I. What is prepuce?
Prepuce refers to the narrow opening of the foreskin, so that the foreskin cannot be flipped to reveal the head of the penis. There are two types: congenital and acquired. Congenital prepuce can be seen in every normal child and infant. The adhesions between the foreskin and the head of the penis are gradually absorbed after a few months and the foreskin is separated from the head of the penis. By the age of 3~4 years old, due to the growth of the penis and the head of the penis, the penis becomes erect, the foreskin recedes upward on its own and the foreskin is turned out to reveal the head of the penis.
Circumcision is a normal phenomenon in children and is not pathological. When children are 3 years old, 90% of circumcision heals itself. after 17 years old, only less than 1% have circumcision. Some children have a very small prepuce opening that prevents the foreskin from retracting and hinders the development of the penis head or even the entire penis. The urethral opening is also very small, and sometimes the foreskin opening is as small as a pinhole, so that difficulties in urination occur. Children with prepuce, due to the secretions accumulated under the foreskin, often stimulate the mucous membrane, can cause the head of the penis foreskin inflammation.
Acquired prepuce is mostly secondary to foreskin infection of the head of the penis and injury to the foreskin and head of the penis. The foreskin mouth has scar contracture formation, losing the elasticity and expansion ability of the skin, and the foreskin cannot recede upward, and is often accompanied by urethral stenosis. This type of prepuce does not heal on its own.
Clinical symptoms Those with narrow foreskin opening have difficulty in urination, thin urine line and foreskin puffing up. Long-term difficulty in urination can cause complications such as prolapse. Urine accumulation in the foreskin sac often stimulates the foreskin and penile head, prompting it to produce secretions and epidermal shedding, forming excessive foreskin scale. Severe cases can cause ulceration of the foreskin and head of the penis or the formation of stones.
The accumulated foreskin scale is milky tofu-like, discharged from the tiny foreskin mouth. Some of the foreskin scale is as big as a soybean and accumulates at the coronary sulcus, with a small white lump across the foreskin, which is often mistaken for a tumor by parents and seen by the doctor. The fact that the foreskin scale accumulates under the foreskin can induce foreskinitis of the penis head. In acute inflammation, the mucous membrane of the head of the penis and foreskin is moist and red, and thick secretions can be produced.
Children have pain and uneasiness, foreskin edema, and sometimes acute urinary retention. Repeated episodes of penile head prepuce inflammation may cause the pediatrician to become excitable and neurotic. Due to the painful itching of the penis and difficulty in urination, he often develops the habit of squeezing the penis with his hand, thus possibly causing masturbation.
Treatment For congenital prepuce in infancy, the foreskin can be repeatedly tried to be turned up in order to expand the foreskin opening. Be gentle with your hands and do not be overly eager to retract the foreskin up. When the head of the penis is exposed, clean the foreskin, apply antibiotic ointment or liquid paraffin to lubricate it, and then restore the foreskin, otherwise it will cause imbedded prepuce.
Most children treated by this method can be cured as they grow older. Now due to environmental pollution, the need for circumcision is significantly more than before. Patients with acquired circumcision need to be circumcised because of the fibrous narrow ring at the mouth of their foreskin. The indications for circumcision vary. In some countries and regions, circumcision is routinely done after birth because of religious or ethnic customs.
Some people believe that circumcision can reduce the incidence of penile cancer or cervical cancer. From the point of view of disease prevention, routine circumcision of circumcised children can reduce the incidence of tumors and inflammatory diseases.
For children with penile head circumcision, antibiotics should be applied to control inflammation during the acute stage, and local soaking with warm water or 4% boric acid water several times a day. After the inflammation subsides, a trial of manual separation is performed first. Local cleaning treatment, consider circumcision when ineffective. If the inflammation is difficult to control, a dorsal circumcision should be made to facilitate drainage.
Second, what is circumcision?
The foreskin is wrapped around the glans and the foreskin can be turned up to reveal the head of the penis. The foreskin is a layer of skin that is wrapped around the head of the penis. If you turn the foreskin over, you can see the glans behind the ring-shaped narrowing area called the coronal groove. There are many sebaceous glands in the skin near the coronal groove that secrete a foul-smelling secretion in the form of a yellowish-white mud called “foreskin scale”.
When the foreskin or prepuce is too long, the secretions of the sebaceous glands in the foreskin cannot be discharged, and gradually form the smelly prepuce. The foreskin scale is suitable for bacterial growth, so it can cause inflammation of the penis head and foreskin. The inflammation that occurs at the urethral opening can cause the urethral opening to narrow after healing, causing difficulty in urination. Penile cancer may also occur when the head of penis is stimulated by prepuce for a long time.
It is reported that about 85%-95% of penile cancer patients have a history of circumcision or prepuce. In addition, it is also extremely unfavorable to women. If the husband’s foreskin is too long, the foreskin scale will enter the female reproductive tract during sexual intercourse, which may induce cervical cancer due to long-term chronic stimulation of cervix. Medical doctors have investigated the Jews, and the incidence of cervical cancer in women is extremely low among those who had their male babies circumcised after birth.
A survey of residents of Peiji Island in the South Pacific found that the incidence of cervical cancer was eight times higher in the wives of uncircumcised people compared to those who had been circumcised. Therefore, boys should develop the good habit of washing their vulva with clean, warm water every day. The method is simple, as long as the foreskin is pulled back, washed with warm water and then wiped with a warm, wet towel.
At the same time, if the foreskin is too long, you should choose a professional hospital as soon as possible to check whether you need to perform circumcision. The long foreskin is also likely to cause urine to remain in the foreskin, forming glans glans adhesions and causing infection. Children with frequent infections are best circumcised early.