

Although there is debate within Islam over whether it is a religious requirement, circumcision called khitan is practiced nearly universally by Muslim males. 

The procedure is not mentioned in the Quran, but rather adherents believe it is a tradition established by Islam's prophet Muhammad directly , and so its practice is considered a sunnah(prophet's tradition). 

For Muslims, circumcision is a matter of cleanliness, purification and control over one's baser self (nafs). There is no agreement across the many Islamic communities about the age at which circumcision should be performed 

It may be done from soon after birth up to about age 15, with it most often performed at around six to seven years of age. The timing can correspond with the boy's completion of his recitation of the whole Quran. 

with a coming-of-age event such as taking on the responsibility of daily prayer or betrothal. Circumcision may be celebrated with an associated family or community event. 

INDICATIONS FOR CIRCUMCISION:

Routine Indications: 

Religious Beliefs.

Medical Indications: 

Phimosis.

Balanoposthitis.

Recurrent Urinary Tract Infections. 

Indicated also for treatment of 

HPV 

Phimosis.

Balanitis.

Balanoposthitis. 

Studies have shown that Circumcision reduces the risk of HIV . 

                            

CONTRAINDICATIONS:

Infants with Genital Structure Abnormalities like (hypospadias, Epispadias, & Ambiguious Genetalia.) 

PROBLEMS WHICH COULD OCCUR IF CIRCUMCISION IS NOT PERFORMED 

PARAPHIMOSIS

DIFFICULTY IN SEXUAL INTERCOURSE DURING THE FIRST NIGHT OF MARRIAGE WITH ALARMING BLEEDING DUE TO FRENULUM TEAR. 

BALANOPOSTHITIS.

TECHNIQUE:

Removal of Foreskin: 

For infant circumcision, devices such as the Gomco clamp, Plastibell and Mogen clamp are commonly used in the USA. 

These follow the same basic procedure. First, the amount of foreskin to be removed is estimated. The practitioner opens the foreskin via the preputial orifice to reveal the glans underneath and ensures it is normal before bluntly separating the inner lining of the foreskin (preputial epithelium) from its attachment to the glans. 

The practitioner then places the circumcision device (this sometimes requires a dorsal slit), which remains until blood flow has stopped. 

Finally, the foreskin is removed . 

The procedure is best performed done by Urologist. 

PLASTIBELL TECHNIQUE :

It also is another technique used in some centers . 

RECOVERY PERIOD FOR ADULTS AND CHILDREN:

The hospital stay is after circumcision is only a few hours for children and adults. 

At Ramayya Pramila Urology Hospital the dressing after circumcision is applied in such a way that it disconnects automatically within a few hours. This makes the postoperative recovery painless. 

Children are back to normal in about 24 to 48 hrs. 

Adults require about a week before they can resume normal activities.