Dorsal Slit

In much of Oceania a simplified form of circumcision is used. To quote Bengt Danielsson (reference below):

The form of circumcision which the Polynesians practised differed considerably from the Jewish, and should perhaps rather be called by the medical terms incision or superincision. Instead of removing the foreskin altogether in the Jewish manner only a long slit was made in the upper side of it. The 'operation' was quite painless and simple, and was considered necessary; public opinion, indeed, was so strong that all boys without exception submitted to it on reaching the age of puberty.
One might be inclined to query his statement that it was quite painless - these boys were pretty tough. After this cut the two flaps of skin fall to the side, leaving the glans fully exposed. The inner and outer skin heal together along the cut line. This is operation was common in the Phillipines, Polynesia and Melanesia, but in all these regions some groups practised a full circumcision (and some practised none). Maoris (Polynesians), in particular, don't circumcise. In Papua New Guinea (Melanesians) a recent study found 43% of men were uncircumcised, 47% had a full dorsal slit, and 10% had a complete circumcision (see our Papua New Guinea page).

In the West, the dorsal slit has always had a place as a more conservative, and simpler, operation than circumcision. Lewis Sayre, the 19th century doctor who is commonly (but probably wrongly) regarded as the father of widespread circumcision in the USA actually favoured a simple dorsal slit when operating on infants; he only performed full circumcisions on boys aged 10 or more (see references, below). It continues to have a place as a more conservative operation than circumcision. One of the Editor's school friends had had the operation at a young age (but old enough to remember). Contrary to some Web accounts, the result was perfectly satisfactory cosmetically - he just looked circumcised, but could in fact mobilize his skin over the glans if he wanted, though it wouldn't stay there.

Paraphimosis operation

There are special cases where this operation is called for, and one is the emergency relief of paraphimosis (left). It is also valuable for elderly patients with foreskin problems since it is less stressful than a full circumcision. Diabetes leads to the presence of sugar in the urine which in turn leads to balanitis in uncircumcised men, and this is quite a common scenario.

A dorsal slit is also the starting point of one technique of full circumcision - after cutting the slit, the foreskin is cut around the base of the glans, giving a circumcision with most inner foreskin removed.

Sometimes the intent is not to uncover the glans but just to make the foreskin loose and retractable. Therefore a partial slit is made. This can be problematic. First of all, scars can shrink and toughen meaning that although the orifice is enlarged, it is now stiff and inflexible. Secondly, the appearance can be unsightly. To quote Wahlin (see references, below):

Circumcision is the accepted operation to treat phimosis. However, when the purpose is to achieve retractility of a narrow foreski to avoid further scarring and phimotic development after recurrent balanitis, a preputial plasty might be sufficient. Several methods with single or multiple incisions have been introduced throughout the years. None of them seems to have gained general acceptance. Single plasties tend to give cosmetically unsatisfactory results with an apparent cleft or deformity, while the multiple ones, where the deformity is more or less spread around the circumference, are not always easily done, at least not in children. Still, circumcision seems to remain the standard procedure for preputial relief. A simple technique, where three longitudinal incisions are transversely sutured, is described. It has been used in a series of 63 consecutive patients with good results, and seems to offer a good compromise between simplicity and cosmetical demands.
One of the more complex 'plasties', with a Z-shaped cut, is described by in an Australian paper by Emmett (below). If these procedures have gained any acceptance it is only in Scandinavia, where opposition to circumcision is strong. Trials in other countries have typically led to many participants ending up getting properly circumcised.

1. Danielsson, B. Love in the South Seas. (tr. F. Lyon). London: Allen & Unwin, 1956: 240pp. Quotation is from page 91.
2. Sayre, Lewis A., 1888. On the deleterious effects of a narrow prepuce and preputial adhesions. Transactions of the Ninth International Medical Congress, Vol.III Full text available here.
3. Wahlin. N, 1992. "Triple incision plasty" - a convenient procedure for preputial relief. Scandinavian Journal of Urology and Nephrology 26, 107-110
4. Emmett. AJ, 1982. Z-plasty reconstruction for preputial stenosis - a surgical alternative to circumcision. Australian Paediatric Journal 18, 219-220

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