The Most Painful Medieval Torture
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SA's second - and world's third - penis transplant recipient is one 'happy patient'
This is the third ever penis transplant conducted with the second one conducted in Boston at the Massachusetts General Hospital.
The recipient‚ a 40 year old man‚ has been without a penis for 17 years after a botched traditional circumcision. His name is being kept anonymous for ethical reasons.
“He is certainly one of the happiest patients we have seen in our ward. He is doing remarkably well. There are no signs of rejection and all the reconnected structures seem to be healing well‚” said Professor Andre Van der Merwe‚ Head of the Division of Urology at Stellenbosch University s Faculty of Medicine and Health Sciences.
The patient is expected to regain full use of his penis within six months of the transplant‚ said the release.
Medical tattooing will be used to correct the colour discrepancy between the recipient and the donor organ in six to eight months after the operation.
“Patients describe a penis transplant as ‘receiving a new life’. For these men the penis defines manhood and the loss of this organ causes tremendous emotional and psychological distress‚” said Dr Amir Zarrabi of the FMHS’s Division of Urology‚ who was a member of the transplant team. “I usually see cases of partial or total amputations in July and December – the period when traditional circumcisions are performed.”
The team consisted of Van der Merwe‚ Dr Alexander Zühlke‚ who heads the FMHS’ Division of Plastic and Reconstructive Surgery‚ Prof Rafique Moosa‚ head of the FMHS’ Department of Medicine‚ Zarrabi and Dr Zamira Keyser of Tygerberg Hospital. They were assisted by transplant coordinators‚ anaesthetists‚ theatre nurses‚ a psychologist‚ an ethicist and other support staff.
The first ever penis transplant patient from December 2014 is using his penis as normal.
“The patient is doing extremely well‚ both physically and mentally”‚ says Van der Merwe. “He is living a normal life. His urinary and sexual functions have returned to normal‚ and he has virtually forgotten that he had a transplant."
The transplant procedure is very complicated as nerves‚ blood‚ vessels and muscle from the donor organ have to be connected to the recipient.
“The diverse presentation of the blood vessels and nerves makes the operation very challenging and means each case is unique. All these structures need to be treated with the utmost delicacy and respect in order to be connected perfectly to ensure good circulation and function in the long term‚” said Zühlke.
Micro-surgery was used to connect small blood vessels and nerves.
It is thought that up 250 partial or complete penile amputations take place a year in South Africa due to botched traditional circumcisions. “At Stellenbosch University and Tygerberg Hospital we are committed to finding cost-effective solutions to help these men‚” says Van der Merwe. The procedure was part of a proof of concept study to develop a cost-effective penile transplant procedure that could be performed in a typical theatre setting in a South African public sector hospital‚ he said.
The costs of the second procedure was much less than the first.
The biggest challenge to rolling out this procedure is the shortage of organs. “I think the lack of penis transplants across the world since we performed the first one in 2014‚ is mostly due to a lack of donors. It might be easier to donate organs that you cannot see‚ like a kidney‚ than something like a hand or a penis‚” said Van der Merwe.
“We are extremely grateful to the donor’s family who so generously donated not only the penis‚ but also the kidneys‚ skin and corneas of their beloved son. Through this donation they are changing the lives of many patients.
The patient had counselling over two years to explain and ensure he understood the operation is not a tried and tested treatment‚ but is still an experimental procedure with many risks.
How men from Africa and Asia can easily migrate to Europe: Apulia and Calabria route
Although not a major point of entry for irregular migrants, the open sea route to southern Italy remains a source of particular concern to border authorities.
Irregular migrants picked up in Apulia tend to be travellers who previously entered the EU via Greece. Increasing numbers of migrants, usually from Asia, claim to have been living in Greece for months or years before deciding to leave for other EU Member States.
Those detected in Calabria usually come from Turkey or Egypt. Most are Syrians, although there have also been significant numbers of Pakistanis and Afghans, as well as Egyptians.
The peak year for this route was 2011 with 5259 detections of illegal border crossings, the year of the Arab Spring. The decline in numbers since then is attributed to a growing preference for the overland route through the Western Balkans.
The smuggling techniques used on this open sea passage are quite different from the flimsy dinghies typically seen in the calmer waters of the eastern Aegean. Smugglers attempting entry in Apulia often use ocean-going pleasure yachts. Migrants are hidden below the deck, often in dangerously crowded conditions with insufficient ventilation. In some cases, the boats are modified with additional wooden bunking in order to maximize capacity. Only a small crew is visible to coastguard patrols, sometimes accompanied by women to allay suspicion.
Smuggling networks from Egypt, on the other hand, used to use small fishing boats – but had switched to larger ‘mother ships’ instead, with strings of fishing boats towed behind. On departure from Egypt the migrants were stowed in the mother ship, which then stopped en route to collect further passengers. Once close to the Italian shore, the migrants were transferred to the fishing boats while the mother ship returns to port – a technique that naturally allowed smugglers to evade arrest.
You probably have to look at imagery of death and dying regularly to stay focused on what really counts in life: great sex before you are gone anyway.
How Sex Addiction Became A Diagnosis
There’s a long history of using medical language to explain socially unacceptable sexual appetites.
Last month, former congressman Anthony Weiner pleaded guilty to charges related to sexing with a 15-year-old, declaring, “I have a sickness, but I do not have an excuse.”
Weiner’s seeming inability to stop sending sexts to a minor, despite all the personal and political consequences he knew he could face, has touched off a debate around the dubious science of sex addiction. Weiner’s actions put him in a long line of famous men — from Tiger Woods to David Duchovney to Josh Duggar — who argue that their sexual behavior reflects an addiction.
