Circumcision





Definition

The surgical removal of the foreskin of the penis, or prepuce of the clitoris.


Purpose

In the United States, circumcision in infant boys is performed for social, medical, or cultural/religious reasons. Once a routine operation urged by pediatricians and obstetricians for newborns in the middle of the twentieth century, circumcision has become an elective option that parents make for their sons on an individual basis. Families who practice Judaism or Islam may select to have their sons circumcised as a religious practice. Others choose circumcision for medical benefits.

Female circumcision (also known as female genital mutilation) is usually performed for cultural and social reasons by family members and others who are not members of the medical profession, with no anesthesia. Not only is the prepuce of the clitoris removed but often the vaginal opening is sewn to make it smaller. This practice is supposed to ensure the virginity of a bride on her wedding day. It also prevents the woman from achieving sexual pleasure during coitus. This practice is not universally approved by the medical profession and is considered by many to be a human rights violation.

Some of the medical reasons parents of male infants choose circumcision are to protect against infections of the urinary tract and the foreskin, prevent cancer, lower the risk of getting sexually transmitted diseases, and prevent phimosis (a tightening of the foreskin that may close the opening of the penis). Though studies indicate that uncircumcised

During a circumcision, the outer layer of the foreskin around the penis is cut (A). The foreskin is pulled away (B), and the remaining membrane is cut away (C). Sutures are used to stitch the area (D). (Illustration by GGS Inc.)
During a circumcision, the outer layer of the foreskin around the penis is cut (A). The foreskin is pulled away (B), and the remaining membrane is cut away (C). Sutures are used to stitch the area (D). (
Illustration by GGS Inc.
)
boys under the age of five are 20 times more likely than circumcised boys to have urinary tract infections (UTIs), the rate of incidence of UTIs is quite low and treatable with antibiotics . There are also indications that circumcised men are less likely to suffer from penile cancer, inflammation of the penis, or have many sexually transmitted diseases. Here again, there is a low rate of incidence. Good hygiene usually prevents most infections of the penis. Phimosis and penile cancer are very rare, even in men who have not been circumcised. Education and safe sex practices can prevent sexually transmitted diseases in ways that a surgical procedure cannot because these are diseases acquired through risky behaviors.

In 2002, however, new research indicated that circumcised men may be less at risk for contracting HIV infections than uncircumcised men, whose foreskins have higher concentrations of cells that are targeted specifically by HIV. Genital hygiene and safe sex practices are still crucial to preventing the spread of HIV.

Another study during that same year found that circumcised men who engaged in risky sexual behaviors were less likely to contract penile human papillomavirus (HPV), which has been implicated in the incidence of cervical cancer in women. There was little difference between circumcised and noncircumcised men's incidence of the virus if the men were in a monogomous relationship.

With these factors in mind, the American Academy of Pediatrics has issued a policy statement that maintains that though there is existing scientific evidence that indicates the medical benefits of circumcision, the benefits are not strong enough to recommended circumcision as a routine practice.


Demographics

Though the incidence of male circumcision has decreased from 90% in 1979 to 60% in 1999, it is still the most common surgical operation in the United States. Circumcision rates are much lower for the rest of the industrialized world. In Britain, it is only done for religious practices or to correct a specific medical condition of the penis.


Description

The foreskin of the penis protects the sensitivity of the glans and shields it from irritation by urine, feces, and foreign materials. It also protects the urinary opening against infection and incidental injury.

In circumcision of infants, the foreskin is pulled tightly into a specially designed clamp, which forces the foreskin away from the broadened tip of the penis. Pressure from the clamp stops bleeding from blood vessels that supplied the foreskin. In older boys or adults, an incision is made around the base of the foreskin, the foreskin is pulled back, and then it is cut away from the tip of the penis. Stitches are usually used to close the skin edges.

