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lastsonlost · 7 years ago

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A circumcision masterpost for anyone who needs it..

THIS IS THE FUNCTIONALITY YOU LOSE TO CIRCUMCISION

Frenar Band, or Ridged Band The frenar band is a group of soft ridges near the junction of the inner and outer foreskin. This region is the primary erogenous zone of the intact male body. Loss of this delicate belt of densely innervated, sexually responsive tissue reduces the fullness and intensity of sexual response. [Source: Taylor, J. R. et al., “The Prepuce: Specialized Mucosa of the Penis and Its Loss to Circumcision,” British Journal of Urology 77 (1996): 291-295.]

Mechanical Gliding Action The foreskin’s gliding action is a hallmark feature of the normal, natural, intact penis. This non-abrasive gliding of the penis in and out of its own shaft skin facilitates smooth, comfortable, pleasurable intercourse for both partners. Without this gliding action, the corona of the circumcised penis can function as a one-way valve, making artificial lubricants necessary for comfortable intercourse. [Source: P. M. Fleiss, MD, MPH, “The Case Against Circumcision,” Mothering: The Magazine of Natural Family Living (Winter 1997): 36-45.]

Meissner’s Corpuscles Circumcision removes the most important sensory component of the foreskin - thousands of coiled fine-touch receptors called Meissner’s corpuscles. Also lost are branches of the dorsal nerve, and between 10,000 and 20,000 specialized erotogenic nerve endings of several types. Together these detect subtle changes in motion and temperature, as well as fine gradations in texture. [Sources: 1. R. K. Winkelmann, “The Erogenous Zones: Their Nerve Supply and Its Significance,” Proceedings of the Staff Meetings of the Mayo Clinic 34 (1959): 39-47. 2. R. K. Winkelmann, “The Cutaneous Innervation of Human Newborn Prepuce,” Journal of Investigative Dermatology 26 (1956): 53-67.]

Frenulum The frenulum is a highly erogenous V-shaped structure on the underside of the glans that tethers the foreskin. During circumcision it is frequently either amputated with the foreskin or severed, which destroys or diminishes its sexual and physiological functions. [Sources: 1. Cold, C, Taylor, J, “The Prepuce,” BJU International 83, Suppl. 1, (1999): 34-44. 2. Kaplan, G.W., “Complications of Circumcision,” Urologic Clinics of North America 10, 1983.]

Dartos Fascia Circumcision removes approximately half of this temperature-sensitive smooth muscle sheath which lies between the outer layer of skin and the corpus cavernosa. [Source: Netter, F.H., “Atlas of Human Anatomy,” Second Edition (Novartis, 1997): Plates 234, 329, 338, 354, 355.]

Immunological System The soft mucosa (inner foreskin) contains its own immunological defense system which produces plasma cells. These cells secrete immunoglobulin antibodies as well as antibacterial and antiviral proteins, including the pathogen killing enzyme lysozyme. [Sources: 1. A. Ahmed and A. W. Jones, “Apocrine Cystadenoma: A Report of Two Cases Occurring on the Prepuce,” British Journal of Dermatology 81 (1969): 899-901. 2. P. J. Flower et al., “An Immunopathologic Study of the Bovine Prepuce,” Veterinary Pathology 20 (1983):189-202.]

Lymphatic Vessels The loss of these vessels due to circumcision reduces the lymph flow within that part of the body’s immune system. [Source: Netter, F.H., “Atlas of Human Anatomy,” Second Edition (Novartis, 1997): plate 379.]

Estrogen Receptors The presence of estrogen receptors within the foreskin has only recently been discovered. Their purpose is not yet understood and needs further study. [Source: R. Hausmann et al., “The Forensic Value of the Immunohistochemical Detection of Oestrogen Receptors in Vaginal Epithelium,” International Journal of Legal Medicine 109 (1996): 10-30.]

Apocrine Glands These glands of the inner foreskin produce pheromones - nature’s powerful, silent, invisible behavioral signals to potential sexual partners. The effect of their absence on human sexuality has never been studied. [Source: A. Ahmed and A. W. Jones, “Apocrine Cystadenoma: A Report of Two Cases Occurring on the Prepuce,” British Journal of Dermatology 81 (1969): 899-901.]

Sebaceous Glands The sebaceous glands may lubricate and moisturize the foreskin and glans, which is normally a protected internal organ. Not all men have sebaceous glands on their inner foreskin. [Source: A. B. Hyman and M. H. Brownstein, “Tyson’s Glands: Ectopic Sebaceous Glands and Papillomatosis Penis,” Archives of Dermatology 99 (1969): 31-37.]

Langerhans Cells These specialized epithelial cells are a component of the immune system in the penis. [Source: G. N. Weiss et al., “The Distribution and Density of Langerhans Cells in the Human Prepuce: Site of a Diminished Immune Response?” Israel Journal of Medical Sciences 29 (1993): 42-43.]

Natural Glans Coloration The natural coloration of the glans and inner foreskin (usually hidden and only visible to others when sexually aroused) is considerably more intense than the permanently exposed and keratinized coloration of a circumcised penis. The socio-biological function of this visual stimulus has never been studied. ——– The glans ranges from pink to red to dark purple among intact men of Northern European ancestry, and from pinkish to mahagony to dark brown among intact men of Color. If circumcision is performed on an infant or young boy, the connective tissue which protectively fuses the foreskin and glans together is ripped apart. This leaves the glans raw and subject to infection, scarring, pitting, shrinkage, and eventual discoloration. Over a period of years the glans becomes keratinized, adding additional layers of tissue in order to adequately protect itself, which further contributes to discoloration. Many restoring men report dramatic changes in glans color and appearance, and that these changes closely mirror the natural coloration and smooth, glossy appearance of the glans seen in intact men. ——— [Source: P. M. Fleiss, MD, MPH, “The Case Against Circumcision,” Mothering: The Magazine of Natural Family Living (Winter 1997): 36-45.]

Length and Circumference Circumcision removes some of the length and girth of the penis - its double-layered wrapping of loose and usually overhanging foreskin is removed. A circumcised penis is truncated and thinner than it would have been if left intact. [Source: R. D. Talarico and J. E. Jasaitis, “Concealed Penis: A Complication of Neonatal Circumcision,” Journal of Urology 110 (1973): 732-733.]

Blood Vessels Several feet of blood vessels, including the frenular artery and branches of the dorsal artery, are removed in circumcision. The loss of this rich vascularization interrupts normal blood flow to the shaft and glans of the penis, damaging the natural function of the penis and altering its development. [Sources: 1. H. C. Bazett et al., “Depth, Distribution and Probable Identification in the Prepuce of Sensory End-Organs Concerned in Sensations of Temperature and Touch; Thermometric Conductivity,” Archives of Neurology and Psychiatry 27 (1932): 489-517. 2. Netter, F.H., “Atlas of Human Anatomy,” Second Edition (Novartis, 1997): plates 238, 239.]

Dorsal Nerves The terminal branch of the pudendal nerve connects to the skin of the penis, the prepuce, the corpora cavernosa, and the glans. Destruction of these nerves is a rare but devastating complication of circumcision. If cut during circumcision, the top two-thirds of the penis will be almost completely without sensation. [Sources: 1. Agur, A.M.R. ed., “Grant’s Atlas of Anatomy,” Ninth Edition (Williams and Wilkins, 1991): 188-190. 2. Netter, F.H., “Atlas of Human Anatomy,” Second Edition (Novartis, 1997): plate 380, 387.]

Other Losses

- Circumcision performed during infancy disrupts the bonding process between child and mother. There are indications that the innate sense of trust in intimate human contact is inhibited or lost. It can also have significant adverse effects on neurological development.

-Additionally, an infant’s self-confidence and hardiness is diminished by forcing the newborn victim into a defensive psychological state of “learned helplessness” or “acquired passivity” to cope with the excruciating pain which he can neither fight nor flee.

- The trauma of this early pain lowers a circumcised boy’s pain threshold below that of intact boys and girls. This has been proven in a study during vaccination time. [Sources: 1. R. Goldman, Circumcision: The Hidden Trauma (Boston: Vanguard Publications, 1997), 139-175. 2. A. Taddio et al., “Effect of Neonatal Circumcision on Pain Responses during Vaccination in Boys,” Lancet 345 (1995): 291-292.]

- Every year some boys lose their entire penises from circumcision accidents and infections. They are then “sexually reassigned” by castration and transgender surgery, and are expected to live their lives as females. [Sources: 1. J. P. Gearhart and J. A. Rock, “Total Ablation of the Penis after Circumcision with Electrocautery: A Method of Management and Long-Term Followup,” Journal of Urology 142 (1989):799-801. 2. M. Diamond and H. K. Sigmundson, “Sex Reassignment at Birth: Long-Term Review and Clinical Implications,” Archives of Pediatrics and Adolescent Medicine 151 (1997): 298-304.]

-Every year many boys in the United States and elsewhere lose their lives as a result of circumcision - a fact that is routinely ignored or obscured.

[Sources: 1. G. W. Kaplan, “Complications of Circumcision,” Urologic Clinics of North America 10 (1983): 543-549. 2. R. S. Thompson, “Routine Circumcision in the Newborn: An Opposing View,” Journal of Family Practice 31 (1990): 189-196.

NOT LONG ENOUGH FOR YOU? I DIDN’T THINK SO EITHER.

