Adult Circumcision: A Difficult Decision

man thinking Most adult men contemplating circumcision suffer from one of a number of conditions that are best treated by circumcision. But some men opt for circumcision to improve their sex lives or please their partners.

In March 1999, the American Academy of Pediatrics revised its recommendations on infant circumcision to say that there are some health benefits to being circumcised, but these benefits aren't "essential to health" or significant enough to warrant routine infant circumcision. However, some men do encounter a medical need to be circumcised later in life.

Medical Reasons to Be Circumcised as an Adult

"For men who can't retract their foreskin or who have recurrent infections, there's a clear indication," says Ira D. Sharlip, MD, a San Francisco urologist. "Actually, it's not just an indication, it's a need."

Dr. Sharlip says that if men are facing the prospect of circumcision, they are probably suffering from at least one of a number of medical indications.

  • Phimosis

    The number one reason for circumcision after infancy is phimosis , a tightness of the foreskin that prevents it from being retracted. Phimosis can be normal in boys less than six months old. In males older than that, however, it can make urination and hygiene difficult and erection painful.

Paraphimosis In paraphimosis , "the second most common reason for post-infancy circumcision," the foreskin is permanently retracted, constricting the shaft of the penis and causing swelling and pain. Recurrent infections Balanitis (infection of the head of the penis, often caused by accumulation of secretions) and posthitis (infection of the foreskin) can be treated without surgery. 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 foreskin problems Tumors of the foreskin, loose foreskin, and tears in the fold of skin of the penis that attaches to the foreskin are all conditions that can be treated non-surgically. However, tumors of the foreskinwhich occur very rarelyare often managed in part by circumcision
In addition, there has been research published recently that shows that circumcision reduces the risks of HIV transmission. The initial two studies that showed the clear advantage in this regard were done in Africa, where HIV infection is rampant and standard methods of prevention are not widely utilized. In fact, the two studies were stopped early by NIH in light of clear benefit of circumcision. The protection rate is estimated to be about 65% Circumcision for Sexual Reasons In Dr. Sharlip's experience, less than 5% of men who undergo circumcision do so for non-medical reasons. Some of these men are prompted by the request of their sexual partners or by expectations that being circumcised will provide enhanced feeling during sex. One 1997 study found that in comparison to circumcised men, uncircumcised men over 45 years of age are significantly more likely to lack enjoyment of sex, be anxious about their performance, and have difficulty maintaining erection. These differences were not present in younger men. No studies have compared mens sexual functioning before and after circumcision. The Procedure In newborns, circumcision takes only a few minutes, but the procedure in older children and adults is a more intricate operation. General anesthesia for adult circumcision was once routine, but now local pain blocks are usually used, and the procedure itself is usually done on an outpatient basis, even in older men.
If phimosis or paraphimosis has caused a lot of swelling, the circumcision may require two procedures: one to make a slit in the foreskin that relieves the pressure and the pain, and another at a later date to finish the circumcision after the swelling has gone down. The Recovery In most cases, men should refrain from sexual intercourse or masturbation for about six weeks after circumcisionuntil the incisions are healed and the sutures are removed. Some men experience frequent and prolonged erections in the first days after the surgery. After the first 48 hours or so, ointments or bandages aren't usually needed, but wearing loose clothing for a few days is recommended. As with any surgical procedure, bleeding and infection are risks. Rare complications include blood clots, tearing of the sutures (usually due to erections), and complications from the anesthesia. Making the Decision If your medical condition warrants a circumcision, then surgery may be the right choice. But if you're considering the procedure solely for aesthetic reasons, think again. Dr. Al Cooper of the San Jose Marital and Sexuality Center in San Jose, California, warns, "Remember that there is no turning back." He adds that, although a sexual partner may claim to prefer a man with a circumcised penis, your decision to have this procedure should not be based on another person's preference.
RESOURCES: American Academy of Family Physicians http://www.aafp.org/ American Academy of Pediatrics http://www.aap.org/ References Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States:prevalence, prophylactic effects, and sexual practice. JAMA. 1997;277:1052-1057. Sawires SR, Dworkin SL, Fiamma A, Peacock D, Szekeres G, Coates TJ. Male circumcision and HIV/AIDS: challenges and opportunities. Lancet. 2007;369(9562):708-713. Last reviewed February 2007 by Marcin Chwistek, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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