Male Circumcision

Male circumcision refers to the removal of foreskin which surrounds a male’s glans penis. This medical procedure—often considered to be the oldest documented surgical procedure1—is mostly performed on infants, but it is not uncommon for circumcision to be performed on adult males as well. While it most likely began as a religious practice1, circumcision has become the norm in many areas of the world for its health benefits, and often for a preference towards the way it looks, rather than for religious obligation. 

 

What Is the Procedure Like? 

Circumcisions, like any surgical procedure, are inherently risky. They should only be performed by a licensed professional in a sterile environment in order to avoid infection and potential lifelong damage to the penis. There are a variety of methods used to perform circumcisions. The methods used for circumcising infant males are generally not the same as those used for circumcising adult males due to the increased risks of the procedure that are associated with age. 

There are three main methods of circumcision used for infant males. These methods include the Plastibell technique, the Gomco clamp, and the Mogen clamp: 

  • The Plastibell technique. This method utilizes a Plastibell, which is a device comprised of a small plastic bell with a rim around it. The size of the Plastibell used will vary depending on the infant who is being circumcised. In this technique, after an incision is made in the foreskin, the Plastibell is inserted directly under the foreskin and over the glans. A string is tied around the rim of the Plastibell in order to cut off blood supply to the foreskin. Then, a scalpel is used to cut off the extra foreskin. The Plastibell is left on until it falls off naturally, about six to twelve days later.1
  • The Gomco clamp.This method is similar to the Plastibell technique. After the foreskin is separated from the glans, a bell-shaped device is placed directly over the glans and under the foreskin. The foreskin is pulled around the device, and a clamp is fastened around it so that blood flow is reduced. Again, a scalpel is then used to remove the foreskin.2
  • The Mogen clamp.In this method, similar to the others, the foreskin is first separated from the head with a probe. It is then pulled out in front of the head and inserted through a slot in a metal clamp. Still held in place inside the clamp, the foreskin is then cut with a scalpel. It remains in place for a short time after being cut in order to ensure that any bleeding is under control.3

Aftercare for infant male circumcision includes applying antibiotic ointment to the wound to protect against infection and aid in the healing process. The wound should be monitored in case signs of infection or bleeding occurs. If the Plastibell technique was used, parents are encouraged to take their children back to the professional who performed the procedure once the ring has fallen off or if it has not fallen off after two weeks.4

There are two popular methods of circumcision for adult males. These include the dorsal slit technique and the sleeve technique. 

  • The dorsal slit technique. This technique is favorable when the reason for circumcision is severe phimosis or paraphimosis. The corona of the glans is identified, and a single slit is made starting from the corona and going along the upper length of the foreskin. The dorsal slit technique is performed to relieve pain, and it is not necessarily a full circumcision.3
  • The sleeve technique. This method may be used in both adult and adolescent males. Unlike the dorsal slit technique, which pulls the foreskin over the head of the penis before the circumcision, the sleeve technique performs the circumcision while the foreskin is retracted. Two circumferential marks are made on the penis—one near the corona and one farther down on the shaft. Then, the foreskin between the two markings is removed. The edges of the two cuts are then stitched together.3

When caring for the wound post-procedure, males should wear loose-fitting bottoms such as sweatpants, boxers, or athletic shorts. The wound should be regularly cleaned for at least a week following the circumcision. It is also important that the male avoids sexual arousal for about six weeks, as an erection might pull at the stitches on the wound and could interfere with the healing process.  

There are complications associated with circumcisions that, although not too common, are experienced by some males either during or after the procedure. The most common complications are bleeding and infection. Beyond those, there are also less common complications: 

  • Pain and/or swelling 
  • Tearing of the stitches, most likely as a result of sexual arousal 
  • Too much skin removed during the procedure 
  • Too little skin removed during the procedure 
  • Damage to the urethra 
  • Formation of a hematoma 

In extreme but very rare cases, complications have included amputation and even death.5However, these are both extremely rare and are often avoided by going to an experienced and licensed medical professional in a sterile environment.3

 

What Is the History of Circumcision? 

Male circumcision has a long history and was most likely started as a religious practice. In fact, one of the oldest mentions of the practice comes from religious texts such as the Torah and the Old Testament of the Bible, which may be dated back to the 6th century BCE. These texts describe Abraham’s covenant with God, in which he promised that he and his male descendants would be circumcised from then on. It is because of this covenant that circumcision is a ritual in Judaism. Male infants from Jewish families are still regularly circumcised on the eight days of their lives in what is called the Bris Ceremony. Beyond Judaism, circumcision is also practiced in Islam. Muslims believe that Abraham’s first circumcised son was Ishmael, one of their prophets and an ancestor to Muhammad. However, the Islamic tradition of circumcision differs from the Judaic tradition in that Muslim families do not necessarily circumcise their sons eighth days after birth. Instead, they might choose to wait up to twelve years, because Ishmael’s foreskin was not removed until puberty.1

Other religions have more complicated histories with circumcision. Different sects of Christianity vary regarding their views on the practice. For example, the Catholic Church’s stance is that circumcision that is not conducted out of medical necessity violates moral law.On the other hand, sects of Christianity that read and follow the teachings of both the Old and New Testaments might be more supportive of the practice, as the Old Testament advocates for circumcision. 

