Guide to Male Circumcision - Procedures, Benefits, and Risks

Understanding Male Circumcision

Circumcision is a procedure to remove the foreskin from the human penis. It is one of the most common surgical procedures globally, with an estimated 37-39% of males worldwide circumcised. The procedure dates back at least 15,000 years with ancient evidence indicating circumcision was practiced in ancient Egypt, Sub-Saharan Africa, and the Middle East.

Circumcision gained prominence in the United States in the late 19th century as a supposed cure for a wide range of conditions including paralysis, headache, epilepsy, malnutrition, and excessive masturbation. By the 1950s, around 90% of American males were circumcised. The rate has declined over recent decades to around 55-65% today.

There has been extensive research into the risks and benefits of circumcision. Potential benefits include lower risk of urinary tract infections, some sexually transmitted diseases, and penile cancer. Risks include bleeding, infection, and loss of sexual function. The American Academy of Pediatrics states potential medical benefits outweigh risks, but stops short of universally recommending routine circumcision.

Types of Circumcision Procedures

There are several methods to perform circumcision. The specific technique used depends on factors like the age of the individual and their personal preferences.

Conventional Circumcision

This is the most common technique used today. It involves using a clamp to grasp the foreskin and guide a scalpel in cutting away the tissue. Stitches may be used to close the skin and stop minor bleeding. This method is quick and effective for newborns and infants.

Gomco Clamp

This uses a specialized metal clamp consisting of a bell, base, and arm. The clamp is fitted over the glans and foreskin, with the foreskin tightened between the base and bell. A scalpel is used to excise the excess tissue above the clamp. It provides good skin margins and hemostasis.

Plastibell Circumcision

Plastibells utilize a plastic ring with handle and deep groove. The ring is fitted between the glans and foreskin, with a thread tied around the ring groove to tightly seal off blood flow. The excess tissue above the ring is removed and the handle later breaks off after 5-8 days.

Preputioplasty

Preputioplasty is less invasive plastic surgery to alter the foreskin without full removal. Excess foreskin may be excised or the opening widened to treat conditions like phimosis. This preserves structure and function better than full circumcision.

Laser Circumcision

This uses focused laser energy to ablate and vaporize penile tissue instead of scalpels. It requires no stitches and causes minimal bleeding, but requires specialized expensive equipment. It also has higher risk of wound margins reattaching during healing.

Circumcision Procedures in Babies and Adults

The procedure for circumcision differs based on the age of the individual:

Infant Circumcision

Infant circumcision is typically performed within 10 days after birth, often within the first 48 hours. The delicate penile skin requires gentle handling to avoid complications. The Plastibell and Gomco techniques are commonly used.

Child Circumcision

Circumcision in young children may be done for religious/cultural reasons or treatment of phimosis. General anesthesia is recommended to prevent psychological trauma. Skin adhesions from infancy must be carefully managed.

Adult Circumcision

Adult circumcisions require advanced surgical skill to account for the larger and more vascular penile tissue. Dissolvable stitches minimize discomfort from removal. Healing takes 4-6 weeks requiring abstinence from masturbation and sex.

Religious and Cultural Circumcision Traditions

Circumcision has significance in several major religions and cultures globally. These traditions help explain the origin and continued prominence of circumcision today.

Judaism

Jewish law based on the Hebrew Bible commands that infant boys be circumcised on the 8th day after birth as a sign of the covenant between Abraham and God. It is seen as non-negotiable and essential for Jewish identity.

Islam

While not discussed explicitly in the Quran, circumcision is widely practiced among Muslims and considered mandatory based on Hadiths and Sharia law. It is seen as promoting cleanliness and purity in the faith.

West Africa

Male circumcision is a traditional rite of passage to manhood in some West African nations like Ghana, Nigeria, and Sierra Leone. It occurs in late childhood to symbolize the transition to adulthood.

Aboriginal Australians

Indigenous groups in Australia have practiced circumcision for thousands of years as a ritual initiation into manhood. Traditional methods included stone tools and cauterization using fire sticks.

The Circumcision Procedure Step-by-Step

The circumcision procedure consists of several key steps that are followed regardless of specific technique used:

1. Preparation

The genitals are cleaned and disinfected thoroughly. Local anesthetic may be injected at the base of the penis for pain management. The amount of foreskin to be removed is estimated.

2. Clamping

A clamp is applied across the penis to tightly seal off blood flow to the foreskin area to be cut. This minimizes bleeding and aids the procedure.

3. Cutting

Guided by the clamp, the foreskin is cut with surgical scissors or a scalpel, removing the excess tissue. Bleeding is carefully controlled.

4. Suturing

Stitches may be applied to close the skin edges for better and faster healing. Suturing is not always necessary.

5. Bandaging

Light sterile bandages are applied over the wound area. These help manage any residual bleeding and protect the sensitive healing skin.

Healing, Aftercare, and Potential Complications

With proper aftercare, circumcision wound healing normally completes without issues in infants within 7-10 days. For older children and adults, healing may extend up to 6 weeks. Potential complications include:

Bleeding

Bleeding is easily controlled during the procedure but can persist afterward. Applying steady direct pressure quickly stops any concerning bleeding.

Infection

Infection is rare but possible if wound care and bandage changing are inadequate. Signs include pus, redness, and fever requiring antibiotics.

Pain

Mild postoperative pain is normal and managed with OTC medication as needed. Severe pain warrants examination for rare complications like hematoma.

Insufficient Skin Removal

Too little foreskin removal can lead to unusual scarring or need for revision surgery later on. The initial amount of skin to remove must be judged carefully.

Curvature

Asymmetry from uneven skin removal may cause curvature of the penis during erections. Prevented by meticulous surgical technique.

The Benefits and Risks of Circumcision

Several potential benefits of male circumcision have been identified, which must be weighed against the risks and ethical concerns regarding consent in children.

Benefits

• Lower UTI risk
• Reduced HIV and STD transmission
• Decreased risk of penile cancer
• Easier genital hygiene

Risks

• Pain, bleeding, infection
• Loss of sexual function
• Psychological trauma
• Ethical issues in children

Research continues on quantifying these factors to better inform public health policies on circumcision. Parents should carefully weigh them in choosing what is best for their child.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.