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definition - Dorsal_slit

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Dorsal slit

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A dorsal slit (often referred to in anthropology as superincision) 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 been a traditional custom among a number of peoples, particularly Filipinos and Pacific Islanders, probably for thousands of years. In Western medicine it was used as an alternative to circumcision to relieve conditions such as phimosis and paraphimosis, although a perception of poor cosmesis limited its popularity. It is still used when circumcision or other measures are impractical or undesirable.

Contents

Traditional custom

Earliest known circumcision or a dorsal slit?

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 been widely practised by people of the Pacific, stretching from Hawai‘i[3] to the Philippines.[4] However, 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 Maori of New Zealand, who do not circumcise or superincise, 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 Aoteoroa.[6]

Medical practice

File:Penis after dorsal slit erection.JPG
Penis after dorsal slit

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"[7] or refers to the "untidy apron-like appearance" it could produce.[8]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, increasingly, preputioplasty to both retain the foreskin and relieve the phimosis.[9]

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.[10][11] While it was formerly recommended that circumcision be subsequently performed once the originating condition has subsided,[12] this appears to be no longer the case.[13]

References

  1. 1.0 1.1 Christianakis E (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. PMID 18318903. PMC 2311323. http://www.biomedcentral.com/1471-2490/8/6. 
  2. Tasmania Law Reform Institute Non-Therapeutic Male Circumcision 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. http://www.hawaii.edu/PCSS/biblio/articles/2000to2004/2004-sexual-behavior-in-pre-contact-hawaii.html.  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, Humanities & Social Sciences papers, Bond University (p.5)
  5. Afsari M, Beasley SW, Maoate K, Heckert K (March 2002). [Expression error: Missing operand for > "Attitudes of Pacific parents to circumcision of boys"]. Pacific Health Dialog 9 (1): 29–33. PMID 12737414. 
  6. Young, H and McGrath, K (2001). "A review of circumcision in New Zealand". in Hodges, Frederick Mansfield; Denniston, George C.; Milos, Marilyn Fayre. Understanding circumcision: a multi-disciplinary approach to a multi-dimensional problem. New York: Kluwer Academic/Plenum Publishers. pp. 130. ISBN 0-306-46701-1. 
  7. "A Ritual Operation". Br Med J. 2 (4642): 1458–1459. 1949 December 24. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2051965/pdf/brmedj03656-0034.pdf/?tool=pmcentrez. 
  8. Welsh, Fauset (1936 October 10). "Indications for Infant Circumcision". Br Med J. 2 (3953): 714. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2457672/pdf/brmedj06861-0016a.pdf/?tool=pmcentrez. 
  9. Yachia, Daniel (2007). Text Atlas of Penile Surgery. Informa Healthcare. p. 16. ISBN 1-84184-517-5. http://books.google.com.au/books?id=bQy4pZVETlwC&dq=atlas+penile+surgery&printsec=frontcover&source=bl&ots=tfKnRif8iH&sig=Y4rsJ8CD47M531Z452C23lkjoKI&hl=en&ei=x6dOS8-VBoyOkQXeptG5Cg&sa=X&oi=book_result&ct=result&resnum=8&ved=0CCQQ6AEwBw#v=onepage&q=&f=false. 
  10. 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. PMID 15056750. PMC 1079370. http://www.jrsm.org/cgi/pmidlookup?view=long&pmid=15056750. 
  11. Kessler CS, Bauml J (November 2009). [Expression error: Missing operand for > "Non-traumatic urologic emergencies in men: a clinical review"]. The Western Journal of Emergency Medicine 10 (4): 281–7. PMID 20046251. 
  12. Warner E, Strashin E (November 1981). [Expression error: Missing operand for > "Benefits and risks of circumcision"]. Canadian Medical Association Journal 125 (9): 967–76, 992. PMID 7037142. 
  13. McGregor TB, Pike JG, Leonard MP (March 2007). "Pathologic and physiologic phimosis: approach to the phimotic foreskin". Canadian Family Physician Médecin De Famille Canadien 53 (3): 445–8. PMID 17872680. PMC 1949079. http://www.cfp.ca/cgi/pmidlookup?view=long&pmid=17872680. 

 

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