Ujian Praktikum Kedokteran Trisakti

Cara Hidup Sehat

25 Cara Hidup Sehat

Edited by Siti Hadijah • 11 November 2016

Kesehatan adalah harta yang tak ternilai harganya. Oleh karena itu untuk tetap sehat orang rela melakukan apa saja. Segala cara yang dilakukan baik yang bernilai medis maupun non medis, dari yang logis hingga yang bernuansa supernatural adalah beragam usaha yang dilakukan oleh banyak orang dari berbagai kalangan untuk senantiasa sehat atau mendapatkan kembali kesehatannya.

Tak jarang cara yang dilakukan menghabiskan banyak biaya dan bahkan juga tidak jarang menabrak aneka norma dan logika. Tetapi sebenarnya menjaga diri untuk tetap sehat tidaklah sulit, bahkan juga kadangkala tidak memerlukan biaya sama sekali. Tetapi tentunya butuh ekstra kesabaran dan ketelatenan yang hanya sedikit orang bisa untuk tetap konsisten menjalani. Berikut kami sajikan 25 cara hidup sehat yang dapat Anda jadikan rujukan untuk tetap sehat dan senantiasa bahagia dalam menjalani hidup. Berikut paparannya untuk Anda.

Baca Juga : 5 Cara Kendalikan Keuangan Agar Tetap Sehat

1. Perbanyak Konsumsi Air Putih

Mengkonsumsi Air Putih via jejakwaktu.com

Tahukah Anda bahwa sebagian besar dari kita sebenarnya seringkali kurang minum cukup air setiap hari? Ini tentu hal yang tidak baik sebab seperti kita ketahui air sangat penting bagi tubuh kita. Ini karena kita kehilangan air setiap hari melalui urine, buang air besar, keringat dan pernapasan, sehingga kita perlu mengisi asupan air kita.

Sebuah penelitian menunjukkan jumlah air yang kita butuhkan adalah tergantung pada berbagai faktor. Seperti kondisi iklim dan cuaca, aktivitas fisik yang kita lakukan, dan berat badan, tetapi umumnya kita perlu 2,7-3,7 liter asupan air. Jika muncul tanda-tanda seperti misalnya; urine Anda berwarna atau agak kuning, bibir kering, mulut kering dan sedikit buang air kecil. Segeralah minum air karena itu tanda-tanda yang muncul karena tubuh Anda mulai kekurangan cairan.

2. Tidur dan Beristirahatlah yang Cukup

Tidur dan istirahat yang cukup adalah salah satu kunci dari kebiasaan hidup yang sehat. Ini sangat beralasan sebab tubuh sangat membutuhkan istirahat untuk dapat beraktifitas kembali dengan maksimal. Tetapi bila Anda tidak beristirahat dengan baik, Anda bisa mengkompensasi dengan makan lebih banyak, tetapi ini sangat tidak direkomendasikan oleh para ahli kesehatan. Cukup istirahat dan tidur juga mencegah penuaan dini.

3. Meditasi

Meditasi menenangkan pikiran dan menenangkan jiwa Anda. Ketenangan sendiri sangat bermanfaat untuk kesehatan karena dapat menjauhkan kita dari stress yang menjadi sumber dari banyak penyakit dan gangguan kesehatan.

4. Berolahraga Teratur

Penelitian telah menunjukkan bahwa berolahraga setiap hari membawa manfaat luar biasa bagi kesehatan kita, termasuk peningkatan rentang hidup, menurunkan risiko penyakit, kepadatan tulang yang lebih tinggi dan penurunan berat badan. Jika Anda tidak punya waktu untuk berolahraga atau pergi ke pusat kebugaran, berjalan kaki atau aktifitas sehari-hari seperti memilih untuk naik tangga dan buka lift akan menjadi aktifitas pengganti olahraga yang mudah dan murah.

5. Lakukan Olahraga Sebagai Bagian dari Kesenangan

fun exercise via hellodoctor.co.za

Ketika Anda menikmati olahraga, Anda akan secara alami ingin melakukannya. Sebab olahraga yang terpaksa akan menimbulkan penderitaan yang alih-alih menyebabkan Anda ingin terus melakukannya tetapi malah menjadikan Anda malas. Jadi pilih olahraga yang Anda senangi dan lakukanlah rutin.

6. Berolahragalah seperti Bermain

Latihan kardio saja seperti misalnya jogging akan membuat Anda penat dan bosan. Berikan tubuh Anda lebih banyak olahraga yang menyenangkan dan berkelompok, seperti misalnya basket, sepak bola, renang, tenis, badminton atau voli dan masih banyak yang lain. Ini akan menyenangkan karena Anda sekaligus juga dapat bersosialisasi dengan orang lain sembari melakukan aktivitas yang sehat.

7. Makan Lebih Banyak Buah

Makanlah lebih banyak buah dan kurangi vitamin sintetis. Ada banyak jenis buah yang dapat Anda konsumsi yang selain menyehatkan juga rasanya dijamin enak.