Circumcision should not be performed on infants with certain deformities of the penis that may require a portion of the foreskin for repair. The most common condition for surgery using the foreskin is hypospadias, a congenital deformity of the penis where the urinary tract opening is not at the tip of the glans. Also, infants with a large hydrocele, or hernia, may suffer complications through circumcision. Premature infants and infants with serious infections are also poor candidates to be circumcised, as are infants with hemophilia, other bleeding disorders, or whose mothers had taken anticoagulant drugs. In older boys or men, circumcision is a minor procedure and can be performed on virtually anyone without a serious illness or unusual deformity.


Diagnosis/Preparation

Despite a long-standing belief that infants do not experience serious pain from circumcision, physicians now believe that some form of local anesthesia is necessary. Over 80% of pediatric residents, 80% of family practice residents, and 60% of obstetric/gynecological residents are routinely given instruction on pain control for circumcisions. Local anesthesia is often injected at the base of the penis (dorsal penile nerve block) or under the skin around the penis (subcutaneous ring block). Both anesthetics block key nerves and provide significantly lowered perceived pain. EMLA cream (lidocaine 2.5% and prilocaine 2.5%) can also be used.


Aftercare

After circumcision, the wound should be washed daily. An antibiotic ointment or petroleum jelly may be applied to the site. If there is an incision, a wound dressing will be present and should be changed each time the diaper is changed. Sometimes a plastic ring is used instead of a bandage. The ring will usually fall off in five to eight days. The penis will heal in seven to 10 days.

Infants who undergo circumcision may be fussy for some hours afterward, so parents should be prepared for crying, feeding problems, and sleep problems. Generally, these go away within a day. In older boys, the penis may be painful, but this will go away gradually. A topical anesthetic ointment or spray may be used to relieve this temporary discomfort. There may also be a bruise on the penis, which typically disappears with no particular attention.


Risks

Complications following newborn circumcision appear in between two and six of every 1,000 procedures. Most complications are minor. Bleeding occurs in half of the complications and is usually easy to control. Infections are rare and occur at the circumcision site, the opening to the bladder, or at the tip of the penis as a result of contact with urine or feces. Infections are indicated by fever and signs of inflammation, and are treatable with antibiotics.

There may be injuries to the penis itself, and these may be difficult to repair. In 2000, there were reports that the surgical clamps used in circumcision were at fault in over 100 injuries reported between July 1996 and January 2000. In nearly all cases, the clamps were assumed to be in working order but had been repaired with replacement parts that were not of the manufacturer's specifications. Physicians were urged to inspect the clamps before use and ensure that their dimensions fit their infant patients.


Normal results

When an infant or an adult is circumcised, the surgical wound should heal quickly, with normal urinary function resuming immediately. An infant or older child should have no complications and should be able to pass through adolescence and eventual sexual activity normally. After a period of recovery, an adult male should be able to resume sexual intercourse normally.


Morbidity and mortality rates

Complications as a result of circumcision are usually minor if the physician is experienced and makes sure the Mogen or Gomco clamps that are used are in good working order. Severe penile injuries are rare, but they are serious, and include penile amputation (partial or total), laceration, hemorrhage, and damage to the urinary tract. Other serious complications such as meningitis, penile necrosis, necrotizing faciitis, and sepsis can occur. Some of these, like meningitis and sepsis, can even cause death.

Hidden complications also occur. Subcutaneous masses have been detected under the skin of the penis. These masses usually have no symptoms, but, left untreated, could lead more serious outcomes. Physicians should examine the penis at every well-baby checkup during the first year. If a mass is detected, it can easily be removed under a local anesthesia and sent to a pathology lab.


Alternatives

The only alternative to this surgery is to make an informed decision not to have an infant circumcised. Some Jewish parents are even electing not to hold a Bris Milah , a religious circumcision, for their sons, and choosing instead to hold a Brit Shalom , a naming ceremony, similar to that given for their infant daughters.


Resources

BOOKS

Gollaher, David L. Circumcision: A History of the World's Most Controversial Surgery. New York: Basic Books, 2000.

