The waiting game


Many men would adopt a “wait and see” attitude when it comes to their health despite suffering pain or even irritation. 

Being away in the United Kingdom for many years and after coming back to Malaysia and serving as a doctor, I realised that generally, Malaysians tend to defer medical treatment. There are two distinct periods when clinics can be quiet, as Chinese patients tend to defer the necessity of receiving care in the hospital unless that is the last resort (in most cases, this is really the case). 

I am sure many of you would have guessed the periods I am referring to are Chinese New Year (yes, all sixteen days, including the eve); and the ghost month (and yes, the whole month!). Thankfully, in my line of work, many patients’ conditions can wait for such extended intervals. 

According to my nurse, patients who have built up the “ong” (good chi) during Chinese New Year are trying their upmost best to preserve this good fortune and avoid the “dodgy zones” like the hospital, where many believe have bad “fung shui”. 

I have also swiftly learnt to arrange for extended family holidays revolving around these dates. I guess even doctors want to preserve their “ong” as much as possible. 

On the third day of my leave, I received a phone call from a distressed patient who requested for an urgent circumcision. Yes, you heard right, “urgent circumcision”. Okay, it is not totally impossible to perform an emergency circumcision in our line of work.

Occasionally, we encounter patients with foreskin that becomes trapped behind the glans penis and impossible to pull back even in the flaccid state (paraphimosis). Yes, it sounds painful and I assure you it is excruciating.

If the condition persists for several hours, the blood circulation may be impeded and can result in the gangrene of the penis. That, in anyone’s book, is an emergency! 

Mr Wong is a thirty-year-old man who I’ve known for several years. He suffers from a condition called Balanitis Xerotica Obliteran (BXO). 

The medical term may sound a bit fanciful, but in layman’s term, it is essentially an inflammatory condition affecting male genitalia causing induration and hardening of the skin. Such chronic condition usually results in cracks and tightness of the foreskin and prevents retraction.

BXO is a surprisingly common condition that usually affects middle-aged men, especially uncircumcised ones. Despite the condition has being in the medical literature since 1928, the etiology of such disease is largely unknown.

Most researchers had concluded that the chronic inflammation of the male genitalia was the result of the presence of unhygienic foreskin with repeated infections; others also demonstrated the role of autoimmunity, sexually transmitted infection and diabetes mellitus. 

BXO is often progressive if untreated. This will result in pain during intercourse, irritation and even obstruction of the penile outline caused by scarring.

Many urologist will also advocate treatment by  way of circumcision, as there are mounting evidence that BXO may play a pre-cancerous role resulting in the cancer of the penis. The definitive treatment for most men with BXO is circumcision. 

As far as my patient is concerned, the tightness and the scarring of his foreskin had resulted in pain during intercourse and a mild degree of irritation.

He may experience many weeks or months of unclean genitalia, which can only lead to repeated infection (Balanoposthitis), and a need for regular visits to the clinic for antibiotics. Despite repeated advice, my patient was hesitant about going through the surgical knife. 

But on further discussion with Mr Wong about his ordeal, I discovered he is neither having infection nor paraphimosis (phew!). And he was done with the waiting game, and decided to “part” with the foreskin, and ready for an urgent circumcision during the festive season in order to have time to recuperate.   

He was pleasantly surprised when I offered him general anesthesia for the circumcision and assured that he will not be crippled in a sarong for a month. When he was more calmed, Mr Wong decided to go ahead with the circumcision.

As I was arranging for the operation list for the following week of my schedule, I was somewhat puzzled and perplexed by the treatment-making decisions by my male patients. 

In most instances, many men would adopt a “wait and see” attitude when it comes to their health despite suffering the irritation or even pain. Of course, many had not come to any harm in this waiting game, but sadly, the treatment success may be compromised as a result of the delay.

>The views expressed are entirely the writer’s own. 

 

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