CIRCUMCISION - a patient's guide
Dr Gerald Young - Family Doctor
Introduction Circumcision is a subject that is somewhat like religion or politics to discuss. People tend to have strong views on the subject from a predetermined position and no amount of evidence will change their positions. I have found that the best that I can do is to provide information and make people aware of some of the main facts about circumcision.
Reasons for circumcision: 1. Hygiene
Many parents believe that it is more hygienic or at least it is easier to care for a boy's penis if it is circumcised.
Infection or inflammation of the foreskin affects 10% - 14% of uncircumcised boys. Inflammation of the glans (balanitis) is twice as frequent in an uncircumcised child than a circumcised child, and it is greater than five fold in adults. Urinary tract infections occur in about 1 in 100 uncircumcised boys in the first year of life, and 1 in 1,000 in circumcised boys.
There is an increased risk of inflammation and infections of the foreskin and glans in uncircumcised males. However it will come down to personal opinion whether the increased risks are significant enough to warrant circumcision.
2. Other infections
Uncircumcised adults have an additional increase in the risk of foreskin infection, such as candida (thrush) if they also have diabetes.
There have been studies that have showed that some sexually transmitted infections (STIs), particularly gonorrhea and syphilis, are less frequent in circumcised men. Other STIs such as herpes, NSU and genital warts have similar rates in both groups.
Studies from Africa have shown that circumcised men are at less risk of becoming HIV infected than uncircumcised men however this is not reproduced in USA studies. The suggestion has been put forward that the reason for this is that there is a different HIV subtype in Africa than in developed countries, which may account for the difference.
3. Religious Reasons
Circumcisions for religious reasons date back to Biblical times and the story of Abraham circumcising himself and his sons as a sign of his devotion to God. Jews and Muslims continue this custom to this day and firmly believe that circumcision is an integral part of their religion.
Other religious groups also continue the practice of circumcision to a greater or lesser degree.
4. Cultural Reasons
Some cultures strongly believe in circumcision, and circumcision is an integral part of their culture. Notably the Pacific Islanders in New Zealand have an almost 100% circumcision rate. The Pacific Islanders traditionally choose to have circumcision performed in late childhood or early puberty as a rite of passage to manhood.
5. Medical Reasons
Some males will need to have circumcision for medical reasons because of recurrent inflammation and infection to the foreskin and glans. This can produce tightening of the foreskin (phimosis) that makes it difficult or impossible to retract the foreskin, which leads to poor hygiene and further infections.
Circumcision or dorsal slit (which is dividing the foreskin on the upper side of the penis to make the foreskin easier to retract) are the only solutions in this circumstance. In 2-10% of boys phimosis can occur without a significant history of infection of the foreskin, however the treatment is the same.
6. Social/Sexual
Some men seek to have circumcision because they or their partners prefer to have a circumcised penis. Some of the reasons found for this request are that the foreskin is very tight with an erect penis but may not be a problem when the penis is not erect. In some cases the foreskin can tear with an erection.
Some couples complain of the smell of the smegma especially with oral sex (fellatio) before circumcision. Others state that they just prefer the appearance of a circumcised penis to a non-circumcised penis.
There is no evidence to suggest that sexual performance is different between circumcised versus non-circumcised men.
7. Cancer Risk
There is a 1 in 400-900 risk of getting cancer of the penis in uncircumcised men. This is not a high risk and I have not had anyone have a circumcision to prevent cancer as a reason.