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      Post-traumatic stress disorder (PTSD) among Filipino boys subjected to non-therapeutic ritual or medical surgical procedures: A retrospective cohort study

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          Abstract

          In the Philippines, non-therapeutic genital cutting is viewed as a culturally sanctioned rite of passage from boyhood to manhood. Strong social and peer pressure is exerted on boys aged between 8-16years to submit to destructive genital cutting, despite the fact that many men who have been subjected to genital cutting during infancy or childhood often describe their experiences in the language of violence, torture, mutilation, and sexual assault. Among a group of 505 Filipino boys subjected to ritual genital cutting (Tuli), 69% fulfilled the DSM-IV criteria for a diagnosis of PTSD, while among 1072 boys circumcised by medical operators or their assistants, 51% exhibited PTSD symptoms. Pursuant to ritual genital cutting, almost 3 out of every 4 boys exhibited PTSD-like symptoms.

          Highlights

          • 1072 Filipino boys (11–16 years) from the Batangas had undergone medical circumcision and 505 ritual circumcision (Tuli).

          • 69% of the Tuli group exhibited PTSD symptoms and 51% of boys circumcised by medical operators exhibited PTSD symptoms.

          • Boys subjected to Tuli exhibited PTSD comparable to Vietnam veteran inpatients at St. Cloud (Minnesota) VA Medical Center..

          • Both groups reported higher PTSD (p < .0001) than women subjected to “very distressing or terrifying” obstetric procedures.

          • A limitation of the study was its failure to examine ongoing levels of PTSD in both groups over increasing time intervals.

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          Most cited references17

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          Post-traumatic stress disorder and suicidal behavior: A narrative review.

          There is a large literature investigating the underlying mechanisms, risk factors and demographics of suicidal thoughts and behaviors across a number of psychiatric disorders, such as, major depression, anxiety and schizophrenia. However, less research has focused on the relationship between Post-Traumatic Stress Disorder (PTSD) and suicide. There were two broad aims of this review. The first was to assess the extent to which PTSD is associated with suicide, and the second was to determine the effects of co-morbid disorders on this relationship. Overall, there was a clear relationship between PTSD and suicidal thoughts and behaviors irrespective of the type of trauma experienced. Very few studies directly examined whether depression was a mediating factor in the relationships reported. However, where this was investigated, the presence of co-morbid depression appeared to boost the effect of PTSD on suicidality. It was noteworthy that hardly any studies had investigated concepts thought to be key in other domains of research into suicidality, such as, feelings of entrapment, defeat and hopelessness.
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            The prepuce: specialized mucosa of the penis and its loss to circumcision.

            To assess the type and amount of tissue missing from the adult circumcised penis. The gross and histological features of the prepuces of 22 adults obtained at autopsy were assessed, primarily focusing on the inner or mucosal surface of the prepuce. Skin and mucosa sufficient to cover the penile shaft was frequently missing from the circumcised penis. Missing tissue included a band of ridged mucosa located at the junction of true penile skin with smooth preputial mucosa. This ridged band contains more Meissner's corpuscles than does the smooth mucosa and exhibits features of specialized sensory mucosa. The amount of tissue loss estimated in the present study is more than most parents envisage from pre-operative counselling. Circumcision also ablates junctional mucosa that appears to be an important component of the overall sensory mechanism of the human penis.
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              Fine-touch pressure thresholds in the adult penis.

              To map the fine-touch pressure thresholds of the adult penis in circumcised and uncircumcised men, and to compare the two populations. Adult male volunteers with no history of penile pathology or diabetes were evaluated with a Semmes-Weinstein monofilament touch-test to map the fine-touch pressure thresholds of the penis. Circumcised and uncircumcised men were compared using mixed models for repeated data, controlling for age, type of underwear worn, time since last ejaculation, ethnicity, country of birth, and level of education. The glans of the uncircumcised men had significantly lower mean (sem) pressure thresholds than that of the circumcised men, at 0.161 (0.078) g (P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity. There were significant differences in pressure thresholds by location on the penis (P < 0.001). The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds than the ventral scar of the circumcised penis. The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.
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                Author and article information

                Contributors
                Journal
                Ann Med Surg (Lond)
                Ann Med Surg (Lond)
                Annals of Medicine and Surgery
                Elsevier
                2049-0801
                25 April 2019
                June 2019
                25 April 2019
                : 42
                : 19-22
                Affiliations
                [a ]University of Melbourne, Parkville, VIC, 3010, Australia
                [b ]Bond University, Gold Coast, QLD, 4229, Australia
                Author notes
                []Corresponding author. University of Melbourne, Parkville, VIC, 3010, Australia. gboyle@ 123456unimelb.edu.au
                [1]

                The study was conducted, and all data was collected in the Philippines, by Samuel Ramos while completing his Bachelor of Social Science (Hons) degree in Psychology at Bond University, under the supervision of Professor Boyle.

                Article
                S2049-0801(19)30030-5
                10.1016/j.amsu.2019.04.004
                6506608
                31080593
                1af40166-2ba1-4b88-b4c7-d25047a16c4b
                © 2019 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 4 October 2018
                : 17 April 2019
                : 21 April 2019
                Categories
                Original Research

                ptsd,ritual genital cutting (tuli),medical circumcision,trauma,stress

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