8. Makan Lebih Banyak Sayuran

Seperti halnya buah-buahan, sayuran penting untuk kesehatan kita. Para ahli menyarankan bahwa kita setidaknya harus mengkonsumsi 5-9 porsi buah-buahan / sayuran, setiap harinya. Kabar buruknya adalah kebanyakan orang kurang menyenangi untuk mengkonsumsi sayuran, dan ini tentu adalah hal yang tidak baik untuk kesehatan kita.

9. Pilih Makanan Berwarna Cerah sebagai Antioksidan

Buah-buahan dan sayuran dengan warna-warna cerah biasanya tinggi dalam anti-oksidan. Anti-oksidan sangat diperlukan oleh tubuh karena mereka menghilangkan dan menangkal radikal bebas dalam tubuh kita yang bisa merusak sel-sel tubuh kita.

Jadi mungkin Anda perlu untuk mulai mengkonsumsi sayur dan buah dengan warna-warna yang berbeda, seperti misalnya; putih (Pisang, jamur), Kuning(Nanas, Mangga), Oranye (Jeruk, Pepaya), Merah(Aple, Stroberi, Tomat, Semangka), Hijau (Jambu, Alpukat, mentimun, Selada, Seledri), Ungu/Biru (Buah Berry, Terong, Buah Plum). Diet Warna ini juga baik untuk menjaga diet yang menyehatkan serta membentuk tubuh ideal.

10. Kurangi Makanan Olahan dan Makanan dalam Kaleng

Makanan Kaleng via ook-wise.com

Makanan  olahan atau kalengan sebaiknya Anda hindari karena berbagai alasan seperti misalnya; nilai gizi yang sering tidak sempurna, adanya pengawet yang ditambahkan yang dapat berdampak buruk bagi kesehatan, jika dikonsumsi terus menerus dan dalam jangka waktu panjang. Bahkan juga penambahan garam yang harus Anda pertimbangkan sebelum mengkonsumsi makanan olahan atau kalengan terlalu sering.

11. Mulailah Mencintai Diri Sendiri

Dengan mencintai diri sendiri Anda akan terhindar dari dampak buruk stress yang dapat berakibat buruk juga bagi kesehatan. Selain itu Anda juga dapat mengambil lebih banyak manfaat dengan pemikiran positif terhadap cara pandang tentang hidup dan kehidupan yang lebih luas yang tentu menjadikan Anda pribadi yang lebih bahagia setiap harinya.

12. Berjalan dengan Bertelanjang Kaki

Ada banyak manfaat yang terbukti positif berjalan dengan bertelanjang kaki berjalan mulai dari dapat memperbaiki postur tubuh Anda lebih baik, mengurangi stres untuk kaki dan sendi Anda. Ini   sungguh beralasan ilmiah karena berjalan dengan bertelanjang kaki memberikan efek pijatan yang menciptakan rasa nyaman ke sekujur badan Anda

13. Jauhi Orang-Orang dengan Pola Pikir Negatif

Sikap mental yang positif merupakan bagian penting dari hidup sehat. Ini tentu menjadikan Anda tidak perlu untuk mendekati Orang-orang berpikiran negatif yang akan meracuni pikiran Anda dengan segala pemikiran yang dapat menyebabkan stres yang berdampak buruk untuk kesehatan Anda.

14. Bersihkan diri Anda Sendiri juga dari Hal yang Negatif

Menjadi sehat adalah pilihan, selain Anda menolak faktor eksternal Anda juga harus mampu untuk menetralisir segala pikiran kontra produktif atau negatif yang dapat menjadikan Anda tidak bahagia dan stres.

15. Tuliskan Mimpi dan Kebahagian Anda

Menulis Keinginan via momitforward.com

Menyimpan pikiran-pikiran ini terpendam dalam diri itu tidak sehat. Oleh karenanya menulis akan bisa menjadi salah satu hal yang memicu pelepasan hal negatif dari dalam diri Anda sendiri. Ini juga berarti bahwa tidak sekedar menulis, tetapi juga meletakkan dasar-dasar kebahagian hidup Anda kedepan. Penelitian telah menyebutkan bahwa, sebagian remaja dan orang dewasa yang tumbuh dengan kebiasaan menulis buku harian memiliki kecenderungan yang lebih bahagia ketimbang yang tidak.

16. Kenali Makanan Pemicu, Kendalikan Asupan Gula dan Garam Anda

Mengkonsumsi gula dan garam berlebihan dapat mengganggu kesehatan, meski demikian tetap diperlukan konsumsi gula dan garam dalam kadar yang tepat.

Baca Juga : Keuangan Anda Sehat? Jawab Dulu 5 Pertanyaan Ini

17. Seringlah Bernafas Dalam-Dalam

Anda mungkin tahu bagaimana untuk bernapas, tetapi sudahkah Anda bernapas dengan cara yang tepat dan sehat? Anehnya sebagian besar dari kita tidak bernapas dengan benar – sebab hanya bernafas dangkal.