PERIODICALS

"Circumcision." Harvard Men's Health Watch 6, no. 3 (October 2001).

Imperio, Winnie Anne. "Circumcision Appears Safe, But Not Hugely Beneficial." OB GYN News 35, no. 7 (1 April 2000): 9.

"Link to Uncircumcised Males Found." Women's Health Weekly (May 9, 2002): 10.

Schmitt, B. D. "The Circumcision Descision: Pros and Cons." Clinical Reference Systems (2000): 1579.

OTHER

American Academy of Pediatrics. New AAP Circumcision Policy Released (Press Release). March 1, 1999. http://www.aap.org/advocacy/archives/marcircum.htm .


Janie F. Franz

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Medical circumcisions are performed in the hospital by a pediatrician for an infant or child. For an adult, a general surgeon or urologist may perform a circumcision, especially if there are other urinary tract repairs to be made.

A Jewish religious circumcision, a Bris Milah , is performed when an infant male is eight days old. It is conducted by a trained mohel , with family and friends present, in a nonmedical setting.

QUESTIONS TO ASK THE DOCTOR


  • Is there a medical reason for performing a circumcision on my child?
  • Is there new research about the benefits of circumcisions that I should be aware of?
  • What kind of anesthesia will be used during the procedure?
  • What should I be aware of when I go home with the baby?
  • When should I call the doctor?


User Contributions:

mike
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Nov 6, 2006 @ 5:17 pm
it's nice to get some facts straight about circumcision. I'm among those uncircumcized, and have so far been completely free of any diseases that effect that area. Of course this probably has much to do with my own luck as anything else, but I do maintain good hygien. It just seems to me there are many myths about uncircumcized males that frankly have always bothered me personally. My children, my brother, and up to my grandfather (one of those 10 percent mentioned) and my dad have never been circumcized. I have no intention of doing so unless by some bad luck any of those medical conditions should befall me. Aside from those few who do suffer penile problems there seems to be little reason to have it done at birth. I would be interested to know some of the stats and numbers to accurately make my own conclusion, If that isn't any trouble. It's nice to have resources like these so that those of that aren't medical professionals can make educated choices. (What is the percentage of the population that suffer from conditions of not being circumcized vs. circumcized?)
Nick
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Apr 29, 2007 @ 3:15 pm
I recently had my son circumsized and I was wondering if it is common for the foreskin to be slightly over the head of penis (head of the penis looks like it is in a crater). We had the procedure done last Monday and the topper fell off 4 days after, so I was concerned about that so I took him back in, but the doctor (not the one who performed the surgery) said that everything looked okay. Is this normal?
Thank you for answering,
Nick
zdiggi
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Jun 23, 2007 @ 3:15 pm
it's nice to get some facts straight about circumcision. I'm among those uncircumcized, and have so far been completely free of any diseases that effect that area. Of course this probably has much to do with my own luck as anything else, but I do maintain good hygien. It just seems to me there are many myths about uncircumcized males that frankly have always bothered me personally. My children, my brother, and up to my grandfather (one of those 10 percent mentioned) and my dad have never been circumcized. I have no intention of doing so unless by some bad luck any of those medical conditions should befall me. Aside from those few who do suffer penile problems there seems to be little reason to have it done at birth. I would be interested to know some of the stats and numbers to accurately make my own conclusion, If that isn't any trouble. It's nice to have resources like these so that those of that aren't medical professionals can make educated choices. (What is the percentage of the population that suffer from conditions of not being circumcized vs. circumcized?)
Ghatak
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Sep 10, 2007 @ 1:13 pm
I'm among those uncircumcised. Can I face any problem during sex with my partner ? Plz help me.
nyna
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Sep 26, 2007 @ 9:09 am
AM under 22 ; i want know , what are the changes happend in penis before sex and after sex with a girl(under the age of 21). i need a image view.
karan
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Oct 27, 2007 @ 6:06 am
if in a 6-7 years old child circumcision is done ..then does it effects growth of penis
Vicky
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May 30, 2009 @ 8:20 pm
My son was circumcised the day after he was born. It looks like not enough skin was taken off. He is now 5 weeks old and I was wondering if he can get recircumcised. If so, can it be done now? I'm hoping he won't need stitches. Would the procedure be the same as for newborns?
Mustafa Demirelli
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Sep 24, 2009 @ 9:09 am
Dear Parents,
I would like to share my following knowledge and experiences with you as a doctor who has performed more than 25.000 male circumcisions (MC) and who has a lot of information about world circumcision map of world.
Besides every people has their habits and truths, there are the medical truths. It is impossible to carry the all male circumcision operations in to operation rooms due to high quantity of operations. It will be meaningless if we say just the trained professional do the all male circumcisions. I would have used to get angry to mass circumcision sponsors specially municipality presidents and would say exactly like that to them: go ahead and serve to the people in different fields like communications, roads, water lines, etc. But I saw that it is not so easy to do as like as to say.
Although I know all circumcision techniques, I use the clamp technique and perform Modern Circumcision Surgery.