MORE ON “THE HEALTHIER THAN DEALING WITH STIGMA” ARGUMENT..

let’s talk infant maintenance:

n babies, the foreskin is completely fused to the head of the penis. You cannot and should not retract it to clean it, as this would cause the child pain, and is akin to trying to clean the inside of a baby girl’s vagina. The infant foreskin is perfectly designed to protect the head of the penis and keep feces out. All you have to do is wipe the outside of the penis like a finger. It is harder to keep circumcised baby’s penis clean because you have to carefully clean around the wound, make sure no feces got into the wound, and apply ointment. The foreskin separates and retracts on its own sometime between age 3 and puberty. Before it retracts on its own, you wipe the outside off like a finger. After it retracts on its own, it will get clean during the boy’s shower or bath. There is nothing special that the parents need to do.

let’s talk about risk and side effects:

Removal of healthy tissue from a non-consenting patient is, in itself, harm (more on this point later). Circumcision has an number of risks and side effects. There is a 1-3% complication rate during the newborn period alone (Schwartz 1990).

Here is a short list potential complications.

Meatal Stenosis: Many circumcised boys and men suffer from meatal stenosis. This is a narrowing of the urethra which can interfere with urination and require surgery to

fix.Adhesions. Circumcised babies can suffer from

adhesions, where the foreskin remnants try to heal to the head of the penis in an area they are not supposed to grow on. Doctors treat these by ripping them open with no anesthesia.Buried penis. Circumcision can lead to trapped or buried penis – too much skin is removed, and so the penis is forced inside the body.

This can lead to problems in adulthood when the man does not have enough skin to have a comfortable erection. Some men even have their skin split open when they have an erection. There are even more sexual consequences, which we will address in a future post.

Infection. The circumcision wound can become infected. This is especially dangerous now with the prevalence of hospital-acquired multi-drug resistant bacteria.

Death. Babies can even die of circumcision. Over 100 newborns die each year in the USA, mostly from loss of blood and infection (Van Howe 1997 & 2004, Bollinger 2010).

All of these dangers are not at all risked if you simply don’t circumcize your child, and all of these dangers are incredibly reduced in likelyhood if at a later time the child makes the decision on their own after puberty in their late teens to early adult hood.

medical misinformation:

Medical advice may have promoted infection in uncircumcised males. A shocking number of doctors are uneducated about the normal development of the foreskin, and they (incorrectly) tell parents that they have to retract the baby’s foreskin and wash inside it at every diaper change. Doing this tears the foreskin and the tissue (called synechia) that connects it to the head of the penis, leading to scarring and infection.American doctors receive little medical school education on the care and treatment of the intact penis. The curriculums assume that all men will be circumcised.

Doctors in America are trained to circumcise. Hence, when an American doctors encounters an intact penis with a minor problem his first recommendation is circumcision.Misinformation was especially prevalent during the 1950s and 60s, when most babies were circumcised and we didn’t know as much about the care of the intact penis, which is why the story is always about someone’s uncle. Doing this to a baby boy would be like trying to clean the inside of a baby girl’s vagina with Q-tips at every diaper change. Rather than preventing problems, such practices would cause problems by introducing harmful bacteria. Remember that humans evolved from animals, so no body part that required special care would survive evolutionary pressures.

The human genitals are wonderfully self-cleaning and require no special care.Also, in medicine we only treat the sick, injured or diseased. We do not prescribe medications preemptively. We do not perform preemptive surgery until there is a real problem. We do not prescribe antibiotic until there is evidence of infection. We do not perform tonsillectomies until there is repeated tonsillitis. We do not perform mastectomies until there is cancer or a proven high risk of cancer. So why should circumcision be any different?

on the subject of urinary tract infection:

Girls have a 3 times higher rate of UTI than boys. Yet no one suggests cutting girls genitals to prevent UTI. When a girl gets a UTI, she is simply prescribed antibiotics. The same treatment works for boys. The UTI claim is based on one study that looked at charts of babies born in one hospital (Wiswell 1985). The study had many problems, including that it didn’t accurately count whether or not the babies were circumcised, whether they were premature and thus more susceptible to infection in general, whether they were breastfed (breastfeeding protects against UTI), and if their foreskins had been forcibly retracted (which can introduce harmful bacteria and cause UTI) (Pisacane 1990). There have been many studies since which show either no decrease in UTI with circumcision, or else an increase in UTI from circumcision. Thus circumcision is not recommended to prevent UTI (Thompson 1990).

How does male circumcision protect against HIV infection? SHORT ANSWER: IT DOESN'T

Robert Szabo, medical resident a, Roger V Short, professor b.

a Faculty of Medicine, Monash University, Wellington Road, Melbourne 3168, Australia, bDepartment of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, 132 Grattan Street, Melbourne 3053, Australia

Correspondence to: R V Short

In his otherwise excellent review of the AIDS epidemic in the 21st century, Fauci presented no new strategies for preventing the spread of the disease.1 He made no mention of male [or female] circumcision, yet there is now compelling epidemiological evidence from over 40 studies which shows that male circumcision provides significant protection against HIV infection; circumcised males are two to eight times less likely to become infected with HIV.2

[The evidence is far from “compelling”. Each of the studies has its own flaws. See the relevant page of this site. The extraordinary history of circumcision as a panacea, and before that as a rite, strongly suggest that latter-day claims of prophylaxis should be regarded with a sceptical, if not jaundiced, eye. Few if any men can be truly neutral about circumcision. The temptation to justify what was done to oneself seems almost irresistible.]

Furthermore, circumcision also protects against other sexually transmitted infections, such as syphilis and gonorrhoea, 3 4 [This is contradicted by Laumann] and since people who have a sexually transmitted infection are two to five times more likely to become infected with HIV,5 circumcision may be even more protective. The most dramatic evidence of the protective effect of circumcision comes from a new study of couples in Uganda who had discordant HIV status; in this study the woman was HIV positive and her male partner was not.6 No new infections occurred among any of the 50 circumcised men over 30 months, whereas 40 of 137 uncircumcised men became infected during this time. [But as Peiperlpoints out, over one-third (29 out of 79) of the circumcised men in this study were HIV-positive before the study began.] Both groups had been given free access to HIV testing, intensive instruction about preventing infection, and free condoms (which were continuously available), but 89% of the men never used condoms, and condom use did not seem to influence the rate of transmission of HIV. [Why not? What’s going on? Did circumcision status influence the rate of usage of condoms?] These findings should focus the spotlight of scientific attention onto the foreskin. [No, on the condoms or their use] Why does its removal reduce a man’s susceptibility to HIV infection? [This is the fallacy of post hoc ergo propter hoc, after this therefore because of this. Circumcision does not take place in a social vacuum. What is associated with circumcision and intactness in Ugandan society? It very commonly goes with religion, for example, and religion in turn influences sexual practice in a variety of ways:

choice of partner

degree of monogamy

use of alcohol and hence unprotected sex

attitudes towards homosexuality]

Summary points

The majority of men who are HIV positive have been infected through the penis [In some parts of the world perhaps, but not all.]

_____________________________________________________________

There is conclusive epidemiological evidence to show that uncircumcised men are at a much greater risk of becoming infected with HIV than circumcised men [No, there is some very debatable, highly selective evidence.] _____________________________________________________________

The inner surface of the foreskin contains Langerhans’ cells with HIV receptors; these cells are likely to be the primary point of viral entry into the penis of an uncircumcised man [Equally, the Langerhans’ cells may have a protective function. Their function is certainly not to receive HIV, as the term “HIV receptors” implies.] _____________________________________________________________

Male circumcision should be seriously considered as an additional means of preventing HIV in all countries with a high prevalence of infection [The Roman Senator Cato would finish every speech, no matter its subject, with “Therefore, Carthage must be destroyed”. This refrain, like that one, tolls like a knell through the literature on HIV and circumcision. There are many other factors that must be considered before moving from a dubious correlation to passionate advocacy.] The development of HIV receptor blockers, which could be applied to the penis or vagina before intercourse, might provide a new form of HIV prevention

Methods

To compile the information for this review a Medline search was done using the terms circumcision, HIV, Langerhans’ cells, penis, foreskin, and prepuce, and extensive email correspondence with other researchers was also undertaken. Histological observations were carried out on samples of penile tissue obtained from 13perfusion fixed cadavers of men aged 60-96 years, seven of whom had been circumcised. [The advanced age of the men from whom the samples were taken, in considering a process that is age-related, throws suspicion on this work.]

The pathogenesis of sexually acquired HIV infection

Between 75% and 85% of cases of HIV infection worldwide have probably occurred during sexual activity.7 Most cases of primary HIV infection are thought to involve HIV binding initially to the CD4 and CCR5 receptors found on antigen presenting cells - which include macrophages, Langerhans’ cells, and dendritic cells - in the genital and rectal mucosa.

The most widely accepted model for the sexual transmission of HIV is based on infection of the genital tract of rhesus macaques with simian immunodeficiency virus. 8 9 After female macaques are inoculated intravaginally with simian immunodeficiency virus, the virus targets the Langerhans’ cells located in the vaginal mucosa. [And do Short and Szabo consider advocating the amputation of vaginal mucosa? The fatal sexism of a policy that protects men but not women, compared with one that protects both, such as condom use, is not considered.] Once infected, these cells fuse with adjacent CD4 lymphocytes and migrate to deeper tissues. Within two days of infection, the virus can be detected in the internal iliac lymph nodes and shortly thereafter in systemic lymph nodes. This ultimately leads to a fatal infection.

Similarly, infection in male macaques occurs when simian immunodeficiency virus is inoculated into the penile urethra or onto the foreskin; the same sequence of cellular events involving the infection of Langerhans’ cells is then likely to occur.9 Infected Langerhans’ cells have also been detected in the penile mucosa of male rhesus macaques that have chronic simian immunodeficiency virus infection.9 In humans, histological studies have identified antigen presenting cells in the mucosa of the inner foreskin and urethra.10 Therefore it seems likely that antigen presenting cells at these mucosal sites are the primary target for HIV in men.