Seperti seorang Atlet yang dilatih teknik pernapasan yang tepat untuk mendapatkan performa terbaik mereka. Sebuah tarikan nafas yang penuh di mana Anda benar-benar mengisi paru-paru Anda dengan oksigen akan membuat kita menjadi lebih segar dan bergairah.

18. Hindari Cara Makan yang Melibatkan Emosional

Tak jarang ketika kita stress atau merasa tertekan kita makan lebih banyak, ini adalah sebuah bencana bagi kesehatan. Cara makan yang melibatkan emosi atau menuruti emosi akan menyebabkan dampak buruk, yang paling terlihat tentunya adalah obesitas.

19. Makanlah dalam Porsi Kecil

Makanlah sedikit tapi sering, ini akan membuat Anda merasa lebih baik. Karena dengan demikian tubuh Anda akan dapat mencerna makanan dalam proses metabolisme dengan lebih sempurna. Ini bukan berarti adalah pembenaran untuk kebiasan mengemil tentunya.

20. Berhenti Makan ketika Anda Merasa Kenyang

Eating via abiummi.com

Kebanyakan dari kita sering kali memiliki kebiasaan makan yang tidak menentu kadang kita makan terlalu banyak atau terlalu sedikit. Tak jarang situasi sosial juga mendukung seperti misalnya ketika kita sedang ada di tengah pesta. Ingatlah bahwa Anda bukan mesin penggiling yang bisa menghabiskan seluruh makanan yang terhidangkan.

21. Karbohidrat Coklat vs Karbohidrat Putih

Menganti nasi putih dengan beras merah atau beras dengan kulit ari yang masih tersisa, roti putih dengan roti gandum utuh. Juga adalah sebuah kebiasan yang baik bagi kesehatan.

22. Hiduplah dengan Tujuan

Kesehatan yang positif dimulai dari dalam! Apakah Anda menjalani kehidupan yang berarti? Apakah Anda hidup sejalan dengan tujuan Anda? Pastikan Anda mencanangkan tujuan hidup Anda, dan raihlah dengan penuh ketenangan adalah suatu hal yang baik dan berati untuk hidup dan kesehatan Anda.

23. Katakan Tidak untuk Makanan Berminyak

Mengurangi asupan makanan cepat saji, gorengan serta makanan berminyak lainnya akan berdampak baik bagi kesehatan Anda.

24. Kendalikan Kandungan Gula pada Tubuh Anda

Simpan hal-hal yang terlalu manis, permen, coklat, cake dengan toping yang terlalu manis. Mungkin semua enak dan luar biasa dipAndan mata mungkin lebih lagi ketika menyentuh lidah, tapi ingatlah kesehatan Anda adalah mutlak adanya.

25. Go organik

Sayuran Organik via hellodoctor.co.id

Sering ada pertanyaan, “apa itu makanan organik?”dan jawabannya adalah "makanan yang dihasilkan tanpa input sintetis seperti pestisida dan pupuk kimia, tidak mengandung organisme hasil rekayasa genetika, dan tidak diproses menggunakan radiasi, pelarut industri, atau makanan tambahan kimia". Dengan memperhatikan penjelasannya saja mungkin sudah terbayang sayuran hijau, atau buah tanpa pestisida yang tentu bebas dari rasa khawatir untuk menyantapnya pula.

Hidup Sehat itu Mudah, Kuncinya Disiplin

Sehat itu mahal, jika sakit apapun yang kita punya bisa habis terjual buat berobat, oleh karena itu jika Anda ingin berhemat, maka jalani saja pola hidup sehat. Hidup sehat sendiri sangat sederhana. Anda tinggal ikuti saja 45 cara hidup sehat seperti uraian diatas. Jika Anda disiplin dalam menjalankannya, selain hemat biaya dalam menjalankannya, kesehatan Anda juga akan terjaga.

