Circumcision is an operation to remove a male’s foreskin. It is one of the oldest and most common surgical procedures. A male may undergo this procedure for religious, social, medical, or cultural reasons.
The Centers for Disease Control and Prevention (CDC) encourage male circumcision on the basis that it appears to reduce the risk of HIV infection during vaginal sex. However, not all health authorities agree, and the recommendations remain somewhat controversial.
Circumcision is fairly common in the United States. In fact, according to the CDC, 58.3% of U.S. newborns underwent circumcision in 2010.
It is less common in other Western countries, however. In the United Kingdom, for example, only around 8.5% of males are circumcised.
This article will discuss what to expect during the procedure itself, as well as some possible benefits and risks.
Circumcision involves the removal of the foreskin of the penis. The foreskin is the shroud of skin that, when gently pulled back, uncovers the head of the penis.
The surgery is relatively simple. A healthcare professional will free the foreskin from the head of the penis and, in newborns, clip it off in a procedure that only takes a few minutes. In adults, they will remove the foreskin with a scalpel, and it takes around 30 minutes.
They will then either cauterize or stitch the wound with dissolvable sutures.
The first circumcisions may have taken place around 15,000 years ago. The procedure then slowly spread across a variety of cultures, especially in the Middle East.
It may have become popular in the ancient world as a public health measure and a way of preventing balanitis. Balanitis leads to swelling and pain in the head of the penis.
This condition might have been more common in ancient societies due to sand building up under the foreskin.
Circumcision became popular in the Western world in the late 19th century, when people began performing the operation in an attempt to prevent masturbation. Many believed that masturbation was associated with conditions such as epilepsy, paralysis, tuberculosis, and insanity.
However, there was little compelling evidence to support these claims. As the newly formed national healthcare systems started facing rising costs, they stopped recommending the procedure.
In the U.S., however, it has remained a relatively common practice, and some major health authorities do still encourage it.
A number of factors are associated with neonatal circumcision.
The most common are:
- health considerations
Some studies have suggested that circumcision reduces the risk of urinary tract infection, but more recent findings have contradicted this, with some suggesting that it might actually increase the risk.
Evidence has indicated a lower risk of some sexually transmitted infections (STIs), including syphilis. Circumcised males also appear to be less likely to contract herpes or HIV.
In very rare cases, balanitis or phimosis can develop in an uncircumcised male. With these conditions, the foreskin cannot retract. This requires surgical treatment.
Cancer of the penis is extremely rare, but it appears to be slightly more common in males with a high body mass index (BMI), males with a history of smoking, males who are uncircumcised, and those with a combination of these factors.
Circumcision is less common in adults than in children. It takes longer and is likely to involve more tissue trauma. It may also cause more psychological trauma than it does in newborns.
However, it may reduce the risk of certain conditions, including phimosis, paraphimosis, and balanitis.
Phimosis is the inability to pull back the foreskin, leading to pain and urinary problems. It can occur if a male is born with a tight foreskin, or due to scarring, infection, or inflammation. Treatment options include topical corticosteroids or circumcision.
Paraphimosis occurs when the foreskin becomes stuck behind the head of the penis and restricts blood flow to the end of the penis. It can result from a medical intervention, such as the use of a catheter. Paraphimosis is a medical emergency. Without treatment, gangrene can result. Treatment aims to reduce the swelling, but most doctors recommend circumcision after recovery, in order to prevent the condition reoccurring.
Balanitis occurs when the head of the penis becomes inflamed or swollen. This may be due to an STI, thrush, skin irritation, or another skin condition. It is uncommon in circumcised males. Circumcision can prevent balanitis reoccurring.
According to the World Health Organization (WHO), there is “compelling evidence” to suggest that circumcision reduces the risk of contracting HIV during vaginal sex by 60%.
However, they point out that circumcision will offer only partial protection, and they urge people to use barrier methods such as condoms as well.
The higher chance of infection may be because the foreskin becomes more prone to splits and ruptures during intercourse, allowing pathogens to enter the bloodstream.
Another possibility is that the space between the penis and the foreskin might provide an environment in which a virus can survive for a period of time, raising the risk of infection for the individual and their next partner.
Some argue that the U.S. has a relatively high rate of HIV despite high circumcision rates. In addition, the results of studies in Africa and Asia associating circumcision with HIV prevention, mainly in heterosexual populations, may not translate to the U.S.
Circumcision is a relatively safe procedure, and severe complications are rare.
However, the following risks are possible:
- The surgeon cuts the foreskin too short or leaves it too long.
- The wound does not heal properly.
- Blood loss and hemorrhage occur.
- Meatal stenosis occurs. This condition causes the urinary stream to be deflected upward, making it difficult to aim.
- Damage affects the urethra, which is the tube that carries urine through the penis. This can make urination difficult.
- In very rare cases, there may be accidental amputation of the head of the penis.
- Blood infection or poisoning, known as septicemia, may develop.
- The foreskin left behind might reattach to the penis and require further minor surgery.
- There may be a decrease in the sensation of the penis, especially during intercourse.
Complications are more likely when:
- an older male undergoes the procedure
- the procedure takes place in unsterile conditions
- inexperienced or untrained providers carry out the procedure
- the procedure takes place in a traditional manner, as a rite of passage
If a qualified medical professional carries out the procedure in a sterile environment, the risks are minimal.
Psychologists have expressed concern about the psychological effects of male circumcision.
The procedure may be psychologically traumatic, especially to infants, children, and teenagers. Infants often undergo surgery without anesthesia, and this can lead to recurring pain and brain changes linked to mood disorders.
Some males have experienced depression, anger, and intimacy problems stemming from the fact that this procedure took place in infancy without their consent.
Older children can experience a degree of trauma with any surgical intervention, and this is particularly the case if it involves the genitals. In adolescence, it can lead to symptoms of post-traumatic stress disorder.
In males with phimosis, using less invasive methods — such as a corticosteroid cream — may help reduce the risk of anxiety and castration anxiety that circumcision could entail.
Parents and caregivers, as well as older males, can use an online circumcision decision maker to help them decide whether or not to consider the operation.
The area will be bruised and swollen for several weeks, and urination may be painful for a few days or weeks.
Some discomfort normally occurs after circumcision, but the pain is not usually severe, as this is a fairly minor operation. Pain medication can help.
Recommendations for the recovery period include:
- wearing underwear that holds the penis in place, rather than loose-fitting boxer shorts
- drinking plenty of fluids, to dilute the acidity of the urine and reduce pain during urination
- avoiding physical activity until the wound has healed
- not using an antiseptic cream or other cream not provided by a doctor, as this can interfere with the healing process and increase the risk of infection and scarring
Applying a little petroleum jelly to the end of the penis may reduce the stinging sensation during urination.
Erections can also be painful during the recovery phase. To minimize the chance of nocturnal erections:
- Empty the bladder before going to bed, and use the bathroom as necessary during the night.
- Lie on one side, rather than on the back.
- Try drawing the knees up into a fetal position.
Circumcision is usually a simple operation, with a relatively low risk of complications. However, it is not always a simple decision to make.
It is worth remembering that the American Academy of Pediatrics, while recommending circumcision for certain health reasons, note that this procedure should be “for families who choose it,” not a routine operation for all male infants.