Circumcision - Risks and Benefits

Circumcision is a surgical procedure, often performed in children, in which the foreskin is removed, the skin that covers the glans (head of the penis).

Historically performed for religious reasons, circumcision has become increasingly common for reasons of hygiene and for being a procedure that reduces the incidence of urological diseases.

Circumcision operation
Circumcision operation

What is the foreskin?

The foreskin is that layer of retractile skin that covers and protects the glans, popularly known as the head of the penis. It has two faces, the external one composed of common skin, and the internal one, facing the glans, which is a mucosa responsible for keeping the penis hydrated and protected against aggression from the external environment.

The foreskin, in adults, covers the glans when the penis is flaccid, but retracts when it is erect.

This skin that covers the penis begins to be formed already in the first weeks of development of the fetus. From birth to the first years of man's life, the foreskin is attached to the glans, a process called physiological phimosis.

With growth, the internal region gradually detaches itself from the glans until it is completely retractable when the penis is erect. It is not necessary to force the detachment of the foreskin in the children, since the same occurs naturally with the passage of the years.

Why is circumcision done?

Circumcision is one of the oldest surgical procedures of mankind, and there have been reports of practice among Egyptians over 15,000 years ago as a way of increasing male hygiene and "purifying the soul".

Circumcision, although it is a surgical procedure, is still often performed on the basis of tradition and religion, although there is no need for medical advice, such as the routine circumcision of Jewish and Muslim children.

In the late nineteenth and early twentieth centuries, circumcision began to become a common medical procedure, even in families with no religious motivation. In some countries like USA and Korea, more than 80% of the male population is circumcised (note: circumcised term does not exist). It is good to make it clear that, despite the known benefits - which will be explained later - the world's leading pediatric societies do not recommend routine circumcision without medical advice.

Circumcision by medical indication is usually done in cases of penile infection (balony-postitis) or pathological phimosis, that is, absence of foreskin retratillation in older children and adolescents.

Benefits of circumcision

Circumcision, when done in childhood, has some benefits, among them, we can mention:

a) Reduction of urinary tract infections

A urinary tract infection in men is uncommon, but occurs more often in children not circumcised because of favoring the growth of bacteria in the secretions stored in the foreskin.

Note: smegma is a species of white mucus composed of exfoliated cells and fat that can accumulate under the foreskin.

b) Reduction of penile infections

The balanitis (glans infection) and the postitis (foreskin infection) also occur less frequently in circumcised children.

c) Reduction of penile cancer and cervical cancer in the partners

Circumcised men have a lower risk of having penile cancer. However, it is worth noting that this disease is also rare in uncircumcised patients (about 1 case per 100,000 people). This benefit only exists when circumcision is done even in childhood. Men circumcised after adolescence do not have lower rates of penile cancer.

In addition to the reduction of penile cancer, partners of circumcised men who do not present a history of promiscuity have a lower rate of cancer of the cervix. The explanation seems to be that uncircumcised men are at increased risk of contamination and transmission of HPV.

d) Reduction of STD and HIV

In addition to HPV, circumcised men have a lower rate of contamination by other STDs, namely trichomoniasis and HIV.

Curiously, circumcision does not provide evidence of protection against gonorrhea and there are conflicting data regarding syphilis.

Risks of circumcision

Circumcision is a surgical procedure that, as such, has risks. However, surgery is quick and simple (lasts about 10 minutes) and has surgical complication rates below 0.5%. The most common complications are bleeding, infection and dissatisfaction with the aesthetic result.

Circumcision, like any other surgery, should be done under anesthesia, preventing the child or even the adult from feeling pain during the procedure.

Loss of sensitivity after circumcision

The mucosa of the foreskin is very innervated and contributes to the sensation of pleasure. One of the arguments against circumcision without medical indication is the risk of penile sensitivity reduction. However, despite the logic behind this theory, the fact is that, in practice, circumcised men do not exhibit less satisfaction with their sex lives.

Even in men who have undergone circumcision only when adults and with an active sex life, there is no conclusive evidence that there are changes in the quality of their sexual life. There are personal reports of decreased sensitivity, however, there are also scientific studies with large groups, which show no changes in the quality of sex. It is a controversial subject.

The fact is that circumcision in children, with no formal medical indication, is currently a controversial procedure. There are groups against circumcision that have the following arguments:
  • Circumcision causes pain in newborns bringing unnecessary stress to the baby.
  • The trauma of circumcision performed when a baby is born for the rest of his life, even if the individual does not realize it.
  • Circumcision goes against human rights, for it mutilates a being incapable of making decisions.

The position of most Pediatric Colleges is not to indicate circumcision for no clear medical reason. However, there are no contraindications to their realization for personal or religious reasons.

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