I am one of the doctors who knows best the male circumcision is very difficult in fact. Absolutely every method has advantages and disadvantages. I never used electro-cauter or thermo-cauter techniques. I have circumcised 5.000 kids between 1990-2002 years by Classic Circumcision Surgery which requires sutures. I met with Smartclamp named device in 2002 and I had a chance to introduce this device to the Turkey. I visited the Turkey step by step. I met with surgeons who make circumcisions in different countries. I circumcised people from different nationalities. I shared my experiences with most of well know people who assigned with circumcision in their countries or all world. I had the difficult experiences of many authors.

I am using the alisklamp disposable circumcision device which I had supported the developing period. I honestly believe that it will be a world brand and suggest to everyone who makes circumcisions to see this product. You will notice that how it approach to ideal circumcision when you see the results at www.alisklamp.com.

Dear friends, although I am you consider me as a clamp user, I also would like to share my opinions about which method is feasible while looking the world circumcision map.


1. The method should supply easiness to operator,
2. The method should be done fast,
3. The method should protect the operator and the people who will get circumcised,
4. The method should not to cause any cosmetic defect,
5. The method should not be a reason for sexual function problems,
6. The method should be applicable easily,
7. The method should easy to learn and to teach,
8. The method should not require to suturing on penis,
9. The method should not require too much surgical instruments,
10. The method and tools should not cause unknown infections like the Catguts,
11. The required tools should be disposable,
12. The method should not require bed resting during the healing period,
13. The method should not require additional antibiotic medicines nor wound dressing
14. The method and tools should not cause glans penis amputations,
15. The method should be a standard method,
16. Post operative bleeding should not be even in case of bleeding anomalies,
17. The method should supply standardization in all conditions.

