Definition and Overview

Circumcision is a surgical procedure that removes a male's foreskin, which covers the penis and is composed of muscle tissues and blood vessels. When removed, the opening of the urethra (external urethra orifice or urinary meatus) and the glans penis (the head of the penis) are exposed.

During childbirth, the glans penis is connected to the foreskin, which appears like a double layer of skin since it also folds unto itself. In the middle of the glans penis is a tube from which the meatus urethra can be found and where urine and semen come out. Although the evidence is weak and inconclusive, many believe that the foreskin protects the glans penis and keeps it moist as well as heighten sexual pleasure because of the presence of nerve endings.

Circumcision is optional. In fact, over the last few years, the rate of circumcision in the United States has decreased from 82% in the 1960s to just 77% in 2010. Despite the drop in numbers, latest studies suggest that circumcision offers multiple benefits.

A report released by the Centers for Disease Control and Prevention (CDC) suggests that foreskin tends to increase the risk of HIV infection particularly because it boosts the possibility of a tear, which can be a potential pathway for pathogens like HIV. Moreover, in random clinical trials, viruses that lead to cancer such as cervical, anal, and penile and vulva cancers have been associated with male uncircumcision. Meanwhile, a US study on penile cancer between 1954 and 1997 revealed that at least 95% of the patients were uncircumcised. Circumcision is also believed to lower the risk of urinary tract infections (UTIs).

Who should undergo and expected results

One of the primary reasons for male circumcision is religion. It is required among the Jews and is also practiced by Christians and Muslims. According to Jewish beliefs, God has commanded his people through Abraham that all males should be circumcised. The Bible has also mentioned that Jesus, who is believed to be the Son of God, was presented to a temple for his own circumcision.

In other countries, circumcision has a combination of cultural and religious basis. For example, it can be viewed as a sign of puberty. This will then explain why in other places, it is performed on boys between the ages of 10 and 12 years old.

Nevertheless, the foreskin may also have to be removed due to medical reasons. These include the foreskin's inability to retract due to its tightness (phimosis) and paraphimosis, which happens when the foreskin is pulled back to reveal the glans penis but cannot be pulled down again. Both of these conditions can cause pain in the penis as well as inflammation. Male circumcision may also be needed if the foreskin has become inflamed or the person is diagnosed with penile cancer.

A parent can decide when he wants his child to be circumcised. In most cases, though, it's performed while the child is still a baby, preferably between 2 and 8 days old (8 days old is the best time for male circumcision for those of Jewish faith). This may be delayed if the newborn has a medical condition or is against the advice of the doctor. Health experts tend to agree that the sooner it is carried out, the better, since complications and risks are less.

How the procedure works

Male circumcision may be performed by a pediatrician or urologist. Prior to the procedure, the doctor first checks that the child is well enough for it. If the child is already older, it may be scheduled during the summer when the child has enough time to recover from the surgery.

The procedure can be performed in a hospital or a clinic. If the child is a newborn, it's performed in the nursery treatment room. During the procedure, the child lies comfortably on the table, with his penis exposed. The doctor provides pain blockers on and around the penis, which may be in the form of a cream, suppository, or injection. Depending on the age and condition of the child, either one or a combination of these options can be given.

The doctor can use different methods in removing the foreskin. It may include the use of a bell-shaped device that is inserted around the head and underneath the foreskin, which is then pulled back into the device. A clamp is then used to tighten the device and cut off the supply of blood to the foreskin before it is cut.

Another option is called the Plastibell method, which is very similar to the first technique except that sutures are used to hold the bell-shaped device. The excess foreskin is cut while the device and sutures are kept until the skin falls off because it no longer receives blood supply.

Any blood is cleansed and the wound is covered with gauze. The doctor then advises the child and/or the parents on proper wound management.

Possible risks and complications

Risks and complications are less common in male circumcision and are often minor. These may include infection, which usually occurs due to poor wound management and bleeding. In less-developed countries, the risks are particularly high especially if unlicensed health practitioners perform the procedure.



Reference:

  • American Academy of Pediatrics Task Force on Circumcision. Circumcision policy statement. Pediatrics. 2012 Sep;130(3): 585-6.
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