Circumcision is a process that involves surgical removal of the foreskin, i.e. the skin covering the tip of the penis. Circumcision is usually performed for religious or cultural reasons but in some cases, may be performed as a health care measure.
For newborns, the procedure is usually carried out within one to ten days of birth. The penis and surrounding areas are cleansed, followed by application of an anesthetic which may either be injected or applied as a cream. A clamp is attached to the penis and the foreskin is removed using scissors or a scalpel or other suitable surgical equipment. The procedure does not take longer than five to ten minutes.
The procedure is similar for older children and adults. However, a general anesthetic may be used for them for pain management. In adults, the procedure may take around one hour.
Healing process and precautions
The healing process usually takes seven to ten days in newborns but may take from four to six weeks in adults. The penis could be red and swollen after the procedure and painkillers may be required to relieve pain for a few days.
It is advisable to follow certain precautions after circumcision, for instance, practising good hygiene, dressing babies in loose clothing to avoid irritation, and applying anti-bacterial cream. Slightly older kids may be advised not to sit on bikes or other toys that may directly put pressure on the affected area. Adults are advised abstinence from intercourse for a few weeks till the wound heals.
Routine circumcision may be performed for religious or cultural reasons. It is entirely a matter of personal or familial choice and is prevalent in the Middle East, United States, Canada and some parts of Africa. It is relatively uncommon in Europe, Asia and Latin America. Such circumcision is performed in newborn children soon after birth.
In older children and males, the procedure may be performed to avoid or treat certain medical conditions. These include:
Phimosis: Phimosis is the inability to retract or pull back the foreskin, and may be present at birth or caused due to an infection or injury. Removal of the foreskin is one of the ways to treat it.
Paraphimosis: This is a condition whereby the foreskin once pulled back (retracted), cannot be returned to its original position. Since paraphimosis can lead to blockage of blood supply in the area, this is considered a medical emergency and can lead to complications if left untreated. Paraphimosis may develop as a result of certain medical procedures, such as cystoscopy (thin tube with a camera inserted through the penis into the bladder), or urinary catheterization.
Balanitis: This condition is inflammation of the foreskin due to a bacterial infection. It is usually treated through antibiotics but circumcision may be recommended in recurrent cases.
Urinary tract infections: Research has suggested that circumcision reduces the risk of contracting urinary tract infections. Many such infections are believed to be caused by bacteria inside the foreskin.
Sexually transmitted diseases (STDs): It is believed that circumcision reduces the risk of contracting certain types of STDs, such as HIV, HPV (human papilloma virus), genital herpes, syphilis, and chancroid. Research suggests that superficial layers of the penis contain certain cells that attract HIV cells. Removal of the foreskin, thus, may reduce the risk of HIV in heterosexual males. Similarly, it is believed that the foreskin provides a conducive environment for syphilis and chancroid bacteria to grown, and its removal may reduce risk of such diseases. However, circumcised or not, it is important to maintain safe sexual practices.
Penile cancer: As many cases of penile cancer develop in the foreskin, it is thought that circumcision reduces risk of developing it. Penile cancer is very rare. However, persons with a family history of cancer of the penis or weakened immune systems may sometimes be advised to undergo circumcision.
The major risks associated with circumcision are infection and bleeding. There may be cases where too much or too little foreskin has been removed. Other than that, circumcision when performed by a medical practitioner does not pose too many risks. Circumcision also does not appear to have an adverse impact on sexual activity.
In some rare cases, the procedure may lead to complications, such as decrease in sensation, damage to the urethra causing difficulties in urinating, blood infection.
Circumcision should not be performed in newborns born with physical abnormalities that require surgical correction as the foreskin could later be used during reconstructive surgery. Also circumcision may not be advisable for prematurely born babies or those with special medical conditions.
With advancement in medical science, the necessity of performing routine circumcision on newborns has been contested by many who contend that the procedure does not appear to provide substantial benefits. Unless required to treat one or more medical conditions, the matter remains largely one of a personal choice.