翻譯練習：國外雜志上一篇關于環切手術的文章（三）

（接上文）

6. 不過，不割包皮也是十分普遍和正常的。

既然新生兒的丁丁覆蓋着包皮，那麼我們應該承認不割包皮的狀态才是生物學意義上自然和原生的。當然，這并不意味着割包皮是錯誤的——正如不割包皮也同樣沒有什麼錯誤。

7. 不割包皮也并不意味着丁丁的衛生狀況更差。

“隻要有好的個人衛生習慣，這（不割包皮）并不會造成什麼問題。”拉明博士說。布拉姆巴特博士也持有相同的觀點，他進一步解釋說，未割包皮的男性需要将包皮上翻，并用柔和的香皂及清水将包皮内側清洗幹淨。如果不經常清洗，油脂和死皮細胞會混合形成白色的包皮垢藏匿在包皮下。而比較注意丁丁衛生的人一般會将清洗包皮作為日常護理的常規步驟，變成自然而然的行為習慣。

8. 與沒有割包皮的男性發生關系，并不意味着女性會因此有更高的概率感染性傳播疾病。

敲黑闆——因為這個話題有一點點複雜。

2018年，美國疾病控制與預防中心（CDC）發布了一個針對醫療服務人員的參考指南，令他們可以更好地幫助男性新生兒家長及未割包皮的成年男性了解包皮環切對于性健康的作用。

對于男性，數據顯示包皮環切可以降低——但不能完全避免——陰道性交中HIV及其它性傳播疾病（例如滴蟲病）的感染風險，但是對于肛交卻并沒有類似效果，而對于口交則依然沒有定論。（另外需要注意的是，CDC強調說上述結論很大程度上是基于南撒哈拉地區的研究數據，而這些地區的HIV感染率遠遠高于美國。）

而對于女性，目前也還沒有确切的統計結論。沒有數據可以證明性夥伴接受過包皮環切手術有助于降低女性感染HIV的風險，但臨床試驗顯示滴蟲病等其它性傳播疾病的傳染風險有所降低。

割包皮似乎可以降低男性患尿路感染的風險。男性患上此病的概率其實非常低，但醫學專家們認為有包皮覆蓋的環境可能更容易滋生導緻尿路感染的細菌。

此外，割包皮似乎可以降低男性陰莖癌的患病率。陰莖癌在美國已經相當少見，根據美國癌症協會（ACS）的統計，2018年全美确診病例約2320例。包皮垢可能刺激丁丁并引起發炎，炎症則可能進一步誘發陰莖癌，甚至掩蓋癌症的一些早期征兆，因此包皮垢被認為是陰莖癌的潛在緻病因素之一。環切手術可以減少包皮垢的形成和堆積，從而降低陰莖癌的患病風險。研究者們目前正在嘗試定量研究手術實際能帶來的差異。

根據以上研究數據，美國兒科醫學會（AAP）2012年在官方層面上對新生兒包皮環切手術表達了支持态度（AAP認為在安全無菌條件下的完成手術的健康收益大于愈合不良等可能的手術風險），這一态度也得到了美國婦産科醫師學會的支持。但是，他們也強調說選擇權在新生兒父母手上，在嬰兒期後完成環切手術出現并發症的幾率會上升。

（未完待續）

（以下是原文）

11 Things Everyone Should Know About Uncircumcised Penises

It’s time to talk about uncircumcised penises. We here at SELF give vaginas a lot of attention, which makes sense. But penises - including uncircumcised penises in particular - deserve their time in the sun, too. Why the emphasis on the uncircumcised penis instead of, well, all of them? I don’t know about you, but I’ve heard a fair amount of trepidation or even a bit of judgment when uncircumcised penises come up in conversation, which happens more often than you’d think when you’re a health reporter and editor. So, it’s time to share some facts. Here are 11 things everyone should know about uncircumcised penises, and, as a bonus, some circumcision facts sprinkled in, too.

1. Circumcision involves surgically cutting off some or all of a penis’s foreskin.

The foreskin is the protective shroud that covers the head (glans) of a penis, S. Adam Ramin, M.D., urologic surgeon and medical director of Urology Cancer Specialists in Los Angeles, tells SELF. "When that piece of skin is removed, then the head of the penis is exposed to the outside environment," he says.

According to the Cleveland Clinic, other parts of the penis include:

The meatus: Urine and semen come from this hole at the tip of the penis.

The shaft: This is the longest part of the penis, located in between the glans and the pelvis.

The corpora cavernosa: These two chambers inside the penis contain blood vessels.

The urethra: This is the tunnel through which urine and semen travel. It’s located underneath the corpora cavernosa.