I suggest to everyone to perform and advice the method which covers the most of above features in male circumcision practices.
I wish the success to all doctors who contribute to developments in circumcision techniques and technologies.
Dr. Mustafa Demirelli.
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Apr 9, 2010 @ 6:06 am
I liked all the contents of the article. Did help me to prepare my self with my child circumcision.
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May 3, 2010 @ 8:08 am
male circumcision has no medical indication,it is only for cosmetic purpose, for social acceptance and for religious purpose.
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May 5, 2010 @ 9:09 am
I reasently had a circumcision done the doc used a gomco clamp he stiched it in the midle btween the four skin and shaft skin. four skin still remains covering half the head is this normal
Kathy
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May 12, 2010 @ 8:20 pm
Dale - no, it is not normal, it sounds like the surgeon did not remove sufficient skin. Most surgeons allow you to specify the tightness of your circumcision, and unless you told them you wanted a loose cut, you've been short-changed. They should be able to reschedule you to have it redone (my advice is to go for as tight as possible) within 3-6 months after the initial healing is fully completed.
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Jun 29, 2010 @ 11:23 pm
My grandsun was injured during circumsicion. Almost half of the penis is denuded. I do not know if it is possible to fix. I am still waiting for an appointment to pediatric urologist. I would like to sue a mohel for enjuring a perfectly healthy baby. Do you know what type of lower I need to look for.
Thanks
Rima
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Aug 2, 2010 @ 4:04 am
Hi i am not circumcised but i thought that why not so could you go to my school and cirumcise of the lads and this is the postcode DL15 0QF Parkside Spotrs college willington england county Durham
snail
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Sep 15, 2010 @ 12:00 am
If it is called mutilation when it is done to a female, why isn't it called mutilation when it is done to a male? Also, how is it anyone's right to decide to remove part of someone else's penis before that person is old enough to consent? If I were a male who was circumcised as a baby, I think I would be pretty upset about it and would see it as a violation.
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Oct 29, 2010 @ 7:07 am
What antibiotics do you use after the so called surgery?
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Nov 22, 2010 @ 11:11 am
i had circumsized before 6 days and now it was badly swell and pain. Even i can see yellow blood in stitch area and i can feel it smell.is this normal or anything wrong? please advice me.

Thanks
Nicole
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Nov 22, 2010 @ 9:21 pm
Thank you, thank you Snail!! That was exactly my thinking. When I had my son everyone on my husband side was making fun of me because of my decision not to have him circumcised. I told them it was not my body and I didn't feel comfortable with altering it in anyway.
Charles II
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Jul 18, 2011 @ 7:19 pm
One thing important got left out. Under "alternatives," it says the ONLY one is a decision not to circumcise. That is not the only alternative, nor necessarily the best one.
If a decision is made against circumcision, a whole separate list of things come into play that amounts to a lifetime of foreskin maintenance.
In lieu of all that, it is often possible, and should be explored and encouraged, to get the foreskin retracted just as soon as it is freely and easily retractable, and to keep it that way. Pay attention now. I did NOT say prematurely or forcibly, but only when it is ready to be retracted. Normally, this happens around age 3 - 5, but can occur as early as birth or as late as about age 10. It should not be delayed past puberty, at which point intervention is called for. If frequent or permanent retraction can be achieved, then almost all of the benefits of circumcision can be had, and foreskin maintenance can be greatly reduced or eliminated.
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Aug 14, 2011 @ 12:00 am
it is importent for all mail adult and children its easy i oprating in the homes huts and very poor pepals and defrant places
Juan
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Aug 3, 2012 @ 1:01 am
I have a question. I am an 18 year old and I Want to get circumsized, but I don't know what to expect and if it would hurt a lot or if it would hurt while I'm getting circumsized. Can Someone help me please??
Darryn
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Sep 24, 2012 @ 7:19 pm
Hi, I'm 21 years of age and have read through this entire
Article and find it very educating and elightening...

I am uncurcimcised( I still have a foreskin) and have, for a while now wondered whether I should get circumcised as my foreskin is over the Glans, and sometimes in summer, my foreskin tends to "dry out" and the tip of my foreskin kind of like gets splits around the tip...so I have seeked professional medical treatment and was supplied with an ointment, but it doesn't work, and the same thing just happens all over again...but my foreskin is not too tight, sometimes when I pull my foreskin back when I bath, or when I urinate, the foreskin feels tight and then "tears" on the tip as it's "dry-like"...

Growing up, I never had problems with my foreskin, and I have only encountered an issue with my foreskin since I was 19 (in 2009) and I was wondering if there are any other adult males out there that have encountered or are going through the same. Experiences as me and what they've done to reslove the issue...?

Please could you advise me on what to do, and as Juan-19 (above) typed " I'm afraid whether the circumcision would be painful" I am too, and how long would the wound take to heal after the sutures are put in.?