Cure for Diabetic Neuropathy(DN) by natural way

Have you paid attention to your friends or relatives who feel pain in their leg during walking in the yard ?  As we know this is the effect of his diabetic illness. Elevated blood glucose levels in a diabetic eventually cause the development of nerve damage throughout the body. Early nerve damage may not have any obvious symptoms. As it worsens, a diabetic may experience burning pain, loss of tactile sensation, or tingling in the feet and hands.Diabetic neuropathy is a family of nerve disorders caused by diabetes. There are different types of diabetic neuropathy; one of them is peripheral sensory neuropathy. It is a very common complication of diabetes and can lead to numbness, abnormal sensation, and constant pain. Diabetic peripheral neuropathy usually first appears in the feet and lower legs and may occur later in the hands.People with diabetic peripheral neuropathy may find that they start losing their balance or have difficulty walking without wobbling. At this stage, wearing orthopaedic shoes or diabetic shoes may help. A walking aid (cane or frame) may be needed.Bone deformity of the feet may also occur. This is due to the weight redistribution from walking abnormally as well as the impairment of sensorimotor nerve function which affects the leg and feet muscles.Diabetes mellitus affects over 14 million people in the United States and the number of diabetics is increasing by 5% per year. Diabetic neuropathy (DN) is a common complication of diabetes and occurs in approximately 50% of diabetic patients over time. Clinical trials have proven that hyperglycemia almost certainly conditions the development of DN. Despite this fact, we still do not understand the mechanism(s) underlying DN. Several possible etiologies have been proposed including altered metabolism of polyol, lipids, or amino acids, vascular insufficiency, increased superoxide-induced free radical formation, impaired axonal transport or reduced neurotrophism. Accumulating evidence suggests that these defects are likely interrelated and that their interaction(s) within the diabetic milieu are responsible for the development and progression of DN. In this review we will discuss these theories, their interrelationships and how, collectively, these ideas may begin to explain the etiology of DN.
I have been seeking the various kind of therapy and I found that therapy suggested by Dr.Randall (http://neuropath.info) is satisfying.

Circumcision

Poonam Puri, Joginder Kumar, and V. Ramesh

Author information ► Copyright and License information ►

Go to:

Abstract

Circumcision is one of the oldest and the most controversial surgical procedures performed worldwide and is almost universal among Muslim and Jewish men. Most medical institutions in various countries agree that although there may be health benefits, there is no medical justification for routine circumcision in neonates or children. It should be performed only for established medical reasons and should not be universally recommended. There are modern techniques that provide safer, simpler, quicker, and cheaper alternatives to the traditional means of circumcision with good functional and cosmetic results. Female genital mutilation (FGM) includes procedure that alters or injures female genital organs for nonmedical reasons. Various degrees of FGM are prevalent, the most mutilating one being infibulation. There are numerous gynecologic and obstetrical complications with infibulation. FGM also plays a significant role in facilitating the transmission of HIV infection through numerous mechanisms. Health care providers have an important role to play in the eradication of this practice. Increased professional and public awareness about such a practice is required.

Keywords: Circumcision, genital mutilation, infibulation, phimosis

Go to:

MALE CIRCUMCISION

Introduction

Circumcision is the removal of some or the entire foreskin (prepuce) from the penis.[1] The word “circumcision” comes from Latin circum (meaning “around”) and cædere (meaning “to cut”). In Judaism male circumcision is considered a commandment from God. Male circumcision is widely practiced and considered to be a Sunnah[2] in Islam. In Jews, it is performed without anesthesia on the child’s 8th day of life, whereas in Muslims between 4 and 13 years of age.[3]

History

Circumcision is one of the oldest and most controversial surgical procedures.[4] It has been described in Egyptian papyri and wall carvings dating back to 4000 BC[5] where the ancient mummies were found to be circumcised.[3] Circumcision was probably started as a public health measure for preventing recurrent balanitis due to accumulation of sand under the foreskin in the ancient societies of the Middle East.[6]

Prevalence

World Health Organization (WHO) estimates that 30% of all males in the world 15 years and older are circumcised and almost 70% of them are Muslims.[7]

Modern circumcision procedures

The procedure is done under local anesthesia using either topical local anesthetic cream, which is applied 60–90 min prior to the procedure at the site of circumcision, or a local anesthetic is infiltrated at the base of the penis to block the dorsal penile nerve or injected around the middle of the penis as a subcutaneous ring block.[8] For infant circumcision, clamps along with a restraining device are used.[9] First, the extent of the foreskin to be removed is determined. The foreskin is then opened via the preputial orifice to reveal the glans underneath. The inner lining of the foreskin (preputial epithelium) is then bluntly separated from its attachment to the glans. The restraining device is then placed till blood flow has stopped. Finally the foreskin is amputated.[8] Adult circumcisions are often performed without clamps and require 4–6 weeks of abstinence from masturbation or intercourse after the operation to allow the wound to heal.[9] The most common complications are blood loss and infection. The long-term complication of circumcision is meatal stenosis, which can lead to dysuria, incontinence, bleeding after urination, and urinary tract infections.[10] Other complications include concealed penis,[11] urinary fistulas, chordee, cysts, lymphedema, ulceration of the glans, hypospadias, epispadias, and impotence. Most of these complications are preventable as these occur by untrained persons who are neither urologists nor surgeons. Occasional death estimated at 1 per 500,000 circumcisions has been cited by American Academy of Family Physicians.[12]

Ethical issues

Controversy exists in new born males regarding indications of ritual circumcision on religious groundsBecause neonatal circumcision is not necessary for the child’s wellbeing, various medical associations, such as the American Academy of Pediatrics (AAP), British Medical Associations and Canadian Paediatrics Society, Royal Australasian College of Physicians, suggested that it should be performed only for established medical reasons and not to be universally recommended.[13] Infant circumcision infringes upon individual autonomy and represents a violation of human rights.[14] Parents who believe that circumcision is of medical benefit should be educated on the pros and cons of the procedure, and available alternatives to circumcision. They should be explained that their child can lead a healthy life even with an intact foreskin. Such information enables them to make the right choice for their child. UNAIDS states that “male circumcision is a voluntary surgical procedure and health care providers must ensure that men and young boys are provided information to enable them to make decision either for or against getting circumcised.”

