Sao Paulo – Many men worry about the idea that size matters. What they need to watch out for though, is the excess skin around their friend and their hygiene. Improper cleansing and phimosis can cause penile cancer, a disease that kills an average of 400 people nationwide each year and has around 500 new diagnoses. Additionally, there have been more than 7,000 amputations in the past 14 years.
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To reduce these figures and inform the population, doctors linked to the SBU (Brazilian Society of Urology) made a joint effort in February of phimosis surgeries – removal of the foreskin that is on the glans – in the northern states and from the North East.
Initially, the group estimated to perform 100 circumcisions, but up to the 25th there were 187. During the month, states joined in as elective surgeries were released, as they were subject to a veto due to the omicron variant of Covid-19.
The queue for procedures like this is long in SUS, and the downside is the time required and few rooms for the operation. “The problem of postectomy surgery [como também é conhecida a circuncisão] it’s that, especially in adults, it takes longer because of the suturing, because you have to have the skills of a plastic surgeon, so that it doesn’t become ugly. You are going step by step”, explains Alfredo Canalini, president of the SBU.
TIP NUMBER ONE
Phimosis occurs when the man is unable to pull the skin covering the glans so that the head of the penis is not exposed, or when the organ feels like it is being crushed. According to urologist Fernando Tardelli, this promotes the accumulation of smegma – a secretion produced by the glands of the penis – in this region, which can lead to changes in local cells and thus evolve into a tumor of the penis.
“It is very interesting for those with phimosis to undergo surgery to remove the excess foreskin, thus improving the hygiene of the head and body of the penis. You do not need to perform the operation “, explains Tardelli.
On-site hygiene is the number one expert tip for preventing penile cancer. And no big investment is needed, since soap and water will do the trick. The orientation is, while bathing, to pull the skin until the head of the organ is exposed, clean with the double soap and water, rinse well, dry and put the foreskin back in place.
Care should be taken when drying the penis, both after bathing and after urinating and ejaculating, so that the place does not remain wet for a long time. If the organ is no longer in a normally ventilated environment, imagine the part covered with skin?
VACCINATION AGAINST HPV
Doctors also recommend keeping HPV (Human Papillomavirus) vaccination up to date, available in the SUS for boys ages 11-14 and girls ages 9-14, and using condoms when having sex.
The penile tumor usually appears as a lesion that increases in size and can present in several ways. “Such as an area of skin that changes color or thickens, a superficial lump or lump on the penis, a superficial or deep sore (ulcer) that bleeds and does not heal, reddened, velvety skin bumps, lesions of brownish color, persistent discharge, often with a bad smell”, enumerates Tardelli.
This stench, the doctor says, often causes the man to withdraw from romantic relationships and social life, seeking help only when the disease is advanced.
These lesions usually appear on the head of the penis, but they can also appear on the foreskin or the shaft of the penis. The indication of specialists is that, if a lesion does not improve, the man goes to the urologist to find out the reasons.
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Canalini, the president of the SBU, also recommends monitoring for candidiasis and diabetes, two diseases that facilitate penile infections. He says he learned this in college, when an endocrinology resident went to see a urology resident and reported having inflammation in his limb. The first did not believe it when the second evoked the hypothesis of diabetes, but it was there that the doctor discovered that he had the disease.
As with other diseases, the diagnosis of new cases of penile cancer has declined in recent years. While in 2018 and 2019 there were 2,142 and 2,197 registrations respectively, in 2020 2,095 were reported and, in 2021, 1,791.
The president of the SBU believes that the drop is a consequence of the Covid-19 pandemic, as many people have stopped seeking doctors for fear of contamination, as well as many hospital centers have turned their efforts towards the health crisis.
Another fact that attracts attention is that São Paulo and Minas Gerais lead the ranking of states with the most penile cancer records. According to Canalini, statistics from the Ministry of Health give the false impression that there are more cases in the Southeast.
What happens, he says, is that the government is based on where the patient is cared for, not where they live. The doctor says it is common for sick people to seek out large treatment centers, which ends up interfering with national data.
“We know from our studies and observations that most of these patients come from the northern and northeastern regions of the country,” says Canalini. That is why the surgery campaign took place in Alagoas, Amazonas, Ceará, Espírito Santo, Maranhão, Pará, Paraíba, Piauí, Rondônia and Tocantins.
FIRST OPERATION
But if there is a chance that a boy will develop phimosis in the future, why not operate on him at birth or in the first years of his life? This practice was even common decades ago, when a doctor performed circumcision in the delivery room.
Urologist Tardelli says this is a hotly debated issue in the medical literature. “What we do know is that circumcision of male children in areas with a high incidence of penile tumors is a welcome strategy, because who knows when that child will have access to health care again.”
On the other hand, the doctor points out, if the family finds it easier to go to the doctor, it is possible to wait and monitor the appearance of the skin around the boy’s penis.
According to Canalini, the natural adhesions between the skin and the glans break down over time, and there are also ointments that can be applied to help with the process. “When the boy hits adolescence and doesn’t get that retraction, he’s got a kettle spout and the mouthpiece won’t let him put it on. [a glande] outside, you have to operate,” he explains.
Anyway, what matters is that people learn from an early age to take care of themselves and pay attention to their own bodies. As the president of the SBU says, “we must keep this in mind, informing is a means of promoting health”.
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