For the most part, modern medical professionals are skeptical about the science of sex addiction. But there’s a long tradition of using medical language to explain socially unacceptable sexual appetites.
Sex addiction as we currently understand it became part of the public discussion around 1980, as Barry Reay, Nina Attwood and Claire Gooder of the University of Aukland explained in a 2012 paper.
After the country had experimented with two decades of free love, disco clubs and shifting gender and sex roles, there was a serious pushback to sexual promiscuity, particularly coming from conservative Christians and certain strains of feminism. Rising concern about addictions to drugs, alcohol and gambling provided an easy way to talk about destructive sexual behavior. The term “sexual addiction” was broad enough to encompass any sort of sexual thought or action that made people feel guilty or ashamed.
“Its success as a concept lay with its medicalization, both as a self-help movement in terms of self-diagnosis, and as a rapidly growing industry of therapists on hand to deal with the new disease,” Reay and his colleagues wrote.
Today, when we talk about sexual addiction, we’re often talking about the danger of people retreating from “real life.” Framing it as addiction helps us understand why men like Weiner and Woods would wreck their marriages and careers for fleeting encounters. Checklists of sexual addiction symptoms include items like “thinking of sex to the detriment of other activities” and “neglecting obligations such as work, school or family in pursuit of sex.”
A long history of pathologizing sex
For thousands of years, doctors have worried that excessive or inappropriate sexual behavior would harm men’s ability to function in productive, socially appropriate ways. In the days of early Christianity, cultural studies scholar Elizabeth Stephens explains, medical texts warned that “excessive” ejaculation depleted masculinity.
She quotes historian Peter Brown’s description of the belief among Roman doctors that “no normal man might actually become a woman, but each man trembled forever on the brink of becoming ‘womanish.’ His flickering heat was an uncertain force.”
If the link between ejaculation and weakness was a longstanding concern, it took on a sudden new urgency in the 19th century, Stephens wrote. In the 1830s, French physician Claude-François Lallemand “discovered” spermatorrhea, a malady roughly comparable to sex addiction. Noting the asymmetrical testes of a man who had died of a cerebral hemorrhage, he concluded that the unfortunate man’s troubles began with the excessive discharge of semen.
Suddenly doctors were seeing spermatorrhea everywhere. Doctors compiled long lists of the purported disease’s symptoms, including decreased sexual desire, “erections and emissions upon slightest excitement,” nervous asthma, cowardice, poor memory and insanity.
Doctors believed the most significant cause of spermatorrhea was masturbation, Stephens wrote. The treatments ranged from exercise and cold bathing to injections of acetate of lead, blistering of the penis, and occasionally, castration.
Stephens argued that “many of the concerns about non-reproductive male sexual practices in the nineteenth century derive from an unease about modern indulgences making men soft, weak, incontinent, and undisciplined.”
Race, class and sexual panic
In the 19th-century U.S., this medical panic had a lot to do with a rapidly changing society. Middle-class young men were leaving rural areas and seeking upward mobility in the growing cities. Historian Kevin J. Mumford explained that this new freedom demanded individual self-control. Reformers warned that men who succumbed to urban vice “were likely to be found wanting in virtually all manly endeavors, especially in the pursuit of profit,” he wrote.
If spermatorrhea was a great threat, being susceptible to it was also seen as a mark of civilization and racial superiority. Nineteenth-century racial “science” held that black men were utterly lacking in self-control and prone to becoming rapists, yet they were in no danger of the physical and mental damage that sexual licentiousness caused white men. That meant, Mumford wrote, that by exercising sexual self-restraint, men “not only avoided sexual disorders but also distinguished themselves as white.”
Medical attitudes toward women’s sexuality also took a sharp turn in the 19th century. Before then, according to historian Carol Groneman, Western doctors generally believed women were as lewd and lascivious as men, and that female orgasm was necessary for pregnancy. But as men left their farms and home workshops for jobs in the industrializing economy, cultural belief in the differences between men and women’s sexual desires grew. Now, middle-class white women were seen as naturally nurturing and civilizing, and excessive female sexual desire was a threat to social order.
Groneman described an 1856 account by a gynecologist of a married 24-year-old woman who came to him complaining about her lascivious dreams about men other than her husband. The doctor instructed her to reduce her intake of meat, take cold enemas and swab her vagina with a borax solution. “If she continued in her present habits of indulgence, it would probably become necessary to send her to an asylum,” he wrote.
In other cases, gynecologists treated what they now termed nymphomania —defined rather ambiguously as “excessive” female sexual desire — with surgery, removing women’s ovaries and clitorises.
By the turn of the 20th century, Groneman writes, nymphomania was closely tied to all kinds of “dangerous” female behavior, including lesbianism, prostitution and agitating for economic and political rights.
For both women and men, the concept of sexual disorders in the past was broad enough to encompass all manner of social and economic upheaval. That’s still true today. As the cases of Weiner and other prominent men suggest, we can use “sex addiction” to mean being bad at monogamy, committing actual sexual crimes, or simply lacking the self-control to put long-term goals ahead of momentary pleasure.
The truth is, psychiatrists now generally don’t consider sexual addiction to be a real disorder. The American Psychiatric Association left it out of the latest edition of the Diagnostic and Statistical Manual of Mental Disorders after studies found little evidence to support the “addiction” label. For example, people who exhibit the behaviors we call sexual addiction don’t show the same patterns in brain activity as those who are addicted to drugs. “Sexual addiction” may actually be a loose collection of traits like high sex drive and lack of impulse control.
But history suggests that the way we think about sexual disorders isn’t just about medical evidence. It’s about our understanding of self-control, and the expectations we have for how men and women are “normally” supposed to behave.
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