Manual for Male Circumcision under Local Anaesthesia
Manual for Male Circumcision under Local Anaesthesia
Manual for Male Circumcision under Local Anaesthesia
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<strong>Male</strong> circumcision <strong>under</strong> local anaesthesia<br />
Version 3.1 (Dec09)<br />
In addition, men with diabetes are at greater risk of balanitis. Glucose<br />
(sugar) in the urine that is trapped <strong>under</strong> the <strong>for</strong>eskin serves as a<br />
breeding ground <strong>for</strong> bacteria.<br />
Treatment <strong>for</strong> balanitis<br />
Treatment <strong>for</strong> balanitis depends on the <strong>under</strong>lying cause. If there is an<br />
infection, treatment should include an appropriate antibiotic or<br />
antifungal medication, according to national guidelines. In cases of<br />
severe or persistent inflammation, or if there is difficulty in retracting<br />
the <strong>for</strong>eskin, circumcision is usually recommended.<br />
If the diagnosis or treatment of balanitis is uncertain, the patient<br />
should be referred to a higher level of care. Maintaining good personal<br />
hygiene can help prevent balanitis. In addition, the patient should be<br />
advised to avoid strong soaps or chemicals, especially those known to<br />
cause a skin reaction.<br />
Phimosis<br />
Phimosis is a condition in which the <strong>for</strong>eskin of the penis is so tight<br />
that it cannot be pulled back (retracted) from the head of the penis<br />
(Fig. 2.2).<br />
Fig. 2.2 Phimosis showing that the <strong>for</strong>eskin cannot be retracted at<br />
erection<br />
Reproduced with permission from www.netterimages.com (image no.<br />
1468).<br />
Causes of phimosis<br />
Phimosis can occur at any age and may be present at birth. It may be<br />
caused by an infection (balanitis) or by scar tissue <strong>for</strong>med as a result<br />
of injury or chronic inflammation. A tight phimosis can interfere with<br />
urination, resulting in a thin urinary stream. In extreme cases, urine<br />
may collect between the <strong>for</strong>eskin and the glans, causing ballooning of<br />
the <strong>for</strong>eskin. In this situation an urgent circumcision is necessary,<br />
usually using the dorsal slit method.<br />
Linking male circumcision and other male SRH services Chapter 2-9