In vitro studies have shown that the CD4 receptor is generally necessary, although insufficient on its own, to permit HIV-1 to enter host cells.11 The entry of HIV-1 into cells requires an additional chemokine receptor, usually CCR5, although CXCR4 is used by cells that become infected during the later stages of the disease.12 After primary infection occurs, the virus mutates, which allows it to utilise other chemokine receptors, such as CXCR4, and thus spread to a variety of cell types. However, more than 99% of HIV-1 isolates from acutely infected patients are homologous, indicating that one specific variant is likely to be responsible for most cases of primary HIV infection.13 HIV variants that are transmitted to other individuals almost invariably use CCR5 as a coreceptor and are therefore named R5 viruses, to reflect their specific requirement for a coreceptor.14

How HIV enters the penis

About 70% of men infected with HIV have acquired the virus through vaginal sex, and a smaller number have acquired it from insertive anal intercourse.7 Thus, on a global scale most men who are HIV positive have acquired the virus via the penis. This raises questions of how HIV enters the penis and why men who are uncircumcised are potentially more susceptible to becoming infected with HIV.

The uncircumcised penis consists of the penile shaft, glans, urethral meatus, inner and outer surface of the foreskin, and the frenulum, the thin band connecting the inner foreskin to the ventral aspect of the glans. A keratinised, stratified squamous epithelium covers the penile shaft and outer surface of the foreskin. This provides a protective barrier against HIV infection. [There is no evidence for this claim.] In contrast, the inner mucosal surface of the foreskin is not keratinised15 and is rich in Langerhans’ cells,10 making it particularly susceptible to the virus. [Again, this is conjecture.] This is particularly important because during heterosexual intercourse the foreskin is pulled back down the shaft of the penis, and the whole inner surface of the foreskin is exposed to vaginal secretions, providing a large area where HIV transmission could take place. [In that case, why are women, with the much greater area of their vaginal surfaces, not vastly more susceptible to HIV infection from men?]

There is controversy about whether the epithelium of the glans in uncircumcised men is keratinised; some authors claim that it is not,15 but we have examined the glans of seven circumcised and six uncircumcised men […aged 60 to 96…], and found the epithelia to be equally keratinised. In circumcised males only the distal penile urethra is lined with a mucosal epithelium. However, this is unlikely to be a common site of infection because it contains comparatively few Langerhans’ cells.10 [This is an example of begging the question, assuming what you have to prove.]

Ulcerative or inflammatory lesions of the penile urethra, foreskin, frenulum, or glans that are caused by other sexually transmitted infections may provide additional potential routes for HIV transmission. In uncircumcised males, the highly vascular frenulum is particularly susceptible to trauma during intercourse, [It is equally so in circumcised males - if it has not been ablated - and in addition traumas and tearing of the scarred ring are only possible in circumcised men] and lesions produced by other sexually transmitted infections commonly occur there. Thus, male circumcision further reduces the risk of infection by reducing the synergy that normally exists between HIV and other sexually transmitted infections.5

Conclusions

Of the estimated 50 million people infected with HIV worldwide, about half are men, most of whom have become infected through their penises

[… and a vast number of whom were circumcised].

The inner surface of the foreskin, which is rich in HIV receptors, and the frenulum, a common site for trauma and other sexually transmitted infections, must be regarded as the most probable sites for viral entry in primary HIV infection in men.

[“Must”? Yet a vast number of them don’t have one.]

Although condoms must remain the first choice for preventing the sexual transmission of HIV, they are often not used consistently or correctly, they may break during use, and there may be strong cultural and aesthetic objections to using them. Cultural and religious attitudes towards male circumcision are even more deeply held,

[and the perfectly rational view that it reduces sexual pleasure, and the human rights issue of consent]

but in the light of the evidence presented here circumcising males seems highly desirable,

[“Desirable”? A strange choice of word, suggesting a sexual rather than rational motivation]especially in countries with a high prevalence of HIV infection. [Yet Ethiopia and the US already have high prevalences of both HIV infection and circumcision.]

Although neonatal circumcision is easy to perform, and has a low incidence of complications,16[Other references cite much higher rates] it would be 15-20 years before a programme of circumcision had any effect on HIV transmission rates. Circumcision at puberty, as practised by many Muslim communities, would be the most immediately effective intervention for reducing HIV transmission since it would be done before young men are likely to become sexually active

[… and knew what they had been deprived of].

It may also be time to re-think the definition of “safe sex.” Since the penis is the probable site of viral entry, neither infected semen nor vaginal secretions should be allowed to come in contact with the penis, particularly in uncircumcised males. Thus, mutual male masturbation during which a penis is exposed to the potentially infected semen of another male should be regarded as risky sexual behaviour.

[Szabo and Short present no evidence for this claim. They have reasoned backward from their analysis of the literature of heterosexual transmission.]

Let’s not even get started on Africa & FAILED HIV/STD PREVENTION:

Three studies in Africa several years ago claimed that circumcision prevented HIV transmission and that circumcision was as effective as a 60% effective vaccine (Auvert 2005, 2006). These studies had many flaws, including expectation bias (both researcher and participant), selection bias, lead-time bias, attrition bias, duration bias, and early termination that favored the treatment effect the investigators were hoping for. (Van Howe, Storms 2011: How the circumcision solution in Africa will increase HIV infections.)It as been suggested that the researchers tailored the studies to reach the conclusions they wanted. Read more about how circumcision is a dangerous mistake for HIV prevention.There have also been several studies that show that circumcision does not prevent HIV (Connolly 2008).

There are many issues at play in the spread of STDs which make it very hard to generalize results from one population to another.In Africa, where the recent studies have been done, most HIV transmission is through male-female sex, but in the USA, it is mainly transmitted through blood exposure (like needle sharing) and male-male sex. Male circumcision does not protect women from acquiring HIV, nor does it protect men who have sex with men (Wawer 2009, Jameson 2009).

What’s worse, because of the publicity surrounding the African studies, men in Africa are now starting to believe that if they are circumcised, they do not need to wear condoms, which will increase the spread of HIV (Westercamp 2010). Even in the study with the most favorable effects of circumcision, the protective effect was only 60% – men would still have to wear condoms to protect themselves and their partners from HIV.

In the USA, during the AIDS epidemic of the 1980s and 90s, about 85% of adult men were circumcised (much higher rates of circumcision than in Africa), and yet HIV still spread.It is important to understand, too, that the men in the African studies were adults and they volunteered for circumcision. Babies undergoing circumcision were not given the choice to decide for themselves.

Recent studies have demonstrated that circumcised men are at increased risk of contracting gonorrhea, syphilis and genital warts. Men are at equal risk for developing human papillomavirus lesions and herpesvirus infections regardless of circumcision status. At least four studies have shown human immunodeficiency virus infection to occur more commonly in circumcised men.

SEXUAL INTERCOURSE… CIRCUMCISED VERSUS UNCIRCUMCISED:

The function of the foreskin for women in intercourse is to seal the natural lubrication inside the vagina and provide a gentle internal massaging action. The intact penis moves in and out of its foreskin, which provides a frictionless, rolling, gliding sensation.

Intact men tend to make shorter strokes that keep their bodies in contact with the clitoris more, thus aiding female orgasm (O’Hara 1999). On the other hand, the circumcised penis functions like a piston during intercourse – the head of the penis actually scrapes the lubrication out of the vagina with each stroke.

As the man thrusts, his skin rubs against the vaginal entrance, causing discomfort, and sometimes pain (O’Hara 1999, Bensley 2001). Far from making sex better for women, circumcision decreases female satisfaction.

In a landmark study of US women, 85% who had experienced both circumcised and intact men preferred sex with intact men. Sex with a circumcised man was associated with pain, dryness and difficulty reaching orgasm (O’Hara 1999). In another study, women were twice as likely to reach orgasm with an intact man (Bensley 2003). Even when a woman said she preferred a circumcised partner, she had less dryness and discomfort with intact men (O’Hara 1999).

Men who are circumcised are 60% more likely to have difficulty identifying and expressing their feelings, which can cause marital difficulties (Bollinger 2010). Circumcised men are 4.5 times more likely to be diagnosed with erectile dysfunction, use drugs like Viagra, and to suffer from premature ejaculation (Bollinger 2010, Tang 2011).

Men who were circumcised as adults experienced decreased sensation and decreased quality of erection, and both they and their partners experienced generally less satisfaction with sex (Kim 2007, Solinis 2007).

The foreskin contains several special structures that increase sexual pleasure, including the frenulum and ridged band (the end of the foreskin where it becomes internal), both of which are removed in circumcision.

The LEAST sensitive parts of the foreskin are more sensitive than the MOST sensitive parts of the circumcised penis (Sorrells 2007).

In other words, if you wanted to decrease a penis’ sensitivity the most, circumcision would be the ideal surgery.

The foreskin has nerves called fine-touch receptors which are clustered in the ridged band (Cold 1999). This type of nerve is also found in the lips and fingertips. To get an idea of the sensation these nerves provide, try this experiment: first lightly stroke your fingertip over the back of the other hand. Now stroke your fingertip over the palm of your hand. Feel the difference?

That is the kind of sensation the foreskin provides, and the circumcised man is missing. It may feel like the penis is overly sensitive to a circumcised man because there is little sensation left to indicate excitement, leading to unexpected premature ejaculation (a common problem with circumcised young men).

However, as circumcised penises age they become calloused and much less sensitive.

It is documented that circumcised adult males exhibit a greater tendency to engage in risky sexual behavior. Hooykaas and colleagues reported that circumcised men in the Netherlands engage in more risky sexual behavior and have markedly higher rates of STDs. Laumann and colleagues reported more risky sexual behavior amongst circumcised men in the United States and have higher rates of STDs.

Michael et al.reported more variability in sexual behavior, less condom usage, and more STD amonst the predominantly circumcised population of the United States as compared with the predominantly non-circumcised intact males of the United Kingdom.

Do you STILL NEED MORE sources? HERE YOU GO…!!

