When is adult circumcision necessary?
September 20, 1999
Web posted at: 10:23 AM EDT (1423 GMT)
By Steven N. Gange, M.D.
Adult circumcision is not uncommon, though it's also not something a doctor will advise unless a man is experiencing certain health problems, such as balanoposthitis, inflammation of the head of the penis and overlying foreskin, or phimosis, difficulty retracting the foreskin. Both problems are seen more commonly in diabetics, but can occur in any uncircumcised man. They are caused by chronic irritation and scarring and can usually be prevented with careful cleaning beneath the foreskin.
As a first measure, a urologist will likely prescribe an anti-fungal and anti-inflammatory ointment, which may help clear up the problem -- there is often an associated yeast infection, which thrives in the warm, moist environment created beneath the foreskin. Unfortunately, these conditions often recur, and when they do, a circumcision is advisable.
Other reasons for an adult circumcision
In addition to balanoposthitis and phimosis, several other conditions can prompt a man to become circumcised:
Paraphimosis is the inability to position the foreskin back over the head of the penis after it has been retracted; this is usually associated with phimosis and can be a surgical emergency since blood flow to the head of the penis can become impaired.
Genital warts (condylomata) can become quite large and unresponsive to topical medications, and if located on the foreskin, may be best treated with circumcision.
Penile cancer, if caught early enough, may be treated with circumcision (interestingly, penile cancer virtually never occurs in circumcised men).
Finally, many men ultimately request circumcision for cosmetic reasons only; they (and their partners) seem to prefer the appearance of the circumcised penis.
What happens during an adult circumcision
Undergoing a circumcision as an adult can be intimidating, but it is generally safe. The procedure is usually performed under general anesthesia, but it can also be performed under local. Healing can potentially be complicated by nocturnal erections, which put pressure on the incision and can cause bleeding (this is usually self-limiting, but can create swelling and bruising). Diabetics have a greater risk of postoperative infection, which is generally a low risk after this surgery.
Effects of a circumcision on sexual stimulation
A circumcision can affect penile sensitivity and sexual stimulation. The most sensitive area of the penile skin is the frenulum, the area just below the head of the penis on its underside. Even with efforts to preserve as much of this skin as possible, some men notice less sexual satisfaction after circumcision. All that having been said, urologists successfully perform many medically necessary -- and cosmetic -- circumcisions in men every year. Because problems are often seen in adults, some urologists are admittedly biased toward neonatal circumcision.
The circumcision controversy
Generally, pediatricians or family physicians perform circumcisions during the newborn period. The most recent statement on circumcision from the American Academy of Pediatrics (March 1999) asserts: "There are potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision," but adds, "It is legitimate for the parents to take into account cultural, religious, and ethnic traditions, in addition to medical factors, when making this choice." As a result of this stance, there has been a decline in circumcision in newborn males in the United States from 90 percent (in the early 1970s) to approximately 60 percent. This still equates to 1.2 million newborn circumcisions done at a cost of $150 million to $270 million annually, according to Reviews in Urology, 1999.
There are indeed potential risks and benefits to neonatal circumcision. Risks include adhesions or skin bridges and meatal stenosis (narrowing of the penile opening). Some potential benefits include simpler hygiene; a significantly decreased risk of pediatric urinary-tract infection; a less-significantly decreased risk of penile carcinoma; and potential protection against STDs (including HIV). More often than not, parents make a decision about their son's circumcision based more on social or religious tradition than on these medical considerations. In most cases, proper hygiene can allow most uncircumcised boys to grow into adulthood without problems. For those who develop problems, adult circumcision is a safe and effective treatment option.
Steven N. Gange, M.D., is a urologist at the Western Urological Clinic in Salt Lake City, UT.Copyright 1999 WebMD, Inc. All rights reserved.
RELATEDS AT :
American Academy of Pediatrics: New Circumcision Policy
American Medical Association: Men's Health
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