I want to seriously get circumcised, but I truly am afraid of encountering any wierd problems or issues, like penile infections, or deformities...my penis is healthy, and looks good, and I don't want to make the wrong decision by wanting to get circumcised, and then it was a mistake...my father and younger brother are also uncircumcised, as I am too...but I want to get circumcised, as I have a little bit of excess skin, and when the weather is hot or cold, my tip of my foreskin tends to crack, split, or tear; and it can be very painful when I retract my foreskin to go to the bathroom to urinate...please, I need some serious advice here guys.

Help me out,
Thanks,
Darryn Marshall.
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Oct 12, 2012 @ 2:02 am
I gt two en half weeks circumcised my stitches are off but am worried of the sore dat is underneath is to wide open and there water coming out
gabriel
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Nov 16, 2012 @ 12:12 pm
it's nice 2 b "cut". i'm romanian, and i was "cut" since i have 3 years old.of course in romania without an muslim dr.an romanian dr. and and all my life i will pray 4 him, 'cause she make something amazing 4 me with circumcision. and i will tell u, relax and go with your child 4 "cut". when will grow up, will love u 4 that operation, 'cause women will b on him feet. sex duration will b more then 15-20 min on first number, if she have an active sexual life (or when it's on wave:) ). second number can catch 1 hour or more (without the crap drugs) anyway in sex u have maximal performance.that muslim boy have beautiful wife, 'cause make quality sex. and if one boys is "cut" under 3-4 years, it's more better then an adult, 'cause the penis will grow different (in a better way.don't think : wow the muslim have 70 cm of penis if it's circumcise. will have father/mother gene for grow but penis will thicken enough 2 make happy all woman u catch.
medical it's ok 'cause u escape from many disease. not shame 2 b "cut".all boys uncut will b jealous. so listen the dr. above and don't b a reluctant parent's. your son deserve a better life. sorry 4 my english, but it's 2 words : DO IT ! (and b relax)
respect and good heal 2 everyone
gabriel
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Nov 16, 2012 @ 1:13 pm
@d. marshall, i'm not a dr, but i can give u an idea solution. go 2 surgery and ask an dr 2 put an small titanium or ag ball bean size, under foreskin. your skin will b more better:) and of course u will make women's happy the u can think:) in romania most "bad guys" or jailed have 3-4 plastic ball implanted(some at his home dangerous himself-DON'T DO IT YOURSELF!!!u have a lot of micro vein's; some on the clinical surgery). personal i use 1 many time, but my new girlfriend don't let me with balls ' cause it's 2 "hard" 4 she :( if u will b happy after, i will b happy 2 buy me an juice:)
but go on the surgery clinic and speak without shame with an dr. and beg him 2 do that operation. or u can try circumcision. but it's more simple with ball, 'cause u don't have an disease 2 do that. and any operations involves some pain after. u must choice what the dr say if u have problems, but when u can't do anything, u must chose less and easy operation. in 1 months u can make all kind of stuff u do now with your "toy":) best heal my friend, gabriel
Alec
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Dec 23, 2012 @ 11:11 am
@Darryn, I am having the same problem like you. I am 41 now, sexy has been great uncircumsized. But I had cracks and some time bleeding from crack foreskin, during the winter or because of dryness.

I has been frustrating for me for the past 5-6 years and I am done with that kind of feeling. So I consulted with my doctor and had a procedure done on me a few days ago under general anesthetic. The procedure was ok. I can go back about 1 hour later after the drug effect diminished.

I just feel uncomfortable because of the rubbing against the underwear, other than that wounds heal nicely and I am not in much pain at all.

Good luck with your decision. I had thought about it for a few years, and finally had it done..
sidwell
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Nov 8, 2013 @ 6:06 am
Im 37 years still not circumsized, can I still go .. please advice soonest
Joel
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Aug 24, 2014 @ 9:09 am
Am Joel Bieber Mwansa...jst got circumcised last Wednesday(20th August,2014)...its only threatening b4 but so enjoyable and interesting after the whole procedure...GO FOR IT!!!

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