Tue | Dec 18, 2018

Dear Doc | What's the cost of a circumcision?

Published:Sunday | October 8, 2017 | 12:00 AM

Q Good day, Doc. I'm a 20-year-old male and I was wondering what's the average cost for a circumcision?

A Thanks for your question. I was informed by a local surgeon that the average cost for this procedure at your age would be $135,000 if local anaesthetic is used, and $180,000 if you require general anaesthesia.

This is just an average estimate to have the procedure in a private health facility.

Please note that this is also offered free of cost in government-run hospitals. However, these facilities are faced with many challenges and you may be given a long appointment. Best of luck.


Recurring rash on my vulva


Q Good day, Doc. I am in my early 20s and I keep having a reoccurring bruise or rash on my vulva. I use to think it was the creams I use to remove the hair, but now even when there is pubic hair, it still occurs. Is it something I should be concerned about? I am not in an intimate relationship. I am very concerned.

A All genital rashes should be investigated as there are numerous causes. Certain features of the rash - such as it's size, colour, texture, if it is itchy, associated with fever, vaginal discharge or enlarged lymph nodes - are important clues for a diagnosis. So, it is important that you be examined by your doctor, who may take a swab of the rash and, perhaps, do a blood test to find the exact cause.

Based on the limited history you have given, some of the likely causes are: an allergic reaction to the creams you have been using, fungal infection. The herpes virus is a common cause of a recurring genital rash in sexually active individuals. Please see your doctor as soon as possible.


Can surgery to loosen my foreskin compromise sensitivity?


Q Dear Doc, I am a 28-year-old male who suffers from phimosis, but only when erect. But in recent weeks, retraction of the prepuce has become increasingly difficult, even when flaccid. I had preputioplasty in mind, but my urologist recommend that I do frenuloplasty instead. However, my concern is that the post-op foreskin will be too loose with nothing to hold it up. Also, the most sensitive area of the penile gland is the back, where the frenulum meets the opening of the urethra. Will frenuloplasty compromise the level of sensitivity coming from that area in any way, shape, or form? Is my urologist correct in saying that frenuloplasty is a more viable option than freputioplasty?

A These are very important questions, and are ones on which research papers can be written. However, for the sake of our readers who are not familiar with the technical terms you used, let us define them.

Phimosis is a condition where the penile foreskin cannot be pulled back past the glans (the head) of the penis. This occurs in varying degrees. Most men are born with a certain degree of phimosis, but this usually resolves on it's own by age seven, and only about one per cent of males are said to have the condition past their teen years. This can lead to discomfort during sex and increased rate of fungal infection may cause problems with urination.

The two procedures you mentioned are surgery which loosens the foreskin without totally removing it. Preputioplasty involves making a vertical cut in the foreskin along the back or sides of the penis then closing them across.

Frenuloplasty, on the other hand, involves cutting and lengthening the slip of flesh that attaches the foreskin to the head of the penis from the under surface.

Your concerns are well founded, and since the penis is such a vital organ, we need to examine this delicate issue.

It has been found that the under surface of the head of the penis in the region, where the frenulum attaches, is the most sensitive. Some call it the 'male G-spot'. Cutting into that area, just like in any other area, will inevitably cut through some nerves. Some men who have had the procedure do complain of hyper/extra sensitivity which can be uncomfortable.

Preputioplasty is more commonly performed on children, as it has a better success rate in this age group, possibly due to their thinner, softer foreskins. This procedure is also not very effective in those who have had repeated infections of the foreskin. You did mention that your foreskin was getting more difficult to pull back, which indicates possible inflammation.

I suggest that you have a detailed discussion with your urologist regarding your situation, and the pros and cons of the treatment methods available to you, so that you are at peace with your final decision.


Could I be pregnant?


Q Dear Doc, my husband and I have been trying to get pregnant for a few months now. However, after hearing about the Zika outbreak, we've decided to give it a break. We decided to go with coitus interruptus. My menses started acting very strange last month. It was 10 days late! This month I notice that it was seven days late. I took two pregnancy tests and they both came out negative - could I still be pregnant? What are the other factors that could cause a delay? I would be very elated to know I was pregnant for sure, but extremely worried if I was, with the Zika going around.

I want to weigh my options as I'm also terrified of visiting the doctor's office unless it's a must. Patiently awaiting your response.

A Stress and anxiety affect the body's hormones, which can interfere with your period. Other factors which can cause a delay or irregularity include lifestyle changes such as diet and exercise which also create hormonal changes, due to a difference in percentage body fat. Medical conditions such as uncontrolled diabetes and thyroid problems are also factors, as they are related to your body's metabolism.

Some types of blood pressure and anti-allergy medication can cause a delay in the menses.

Please note that the normal menstrual cycle ranges from 21 to 35 days, so you may not be late at all. Just ensure that you are tracking it accurately.

Sometimes if a pregnancy test (the urine-based kit that can be bought over the counter) is done too early after a missed period, it may come back negative as the pregnancy hormone levels are not yet high enough in the urine to be detected. Drinking lots of water before the test will lead to a similar scenario as a diluted urine will have a low concentration of the pregnancy hormone. So it's best to do the test using the first early morning urine. Caffeine is also known to cause frequent, dilute urine, which creates the same problem. Always ensure that you check the expiry date on the kit; if it is outdated, it could give you misleading results.

Having a pregnancy outside the womb, such as in the tubes, can also give you a negative result with the urine test kit.

Your concern about the Zika virus during pregnancy is well founded as it is known to cause significant deformity in the developing baby in the early stages. This virus is known to be transmitted by semen, so if you are indeed pregnant, condoms are a necessity if you do decide to have intercourse during this period. The usual precautions such as mosquito mesh, debushing and getting rid of stagnant water in your environment are necessary to reduce the chances of you and your partner contracting this virus.

What should you do? I think the answer is now clear, visit your doctor, who will lay these matters to rest.

- Have Dear Doc answer your questions at deardoc@gleanerjm.com.