Circumcision is an operation to remove a male's foreskin. It is one of the oldest and most common surgical procedures, often performed on infants, for religious, social, medical, and 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. However, not all health authorities agree, and the recommendations remain somewhat controversial.
Fast facts on circumcision
Here are some key points about circumcision. More detail is in the main article.
- The first circumcisions may have been carried out 15,000 years ago.
- It is relatively common in the United States (U.S.) but less common in other western countries.
- Circumcision of a newborn takes 5 to 10 minutes.
- An adult circumcision procedure takes around 1 hour and recovery takes 2 to 3 weeks.
- Circumcision may reduce the risk of developing HIV and other health problems.
- Judaism, Islam, and a number of other religions advocate circumcision.
Circumcision involves the removal of the foreskin of the penis.
The foreskin is the shroud of skin that can be gently pulled back to uncover the head of the penis.
The surgery is relatively simple.
The foreskin is freed from the head of the penis and, in a child, it is clipped off, in a procedure taking 5 to 10 minutes in total. In adults, it is removed with a scalpel, and it takes around 1 hour.
The wound is then either cauterized or stitched with dissolvable sutures.
The first circumcisions may have taken place 15,000 years ago. It 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. It may have been more common then due to sand building up under the foreskin.
Circumcision became popular in the Western world in the late 19th century, when it was carried out in an effort to prevent masturbation. This was believed to underlie a range of conditions, including epilepsy, paralysis, tuberculosis, and insanity.
However, there was little compelling evidence to support these claims. As the newly-formed national health care systems faced rising costs, it was dropped as a recommendation.
In the U.S., however, it has remained a relatively common practice, and some major health authorities encourage it.
A number of factors are associated with neonatal circumcision.
The most common are:
- health considerations
In very rare cases, balanitis or phimosis can occur in an uncircumcised male. With these conditions, the foreskin cannot be retracted. They require surgical treatment.
Cancer of the penis is extremely rare, but it appears to be slightly more common in men with a high body mass index (BMI), a history of smoking, men who are uncircumcised, or a combination of these factors. However, it has been estimated that 300,000 circumcisions may be required to prevent one penile cancer per year.
According to the World Health Organization (WHO) there is "compelling evidence" that circumcision reduces the risk of contracting HIV during heterosexual sex by 60 percent.
However, they point out that circumcision will offer only partial protection, and they urge men to use condoms as well.
The higher chance of infection may be because the foreskin becomes more prone to splits and ruptures during intercourse, leaving an open door for 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.
From 2008 to 2014, new infections with HIV fell from 45,700 to 37,600. Of these, 26,200 new cases were among men who were gay, bisexual, or other men who have sex with with men.
Circumcision is performed less often 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 be recommended in some circumstances:
Phimosis involves an 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 because of scarring, infection, or inflammation. Treatment options include topical corticosteroids or circumcision.
Paraphimosis is when the foreskin is stuck behind the head of the penis and restricts the 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 circumcision is recommended after recovery, to prevent a reccurence.
Balanitis is when the head of the penis becomes inflamed or swollen, due, for example, to a sexually transmitted infection (STI), thrush, skin irritation, or another skin condition. It is uncommon in men who have been circumcised. Circumcision can prevent a recurrence.
Circumcision is a relatively safe procedure, and severe complications are rare.
The following risks are possible:
- The foreskin is cut too short or left too long.
- The wound does not heal properly.
- Blood loss and hemorrhage occur.
- Meatal stenosis results, in which the urinary stream is deflected upwards, making it difficult to aim.
- Damage affects the urethra, the tube that carries urine through the penis, making 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 the procedure is carried out:
- on older males
- in unsterile conditions
- by inexperienced or untrained providers
- in a traditional manner, as a rite of passage
If a qualifed medical professoinal carries out the procedure in a sterile environment, the risks are reduced.
Psychologists have expressed concern about the CDC's encouragement for male circumcision.
They argue that the intervention is psychologically traumatic, especially to infants, children, and teens. Infants, they say, often undergo surgery without anesthesia, and this can lead to recurring pain, and may lead to brain changes that are linked to mood disorders.
A number of men have experienced depression, anger, and intimacy problems, stemming from the fact that their genitals were changed in infancy without their consent.
Older children experience a degree of trauma with any surgical intervention, and particularly if it involves the genitals. In adolescence, it can lead to symptoms of post traumatic stress disorder (PTSD).
Those who do not undergo the operation may feel that their bodies or genitals are somehow "bad" or "inferior," say the psychologists.
Parents to use an online circumcision decision maker to help them decide whether or not their child should undergo the operation.
The affected area will be bruised and swollen for 2 to 3 weeks, and urination may be painful for a few days or weeks.
Some discomfort will normally occur 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 urine and reduce pain on urination, which can be painful in the first few days or weeks after circumcision
- avoiding physical activity until the wound has healed, normally 3 weeks for older boys and men
- not using an antiseptic cream or other cream that has not been prescribed, as this can interfere with the healing process and increase the risk of infection and scarring
A dab of petroleum jelly on the end of the penis may help reduce the stinging sensation during urination.
An erection can be painful during the recovery phase. To minimize the chance of nocturnal erections:
- Empty the bladder before retiring, and using the bathroom as necessary during the night.
- Lie on one side, rather than on the back.
- Try drawing your knees up into a fetal position.
Circumcision is normally a simple operation, with a relatively low risk of complications. However, it is not always a simple decision.
It is worth remembering that the American Academy of Pediatrics (AAP), while recommending circumcision for health reasons, note that this should be "for families who choose it," and not a routine operation for all male infants.