Dorsal slit

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The dorsal slit Dorsal slit.jpg
The dorsal slit

A dorsal slit (often referred to in anthropology as superincision or supercision) is a single incision along the upper length of the foreskin from the tip to the corona, exposing the glans without removing any tissue. An ancient practice, [1] it has been a traditional custom among a number of peoples, particularly Filipinos and Pacific Islanders, probably for thousands of years.

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In Western medicine, it was used as an alternative to circumcision to relieve conditions such as failure of the foreskin to retract (phimosis) or failure to cover the glans penis (paraphimosis), although a perception of poor appearance limited its popularity. While it is a less invasive surgery than circumcision, it is more invasive than preputioplasty since it leaves the incision open. It is still used when circumcision or other measures are considered impractical or undesirable.[ citation needed ]

Traditional custom

Since superincision and circumcision are both forms of genital cutting that expose the glans, it can often be difficult to know which procedure is being described or depicted. Opinion is divided on whether a 4,000-year-old image from Egypt, often described as the first depiction of circumcision, may in fact be of a superincision. [2]

Superincision has been widely practised by people of the Pacific, stretching from Hawaii to the Philippines. [3] [4] With increasing urbanisation, traditional rituals have been giving way in many places to medically performed circumcision, and almost entirely so among Islanders living in New Zealand, where a recent survey found there was "a strong cultural demand from parents". [5] The most notable exception to Pacific superincision is the Māori of New Zealand, who do not circumcise or superincise, [6] although they have an indigenous term for the latter (ure haea or "split penis") and their tradition is that they stopped the practice when they arrived in New Zealand. [7]

Medical practice

Phimosis

Dorsal slit has a long history as a treatment for adult phimosis, [1] since compared with circumcision it was relatively easy to perform, did not risk damage to the frenulum, and before the invention of antibiotics was less likely to become infected. However, the literature often indicates that despite being "a simple operation" it was "not liked by some", [8] or refers to the "untidy apron-like appearance" it could produce. [9]

Dorsal slit is now rare in Western countries as a treatment for phimosis. Standard guidelines suggest conservative approaches first and, should those fail, either circumcision or preputioplasty to both retain the foreskin and relieve the phimosis. [10]

Paraphimosis and other conditions

In some cases the foreskin may become swollen as a result of paraphimosis (foreskin trapped behind the glans) or other conditions such as severe balanitis. Should reduction of the swelling by conservative methods be unsuccessful, a dorsal slit is a common intervention of choice since circumcision is almost always excluded in such cases. [11] [12] While it was formerly recommended that circumcision be subsequently performed once the originating condition has subsided, [13] this appears to be no longer the case. [14]

Dorsal genital slits in some African tribes

A variety of "dorsal slit" circumcision was once predominant amongst the Maasai tribe of Kenya and Tanzania, and is still practised and found in many of the more remote regions of the very large area known as "Maasailand" generally.[ citation needed ]

However, the Maasai operation is different in this: rather than a dorsal slit from the opening of the prepuce to the corona, a heart shaped "oval" is excised from the dorsum of the prepuce and the glans is pushed through this hole. Later the edges of the cut prepuce will heal.[ citation needed ]

The prepuce is first cut off, leaving only a small part where the main veins are located, which is pulled down and the small hole through which the glans in pushed through is created. The remaining part is left hanging down, but the glans exposed.[ citation needed ]

Formerly tribes that copied the Maasai like the numerous Kikuyu of Kenya also practised the same form of circumcision. Photos of the operation and result are numerously found in specialized African books, such as Carol Beckwith and Tepelit Ole Saitoti's Maasai.[ citation needed ]

There are words for the resultant "preputial flap" in the Maa and Gikuyu languages, and possibly in other African tongues. In Gikuyu the word, now archaic, is likely to be ngwati.[ citation needed ]

Dorsal slit reversal

According to Goodwin, the dorsal slit operation may be reversed by suturing the cut ends together, which restores the tissue to its normal position and recreates the foreskin. [15]

Related Research Articles

<span class="mw-page-title-main">Glans penis</span> End of the penis

In male human anatomy, the glans penis, commonly referred to as the glans, is the bulbous structure at the distal end of the human penis that is the human male's most sensitive erogenous zone and primary anatomical source of sexual pleasure. The glans penis is present in the male reproductive organs of humans and most mammals where it may appear smooth, spiny, elongated or divided. It is externally lined with mucosal tissue, which creates a smooth texture and glossy appearance. In humans, the glans is located over the distal ends of the corpora cavernosa and is a continuation of the corpus spongiosum of the penis. At the summit appears the urinary meatus and at the base forms the corona glandis. An elastic band of tissue, known as the frenulum, runs on its ventral surface. In men who are not circumcised, it is completely or partially covered by a fold of skin called the foreskin. In adults, the foreskin can generally be retracted over and past the glans manually or sometimes automatically during an erection.