Routine neonatal circumcision

Routine neonatal circumcision has advantages as well as drawbacks. The beneficial effects include prevention of phimosis, paraphimosis, and balanoposthitis. The risk of urinary tract infection has been shown to decrease from 7 per 1000 to 2 per 1000 after circumcision.[6] Few studies show that human papillomavirus infection of penis is less in circumcised males and their female partners have less chances of developing cervical cancer compared with their uncircumcised counterparts.[15] The incidence of sexually transmitted diseases is 10% lower in circumcised males.[6] There is clear evidence that circumcised men are at a significantly lower risk of acquiring HIV infection.[16] The disadvantage with routine neonatal male circumcision is that it is frequently performed by untrained persons without anesthesia. The babies experience pain more intensely for a prolonged period and over a wider area of the body than older children do.[5] The foreskin not only protects the glans penis but has specialized nerve endings (Meissner corpuscles) for fine touch, which enhances sexual pleasure. Hence, ritual circumcision removes the erogenous tissue, which serves important protective, sensory, and sexual purposes.[13]

Sexually transmitted diseases and circumcision

There are conflicting reports on the effect of circumcision on the incidence of sexually transmitted infections (STIs). A meta-analysis from —26 studies found that circumcision was associated with lower rates of syphilis, chancroid, and genital herpes.[17] Circumcision may protect against both bacterial and viral STIs because the warm, moist area under the foreskin provides a suitable location for the pathogens to replicate. In addition, uncircumcised men may be at increased risk due to entry of pathogens through the inner surface of the foreskin and frenulum. The physical location of ulcers may also affect the role of circumcision on genital ulcerative diseases. Chancroid frequently occurs on the external and internal surfaces of the foreskin,[18] hence circumcision may be more protective against chancroid than against syphilis and herpes, where lesions tend to be found more on the male genitalia. Potential male circumcision interventions to reduce HIV in high-risk populations may provide additional benefit by protecting against other STIs. Three randomized controlled trials in sub-Saharan Africa have shown that circumcision may be protective against genital ulcer disease, herpes simplex type 2, trichomonas vaginalis, and human papillomavirus infection in men.[19] However, a large randomized prospective trial in Uganda found a reduction in herpes simplex virus type 2 (HSV-2) infection, but not syphilis infection in the circumcised patients.[20] A prospective trial in India found that circumcision offered no protective benefit against HSV-2, syphilis, or gonorrhea.[21] A study of 5925 women from Uganda, Zimbabwe, and Thai described that the circumcision status of their partner did not significantly affect the incidence of Chlamydia, gonorrhea, or trichomoniasis.[22]

Circumcision and HIV

There is clear evidence that circumcised men are at a significantly lower risk of acquiring HIV infection,[13–15] probably because the inner surface of the foreskin contains numerous Langerhans cells and CD4+ T lymphocytes (primary HIV-1 target cells),[21] and the warm, moist environment under the foreskin.[23] The latter could also facilitate infection with other sexually transmitted pathogens The protective effect of circumcision on HIV is especially strong among populations more highly exposed to STIs, suggesting that part of the effect on HIV may be mediated via protection against other STIs that facilitate HIV transmission.[13] This explains the surprising low rates of HIV in Islamic nations, such as Egypt, Sudan, Iran, Iraq, Pakistan, Bangladesh, and Indonesia, compared with their neighbors.[15] The WHO (2007), the Joint United Nations Programme on HIV/AIDS (UNAIDS; 2007), and the Centers for Disease Control and Prevention (CDC; 2008) state that male circumcision significantly reduces the risk of HIV acquisition by men during penile–vaginal sex, but is not a substitute for other interventions to prevent HIV transmission.[24,25]

Sexual effects of circumcision

Circumcision increases the ejaculatory latency time without any adverse effect on sexual functions.[26] This may be considered an advantage rather than a complication.

Medical indications of circumcision in children

Circumcision is recommended for acquired phimosis, paraphimosis, recurrent balanitis, and recurrent urinary tract infections.[27]

Contraindications

Circumcision should not be performed in children with congenital penile anomalies, such as hypospadias, epispadias, chordee, megalourethra, or webbed penis. It should be avoided in patients with bleeding disorders.

