Sunday, April 13, 2014

GUEST AUTHOR: Meatal Stenosis


So I've been following the ramblings of a knowledgeable intactivist on Facebook, and I've recently run across something in my news feed that I think merits a guest author post on my blog. I am trying to convince him to start his own blog, but until he does, I think his best should at least be posted SOMEWHERE.

I've seen elsewhere in medical literature that meatal stenosis is a problem most common in circumcised males, and I've understood that it is a narrowing of the meatus, or hole at the end of the penis, but I had no idea how much impact this may have on the well-being of men.

After reading this man's post on the matter, a lot of things suddenly make sense. For example, I myself have actually noticed that there is a different sound when men urinate. And I've often heard of men having problems with urine retention, the "drip" factor, and problems with the urination stream.

A friend of mine, who I know for a fact is circumcised, has confided to me that he has constant UTIs, and that doctors tell him he needs an operation to correct a problem with his urethra. OF COURSE! My friend's meatus and/or urethra are probably narrow, most likely due to his circumcision, causing him urine retention and his constant UTIs!

Learning about my friend, and learning about so many other cases, and reading these thoughts from my online friend gets very frustrating, as UTI reduction is one of the most prominent rationales used by circumcision advocates. According to some, a slight reduction of UTIs within the first few years of life, is quite possibly the only observable benefit of male infant circumcision, if the current body of medical literature is correct. (And many say it is questionable.)

What is the meatus? What is meatal stenosis? How does this impact a man's well-being?

Ladies and Gentlemen, Jason F.!

The following was copied and pasted from a status on the Facebook wall of Jason F. with his permission.

Meatal Stenosis and Its Impact on the Well-being of Males
Jason F.

Hey boys and girls,

Time for my periodic rant about circumcision and meatal stenosis.

Most of us know that meatal stenosis is a routine undesired consequence of infant circumcision. However, even many people who include it in their list of complications don't really know what it is, how it looks, or how it actually affects males.

Stenosis means narrowing. The urinary meatus (in English pronounced mee-AY-tus or mee-AT-us) is the peehole. Many people mistakenly call this the urethra, but the urethra is the tube that carries urine from the bladder to the meatus. The meatus is the terminus of the frenulum, which in turn is the distal end of the male raphe, the seam that runs from the anus, across the perinaeum, across the scrotum, up the ventral side of the penis, and forms the peak of the frenulum and meatus.

First thing to understand about the meatus is that it is supposed to be large. The design of the male urethra is that it becomes linearly larger in diameter from the bladder to the meatus, allowing urine flow to accelerate as it moves through. The widest part of the urethra is just at the meatus, and actually the amazing design of the distal urethra prompts a vortex effect to help pull urine outward. This allows the male to empty his bladder efficiently and completely.

Meatal stenosis occurs when irritation, abrasion, infection or injury allow scar tissue to form and the urinary meatus to narrow. The size of the opening may decrease by half or more. The effect on urination, or ejaculation, is obstruction. What was previously a wide-open highway narrows to a lane or two at the terminus. This disrupts the flow of anything coming down the urethra and creates churn in the fluid dynamics of the urethral chamber toward the end. The effect is a certain amount of reflux, and occasionally backward pressure on the bladder. This can result in retained urine in both the bladder and urethra, as well as damage over time to the bladder muscle. Plain English: cut boys and men drip more.

If there is enough back pressure from meatal stenosis on the central urethra itself, the body may respond with some degree of scar tissue and formation of urethral stricture. This risk is heightened somewhat by urethral infections, which may be more common in circumcised boys because of greater ease of pathogens entering the constantly-exposed meatus and less-efficient flushing of the meatus during micturition.

Friends of mine know that I have been saying for years that I can nearly always tell whether the guy at the urinal next to me is circumcised or intact merely by the sound of his urine stream. Intact males have on average a notably more forceful stream. They generally empty their bladders more rapidly and more thoroughly than circumcised males.

Meatal stenosis risk is much higher in boys circumcised in infancy versus later in childhood, and almost unknown in intact boys and men. The phenomenon is rare where infant circumcision is not routine, so many urologists worldwide have seldom or never encountered it. The medical profession in the United States has begun to grudgingly acknowledge that meatal stenosis is common, but they tend to put the figure low at 5-15% of boys. They decline to admit that it is limited almost exclusively to circumcised boys.

In my personal experience, about ½ to ¾ of all neonatally circumcised males undergo some degree of unnatural meatal narrowing by adulthood. That means about 700,000 new cases every year, a national disgrace. Thousands of American boys undergo surgery to address their advancing meatal stenosis, making it one of the most common surgeries after circumcision. This, along with surgery for readherent prepuce remnant, skin bridges, skin tags and iatrogenic chordee, is just part of the US circumcision industry. It's a booming, if depressing, business for pediatric urologists and a never-ending tragedy for American boys and their families.

The presence and absence of meatal stenosis side-by-side

Photo from the Global Survey of Circumcision Harm.

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