<span class="mw-page-title-main">Foreskin restoration</span> Process to expand skin on the penis

Foreskin restoration is the process of expanding the skin on the penis to reconstruct an organ similar to the foreskin, which has been removed by circumcision or injury. Foreskin restoration is primarily accomplished by stretching the residual skin of the penis, but surgical methods also exist. Restoration creates a facsimile of the foreskin, but specialized tissues removed during circumcision cannot be reclaimed. Actual regeneration of the foreskin is experimental at this time. Some forms of restoration involve only partial regeneration in instances of a high-cut wherein the circumcisee feels that the circumciser removed too much skin and that there is not enough skin for erections to be comfortable.

<span class="mw-page-title-main">Genital modification and mutilation</span> Permanent or temporary changes to human sex organs

Genital modifications are forms of body modifications applied to the human sexual organs, such as piercings, circumcision, or labiaplasty.

Smegma is a combination of shed skin cells, skin oils, and moisture. It occurs in both male and female mammalian genitalia. In females, it collects around the clitoris and in the folds of the labia minora; in males, smegma collects under the foreskin.

<span class="mw-page-title-main">Clitoral hood</span> Part of the vulva that covers and protects the glans of the clitoris

In the female human body, the clitoral hood is a fold of skin that surrounds and protects the glans of the clitoris; it also covers the external clitoral shaft, develops as part of the labia minora and is homologous with the foreskin in the male reproductive system. The clitoral hood is composed of mucocutaneous tissues; these tissues are between the mucous membrane and the skin, and they may have immunological importance because they may be a point of entry of mucosal vaccines. The clitoral hood is also important not only in the protection of the clitoral glans, but also in pleasure, as its tissue forms part of the erogenous zones of the vulva.

<span class="mw-page-title-main">Paraphimosis</span> Medical condition

Paraphimosis is an uncommon medical condition in which the foreskin of a penis becomes trapped behind the glans penis, and cannot be reduced. If this condition persists for several hours or there is any sign of a lack of blood flow, paraphimosis should be treated as a medical emergency, as it can result in gangrene.

<span class="mw-page-title-main">Phimosis</span> Medical condition

Phimosis is a condition in which the foreskin of the penis cannot stretch to allow it to be pulled back past the glans. A balloon-like swelling under the foreskin may occur with urination. In teenagers and adults, it may result in pain during an erection, but is otherwise not painful. Those affected are at greater risk of inflammation of the glans, known as balanitis, and other complications.

The preputial mucosa of the penis is the epithelium of the inside of the prepuce, or foreskin. To differentiate it from the cutaneous skin of the outside of the prepuce, it is sometimes referred to as the inner mucosa. It starts at the ridged band of the prepuce and continues to the coronal sulcus, where it meets the epithelium of the glans and penile shaft. The preputial mucosa is devoid of hair, as is the cutaneous surface.

Penile cancer, or penile carcinoma, is a cancer that develops in the skin or tissues of the penis. Symptoms may include abnormal growth, an ulcer or sore on the skin of the penis, and bleeding or foul smelling discharge.

<span class="mw-page-title-main">Hypospadias</span> Medical condition

Hypospadias is a common variation in fetal development of the penis in which the urethra does not open from its usual location on the head of the penis. It is the second-most common birth abnormality of the male reproductive system, affecting about one of every 250 males at birth. Roughly 90% of cases are the less serious distal hypospadias, in which the urethral opening is on or near the head of the penis (glans). The remainder have proximal hypospadias, in which the meatus is all the way back on the shaft of the penis, near or within the scrotum. Shiny tissue that typically forms the urethra instead extends from the meatus to the tip of the glans; this tissue is called the urethral plate.