Erectile tissue: This surrounds components like the urethra and swells in order to allow erections.

2. Circumcision typically happens soon after birth. There are various reasons why people might decide to circumcise their babies.

For instance, Jewish and Muslim people often circumcise their babies as a religious and cultural tradition. Some parents also choose to circumcise their babies for aesthetic purposes or because circumcision is simply the norm where they live.

3. Some uncircumcised men and people with penises decide to get circumcised as adults.

According to the Mayo Clinic, medical needs can warrant circumcision when someone is no longer a baby. For instance, if a person’s foreskin is too tight to retract (pull back over the head of the penis as it should), circumcision may be recommended. It’s normal for the foreskin not to fully retract when someone is a baby, the Mayo Clinic says, but if this persists as they get older, it can cause discomfort.

Even when it’s not medically necessary, people do sometimes decide to get elective circumcisions because they feel self-conscious about still having their foreskin, Jamin Brahmbhatt, M.D., a urologist at Orlando Health, tells SELF.

4. Circumcision surgery is an outpatient procedure that typically takes around 10 minutes, but the healing can take longer in teenagers and adults than in babies.

The procedure is pretty simple for newborns, who usually get circumcised within 10 days if their parents choose to have the procedure done, according to the Mayo Clinic. It involves these steps in a medical practice:

First, the child is placed on their back with their arms and legs restrained.

A medical professional cleans the penis and surrounding area to prevent infection.

Then they apply a cream anesthetic or inject the penis with numbing medication.

A surgeon removes the foreskin.

A medical professional covers the penis with an ointment and encases it in gauze.

The injury will typically heal within seven to 10 days, the Mayo Clinic says. However, once a person is past infancy, the surgery may require general anesthesia and may take weeks to heal. "I tell patients, 'You're going to be miserable and hate me for a few weeks, but once it all heals up, you should be fine,'" says Dr. Brahmbhatt. (Worth noting: Circumcision is more likely to result in complications like bleeding and infection when someone is no longer a baby, according to the Mayo Clinic.)

After that, simply getting the hang of having different equipment can take some time. "I tell patients it can take up to a year to get used to having a circumcised penis," says Dr. Brahmbhatt.

5. Circumcision has gotten pretty popular in some parts of the world, including the United States.

In 2007, the World Health Organization posited that 33 percent of people in the world who have penises and are 15 and over are circumcised. A 2016 review in Population Health Metrics, which examined the most relevant data from 237 countries and territories, bumped that estimate up to 37 to 39 percent of people with penises globally being circumcised. The prevalence varies based on the exact area in question.

For instance, the Population Health Metrics study found the lowest rates of circumcision in countries including Ecuador (0.11 percent) and Vietnam (0.20 percent). Countries with the highest rates included Morocco (99.9 percent) and Iran (99.7 percent). The United States is also pretty high up there, with the study reporting circumcision in 80.5 percent of U.S. people with penises. Of course, these aren’t hard and fast numbers, but they’re interesting nonetheless.

6. But also, uncircumcised penises are completely normal.

Since babies are born with their foreskins intact, uncircumcised penises are actually the biological default. That doesn’t mean there’s anything wrong with circumcised penises - just that there’s nothing wrong with uncircumcised penises, either.

7. Uncircumcised penises aren’t inherently dirtier than circumcised ones.

That all depends on the penis in question. "As long as good hygiene practices are followed, this shouldn't be a problem," says Dr. Ramin. Dr. Brahmbhatt agrees, explaining that proper hygiene for uncircumcised men and people with penises involves pulling back the foreskin and cleaning everything out. Mild soap and water should be good enough to get the job done.

If a person with an uncircumcised penis doesn’t clean themselves often enough, smegma - dead skin cells and oils that combine to form a white substance - can build up, Dr. Brahmbhatt says. (Yes, even doctors say "smegma".)

If uncircumcised men or people with penises care about being clean in general, they’ll include that cleansing as part of their routine. "It becomes a natural thing," says Dr. Brahmbhatt.

8. You're not way more likely to get a sexually transmitted infection from someone with an uncircumcised penis than someone with a circumcised one.

Buckle up, because this is a little complicated.

In 2018, the Centers for Disease Control and Prevention (CDC) released guidance for health care providers trying to help uncircumcised people and parents of babies with penises learn about the health outcomes of circumcision.

Ultimately, the data show that, for the person with the penis, circumcision can reduce - but not fully remove - the risk of contracting HIV and some sexually transmitted infections like trichomoniasis during penile-vagina sex. But it doesn’t seem to carry that same benefit during anal sex, and experts haven’t yet determined how it may affect this risk during oral sex. (It’s really important to note that much of this evidence comes from studies in sub-Saharan Africa, the CDC says, which has a much higher rate of HIV than in the United States.)

