Circumcision: Risks, Benefits and Postoperative Care

What is circumcision?

Circumcision is a surgical procedure performed on children and adults that involves the removal of the foreskin, the skin covering the glans (head of the penis).

Historically performed for religious reasons, circumcision has become increasingly common for reasons of hygiene and because it is a procedure that reduces the incidence of urological diseases.

In this article, we will explain how and why circumcision is performed, as well as its risks and benefits.

What is the foreskin?

The foreskin is the layer of retractable skin that covers and protects the glans, commonly known as the head of the penis. It has two sides, the outer side, which is made of normal skin, and the inner side, facing the glans, which is a mucous membrane responsible for keeping the penis hydrated and protected from aggression from the external environment.

In adults, the foreskin covers the glans when the penis is flaccid, but retracts when the penis is erect.

The skin that covers the penis begins to form in the first weeks of fetal development. From birth until the early years of a man’s life, the foreskin is attached to the glans, a process called physiological phimosis.

As a man grows, the foreskin gradually separates from the glans until it is entirely retractable when the penis is erect. The detachment of the foreskin should not be forced on children, as it occurs naturally over the years.

Why is circumcision performed?

There are reports of the practice among the Egyptians, over 15,000 years ago, as a way to increase male hygiene and “cleanse the soul”.

Although circumcision is a surgical procedure, it is still often performed today for traditional and religious reasons, without any medical indication, such as the routine circumcision of Jewish and Muslim children.

In the late 19th and early 20th centuries, circumcision became a common medical procedure, even in families without religious motivation. In some countries, such as the USA and Korea, more than 80% of the male population is circumcised.

It is good to clarify that despite the known benefits – which will be explained later – the main pediatric associations in the world do not recommend the routine performance of circumcision without medical indication.

Medically indicated circumcision is usually performed in cases of penile infection (balanoposthitis), pain during sexual intercourse, or pathological phimosis, i.e., inability to retract the foreskin in older children and adolescents.

Advantages

Circumcision, when performed in childhood, presents some advantages, among which we can mention

Reduction of urinary tract infections

Urinary tract infections are rare in men, but they are more common in uncircumcised children due to the growth of bacteria in the smegma, a kind of white mucus composed of shed cells and skin oils that usually accumulate under the foreskin.

Reduction of penile infections

Balanitis (infection of the glans) and posthitis (infection of the foreskin) are also less common in circumcised children (suggested reading: Male Yeast Infection: Symptoms, Pictures & Treatment).

Reduction in penile cancer

Circumcised men have a reduced risk of penile cancer. However, it should be noted that this disease is rare even in uncircumcised men (about 1 case per 100,000 people). The benefit seems to exist only when circumcision is performed in childhood. Men circumcised after adolescence do not have lower rates of penile cancer.

Reduction of cervical cancer in partners

In addition to reducing penile cancer incidence, female partners of circumcised (and monogamous) men have lower rates of cervical cancer. The explanation seems to be that circumcised men have a lower risk of HPV contamination and transmission.

Reduction of STIs and HIV

In addition to HPV, circumcised men have lower contamination rates with other sexually transmitted infections such as chancroid, genital herpes, trichomoniasis, and HIV.

Interestingly, circumcision shows no evidence of protection against gonorrhea, chlamydia, or syphilis.

Better hygiene

Genital hygiene is crucial for penile health. Circumcised men find it much easier to clean their penis properly while bathing and to keep it clean throughout the day.

Circumcision Risks

Circumcision is a surgical procedure, and, as such, there are risks associated with it. However, the procedure is quick and easy (it takes about 20 minutes) and has a surgical complication rate of less than 0.5%. The most common complications are bleeding, infection, and dissatisfaction with the aesthetic result.

Circumcision, like any other surgery, must be performed under anesthesia, which prevents the child or adult from feeling any pain during the procedure.

Loss of sensation after circumcision

The foreskin is highly innervated and contributes to the sensation of pleasure. One of the arguments against circumcision without medical indication is the risk of reduced sensitivity of the penis. However, despite the logic behind this theory, the fact is that in practice, circumcised men do not experience less satisfaction with their sex lives.

Even in men who have undergone circumcision as adults and already have an active sex life, there is no convincing evidence of changes in the quality of their sex life. There is some anecdotal evidence of decreased sensitivity, but scientific studies with large groups show no difference in the quality of sex. It is a controversial issue.

In truth, the circumcision of children without formal medical indication is currently a controversial procedure. There are anti-circumcision groups that make the following arguments:

• Circumcision causes pain in newborns, which puts unnecessary stress on the baby.
• The trauma of circumcision as a baby is carried out for the rest of life, even if the individual is unaware of it (there is no substantial evidence to support this argument).
• Circumcision violates human rights because it mutilates a being incapable of making decisions.

The position of most pediatric societies is not to recommend circumcision for the entire male population without a clear medical reason. However, there are no contraindications to performing circumcision for religious reasons or if it is the patient’s wish (in the case of an adult) or his parents (in the case of a child).

Frequently Asked Questions

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References

• Male circumcision – American Academy of Pediatrics.
• Circumcision of infant males – The Royal Australasian College of Physicians.
• Newborn Male Circumcision – American College of Obstetricians and Gynecologists.
• Neonatal circumcision: Risks and benefits – UpToDate.
• Male adult circumcision – UpToDate.
• Complications of circumcision – UpToDate.

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