Intactivist linksThis list is mostly an effort to consolidate old bookmarks and fix links I’d bookmarked that were broken. It’ll be updated as I find new links, or have to fix broken links. Be aware that links to images or videos are probably NSFW, given that this is a discussion involving genitals.

let's pretend Halloween is around the corner with some circumcision horror stories both domestic and abroad.

A dozen men are ambushed, stripped naked and forced to undergo circumcisions in Kenya after their wives complained that they were not as good in bed.

A 14-Year Old Kenya Boy Recounts Torture, Forced Circumcision

Kenyan men in hiding fearing circumcision

S. African boys saved from forced circumcision:

Kenya: Men Circumcised by Force in Luhya Tribe Ceremony

A Florida mother took her son into hiding to avoid circumcision.

Child forced to undergo circumcision has been diagnosed with leukemia

Forced Circumcisions For Ugandan Males Over 15

(Godfrey Olukya) The Ugandan town of Mbale was brought to a standstill on Tuesday afternoon, as a naked man ran through the streets, with more than 50 men in pursuit. He was fleeing a forced circumcision.

Islamic State (ISIS) FUCKING ISIS forcefully circumcised Assyrian Christian men

32 boys dead in South African botched circumcisions by ill-trained traditional surgeons.

Half a million boys killed and hospitalised by tribal circumcision

Testimony from the Global Survey of Circumcision

Some writing on the topic:

No Justification for routine neonatal circumcision, part 1, fallacious medical arguments

No Justification for routine neonatal circumcision, part 2, unmerited social support The first article includes a lot of links to information supporting the assertions I’ve made.

Those links are also included among the links below on this page.

Videos:

Doctor Discusses Circumcision Controversy

The Prepuce Anatomy and Physiology of the Foreskin Video I originally had linked here was removed from youtube, but this one is excellent.

Child Circumcision: An Elephant in the Hospital ♦

Whose body, whose rights

Difference Between: Male & Female Circumcision

Discussion after screening of the movie “Cut.”

Related to Cut, the Film: Debate with Rabbi Shmuley Boteach Eli Ungar-Sargon offers facts and logic; Rabbi Shmuley preaches, ridicules, and mocks, even after hearing evidence.

Brian D Earp, scientist and ethicist; discusses why there’s no moral difference between male and female circumcision. ††

More from Brian D Earp on comparing male circumcision to female circumcision †††

Brian D. Earp; Female genital mutilation and male circumcision: toward an autonomy-based ethical framework

The Penis - Sex education 101 ††††

Water Bear Brigade: Circumcision, male and female

Doctors on Circumcision:

doctorsopposingcircumcision.org/

Doctors Opposing Circumcision HIV Statement

Medical Association Position Statements

Doctors Opposing Circumcision - Publications

Medical Organizations Statements on Circumcision

How the circumcision solution in Africa will increase HIV infections

Circumcision as a prophylactic against STIs and cancer

NORM COHEN: Circumcision AIDS Fraud

U.S. Navy Finds That Circumcision Does Not Prevent HIV or STIs

Male Circumcision and the HIV/AIDS Myth

Circumcision and Sexually Transmitted Infections

Circumstitions.com: Circumcision and the HIV prevention myth

Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial

PrePex in Rwanda: Male Circumcision Associated with Higher HIV Transmission and Higher Profits

Sub-Saharan and African randomized clinical trials into male circumcision and HIV transmission: Methodological, ethical, and legal concerns

STD prevalence over time: Europe vs U.S.

American Cancer Society: Penile cancer and circumcision

Circumcision the most common risk factor for hepatitis B & C infection in men in Nigeria †

Phimosis: Is circumcision necessary?

Anatomy and function

Functions of the Foreskin: Purposes of the Prepuce

Fine-touch pressure thresholds in the adult penis

Study: Circumcision Removes Most Sensitive Parts

Damage

Leaked Audio Shows Doctors’ Association LYING About Effects Of Circumcision On The Penis

Ritual circumcision and risk of autism spectrum disorder in 0- to 9-year-old boys: national cohort study in Denmark

Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction

Alexithymia and Circumcision Trauma: A Preliminary Investigation

Circumcisionharm.org

Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfillment.

Estimated U.S. Incidence of Neonatal Circumcision Complications (physical only) Affecting Males Born between 1940 and 1990

100+ circumcision deaths each year in United States

Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths

Toddler’s tragic death after circumcision

Baby dies in circumcision

A Gallery of Botched Circumcisions[NSFW]

Male Circumcision: Pain, Trauma and Psychosexual Sequelae

Study Links Circumcision to Personality Trait Disorder

Other Research:

72 peer-reviewed studies

Circumcision and law

Is circumcision legal? Does it matter?

Changes in the practice

Circumcision: Then and Now (How the procedure has become more dramatic)

Timeline of the medicalization of circumcision **

From Ritual to Science, the Medical Transformation of Circumcision in America

Mythbusting

Myths about Circumcision You Likely Believe

More Circumcision Myths You May Believe: Hygiene and STDs

NoCirc PA (archive) Myths vs Facts

Follow the money:

Circumcision: Who Profits?

Wrinkle Treatment Uses Babies’ Foreskins

Interest in circumcision more than foreskin deep

Sale of Neonatal Dermal Fibroblasts is quite lucrative.

Hair Loss Treatment Uses Baby Foreskins

Human Foreskins are Big Business for Cosmetics

Babies’ foreskins used to make cosmetics. Is this ethical?

The Foreskin Mafia

American Bias (1) (2)

Circumfetish

NoCirc.com Articles on Circumcision

For Jewish Readers:

How “Cut” Saved My Son’s Foreskin: A Movie Review By Diane Targovnik

Cut, the film Q & A

Jewish Circumcision Critics Integral in National Circumcision Debate

Jewish Circumcision: An Alternative Perspective by Jenny Goodman, MD.

On Alternative Rituals by Ronald Goldman, Ph.D.

Jewish Intactivism: Circumcision Resources

Jewish Intactivism Part II

Jewish Intactivism Part III, More Jewish Parents Are Skipping Circumcision, Keeping New Sons Intact

Jewish Voices: The Current Judaic Movement to End Circumcision: Part 1

Jewish Voices: The Current Judaic Movement to End Circumcision: Part 2

Jewish Voices: The Current Judaic Movement to End Circumcision: Part 3

Jewish Circumcision Resource Center

Jews Against Circumcision

Beyond the Bris

Brit Shalom

What is a Jewish Bris Shalom (Covenant Without Cutting)? A ‘Bloodless Bris’ is Becoming Popular Among American Jews How Judaic is circumcision? An Israeli Hebrew scholar on Biblical intactivism.

100+ Rabbis and Celebrants who lead intact covenant ceremonies worldwide.

Song for a Brit Shalom.

Bris B'lee Milah Ceremony

A Bris Shalom Ceremony

Judaism, the Foreskin and Human Rights.

Rabbis on a Brit Shalom / Covenant without Circumcision

Humanistic Jewish Movement is Increasingly Intactivist

Jewish Ethical Advancement, the Foreskin, and Human Rights | Part 1.

Jewish Ethical Advancement, the Foreskin, and Human Rights | Part 2.

Jewish Ethical Advancement, the Foreskin, and Human Rights | Part 3.

Israeli Intactivist Groups (Mostly in Hebrew)

Israeli Association Against Circumcision / Intact Son

Protect the Child / Eran Saddeh

Kahal (Jewish & Israeli Parents of Intact Sons)

Intactivism Spreads in Israel. This Time by Jews. (Israeli Intactivist Ads)

Jewish Intactivist Resources and Groups

Cut: A Movie by a Jewish Intactivist.

Questioning Circumcision. A Jewish Perspective By Ron Goldman, Ph.D.

Beyond the Bris Weblog by Rebecca Wald.

Jews Against Circumcision (Bay Area)

Jewish Intactivist Families: Jewish Parents’ Experiences Keeping their Sons Intact.

Jewish Family in Vancouver Canada Opts for a Brit Shalom

A Jewish Father’s Brit Shalom Journey

Laura Stanley: A Jewish Woman and Midwife Denounces Circumcision

Tikkun: Michael Kimmel: The Kindest Un-Cut: Feminism, Judaism, and My Son’s Foreskin

Circumcision Questions (Letter from an Intact Jew). | Published in the Northern California Jewish Bulletin.

Jewish Daily Forward: Outlawing Circumcision: Good for the Jews? By Eli Ungar-Sargon. Published in the Jewish Daily Forward.

Dear Elijah: A Conservative Jewish Father’s Letter to His Intact Son | Published on Peaceful Parenting.

Stacey Greenberg: My Son: The Little Jew with a Foreskin

The debate on neonatal male circumcision isn’t and shouldn’t be about women, but here are some links for those who think it should.

How Male Circumcision Harms Women

Why feminists should be anti-circumcision

Similarities in Attitudes and Misconceptions toward Infant Male Circumcision in North America and Ritual Female Genital Mutilation in Africa

Neonatal circumcision vs female circumcision - though comparison should not matter to the discussion on the right or wrong of performing circumcision on infants, here are some links for those who think it should.

FGC vs MGC

Difference Between: Male & Female Circumcision

On the Good for the goose, good for the gander front, many arguments used to support neonatal circumcision are the same arguments used to support female circumcision

Female circumcision does not reduce sexual activity

The Association between Female Genital Mutilation ( FGM ) and the Risk of HIV/AIDS in Kenyan Girls and Women (15-49 Years)

Yes to female circumcision?

Medical benefits of female circumcision

INDONESIA: Health official claims ‘female circumcision is not genital mutilation’

Two studies have reported that FGC is associated with decreased risk of HIV.

*Note - many of these links I obtained either from

this page

or by researching broken/outdated links on it. I’ve put them here to have them in a place that’s easy to find. I will update this page as I run across new links.