Experts are still investigating whether or not circumcision may offer a protective effect if a circumcised person’s sexual partner has a vagina. The results don’t yet show a benefit when it comes to reducing the chance of contracting HIV if you have a vagina, but clinical trials show a decrease in transmission of sexually transmitted infections like trichomoniasis.

Beyond that, it seems as though circumcision lowers a person’s chances of getting urinary tract infections. These are pretty rare in people with penises, anyway, but experts theorize that an intact foreskin provides a better environment for potentially UTI-causing bacteria.

There’s also a possibility that circumcision makes it less likely that someone will experience penile cancer, which is already quite uncommon in the United States. (The American Cancer Society (ACS) estimates that about 2,320 people will be diagnosed with penile cancer in 2018.) The theory is that getting circumcised reduces penile cancer risk factors like…smegma. Yup, we’re circling back to this substance: Experts believe smegma might increase irritation and inflammation that can raise the risk of penile cancer and also make it harder to see signs of early cancer, according to the ACS. Researchers are still determining how much of a difference circumcision really makes here.

This kind of data is why the American Academy of Pediatrics’ official policy on circumcision, released in 2012 and endorsed by The American College of Obstetricians and Gynecologists, says that the benefits of circumcising babies in a safe, sterile way outweigh risks like the foreskin not healing properly. However, they emphasize, the choice is up to the parent or parents, and complications increase when people are circumcised after infancy.

9. You don't automatically have to treat uncircumcised penises differently if you're fooling around with someone who has a penis. Ask your partner what they like.

Uncircumcised penises are not terrifying sexual mysteries (at least, not any more than circumcised ones are). A penis is typically an easy-to-please body part no matter its circumcision status, not a fleshy Rubix cube. "When it comes to getting the job done, uncircumcised and circumcised penises work in the same way," says Dr. Brahmbhatt.

10. That said, there is an interesting debate around whether uncircumcised or circumcised penises happen to be more sensitive.

Some hypotheses hold that circumcision results in a loss of sensitive tissue, along with the desensitization of the remaining exposed skin. There's also the theory that since the head of the penis isn't always exposed to the outside world the way it is with circumcised ones, uncircumcised penises don’t build up the same level of hardiness.

Dr. Ramin explains another theory: "When the foreskin is still on the head of penis, there's more sensitivity because the foreskin slides back and forth more easily over the head during sexual activity, which is stimulating." But science hasn’t come down hard (yes, going there) on one side or the other. A 2016 review in Danish Medical Journal examined 38 studies on the subject, concluding that there were no major differences in sexual function or sensitivity between people with circumcised and uncircumcised penises. However, they note, more research is necessary.

Basically, ¯\(ツ)/¯.

11. Uncircumcised penises basically come prepared with their own lubrication.

Between the extra skin and some natural moisture between the foreskin and head of the penis, everything slides around more easily, Dr. Brahmbhatt explains. (This means you may not go through lube as quickly for things like handjobs. Budgeting win).

If you're putting a condom onto someone with an uncircumcised penis, you may also need to make a slight tweak based on their preferences, Jessica O'Reilly, Ph.D., Astroglide’s resident sex and relationship expert, tells SELF. "Many people with uncircumcised penises like to gently pull back on the foreskin before putting on a condom, but you should check with your partner and follow their lead," she explains.

There may even be some bonus feel-good action for you. "Because the skin retracts back, it creates a kind of ridge around the penis that may cause increased sensitivity for partners," says Dr. Brahmbhatt. It’s like the natural version of a ribbed condom," he explains. But, he points out, if you're using condoms for safe sex - which you always, always should when you’re unaware of a partner’s STI status - you likely wouldn't be able to tell either way.

Editor: Zahra Barnes

Zahra Barnes joined SELF in November 2015, working on the Culture and Health teams before eventually becoming Executive Editor. She has spent her career as a reporter and editor covering people's lives with a focus on wellness.

Zahra specializes in sexual, reproductive, and mental health, all with the goal of destigmatizing these topics and highlighting issues in underserved communities. She’s passionate about exposing the systemic and institutional flaws that lead to health disparities for marginalized people, as well as providing service that helps readers navigate these systems for the best mental and physical health outcomes possible.

When Zahra’s not working, you can find her watching scary movies, eating salted caramel gelato mixed with Phish Food (life-changing combination), and enjoying time at home with her partner and their perfect ginger tabby, Sonny.