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What is circumcision?

Circumcision is a procedure to remove the foreskin. The foreskin is a flap of skin that covers the head of the penis (glans) and can usually be pulled back over it. The foreskins main function is as a physical barrier. It protects the head of the glans penis from damage that may occur when clothes rub against it.

It's role in heightening sexual pleasure is hotly debated. Many men believe the movement of the foreskin during foreplay and intercourse enhances their sexual experience, but others believe that being circumcised brings more sexual reward for them and their partners.

Circumcision is often done for religious reasons. For example, in Judaism and Islam, it's an important ritual. Some cultures practice circumcision for hygiene reasons: they see the foreskin as unnecessary or the cause of health problems.

Sometimes, circumcision has to be done for a medical reason. This may be because the foreskin is damaged or infected and will not slide back over the head of the penis. Around 1% of men need a circumcision for medical reasons. In the UK, the number of circumcisions carried out is approximately 6%.

Many people have strong views about whether circumcision should be carried out or not. It's not routinely performed in the UK because there's no clear evidence to suggest it has any medical benefit.

What are the medical reasons for circumcision?

There are three main reasons for circumcision but doctors disagree on how promptly circumcision should be offered as the treatment. Some see it as a last resort; others will suggest it sooner.
  • Phimosis
    In babies, the foreskin and the glans develop as one, only separating during childhood. As a result the infant foreskin is frequently tight and inelastic. Some doctors may suggest circumcision in these circumstances. Others say that generally the foreskin loosens by the age of three and that true phimosis, which affects less than 1% of boys, is very rare before the age of five.
  • If possible, watchful waiting is sensible in suspected phimosis because the vast majority of foreskins loosen themselves naturally. While only 4% of baby boys have a retractable foreskin, 98-99% of 18 year-olds do. The figures are from the British Medical Journal, 1993, the same article that revealed that many surgeons simply cannot tell the difference between an everyday tight foreskin and true phimosis.
  • Balanitis
    In Balanitis the glans and/or the foreskin become inflamed. It can affect men of all ages including boys (most commonly around the age of three or four).
  • Poor hygiene, a tight foreskin, skin disorders allergy to products such as soap or washing powder or to the latex or spermicides in condoms can all damage the skin and, if this becomes infected, Balanitis can develop. Balanitis is not transmitted sexually but a fungus called candida can cause it. Sex may also damage the skin. In adults it may be offered as a treatment if a tight foreskin is making sex painful.

    Can circumcision help prevent cancer?

    There is little evidence of this. Circumcision in childhood - but not as an adult - may reduce the risk of penile cancer but this disease is very rare anyway and the real risk factors are poor personal hygiene and smoking. Indeed, the countries with the highest rates of circumcision (USA, for example) are also those with the highest rates of penile cancer.

    Can circumcision reduce the risk of a sexually transmitted disease (STD) or HIV/AIDS?

    Another controversial area. Some sexually transmitted diseases appear more common in uncircumcised men, others in circumcised men.

    Two particular concerns for circumcised men are that:
  • they are less likely to notice the symptoms of the STD chlamydia - the incidence of which is increasing in the UK - so heightening their risk of passing it on; and,
  • they appear more likely to develop penile warts.
  • As regards to AIDS, the international not-for-profit health organisation the Cochrane Collaboration has reviewed all the research into circumcision and HIV and concluded that there is insufficient evidence to support the idea that circumcised men have less chance of contracting HIV. However, it should be said that not all scientists agree with this.

    What everyone agrees on is that all men can reduce the risk of an STD or HIV by using a condom.

    Is circumcision safe?

    It is generally accepted that there are serious complications in perhaps 2% of medical circumcisions - 1 in 50. (Figures are obviously higher if the surgeon or hygiene practices are below hospital standard.) Complications include bleeding, infection, ulceration and psychological and sexual problems.

    Is it reversible?

    Some men think so. There are videos and packs available which claim to show circumcised men how to restore themselves but these should be approached with caution.

    Are there alternative treatments for a tight foreskin?

    Yes. These include steroid creams, stretching methods and less-invasive surgery such as a preputioplasty. Most physicians will try these before resorting to circumcision.

    Operation details

    The operation is generally carried out under local or general anaesthetic. The foreskin is removed and the skin that remains is sewn to the base of the head of the penis. A circumcised penis has the appearance of an uncircumcised one but the foreskin is pulled back.

    Usually, the patient is discharged the same day but many describe the operation and its aftermath as painful.

    After the operation

    The skin appears red and slightly swollen, and will probably be uncomfortable. Simple painkillers, such as paracetamol, are usually all that's needed to relieve any discomfort. It's also a good idea not to wear underpants to avoid rubbing. The stitches dissolve and disappear after a week or so.

    You should be able to return to school/work after about ten days and play sport after a month.

    If there's any persistent bleeding, swelling, redness or discharge near the stitches, seek advice from your doctor or nurse.