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aspiringbelle · 5 years ago

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As if I did not have enough reasons to be upset with Lindsey Graham. One hopes that a prominent local Armenian (Doctor Edward Panosian) will get his friends (his fellow staff and supporters of Bob Jones University*) to go against Graham, and the local Kurdish community will go against Graham too.

* As you may know (and as @wutbju can certainly attest), I am not a friend of Bob Jones University. However, when it comes to Lindsey Graham, and his disastrous foreign policy, I have to say I would be more than willing to have BJU go after him. (The same goes for Kim Kardashian, who I am also not a fan of.)

#politics #armenian genocide #turkey #kurdistan #lindsey graham

0 notes

cancerabcs · 5 years ago

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NCCN COVID Prostate Cancer Guidelines

Care of Prostate Cancer Patients During the COVID-19 Pandemic: Recommendations of the NCCN

What is the NCCN

The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 30 leading cancer centers devoted to patient care, research, and education. NCCN develops patient and treatment specific guidelines that many doctors and insurance companies follow in order to provide comprehensive state of the art treatment to patients.

The NCCN has developed new guidelines for the treatment of many different cancers in light of the COVID-19 Coronavirus pandemic. You can find these guidelines at https://www.nccn.org/covid-19/default.aspx.

The following are the prostate cancer COVID-19 Guidelines as well as Cancer ABCs glossary of some of the terms used in the guidelines:

(Contributions from: Abramson Cancer Center at the University of Pennsylvania, City of Hope National Cancer Center, Dana-Farber/Brigham and Women’s Cancer Center, Duke Cancer Institute, Fox Chase Cancer Center, Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Huntsman Cancer Institute at the University of Utah, Massachusetts General Hospital Cancer Center, Moffitt Cancer Center, the Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, Prostate Health Education Network (PHEN), Robert H. Lurie Comprehensive Cancer Center of Northwestern University, the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Stanford Cancer Institute, UCSF Helen Diller Family Comprehensive Cancer Center, University of Michigan Rogel Cancer Center, University of Wisconsin Carbone Cancer Center, and Vanderbilt-Ingram Cancer Center)

Introduction:

During the COVID-19 global pandemic, cancer patients and physicians must carefully weigh the potential benefit of routine cancer care versus the high morbidity and mortality of COVID-19, especially in patients of older age, patients with comorbidities, and those with cancer.(1) Staff and resources may also be redistributed to care for COVID-19 patients, and thus judicious use of resources is critical during this time. There are continuously evolving policies and guidelines on a global, national, state, institutional, and departmental level; thus, these guiding principles are intended to provide a framework to think about how to manage prostate cancer patients.

For recommendations on prostate cancer early detection during the COVID-19 pandemic, please refer to: https://www.nccn.org/covid-19/pdf/Prostate_Early_Detection.pdf.

General Principles:

1. The benefit of routine localized prostate cancer care should not be overestimated.(2, 3) In most instances, minimal harm is expected with delays in care or treatment of 3–6 months, especially when weighed against the risk of mortality of COVID-19.

2. Remote visits:

Telehealth (phone or video) visits should be used, with rare exceptions, in place of in-

person visits.

If necessary given reallocation of staff/providers, telehealth visits can usually be safely

deferred for patients with localized disease.

Care of Prostate Cancer Patients During the COVID-19 Pandemic: Recommendations of the NCCN

3. Avoid, defer, and shorten/reduce routine care, staging, and treatment when possible: a. Avoid:

Patients with very low, low, and favorable intermediate risk (IR) disease should not undergo further staging, active surveillance, confirmatory testing/monitoring, and treatment until deemed safe.

In general, prophylactic whole pelvic radiation therapy (WPRT) should be avoided during this time due to the increased risk of grade IV lymphopenia (Unpublished data, RTOG 9413).

For patients with non-metastatic disease, avoid initiating androgen deprivation therapy (ADT) for patients with a prostate-specific antigen (PSA) doubling time of >9 months. Once ADT is initiated or intermittent ADT is started, consider remote telehealth visits and PSA/testosterone and other laboratory monitoring to avoid clinic exposures.

b. Defer:

Patients with asymptomatic unfavorable intermediate risk (UIR), high risk,

and very high risk (HR) prostate cancer can defer further staging and radical

treatment until deemed safe.

Neoadjuvant ADT should be considered in asymptomatic UIR and HR

patients planning to receive definitive radiation therapy (RT). This may safely

be given for up to 4–6 months as necessary.(4-6)

Data from Johns Hopkins suggest delaying surgical treatment for UIR and

HR patients upwards of 6 months from biopsy diagnosis will not negatively

impact their outcome.(7)

Individuals who have received definitive treatment for their cancer with either

radiation or surgery could defer initial post-treatment monitoring (PSA-based testing and digital rectal exam [DRE]) until deemed safe. Alternatively, telehealth visits with discussions of PSA and testosterone could be considered.

c. Shorten/reduce:

Consideration to use 3-, 4-, or 6-month formulations of ADT should be

preferred over 1-month injections.

If it is deemed safe for patients to receive RT, the shortest safe external beam

RT (EBRT) regimen should be used. This can consist of 5 to 7 fractions, consistent with current NCCN Guidelines.

2. Care of Prostate Cancer Patients During the COVID-19 Pandemic: Recommendations of the NCCN

iii. For symptomatic patients (eg, obstruction, bleeding), conservative measures should be prioritized (eg, medical therapy, ADT, clean intermittent catheterization). If necessary, surgical intervention or RT may be considered.

4. Encourage and consider:

Encourage communication with patients’ primary care providers to coordinate care, reduce overall health risks, and clarify advanced planning.

Address and document goals of care and advanced directives early if frail, and/or limited life expectancy to avoid unwanted emergency department (ED) visits and hospitalizations.

Discuss and document Durable Power of Attorney (DPOA) and emergency contact information.

Encourage patients to have an adequate supply of oral cancer medications and supportive care medications on hand (and/or have delivered by mail).

Consider deferring repeat imaging over time if PSA is declining and absence of symptoms until risk of COVID-19 has resolved.

Educate patients receiving chronic steroids (eg, prednisone, methylprednisolone) and their caregivers that if they become sick, they may need stress-dose steroids.

For patients with advanced disease:

Consider non-myelosuppressive regimens when alternatives exist to

minimize risk of immunosuppression and infectious complications.

When cytotoxics are used consider growth factor support with administration

of same-day growth factor injections or pegfilgrastim to minimize visits.

Consider deferring sipuleucel-T until COVID-19 risk has resolved given risks

of exposure in Red Cross centers and hospital infusion centers.

Consider telehealth genetic counseling options if available, or deferring in-person visits

until COVID-19 risk has passed to minimize exposure.

Please consult your institutional, state, and federal policies. The following are useful resources:

· AMA: https://www.ama-assn.org/delivering-care/public-health/covid-19-2019-novel-coronavirus- resource-center-physicians

· ASCO: https://www.asco.org/asco-coronavirus-information

· ASTRO: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information

· AUA: https://www.auanet.org/covid-19-info-center

3 . Care of Prostate Cancer Patients During the COVID-19 Pandemic: Recommendations of the NCCN

· CDC: https://www.cdc.gov/

· CMS: https://www.ama-assn.org/delivering-care/public-health/cms-payment-policies-regulatory-

flexibilities-during-covid-19

· WHO: https://www.who.int/health-topics/coronavirus#tab=tab_1

· *Prostate cancer radiotherapy guidelines:

https://www.astro.org/ASTRO/media/ASTRO/Daily%20Practice/PDFs/COVID-Zaorsky-et- al(ADRO).pdf

· CMS Adult Elective Surgery and Procedures Recommendations: https://www.cms.gov/files/document/31820-cms-adult-elective-surgery-and-procedures- recommendations.pdf

References:

1. Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020;21(3):335-337. 2. Wilt TJ, Vo TN, Langsetmo L, et al. Radical prostatectomy or observation for clinically localized prostate cancer: Extended follow-up of the Prostate Cancer Intervention Versus Observation Trial (PIVOT). Eur Urol 2020.

3. Bill-Axelson A, Holmberg L, Garmo H, et al. Radical prostatectomy or watchful waiting in prostate cancer—29-year follow-up. N Engl J Med 2018;379(24):2319-29. 4. Pisansky TM, Hunt D, Gomella LG, et al. Duration of androgen suppression before radiotherapy for localized prostate cancer: radiation therapy oncology group randomized clinical trial 9910. J Clin Oncol 2015;33(4):332-339.

5. Denham JW, Steigler A, Lamb DS, et al. Short-term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer: 10-year data from the TROG 96.01 randomised trial. Lancet Oncol 2011;12(5):451-459. 6. Morris WJ, Tyldesley S, Rodda S, et al. Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy (the ASCENDE-RT Trial): an analysis of survival endpoints for a randomized trial comparing a low-dose-rate brachytherapy boost to a dose- escalated external beam boost for high-and intermediate-risk prostate cancer. Int J Radiat Oncol Biol Phys 2017;98(2):275-285.

7. Gupta N, Bivalacqua TJ, Han M, et al. Evaluating the impact of length of time from diagnosis to surgery in patients with unfavourable intermediate-risk to very-high-risk clinically localised prostate cancer. BJU Int 2019;124(2):268-274.

Definition of Terms – for Patients & Caregivers

· ADT – Androgen Deprivation Therapy, also called Hormone Therapy. These are usually injections like Lupron, Firmagon, Eligard, Trelstar, or Zoladex. ...

· Asymptomatic - Having no signs or symptoms of a disease (NCCN). In prostate cancer, the most common symptom is pain, but can also include urinary problems, and other less common symptoms. .

· Comorbidity - The condition of having two or more diseases at the same time. (NIH). For example, heart disease would be a ‘comorbidity’ when considering a cancer treatment. .