The alternatives to radical circumcision

Radical circumcision is now an obsolete procedure. It is a painful procedure with prolonged recovery time. There is destruction of functional tissue sometimes associated with serious complications. The alternative conservative treatment for relieving preputial stenosis consists of topical steroid application (0.05% clobetasol propionate cream applied twice daily for 1–2 months.[28] Gentle stretching of the foreskin over a period of time will open up the narrow preputial opening, while preserving the foreskin. Preputioplasty and dorsal slit are conservative alternatives to the radical circumcision.[29] They are rapid and less painful procedures with early recovery. “Triple incision preputioplasty” is a simple, safe, and rapid technique with good functional and cosmetic outcome. In this procedure, 3 longitudinal incisions on the stenosing segment are made, which are sutured diagonally.[30] Nd:YAG laser contact technique[31] and octyl cyanoacrylate glue[32] are other modalities used to perform sutureless circumcision.

Key facts

1. Circumcision should be performed only for established medical reasons and should not be recommended routinely.
2. The health benefits should be weighed against the potential risks that the procedure offers.

Go to:

FEMALE CIRCUMCISION

Introduction

Female circumcision is a procedure involving partial or total removal of the external genitalia for cultural, religious, or nontherapeutic reasons.[33] It is mostly carried out on young girls between infancy to adolescence. The procedure has no health benefits for girls and women. The WHO recommends the use of the term female genital mutilation (FGM).[34]

History

FGM has been practiced for centuries. Egyptian mummies were found to have been circumcised as far back as 200 BC In the 19th Century it was practiced in Europe and North America as a remedy for ailments, such as epilepsy, hysteria, and masturbation.[35]

Prevalence

An estimated 130 million girls and women worldwide have been subjected to some form of FGM, with over 3 million girls at risk of undergoing FGM every year. FGM is mainly practiced in 28 countries of Africa. The country where FGM is most prevalent is Egypt, followed by Sudan, Ethiopia, and Mali. The practice can also be found among some ethnic groups in South America. Immigration has led to its spread in Europe, Australia, and the United States. Daughters of some tradition-minded families undergo FGM while visiting their home countries on vacation.

Procedure

The WHO divides the procedure into 4 major types[36] :

Type 1

Clitoridectomy: partial or total removal of the clitoris (clitoridectomy) and/or the prepuce (clitorial hood). It is similar to male circumcision. It is termed Sunnah for men and Makramah for women. Makramah means honorable deed.[37]

Type 2

Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora.

Type 3

Infibulation: In this procedure, there is narrowing of the vaginal orifice with creation of a covering seal by cutting and repositioning the labia minora and/or the labia majora, with or without excision of the clitoris. There is extensive tissue removal of the external genitalia, including the entire labia minora and the inside of the labia majora. Only an opening at the inferior portion of the vulva remains to allow urine and menstrual blood to pass through.[38] Generally, a local village practitioner or a midwife of the village performs infibulation in the bush, without asepsis or anesthesia. The term Infibulation refers to the use of clasp (infibula) to keep the cut edges of the vagina together. It accounts for 10% of all FGM procedures from Africa.[39] Reversal of infibulation (anterior episiotomy) is possible to allow sexual intercourse or during labor to allow vaginal delivery, so the infibulation is opened completely and may be closed after delivery.

Type 4

Other types: All other harmful procedures to the female genitalia for nonmedical purposes, for example, pricking the clitoris with needles, piercing, incising, scraping, and burning of the genital area.[36]

Consequences and complications

Complications of female circumcision may occur immediately after the procedure or later and these can be physical or psychological. They occur most frequently with the procedure of infibulation.[40] Immediate complications include severe pain, shock due to excessive bleeding, tetanus, or sepsis, open sores in the genital region, injury to the adjacent genital tissue, and urine retention. Long-term consequences include recurrent bladder and urinary tract infections, cysts, infertility, pelvic inflammatory disease, and a higher risk of childbirth complications and newborn deaths. Women who have been infibulated face a lot of difficulty during delivery, especially if the infibulation is not opened completely. There are chances of severe tearing of the infibulated area or fetal death.[41]

Cultural, religious, and social causes

The FGM is performed as a result of cultural, religious, and social factors within families and communities. FGM is considered a necessary part of raising a girl properly and to prepare her for adulthood and marriage. FGM is said to ensure a “proper” sexual behavior, premarital virginity, and marital fidelity, and reduced woman’s libido.[42] Certain cultural ideas of femininity and modesty include the notion that girls are “clean” and “beautiful” after removal of body parts that are considered “male” or “unclean.” A few religious leaders still promote FGM, some consider it irrelevant to religion while others contribute to its elimination.