<span class="mw-page-title-main">Balanitis</span> Inflammation of the glans penis

Balanitis is inflammation of the glans penis. When the foreskin is also affected, the proper term is balanoposthitis. Balanitis on boys still in diapers must be distinguished from redness caused by ammoniacal dermatitis. The word balanitis is from the Greek βάλανοςbalanos, literally meaning 'acorn', used because of the similarity in shape to the glans penis.

<span class="mw-page-title-main">Frenulum breve</span> Medical condition

Frenulum breve, or short frenulum, is a condition in which the frenulum of the penis, which is an elastic band of tissue under the glans penis that connects to the foreskin and helps contract it over the glans, is too short and thus restricts the movement of the foreskin. The frenulum should normally be sufficiently long and supple to allow for the full retraction of the foreskin so that it lies smoothly back on the shaft of the erect penis.

Preputioplasty or prepuce plasty, also known as limited dorsal slit with transverse closure, is a plastic surgical operation on the prepuce or foreskin of the penis, to widen a narrow non-retractile foreskin which cannot comfortably be drawn back off the head of the penis in erection because of a constriction (stenosis) which has not expanded after adolescence.

<span class="mw-page-title-main">Penile frenulum</span> Band of tissue under the glans penis connecting the foreskin to the vernal mucosa

The frenulum of the penis, often known simply as the frenulum or frenum, is a thin elastic strip of tissue on the underside of the glans and the neck of the human penis. In men who are not circumcised, it also connects the foreskin to the glans and the ventral mucosa. In adults, the frenulum is typically supple enough to allow manual movement of the foreskin over the glans and help retract the foreskin during erection. In flaccid state it tightens to narrow the foreskin opening.

<span class="mw-page-title-main">Circumcision</span> Removal of the human foreskin

Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. Topical or locally injected anesthesia is generally used to reduce pain and physiologic stress. Circumcision is generally electively performed, most commonly done as a form of preventive healthcare, as a religious obligation, or as a cultural practice. It is also an option for cases of phimosis, other pathologies that do not resolve with other treatments, and chronic urinary tract infections (UTIs). The procedure is contraindicated in cases of certain genital structure abnormalities or poor general health.

<span class="mw-page-title-main">Human penis</span> Human male external reproductive organ

In human anatomy, the penis is an external male intromittent organ that additionally serves as the urinary duct. The main parts are the root (radix); the body (corpus); and the epithelium of the penis including the shaft skin and the foreskin (prepuce) covering the glans penis. The body of the penis is made up of three columns of tissue: two corpora cavernosa on the dorsal side and corpus spongiosum between them on the ventral side. The human male urethra passes through the prostate gland, where it is joined by the ejaculatory duct, and then through the penis. The urethra traverses the corpus spongiosum, and its opening, the meatus, lies on the tip of the glans penis. It is a passage both for urination and ejaculation of semen.

<span class="mw-page-title-main">Corona of glans penis</span> Flare above the sulcus of the human male sex organ

The corona of glans penis or penis crown refers to the rounded projecting border or flare that forms at the base of the glans in human males. The corona overhangs a mucosal surface, known as the neck of the penis, which separates the shaft and the glans. The deep retro-glandular coronal sulcus forms between the corona and the neck of the penis. The two sides of the corona merge on the ventral midline forming the septum glandis. The circumference of the corona is richly innervated and is described as a highly erogenous area of the glans.

<span class="mw-page-title-main">Clitoral hood reduction</span> Cosmetic surgical procedure

Clitoral hood reduction, also termed clitoral hoodectomy, clitoral unhooding, clitoridotomy, or (partial) hoodectomy, is a plastic surgery procedure for reducing the size and the area of the clitoral hood (prepuce) in order to further expose the clitoral glans of the clitoris.

<span class="mw-page-title-main">Foreskin</span> Retractable fold of skin which covers and protects the glans of the penis

In male human anatomy, the foreskin, also known as the prepuce, is the double-layered fold of skin, mucosal and muscular tissue at the distal end of the human penis that covers the glans and the urinary meatus. The foreskin is attached to the glans by an elastic band of tissue, known as the frenulum. The outer skin of the foreskin meets with the inner preputial mucosa at the area of the mucocutaneous junction. The foreskin is mobile, fairly stretchable and sustains the glans in a moist environment. Except for humans, a similar structure known as a penile sheath appears in the male sexual organs of all primates and the vast majority of mammals.