· Cytotoxic – A substance that slows, stops, or kills cancer cells. (NIH) In these NCCN Guidelines, chemotherapy is the most common cytotoxic they’re referring to..

· Genetic Counseling – Having a certified genetic counselor help you and your family understand your inherited [germline] cancer risk. Inherited cancer risk may be passed from parent to child. A genetic counselor explains available genetic tests and what they mean. He or she can also offer information about cancer screening, prevention, and treatment options and provide support. (ASCO).

· Grade IV (4) – A severe side effect that is life-threatening - urgent intervention is needed. (FDA) .

· Growth Factor - A substance that helps new blood cells to be made. (NCCN) In these NCCN Guidelines they are probably referring to treatments for low white blood cells – ask your oncologist. .

· Localized disease - those that are presumed to be confined within the prostate based on pre-treatment findings such as physical exam, imaging, and biopsy findings. (AUA) For example, A DRE, prostate MRI, CT Scan, don’t show any cancer outside the prostate. .

· Lymphopenia - A condition in which there is a lower-than-normal number of lymphocytes (a type of white blood cell) in the blood. (NCI)>

· Neoadjuvant - A treatment that is given before the main treatment to reduce the cancer. (NCCN) In this case, neoadjuvant ADT before radiation is the example given..

· Non-Myelosuppresive - Treatment that DOESN’T stop or slow the growth of blood-forming cells in the bone marrow, such as red blood cells, white blood cells, and platelets. (NIH) In prostate cancer, the most common MYELOSUPPRESSIVE therapy is chemotherapy, but can also be radiation therapy in some situations.

Created by: Jan Manarite and Joel Nowak, Cancer ABCs April 2020

#NCCN Guidelines

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timclymer · 5 years ago

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Finding the Best Hospitals in Beijing

Beijing is the capital of the People’s Republic of China and also the cultural and educational center of this big nation. One can find a large number of modern hospitals and health care centers in Beijing with global standards. All these major hospitals offer world class technology, highly qualified medical professionals and excellent infrastructures facilities. Nowadays they provide staffs who are fluent in English. Major hospitals are accepting credit card payments and the visitors are usually asked to put a deposit before their admission to the hospitals to cover the cost of treatments and services.

I would like to give a brief description of some of the better hospitals in Beijing.

Beijing United Family Hospital and Clinics (“BJU”) is the first and the only foreign-invested hospital operating in Beijing, China. This world class hospital was founded in 1997 by Chindex International, an American company, and achieved the prestigious US Secretary of State’s Award for Corporate Excellence in 2002. The hospital is provided with all most the medical departments and is headed by highly qualified. Most of the staffs are English speaking. T: + 86-10 6433-3960

The China-Japan Friendship Hospital which is an outstanding medical institution in Beijing could be the first choice for a visitor. The hospital was rated as the best hospital for foreigners in Beijing by the Association for Foreigners. The hospital is a real master in medical fields with its highly-skilled medical staffs, excellent treatment and research facilities and warm hospitality. They are giving first preference to their patients in all the matters concerned. T: 86-10-6422-1122.

Beijing Hospital which is located in the heart of city, and adjoins Chang'an Street, is another major hospital of the area. The hospital provides professional medical treatments and related services in all main departments. They try to keep the international standards in all the services they are offering. T: 86-10-6513-2266

Cancer Institute & Hospital (CIH) is China’s pioneer in advanced cancer research and treatment. This world famous institute is rated as the largest cancer prevention and treatment center in Asia. This WHO approved research center offers the best available treatments and research facilities for the needed persons and institutions.

Beijing An Ding Hospital, Capital Medical University (BADH-CMU), is a pioneer in psychiatric treatments. The hospital was founded in 1914. and is located near the moat on the north of age-old De Sheng Men .. This huge institute is a leader in medical service, teaching and scientific research in mental health and psychiatry. In 2000, the hospital became the first Faculty of Mental Health in China, and the array of high quality medical professionals the hospital providing is really great.

Gynecology & Obstetrics Hospital, BJ which is located at No.17 Beichi Ziqihelou Dongcheng-qu is a trusted hospital in gynecological treatments. The hospital has been offering warm hospitality and excellent treatments and services for years. T: 86-10-6525-0731

International Medical Center (IMC) is another major hospital which is located at the Beijing Lufthansa center, 50 Liangmaqiao Lu, Chaoyang District. They hold world class facilities for treatment and health services. The hospital is well known for the personal care they are providing. Well qualified English speaking staffs are available here. T: + 86-10 6465-1561 / 1562/1563

Capital City Dermatology Hospital of Beijing is a large specialized dermatology hospital in China. The hospital is providing world class treatments and services in all departments of skin care like the Department of Dermatology, Specialty of Dermatology, Specialty of Sexually Transmitted Disease, Department of Medicine Laboratory, Department of Rehabilitation Medicine etc

Sekwa Eye Hospital which was founded in 2004 by a group of eye physicians and surgeons in Beijing. Now this is one of the pioneer private hospitals in China. With the support from the Norwegian government and from the Ministry of Science and Technology of China, the hospital is giving leadership to a number of research activities in eye care.

Source by Jeffery Gulleson

from Home Solutions Forev https://homesolutionsforev.com/finding-the-best-hospitals-in-beijing/ via Home Solutions on WordPress from Home Solutions FOREV https://homesolutionsforev.tumblr.com/post/188680182895 via Tim Clymer on Wordpress

#Home Solutions FOREV

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homesolutionsforev · 5 years ago

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Finding the Best Hospitals in Beijing

Beijing is the capital of the People's Republic of China and also the cultural and educational center of this big nation. One can find a large number of modern hospitals and health care centers in Beijing with global standards. All these major hospitals offer world class technology, highly qualified medical professionals and excellent infrastructures facilities. Nowadays they provide staffs who are fluent in English. Major hospitals are accepting credit card payments and the visitors are usually asked to put a deposit before their admission to the hospitals to cover the cost of treatments and services.

I would like to give a brief description of some of the better hospitals in Beijing.

Beijing United Family Hospital and Clinics ("BJU") is the first and the only foreign-invested hospital operating in Beijing, China. This world class hospital was founded in 1997 by Chindex International, an American company, and achieved the prestigious US Secretary of State's Award for Corporate Excellence in 2002. The hospital is provided with all most the medical departments and is headed by highly qualified. Most of the staffs are English speaking. T: + 86-10 6433-3960

Cancer Institute & Hospital (CIH) is China's pioneer in advanced cancer research and treatment. This world famous institute is rated as the largest cancer prevention and treatment center in Asia. This WHO approved research center offers the best available treatments and research facilities for the needed persons and institutions.

Source by Jeffery Gulleson

from Home Solutions Forev https://homesolutionsforev.com/finding-the-best-hospitals-in-beijing/ via Home Solutions on WordPress

#Home Solutions Forev

0 notes

alpabetpertama · 6 years ago

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Teh alif tolong ceritain dong, pengalamannya menjadi wakil sekretari di bem us 2018 dan bendahara umum di blm us 2019

wahh panjang juga sih yah hahah,tp gpp buat menguatkan daya ingat jadi boleh lah kalau diceritain. sebenernya dulu masuk ke bem-us tuh ga sengaja. awalnya mau kehimpunan,eh dari semua yang ikut aku ga lolos haha cuma gara2 ga ada sertikat mabim jurusan gitu lah (bcs,dulu tk 1 masih ogah2 oagahan kuliah di unsil,idealisme nya masih tinggi hahhaha. sampe ikut sbm lg thun 2017 alhamdulillah lolos ke upi tp ga diambil,dipikir2 lgi sayang cost time yg udh dikeluarin). eh pas kitu ditawarin sama A ara anak ep jga sekretaris umum pertama sebelum dia lulus,lalau bu chika naik jadi SK dan aku WSU. awalnya dibem-us itu jadi staff bju merah,trus ngeganti dirjen jadi dirjen bju abu..eh diakhir jadi wakil baju ijo hahaha. Jadi sekretaris mah kaya gampang tp lieur,sebenernya atuh asa ga cocok jdi sekretaris soalnya paling ogah ngurusin adm,tp gapapa lah buat belajar sih. ngurusin surat-surat bikin surat” trus nentuin rapat,ngurus inventarisasi,kadang ngede ttd presmanya hahaha. ampir semua lpj aja ttd presma nya sama aku da si eta mah sibuk melanglang buana. karena jadi sekretaris itu ngurusin jga data tiap anggota,menyatukan semua anggota jga,jd alhamdulillah hampir semua anggota yang ratusan itu kenal. trus kalau secara kekeluarga disana bagus,feel nya udah dpt. ga nyangka bisa ketemu org2 yg luar biasa. dpt keluarga baru sih. banyak cerita deh kalau di bemus 2018 ituu hahahah.kalau di blm emang masih baru baru sihh. mungkin baru jalan 1 bulan lebih kepengurusan. awalnya tuh bingung mau lanjutin dimana ya ini. aa sama tth bemus dulu pada nyaranin lanjutin lgi,kaya presma,a sodong nyuruh buat beraktualisasi diri lagi,nyaah ceunah kamu punya potensi. Nah pas awal itu sempet dikontek sama ketua terpilih pertama sebelum dia ngundurin diri,diajak buat ke blm suruh jdi sekretaris lgi awalnya,ya okelah nope sih,jaba ketuanya seanggkatan ini,eh pas gtu dia ngunduri diri.trus ikut pansus da si boy suruh bantuin *watir iya ke si eta teh da asa hopeless gitu,komo pas ga ada yg daftar wae hahaha* hingga akhirnya kepilih we ketua baru hahahhaha. dipikir2 kalau jadi sekretaris lagi ogah sih,tiap rapat mesti hadir truss hahaha. kalau bendahara saat ini ya baru bantu komisi nyusun rab klau ada kegiatan. mantau keuangan bem sama blm,trus bikin laporan juga buat internal dan nagihan uang kas hahahhaha.

