One of the most commonly performed surgical procedures in the world is male circumcision. Circumcision involves the procedure of surgically removing a part or all of the penile foreskin called the prepuce. The foreskin or prepuce is normally the retractable fold of skin that covers the head of the penis called the glans penis. The foreskin is the continuation and almost a third of the skin covering the whole penis. Circumcision may be carried out for a number of reasons. Approximately one-third of males in the world have been circumcised for religious, cultural and medical reasons.
Adult male circumcision is much less common than infant circumcision. Some men with an uncircumcised penis have the procedure later in life. Adult circumcision is often a simple procedure, though considered a larger surgery than in infants. Latest advancements in non-invasive procedures such as stapler circumcision have made adult male circumcision accessible to all men with a reason. Specific benefits of adult circumcision are related to medical, preventive and personal reasons. Most of the benefits of adult circumcision involve treatment of an existing medical problem like :
Phimosis is the inability of the foreskin to be retracted behind the glans penis in uncircumcised males. The foreskin that is narrow or closed does not get pulled back causing pain and urinary problems. This condition may persist from birth (physiologic) or appear later (pathologic) in life due to scarring, infection or inflammation. Congenital (by birth) or physiological phimosis is normal in a new born. By 3 years of age, the natural separation is expected to allow the foreskin to retract and expose the glans fully. It is considered abnormal if the condition of phimosis continues in to adolescence or adult hood not allowing the exposure of glans when the penis is either relaxed or erect. The problem of phimosis in certain men, though may exist from birth may start giving problems only after involvement in active sexual activity. The foreskin not being elastic, does not allow easy movement and retraction causing pain and discomfort during full erection.
Problems that Phimosis in adult men can cause are:
- Repeated inflammations of the glans and foreskin
- Pain and discomfort during sexual intercourse
- Erectile dysfunction as a result of painful erections
- Inability to urinate in case of full obstruction of the glans
- High sensitivity under the tight foreskin can cause premature ejaculation
- Penile cancer which is very rare may develop if phimosis has been left untreated for many years
Pharmacotherapy may help in an early stage of pathological phimosis but Circumcision is the only permanent treatment to overcome the structural restriction and its effects.
Paraphimosis is a condition when the retracted foreskin is stuck behind the head of the penis. Paraphimosis often presents as a severe and emergent condition caused either by prolonged foreskin retraction over the glans penis or due to the presence of phimosis. Under given circumstances of existing phimosis, the foreskin in an attempt to be being pulled back violently behind the glans, may not be able to be brought down back to its original position due to the narrow opening of the foreskin. This can cause a tight ring around the penis inhibiting normal blood circulation and restrict blood from flowing to the end of the penis.
Paraphimosis can also result from a careless medical intervention, such as the use of a catheter. If the retracted state of the foreskin remains for an extended period of time, it can cause complications like ischemia and necrosis of the region resulting in gangrene. Hence, it is advised by urologists that paraphimosis must be treated as an emergency, without any delay. Treatment aims to reduce the swelling as an immediate measure but circumcision is recommended after recovery to prevent relapse.
Penile inflammatory skin conditions such as Balanitis is the most common penile disease, especially in uncircumcised males. Inflammation of the penile tissue at the glans is caused by the growth of yeast or other microorganisms under the foreskin. Symptoms of inflammatory penile conditions includes itching, swelling, tenderness and pain. Penile inflammation is responsible for significant related conditions including acquired phimosis, balanoposthitis and lichen sclerosis. Recurrent rates of penile inflammation makes medical treatment quite challenging. Reducing prevalence is therefore considered important. While topical antibiotic applications accompanied by hygiene practices may help short term, the definitive treatment is circumcision. The international journal of preventive medicine, 2017 reveals “circumcised males have a 68% lower prevalence of balanitis than uncircumcised males and that balanitis is accompanied by a 3.8 fold higher risk of penile cancer. Because of the high prevalence and morbidity of penile inflammation, especially in immunocompromised and diabetic patients, circumcision should be more widely adopted globally”.
Prevention of HIV and STIs
Heterosexual transmission of HIV is still the biggest contributor to the HIV epidemic in developing countries. Circumcision is proven to prevent HIV and STDs in men during vaginal sex. Evidence supporting the effectiveness of adult circumcision for the reduction of HIV acquisition in heterosexual men is strong and is based on several randomized controlled trials performed in various parts of the world. Clinical trials have also demonstrated that circumcision reduces HIV infection risk by 50 % to 60 % and reduces by 30%, the risk of contracting Herpes and Human Papilloma Virus (HPV), two pathogens believed to cause penile cancer. Circumcision is encouraged as part of HIV prevention programmes in some countries with high rates of HIV.
Women’s choices for a sexual partner is a subject of widespread interest that provides important socio-sexual information. Sexual participation and satisfaction of women are influenced by numerous factors that also includes aspects of penile anatomy such as male circumcision status. Database searches from 29 publications with original data of various populations revealed overwhelming response of preference for circumcised penis over uncircumcised penis. The main reasons given for this preference were better appearance, better hygiene, reduced risk of infection and enhanced sexual activity involving vaginal intercourse, manual stimulation and fellatio. In general, women’s preferences favour the circumcised penis for sexual activity, hygiene and lower risk of infection. These findings enhance the already well-established health benefits favouring male circumcision.Heterosexual transmission of HIV is still the biggest contributor to the HIV epidemic in developing countries. Circumcision is proven to prevent HIV and STDs in men during vaginal sex. Evidence supporting the effectiveness of adult circumcision for the reduction of HIV acquisition in heterosexual men is strong and is based on several randomized controlled trials performed in various parts of the world. Clinical trials have also demonstrated that circumcision reduces HIV infection risk by 50 % to 60 % and reduces by 30%, the risk of contracting Herpes and Human Papilloma Virus (HPV), two pathogens believed to cause penile cancer. Circumcision is encouraged as part of HIV prevention programmes in some countries with high rates of HIV.