SUNNATH OR CIRCUMCISION

 SUNNATH      OR  CIRCUMCISION  :  Circumcision changes the bacteria ecosystem of the penis, perhaps explaining why the foreskin-snipping procedure reduces the risk of HIV infection, a new study finds.A year after men received circumcisions, the total bacterial load in the area that used to be under the foreskin dropped significantly, researchers report today . Anaerobic bacteria, which thrive in limited oxygen, declined most dramatically. Some aerobic bacteria, which need oxygen to live, increased."It's dramatic," study researcher Lance Price, a genetic epidemiologist at George Washington University in Washington, D.C, said in a statement. "From an ecological perspective, it's like rolling back a rock and seeing the ecosystem changeCircumcision in the United States is usually done within the first few days of life. It's a controversial procedure, with some scientists and anti-circumcision advocates arguing that the removal of the foreskin reduces sexual sensitivity.. Studies on adults who are circumcised later in life have found little to no difference, but many of those men are circumcised for medical reasons, confusing the issue.Circumcision does carry some health benefits, leading the American Academy of pediatricsto conclude in 2012 that the benefits outweigh the risks. The organization recommends parents making the decision for their children after discussing it with their pediatricians.Among the most intriguing benefits of circumcision is the finding that circumcised men are less likely to contract HIV, the virus that causes AIDS. A 2005 study of South African men found that circumcised men who had sex with an HIV-positive woman were 63 percent less likely than uncircumcised men to contract the virus. Circumcision has also been shown to reduce the risk of contracting HPV, or human papillomavirus, which can cause cervical cancerif a man infects his female partners with the virus, and herpes simplex virus type 2, better known asgenital herps.In the new study of men circumcised as adults in Uganda, Price and his colleagues found less biodiversity in the microbes, or microbiome, living in the now foreskin-free area of the penis. The bacterial die-off may be a good thing, Price said, because some of the species that decline are known to cause inflammation.Circumcision in the United States is a controversial procedure and is usually done within the first few days of life.A 2012 policy statement from the American Academy of Pediatrics (AAP) is likely to throw fuel on the fiery controversy surrounding male infant circumcision.The AAP's statement touts the  medical benifits of circumssion while stopping short of recommending the procedure, which opponents decry as painful and unnecessary. For instance, new research has found that circumsisionlowers the risk of acquiring sexually transmitted infections, including HIV, genital herpes, human papillomavirus and syphilis.Circumcision seems to be on the decline in the United States (a 2005 Agency for Healthcare Research and Quality study put the rate at about 56 percent), but the practice has long religious and cultural roots. Here are five circumcision facts that may come as a surpriseIn the late 1800s, doctors turned to circumcision to "cure" an array of ailments, from childhood fevers to brass poisoning to paralysis. This era was a boom time for genital surgery — women were losing their ovaries to the knife in the name of curing hysteria — but it was an 1870 case that shone the spotlight on circumcision.Writing in the journal Transactions of the American Medical Association, Lewis Sayre, a professor of orthopedic surgery at Bellevue Hospital Medical College, told the tale of being called to the bedside of a 5-year-old boy whose knees were flexed and paralyzed, preventing him from walking.During his examination, Sayre discovered that the boy's foreskin had contracted, causing the child great pain. Speculating that the foreskin problem could be the source of the boy's "physical prostration and nervous exhaustion," Sayre conducted a circumcision the next day. In less than two weeks, Sayre reported, the boy was walking again.Whatever the cause of the boy's paralysis and miraculas cure the foreskin can occasionally become trapped over the head of the penis, a condition called phimosis. Modern cures include circumcision, manual stretching of the foreskin, or preputioplasty, an operation to widen the foreskin. ]As far as we know from the historical record, the land of the pharaohs pioneered circumcision. The earliest reference to the procedure dates back to around 2400 B.C. A bas-relief in the ancient burial ground of saqquara depicts a series of medical scenes, including a flint-knife circumcision and a surgeon explaining, "The ointment is to make it acceptable," likely referring to some form of topical anaseptic.

ANCEINT EGYPTIONS      circumcisions were not done in infancy, but instead marked the transition from boyhood to adulthood. The Greeks saw their Mediterranean neighbors' tradition as rather bizarre. In the fifth century, Herodotus made his opinion known in his work "The History of Herodotus."

"They practice circumcision for the sake of cleanliness," he wrote of the Egyptians, "considering it better to be cleanly than comely."An increase in hospital births and a perception of circumcision as promoting cleanliness certainly contributed to the rise of the procedure in the United States. But the procedure may have been a status symbol as well.

Writing in the University of Cincinnati Law Review in 2003, Seton Hall University law professor Sarah Waldeck points out that Sayre and his circumcision-promoting colleagues came onto the scene just as hospital births were becoming more common. The wealthy were more likely to go to the hospital and have a physician-attended birth; thus, circumcision became a marker of class. The need to circumcise essentially became a social norm, Waldeck writes. It was what "good" parents chose. As more and more parents made the choice, it became odder and odder not to, which then put more pressure on parents to    CHOOSE CIRCUM SISIONso their child would be "normal."Most circumcisions in the United States are done with one of three devices: the Mogen Clamp, the Plastibell and the Gomco clamp. The Mogen clamp is a scissorlike device consisting of two flat blades used that are clamped over the foreskin, cutting off blood flow. A scalpel is then used to slice away the tip of the foreskin.

The Plastibell is a plastic device that is placed over the head of the penis, under the foreskin. The doctor or nurse then ties a string around the foreskin, cutting off circulation. The string may be used as a guide for the surgical removal of the foreskin, or the Plastibell may be left on for a week or so, after which the dead foreskin will fall off on its own.

The Gomco clamp is also inserted between the head of the penies and the foreskin.  Again, the surgeon clamps the device over the foreskin, cutting off circulation. After about five minutes, the blood around the clamp will begin to clot, and the surgeon uses a scalpel to cut away the foreskin. This method sometimes leaves a distinctive light brown scar on the head of the penis.

It's possible that the pre-circumcision bacteria activate immune cells in the skin called Langerhans cells, which then respond to HIV by presenting them to the immune system's helper T cells; these helper cells typically coordinate a defensive immune response. Unfortunately, HIV has evolved to thrive and reproduce inside helper T cells, so Langerhans cells that present the virus to the immune system make infection more likely, not less. However, it's still unknown whether Langerhans cells are the culprit behind  HIV infection in uncircumcised men. The researchers plan to follow up to explore this as early as possible.................