MAKASIH ANNON YA sdh menyimak dan membaca. ini annon kayanya sekampus dehh:��” tau dri mana aku jdi bendahara blm. apa pernah liat aku?

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wutbju · 1 year ago

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Elizabeth “Betty” Lloyd Baxter Horton, 84, of Statesville, N.C., went to be with her Lord and Savior on Sunday, February 19, 2023, at Iredell Memorial Hospital surrounded by her family, following a short illness.

Betty was born on September 11, 1938, in Hackensack, N.J., to the late Howard F. and Marian Lloyd Baxter. She grew up in New Jersey and later in Florida, where she grew to have a deep love for the beach. Betty was proud of the fact that she played tackle football in high school. She attended Bob Jones University, where she met her husband, Don Horton, and served as secretary for Dr. Bob Jones III for many years. Betty was proud of serving with her husband as church secretary at Calvary Community Church for nearly fifty years. She found great joy in cooking and baking for all those around her.

In addition to her parents, Betty was preceded in death by her beloved husband of fifty-three years, Rev. Dr. Donald “Don” Lee Horton; brother, Lee Baxter (Jill); and brother-in-law, Ronald “Ron” Horton (Martha), who supported her in the years following Don’s death.

Those left to cherish the memory of Mimi, as she was affectionately known, include her three children, Kevin Wallace Horton (Mandy), Richard “Ricky” Lee Horton (Amy), and Melanie Elizabeth H. Brown (Jeremy); eight grandchildren, Nicholas B. Horton, Jacob “Jake” W. Horton, Bethany E. Wilcox (Dylan), Nathaniel “Wyatt” Horton (Caroline), Jared R. Horton, Brylee A. Smith (Luke), Isabelle “Belle” J. Brown and Sydney N. Horton.

Visitation will be held on Thursday, February 23, 2023, 5 to 7 p.m. at Troutman Funeral Home. Funeral services will be conducted at 3 p.m. on Friday, February 24, 2023, at Calvary Community Church with Rev. Jeff Coley officiating with burial to follow at Oakwood Cemetery.

In lieu of flowers, memorials may be made to Calvary Community Church at 334 N Oakland Avenue, Statesville, NC 28677.

#Bob Jones University #BJU Hall of Fame #Obituary #BJU Alumni Association #2023 #Betty Baxter horton #Don Horton #BJu Staff #Bob Jones III

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Penis Stretching: 5 Exercises for Length and Girth [Dec 2018]

The male reproductive system consists of the penis, the testicles, the seminal vesicles, and the prostate gland. The Penis consists of a spongy body that is responsible for the ability to create an erection and there is a channel inside called the, “urethra,” that conducts the urine out of the body as well as the sperm. The mean length of a flaccid penis is 8.9 cm (measured by staff). A review of several studies found average flaccid length to be 9-10 cm. The average erect penis length is 14-16 cm and girth is 12-13 cm and this was showed by a review published in the 2007 issue of BJU International. Various methods of measurements were included in the review. Regarding the circumference of the adult fully erect penis with the measurement taken mid-shaft, it was found to be 8.9 to 9.9 centimeters on average. Numerous exercises can be done to increase the size of the penis and these exercises showed 100% complete shift in the size of the penis. But this result cannot be achieved unless the exercises are done five days each week for at least 6 months. After two to three weeks of starting the exercises, you will notice an increase in the penis size and an increase in the status of relaxation. 2 inches (5 cm) compared to one inch at the status of erection and when you continue on the penis enlargement exercises, you will notice a real change in the penis size after 6 months.

These exercises should be practiced 5 days each week at a rate of one hour every day with taking two rest days either consecutive or separate and this rest period is important for cells to heal, regenerate.📷

How do exercises increase the penis size?

The penis consists of 3 chambers of spongy tissue which absorb blood that reach the penis from the circulatory system. As these chambers fill with blood, it leads to the erection of the penis. When exercises are done continuously, in a right way, it will cause an expansion in the size of the chambers. Then, it will become able to absorb larger amounts of blood and this will lead to an increase in the size of the penis, and the purpose of these exercises is to create a tensile strength by stretching the tissues that are responsible for erection of the penis and this tensile strength will lead to an increase in the growth of those tissues, gradually.

Legal Notice relating to Penis Enlargement Methods:

Every person looking for methods of Penis Enlargement should consult a urologist to get medical advice about these exercises to make sure that they won't have any bad effect on his health, especially people with certain diseases such as diabetes and cirrhosis of the liver and respiratory diseases and other diseases that affect blood and oxygen flow to the penis and the renewal process of the cells. We are not responsible in this site for any injuries or health problems that may occur directly or indirectly as a result of following what is mentioned in these instructions.

Erogenous Zones Video | Male reproductive system Video | Response To a Sexual Stimulus Video

Symptoms that must be taken into consideration during the penis enlargement exercises: -

1 - The presence of bubbles on the penis is often produced as a result of the use of pressure on the penis severely and for a long time. 2 - Sores in the penis might be caused by the recurrent pulling of the penis 3 – Swelling, resulting from the use of a heavy weight on the penis for a long time, affects the nerves in the penis that will lead to inflammation and swelling of the penis. If swelling continues, it may lead to an atrophy of the penis and then to an erectile dysfunction.

Exercises should be stopped if any of the above symptoms appear and not be resumed until the problem disappears completely.

Before doing the Penile Enlargement Exercises, you have to consider the following: -

1 - Shave the hair in the pubic area to avoid pulling of hair during the exercises.

2 - Eat healthy meals that are rich in vitamins, minerals and proteins, because the food has an impact on the penis work. In addition, you have to drink a good amount of water daily.

3 – It is necessary to be in a good mood before starting exercise. If you do not believe that these exercises will lead to the enlargement of the penis, this will lead to a negative impact on the process and will make penis enlargement difficult to obtain.

4 - Use a moisturizer on the penis before the exercises and it is preferred not to use soap and shampoo as these materials will lead to redness and irritation of the penis skin . If it stays for a long period of time, in addition to dry skin, and the occurrence of cracks, it is preferred to use the Intensive Care Vaseline instead of the ordinary Vaseline as it can stay on the skin for long period of time without irritating or damaging the skin of the penis.

5 - You must measure the penis before starting penis enlargement exercises: -

• First: Measure the length of the penis during an erection:

• You must stand up and hold the erected penis perpendicular to the body, (straight out). Put a ruler next to the penis starting from the pubic bone then take the measurement up to the tip of the head of the penis. • It can be measured by the length of the penis without an erection: You must stand up; the right knee should be adjacent to left knee. Hold the penis from the area that is located below the head of the penis and drag it to the front and put a ruler next to the penis perpendicular to the pubic bone and then take the measurement using a ruler up to the tip of the head of the penis.

Second: Measure the circumference of the penis during an erection:

• This can be done by using a measurement tape to measure the penis circumference during an erection in the area that represents the midpoint of the penis length. If a measuirng tape is not available, use a piece of string. Place a knot near the end of the string. Wrap the string around the erect penis and hold the string adjacent to the knot. Place the string on a ruler by continuing to hold the string where first grasped and determine the length of the string from that grasping point to the knot. This will give you the circumference. Third: Measure the length of the penis during relaxation:

• It can be measured by using fingers so the length of the penis can be expressed by 5 or 4 fingers. And it can be measured during relaxation using the ruler that is placed above the penis then the other side of the ruler is pushed towards the abdomen, and the length of the penis is recorded starting from the base of the penis towards the head of the penis. • Lie on your back and then measure the length of the penis by using fingers or the ruler to record the shortest possible length of the penis.

Vitamins and minerals and their effect on sexual activity:

When you practice the penis enlargement exercises, there are vitamins, minerals and herbs that must be included in your daily diet that have been found to provide the body with a great energy that enhances sexual ability.

Vitamins: -

1 - 2000 mg of vitamin C twice or three times a day. 2 - 30 mg of Zinc. 3 - 100 mg of vitamin A. 4 - 200 mg of magnesium. 5 - 100 IU of vitamin D. 6 - 50 mg of Thiamine.

Erogenous Zones Video | Male reproductive system Video | Response To a Sexual Stimulus Video

Minerals that have a positive effect on sexual activity:

1 - 525 mg of calcium. 2 - 200 micrograms of vitamin B12 3 - 150 mg of vitamin E 4 - 25 micrograms of potassium. 5 - 400 micrograms of folic acid.

These vitamins and minerals can be found at pharmacies in the form of tablets.

How can the amount of seminal fluid during ejaculation be increased: -

It's advised to take 1000-1500 mg of the amino acid L-Arginine daily. It increases the amount of seminal fluid during ejaculation and also causes strong erection. It is taken as 100mg, 2 hours before intercourse. Taking large amounts of this material should be avoided within 24 hours. If any side effects appear, it is advised to stop treatment and consult your doctor before continuing.

Penis enlargement exercises:

1-The Hot Cloth Warm up

This process is necessary before starting any of the penis enlargement exercises as it increases the flow of blood through penile tissues. In addition, it makes the skin more flexible, making it easier to do the exercise and decrease the appearance of bruises. It can be done in the following ways: -

• soak a towel in hot or warm water and then wrap it around the penis and the testicles, you will feel uncomfortable initially then the warmth will become more comfortable , leave the towel two minutes and then repeat this process again 3 times. - You can use other methods to warm up the penis such as Jacuzzi or hot tub, with gentle massage of the penis to increase blood flow. You should not stay in for more than 10 minutes.

2-The jelq method for Penile Enlargement: -

📷This method can enlarge the penis to over 10 inches in length and 7 inches in circumference if it is started by the men in their early teens and continued until the adulthood, and after that the session will be reduced to just once a week.

How does the jelq method work?

• It increases the blood flow in to the corpora cavernosa that will enhance the growth of the shaft cells.