Circumcision and HIV

A few recent reviews have suggested that the female genital circumcision may increase the risk of HIV.[43] The various proposed mechanisms include nonsterile procedures, an increased number of blood transfusions due to blood loss during surgery, increased anal intercourse due to difficult or painful vaginal intercourse, and tearing of the vagina during intercourse. Other studies have found no statistically significant associations.[44]

Circumcision and sexual effects

The effect of FGM on a woman’s sexual experience varies depending on many factors. Clitoris stimulation is not solely responsible for the sexual excitement as sexual arousal during intercourse involves stimulation of complex series of nerve endings in and around vagina, labia minora and majora, cervix, uterus, and clitoris in addition to psychological response and mindset.[45] FGM does not eliminate sexual pleasure totally for every woman who undergoes the procedure, but it does reduce the likelihood of orgasm.

To end the practice

Despite laws forbidding the practice, FGM still remains a tradition in many societies and cultural groups. Few countries that prohibited FGM still experience the practice in secrecy. In many cases, enforcement of this prohibition is a low priority for the governments. Other countries have tried to educate practitioners to make it easier and safer instead of outlawing the practice entirely. However, with pressure from the WHO and other groups, laws are being passed in regard to FGM. On June 28, 2007 Egypt banned female genital circumcision after the death of 12-year-old Badour Shaker during a genital circumcision. The United Nations Population Fund (UNFPA) has declared February 6 as the International Day against FGM.

Key facts

1. It has no health benefits for girls and women.
2. FGM is considered as infringement of human rights against girls and women who are unable to give informed consent.

Go to:

Footnotes

Source of Support: Nil

Conflict of Interest: None declared.

Go to:

Multiple Choice Questions

Q.1. Which of the following is homologous to glans penis?

1. Labia majora
2. Labia minora
3. Mons pubis
4. Clitoris

Q.2. Which one of the following statements is correct?

1. Circumcising newborn boys is necessary for their sexual health
2. There are no valid medical indications to recommend the routine circumcision of newborn boys
3. Circumcising newborn boys is detrimental to their health
4. Circumcising newborn boys often results in life-threatening health complications

Q.3. Type 3 FGM involves

1. Excision of the prepuce only
2. Excision of part or all of the external genitalia
3. Burning the clitoris
4. Introducing corrosive substance in the vagina

Q.4. Decreased incidence of HIV in circumcised cases is due to

1. Poor hygiene
2. Decreased sexual activity
3. Decrease in the number of Langerhans cells
4. Presence of commensals in the preputial sac

Q.5. Find the incorrect statement about male circumcision

1. Male circumcision is associated with a lower risk of HIV infection
2. It reduces risk of some STIs
3. It causes infertility
4. It should not be performed routinely but for established medical reasons

Answers

• Q.1. d. Clitoris
• Q.2. b. There are no valid medical indications to recommend the routine circumcision of newborn boys
• Q.3. b. Excision of part or all of the external genitalia
• Q.4. c. Decrease in the number of Langerhans cells
• Q.5. c. It causes infertility

Go to:

REFERENCES

1. Webster’s Revised Unabridged Dictionary. 1913

2. Rizvi SA, Naqvi SA, Hussain M, Hasan AS. Religious circumcision: A Muslim view. BJU Int. 1999;83:13–6. [PubMed]

3. Williams N, Kapila L. Complications of circumcision. Br J Surg. 1993;80:1231–6. [PubMed]

4. Alanis MC, Lucidi RS. Neonatal circumcision: A review of the world’s oldest and most controversial operation. Obstet Gynecol Surv. 2004;59:379–95. [PubMed]

5. Goodman J. Jewish circumcision: An alternative perspective. BJU Int. 1999;83:22–7. [PubMed]

6. Hutson JM. Circumcision: A surgeon’s perspective. J Med Ethics. 2004;30:238–40. [PMC free article][PubMed]

7. Male circumcision: Global trends and determinants of prevalence, safety and acceptability. Geneva: World Health Organization; 2007.

8. Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision. Pediatrics. 1999;103:686–93. [PubMed]

9. Holman JR, Lewis EL, Ringler RL. Neonatal circumcision techniques. Am Fam Physician. 1995;52:511.[PubMed]

10. Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila) 2006;45:49–54. [PubMed]

11. Trier WC, Drach GW. Concealed Penis. Another Complication of Circumcision. Am J Dis child. 1973;125:276–7. [PubMed]

12. Paediatric Death Review Committee: Office of the Chief Coroner of Ontario. Coroner’s Corner Circumcision: A minor procedure?” Paediatr Child Health. 2007;12:311–2. [PMC free article] [PubMed]

13. Viens AM. Value judgment, harm, and religious liberty. J Med Ethics. 2004;30:241–7.[PMC free article] [PubMed]

14. Tanne HJ. US group lobbies UN to outlaw male circumcision” Br Med J. 2005;331:422.

15. Short RV. Male circumcision: A scientific perspective. J Med Ethics. 2004;30:241. [PMC free article][PubMed]

16. Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial. Lancet. 2007;369:657–66. [PubMed]

17. Weiss HA, Thomas Sl, Munabi SK, Hayes RJ. Male circumcision and risk of syphilis, chancroid, and genital herpes: A systematic review and meta-analysis. Sex Transm Infect. 2006;82:101–9.[PMC free article] [PubMed]