A frenuloplasty of prepuce of penis is a frenuloplasty of the frenulum of prepuce of penis.

References

  1. 1 2 Christianakis E (March 2008). "Sutureless prepuceplasty with wound healing by second intention: an alternative surgical approach in children's phimosis treatment". BMC Urology. 8: 6. doi: 10.1186/1471-2490-8-6 . PMC   2311323 . PMID   18318903.
  2. ↑ Tasmania Law Reform Institute Non-Therapeutic Male Circumcision Archived October 24, 2009, at the Wayback Machine Issues Paper, No. 14, 2009. (p. 14)
  3. ↑ Diamond, Milton (2004). "Sexual Behavior in Pre Contact Hawai'i: A Sexological Ethnography". Revista Española del Pacifico (16): 37–58. Milton Diamond incorrectly terms the procedure subincision, though it is clear superincision is meant.
  4. ↑ Boyle, G and Ramos, S (2000). Ritual and Medical Circumcision among Filipino boys: Evidence of Post-traumatic Stress Disorder Archived 2016-08-15 at the Wayback Machine , Humanities & Social Sciences papers, Bond University (p. 5)
  5. ↑ Afsari M, Beasley SW, Maoate K, Heckert K (March 2002). "Attitudes of Pacific parents to circumcision of boys". Pacific Health Dialog. 9 (1): 29–33. PMID   12737414.
  6. ↑ Circumcision and Māori by Valentino Križanić
  7. ↑ Young H, McGrath K (2001). "A review of circumcision in New Zealand". In Hodges FM, Denniston GC, Milos MF (eds.). Understanding circumcision: a multi-disciplinary approach to a multi-dimensional problem. New York: Kluwer Academic/Plenum Publishers. p. 130. ISBN   0-306-46701-1.
  8. ↑ Editorial (December 1949). "A Ritual Operation". British Medical Journal. 2 (4642): 1458–9. doi:10.1136/bmj.2.4642.1458. PMC   2051965 . PMID   20787713.
  9. ↑ Welsh F (October 1936). "Indications for Infant Circumcision". British Medical Journal. 2 (3953): 714. doi:10.1136/bmj.2.3953.714. PMC   2457672 . PMID   20780160.
  10. ↑ Yachia D (2007). Text Atlas of Penile Surgery. Informa Healthcare. p. 16. ISBN   978-1-84184-517-3.
  11. ↑ Thiruchelvam N, Nayak P, Mostafid H (April 2004). "Emergency dorsal slit for balanitis with retention". Journal of the Royal Society of Medicine. 97 (4): 205–6. doi:10.1177/014107680409700421. PMC   1079370 . PMID   15056750.
  12. ↑ Kessler CS, Bauml J (November 2009). "Non-traumatic urologic emergencies in men: a clinical review". The Western Journal of Emergency Medicine. 10 (4): 281–7. PMC   2791735 . PMID   20046251.
  13. ↑ Warner E, Strashin E (November 1981). "Benefits and risks of circumcision". Canadian Medical Association Journal. 125 (9): 967–76, 992. PMC   1862490 . PMID   7037142.
  14. ↑ McGregor TB, Pike JG, Leonard MP (March 2007). "Pathologic and physiologic phimosis: approach to the phimotic foreskin". Canadian Family Physician. 53 (3): 445–8. PMC   1949079 . PMID   17872680.
  15. ↑ Goodwin WE (November 1990). "Uncircumcision: a technique for plastic reconstruction of a prepuce after circumcision". The Journal of Urology. 144 (5): 1203–5. doi:10.1016/s0022-5347(17)39693-3. PMID   2231896. One patient presented with a dorsal slit because of an acute infection during childhood. All of the normal preputial skin was still present and the patient wished the skin restored to a normal appearance. An inverted V-shaped incision was made where the dorsal slit had been and the two edges were sutured together, thus, reproducing the normal prepuce. The patient was delighted with the results. It could be that this might be an answer to some critics of circumcision. A simple dorsal slit can be performed in patients who have phimosis or severe recurrent infections. At a later date, if they wished restoration, reconstruction to the uncircumcised appearance would be simple.
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