• This exercise tears down the muscle fibers, and at rest, these fibers will grow stronger and larger.

• It increases the flow of blood in the penis that will increase its size.

When will you notice the difference?

You will start to notice a small difference in the size of your penis after 5 weeks, and you will not have obvious changes for 6 months. After 1 year, you will notice an increase of 3 inches in the size and the erection will also become stronger.

How is the jelq method done?

For the maximum benefit, it should be done every day in the following steps:

1. Before beginning you have to warm up with hot cloths as mentioned before.

2. Grasp the base of the semi-erect penis with your thumb and forefinger , make an O by using those 2 fingers, and in that way you'll cut off the blood circulation resulting in more blood collecting in the cells.

3. Start moving your hand forward milking the blood into the penis shaft and by that way you will fill the cells with more blood.

4. When you reach the tip of the penis with your right hand, hold the base of the penis again with your left hand, and do the same as what you did with the right hand.

5. Continue this exercise for 20-25 minutes.

Notes about the jelq method:

• It is normal to have slight bruises or red bumps at the head of the penis. They will disappear spontaneously. To avoid this, start this exercise slowly and then increase the speed of doing it gradually.

• To notice the benefit, you must do this exercise with a semi-erect penis.

• You have to push the blood as much as possible to the head of the penis to fill the cells with more blood than normal, and this collection of blood will change the color of the penis to a dark red color which is normal.

Erogenous Zones Video | Male reproductive system Video | Response To a Sexual Stimulus Video

Common questions about the jelq method:

• How much pressure should be used during this method?

The amount of pressure that should be used is different from one man to another according to his ability to tolerate. For example, if we put a scale of pressure from 1 (no pressure) to 10 (intolerable pressure), then the pressure that should be used is between 5 to 7.

• What if I couldn’t maintain the semi-erection during the exercise?

You have to remember that it's important to do the exercise with a semi- erect penis to gain the maximum benefit and if you lost the semi-erection you have to do anything you can do to bring yourself back to that condition.

• What if I had an excess of loose skin while doing this exercise?

Its normal in some men and to work this out you can use one hand to hold back this loose skin and the other hand can be used for jelqing and switch the hands every 25 jelqs.

• What do we mean by a semi-erection?

The amount of blood in semi-erect penis is 3/4 of the amount of blood during the hard erection and it can be recognized by the color of the shaft of the penis which should be deep red to dark purple.

• Is it better to do the exercise before or after sex?

There is no difference in the results if you do the exercise before or after sex. You can do it whenever you have enough time.

How to get the maximum benefit from the jelq method:

• First week :

Start by doing 250-300 jelqs per day and it's better to be combined with the PC flexes (100-125 PC flexes daily).

Note: The PC flexes will be explained later.

• Second week:

Do the jelq exercise for 10-15 minutes with 200-225 PC flexes per day. And remember, this should be painless. If you have any pain, you should stop immediately and consult your Doctor.

• Third week:

Do the jelq exercise for 30 minutes with 300-325 PC flexes per day.

3-The Pubococcygeus (PC) Flex Exercise for Penile Enlargement:

PC muscle is referred to the pubococcygeus muscle and it extends from the pubic bone to the coccyx and this muscle is responsible for the ejaculation and the erection and it's used to control urination.

You can locate it by holding the urine mid stream when you urinate and this will cause this muscle to contract and you will feel it extending from the area behind the testicles and in front of the anus.

The Benefits of the PC Flex Exercise:

1. It protects from impotence.

2. It controls the ejaculation and protects against premature and poor ejaculations.

3. It results in stronger erection

4. It increases the activity of the prostate gland.

5. it protects from later life problems such as the inability to control urination ( urinary incontinence). . How to do the PC exercise to enlarge the Penis?

• PC Holds:

It starts by locating the PC muscles as we mentioned above, then you have to squeeze and release it several times, you can start with 40 times during the day, then do as many as you can per day until you reach the goal of 250-400 times per day. What is good in this simple exercise is that you can do it anywhere, in the house or the office for example and no one would notice.

• PC Squeeze And Hold:

Start by warming up then do 10 PC flexes as explained before and when you reach the 10th flex, hold it for 25 minutes then have a rest for 1 minute , this entire exercise is preferred to be repeated for 5 times per day.

• PC Increments:

This exercise is important in controlling ejaculation. The man can delay an ejaculation by contracting the PC muscle and this exercise can be done by squeezing the PC muscle gradually until you reach the maximum tightening, hold it for 10 seconds and then release it gradually in the opposite way.

• PC Exhauster

This exercise is hard and very vigorous but it’s the most effective. You can start it by sitting in a comfortable place, then you have to warm up for 30-50 strong contractions, and then hold the penis tightly for 10 seconds and after that do 150 PC flexes, and when you reach to the last PC flex, hold it as long as you can, then take a rest for 3 minutes, and follow this with 40 strong PC flexes.

Erogenous Zones Video | Male reproductive system Video | Response To a Sexual Stimulus Video

4-The length stretch exercise for Penile Enlargement:

1. Start by warming up and you have to do this exercise with a flaccid penis (unlike the jelq method that should be done with semi-erect penis) because it is impossible to stretch an erect penis.

2. Hold the head of the penis gently with little pressure.

3. Pull the penis out in front of yourself and stretch it as much as you can. Feeling a pressure is normal but if you feel any pain, then you have to stop and start over.

4. Hold the stretched position for 15 seconds, and repeat this process 5 times.

5. When you finish the above steps, massage the penis gently to restore the blood circulation.

6. The above exercise can be done by stretching in both up and down directions.

7. Stretch the sides of the penis by holding the head of the penis as mentioned above, then pull it to the left and hold this position for 15 seconds and repeat this process 5 times and do the same in the right direction.

Notes about The length stretch exercise to enlarge the Penis:

• For best results, combine the above exercise with jelq exercise.

• You do not need any kind of lubricant in the length stretch exercise as you need a firm grip so the penis should be dry, as much as possible .

• Be sure to hold the tip of the penis before stretching it.

5-Growth and circulation exercise to enlarge the Penis:

This exercise can increase the blood flow in the penis and prepares it for the semi-erect state that is needed in other exercises ( jelq exercise).

Hold the penis and whip it around gently for no more than 30 times, and make sure that the scrotum is covered by the other hand to protect it from any injuries that might occur during this exercise.

Premature ejaculation:

What is the premature ejaculation?

It is uncontrolled ejaculation that occurs prior to when a man wishes, either before or shortly after sexual penetration, that result in unsatisfactory sexual experience for both sexes.

How to avoid premature ejaculation?

1. You have to discover your point of no return, which is the point at which you have to ejaculate and cannot stop yourself from ejaculation. You can discover it by doing an exercise called 1-10 at which number 1 refers to the beginning of the arousal sensation and number 10 refers to the occurrence of orgasm and ejaculation, therefore number 9 is the point before ejaculation and this is the point of no return. When you do the masturbation and reach the point of 8 stop and restart again after the urge of ejaculation is subsided and then you have to repeat this several times. Masturbate, stop, masturbate, and after 15 minutes you can ejaculate.

2. Another way to avoid premature ejaculation is by PC exercises as explained before.

3. Locking method:

While enjoying sex, if you feel too excited, withdraw the penis from the vagina by holding only the head of the penis inside the vagina and wait for 30 seconds until the urge to ejaculate is subsided, then start over from the point where you left off.

Important tips to achieve a hard erection that lasts longer:

1- Diet: - Stick to a low fat, high fiber diet, as it is found that high level cholesterol in the blood can block blood vessels in the penis causing an impotence. Your diet must contain a little amount of zinc that can be found in such as turkey, cereal, lamb, lean beef, Crabmeat and oysters.

2- Stop smoking.

3- Continue plenty of exercises.

4- Having more erections keeps the muscle tissue of the penis properly oxygenated.

5- Place your index finger at the root of the bottom of the penis and your thumb at the root of the top of the penis. Take a deep breath and squeeze the shaft of the penis in a wave toward the head of the penis. This will push more blood to the head of the penis and this exercise should be repeated 9 times per day.

Frequently asked questions about Penile Enlargement Exercises: -

1- When should I start the exercises?

Some men prefer to do the exercises in the morning and others prefer to do it at night before going to sleep. They may be done at any time.

2- Can I ejaculate before the exercise or at any time during it, or after it?

You should not ejaculate for a few hours before starting the exercise and it is preferred not to ejaculate after the exercise until a few hours have passed. During ejaculation, many chemical changes occur in the body, such as decreased level of testosterone hormone, in addition to tightening in all body connective tissues.

3- The feeling of pain during the jelq exercise is normal or not?

It's normal to feel slight discomfort during the exercise but if you feel sharp or strong pain or if ulcers appear on the penis then you have to stop doing the exercise for several days until healed. To avoid this, you should always warm up before doing the exercises.

4- When should I begin to notice an increase in the penis size?

The first time you will notice an increase in the penis size is usually 2-3 weeks after the beginning, as long as you keep to the regimen completely.

5- What if I get an erection during the jelq exercise?

You have to stop the exercise if erection occurs as you may hurt yourself. Wait until it subsides.

6- Can I do the exercise twice per day?

No, it is best not to. The time needed for the healing process in the body tissues is 48 hours and this depends on the type of tissue. The muscular tissues need less time for healing than the nerve tissues. If you practice these exercises twice per day, the tissues of the penis will not have enough time to heal completely. This can be damaging if practiced improperly or too often.

7- How long can I practice these exercises?

You can practice these exercises forever if you want and you'll notice an increase in the size by 1/2 inch per year.

8- Can I practice these exercises for 7 days a week?

No. You must give your penis a break 2 days out of 7 as this period is important for the healing process.

9- If I don’t have enough time to do the exercises all at one time can i spread them during the day?

Yes you can.

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