18. Nsanze H, Fast MV, D’Costa LJ, Tukei P, Curran J, Ronald A. Genital ulcers in Kenya. Clinical and laboratory study. Br J Vener Dis. 1981;57:378–81. [PMC free article] [PubMed]

19. Larke N. Male circumcision, HIV and sexually transmitted infections: A review. Br J Nurs. 2010;19:629–34. [PMC free article] [PubMed]

20. Tobian AA, Serwadda D, Quinn TC, Kigozi G, Gravitt PE, Laeyendecker O, et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med. 2009;360:1298–309.[PMC free article] [PubMed]

21. Reynolds SJ, Shepherd ME, Risbud AR, Gangakhedkar RR, Brookmeyer RS, Divekar AD, et al. Male circumcision and risk of HIV-1 and other sexually transmitted infections in India. Lancet. 2004;363:1039–40. [PubMed]

22. Turner AN, Morrison CS, Padian NS, Kaufman JS, Behets FM, Salata RA, et al. Male circumcision and women’s risk of incident chlamydial, gonococcal, and trichomonal infections. Sex Transm Dis. 2008;35:689–95. [PMC free article] [PubMed]

23. Szabo R, Short RV. How does male circumcision protect against HIV infection? BMJ. 2000;320:1592–4. [PMC free article] [PubMed]

24. New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications. Geneva: World Health Organization; 2007.

25. Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States. Atlanta: Centers for Disease Control and Prevention; 2008.

26. Senkul T, Iserl C, Sen B, Karademir K, Saracoglu F, Erden D. Circumcision in adults: effects on sexual functions. Urol. 2004;63:155–8. [PubMed]

27. Cantu S., Jr Circumcision. e Medicine Journal [serial online] Available from:http://www.emedicine.com [Last Updated on 2004]

28. Jorgensen ET, Svensson A. The treatment of phimosis in boys with a potent topical steroid (0.05% clobetasol propionate) cream. Acta Derm Venereol. 1993;73:55–6. [PubMed]

29. Cuckow PM, Rix G, Mouriquand PD. Preputial plasty: A good alternative to circumcision. J Paediatr Surg. 1994;29:561–3. [PubMed]

30. Pascotto R, Giancotti E. The treatment of phimosis in the childhood without circumcision: Plastic repair of the prepuce. Minerva Chir. 1998;53:561–5. [PubMed]

31. Vaos G. Circumcision with the Nd: YAG laser contact technique compared with conventional surgery. Photomed Laser Surg. 2004;22:318–22. [PubMed]

32. Subramaniam R, Jacobsen AS. Sutureless circumcision: A prospective randomised controlled study. Paed Surg Int. 2004;20:783–5. [PubMed]

33. Definition used by the World Health Organization.http://www.who.int/mediacentre/factsheets/fs241/en.

34. Schoen EJ. Female circumcision(letter) N Engl J Med. 1995;332:188–9. [PubMed]

35. Dirie MA, Lindmark G. The risk of medical complications after female circumcision. East Afr Med J. 1992;69:479–82. [PubMed]

36. Eliminating female Genital Mutilation An interagency statement OHCHR, UNAIDS, UNFPA, UNHCR, UNICEF, UNIFEM, WHO Department of Reproductive Health and Research (RHR) Geneva: World Health Organization; 2008.

37. Abu Daia JM. Female circumcision. Saudi Med J. 2000;21:921–3. [PubMed]

38. Verzin JA. Sequelae of female circumcision. Trop Doct. 1975;5:163–6.

39. Female genital mutilation. Geneva: World Health Organization; 2000.http://www.who.int/mediacentre/factsheets/fs241/en/index.html.

40. Nicoletti A. Female Genital Cutting. J Pediatr Adolesc Gynecol. 2007;20:261–2. [PubMed]

41. Toubia N. Female Circumcision as a Public Health Issue. N Engl J Med. 1994;331:712–6. [PubMed]

42. Braddy CM, Files JA. Female genital mutilation: Cultural awareness and clinical considerations. J Midwifery Womens Health. 2007;52:158–63. [PubMed]

43. Monjok E, Essien EJ, Holmes L., Jr Female genital mutilation: Potential for HIV transmission in sub-Saharan Africa and prospect for epidemiologic investigation and intervention. Afr J Reprod Health. 2007;11:33–42. [PubMed]

44. Mboto CI, Fielder M, Davies Russell A, Jewell AP. Prevalence of HIV-1, HIV-2, hepatitis C and co-infection in the Gambia. West Afr J Med. 2009;28:16–9. [PubMed]

45. Mah K, Binik YM. Are orgasms in the mind of the body. Psychosocial versus physiological correlates of orgasmic pleasure and satisfaction? J Sex Marital Ther. 2005;31:187–200. [PubMed]

---

Support Cent