Circumcision

The oldest and the most commonly performed surgical procedure. About one third of the world’s males are circumcised, mostly for religious or cultural preferences. In this procedure, part of the foreskin is removed. While clearly not essential, it does have proven health benefits. Circumcised boys are much less likely to acquire urinary tract infection by up to 90%. Circumcised men are much less likely to have a sexually transmitted disease (STDs), in the case of HIV by up to 70% in a single unprotected encounter. Some of the benefits of reducing the spread of STDs is clearly transferred to the female side of the society. Studies in countries with similar cultural mix and differences in the rates of male circumcision shows that females are a lot less likely to have cancer of the cervix, which is related to HPV infection. Also, circumcised men are much less likely to have cancer of the penis, which happens in the elderly.

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Circumcision is still a surgical procedure and carries small risks which are very minimal in expert hands. It is preferably done in the first three months of life as the procedure is simple, can be done under local anesthesia, and the aftercare is easy. Sometimes this is not possible due to anatomical or logistical reasons. Later, it usually requires general anesthesia.

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Reasons not to do circumcision early include deformities of the penis such as a twist or a curvature or abnormal skin attachments or buried penis or hypospadias. In such circumstances, circumcision is better deferred to a later date when it can be done under general anesthesia and all such abnormalities corrected. This is usually done after 6-9 months of age.

 

There are many surgical techniques and devices to perform circumcision, but the ones mostly applied by Dr Ba’Ath are Plastibell (the ring) for the neonatal period, or free hand circumcision later in life. Both give excellent outcomes when applied correctly and should leave no suture marks on the penis. Many people call sutureless circumcision “laser”, which is a misnomer.

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Two common problems seen after early circumcision are glanular adhesions and apparent buried penis. Both are transient problems that resolve spontaneously. Dr Ba’Ath made two education videos about these common problems that can be accessed on his YouTube channel on these links:

 

Buried penis after circumcision

 

Glanular adhesions after circumcision

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Circumcision has little-known long-term effects. The removal of the foreskin can potentially reduce sensation in the penis, but this does not seem to lead to impotence or erectile dysfunction. There is some evidence that circumcised men take slightly longer to climax during intercourse but most participants in medical studies thought about this as an advantage.