Globally, almost half of males who are fifteen years or older are circumcised.The prevalence of circumcision varies widely depending on each country’s cultural and dominant religion. For example, countries with large Jewish and Muslim populations will have a greater prevalence of male circumcision, while primarily Christian countries might have a smaller prevalence. Another factor that affects circumcision rates is access to affordable healthcare. For example, it has been found that shifts in insurance coverage in the United States may have contributed to a decrease in newborn circumcision from 61.3 percent in 2000 to 56.9 percent in 2010.4

 

What Are Some Health Benefits of Circumcision?

There are many cited health benefits to circumcision. These benefits include the following: 

  • Decreased bacterial infections. Bacterial infections are less common in circumcised males because there are not as many hospitable places for bacteria to accumulate and grow. Circumcised males are less likely to experience urinary tract infections (UTIs) than uncircumcised males because it is not as easy for bacteria to build up and enter the urinary tract without the presence of a foreskin.5
  • Decreased risk of phimosis and other related medical conditions. Phimosis occurs when the foreskin cannot be fully retracted from the head of the penis. This medical condition is commonly attributed to scarring, infection, or inflammation under the foreskin.6Circumcision can proactively eliminate the possibility of phimosis and can even be used to treat the condition depending on the severity of the case.6
  • Decreased risk of HIV. In the last few decades, research has found that circumcision on males lowers the risk of being infected with HIV. In fact, male circumcision may decrease a person’s risk of HIV infection by 50 to 60 percent.7This lowered risk also benefits females and males who engage in intercourse with circumcised males, too, as they are less likely to contract HIV from their partner. However, protection such as male or female condoms should still be used to protect against HIV and other STIs until both partners have been tested
  • Decreased risk of other STIs. Studies have found that the likelihood of contracting other STIs such as human papillomavirus (HPV), mycoplasma, and genital ulcer disease (GUD) is also reduced after circumcision.A connection has even been found between circumcision and a decreased chance of contracting herpessyphilis, and chancroid, although circumcision’s connection to these STIs might not be as strong as its connection to HPV.Again, despite the decreased risk of transmission, protection should still be used during intercourse. 

 

What Are Some Possible Disadvantages of Circumcision? 

There are also some possible disadvantages to circumcision. These include the following: 

  • Possible reduced sensitivity. The foreskin is very erotically sensitive, leading many to fear that circumcision diminishes some of their sexual sensitivity and overall satisfaction. However, research has found that there are no significant adverse effects on sexual function, sensitivity, sensation, or satisfaction that accompany circumcision.10 Still, many uncircumcised males claim that their foreskins give them increased sexual pleasure. 
  • Possible complications during and after surgery. As with any surgical procedure, there are risks that accompany circumcision. The older a male is, the more likely they are to experience complications during their circumcision.11 Because of this, many doctors recommend that circumcisions be performed at an early age. Early circumcision prevents future medical problems and ensures that the procedure will not have to be undergone later in life. However, adverse events—although very low in frequency—are not unheard of when it comes to circumcisions performed on infants. Still, this disadvantage might be seen as significant to some. 

 

How does Male circumcision Compare to Female Circumcision? 

Male and female circumcision are extremely different procedures that cannot be accurately compared. Unlike male circumcision, which has come to be recognized for its health benefits beyond its religious and cultural significance, female circumcision is conducted to keep women sexually inexperienced and “pure” before marriage. It is often extremely detrimental to a female’s health—from the procedure itself to the post-procedure short-term and long-term effects. 

Female circumcision is an incredibly painful process that can partially or entirely remove the clitoris (clitoridectomy), remove both the clitoris and the inner labia (excision), or remove the clitoris, the inner labia, and part of the outer labia (infibulation). Infibulation involves stitching together the remainder of the outer labia so that only urine and menstrual fluid may exit.12 Depending on the tools that are used, females who undergo this procedure may be left open to serious infections and increased risk of HIV. Additionally, while the procedure itself can lead to death due to blood loss or other complications, many of the negative effects of female circumcision are seen post-procedure. Some of these effects include urinary and vaginal infections which can be fatal if left untreated, chronic pain, infertility, and extremely difficult labor.13These may be accompanied by psychological effects such as loss of sexual desire and satisfaction.13From this it can be seen that while circumcision can be very beneficial to overall male health, it carries the opposite effects when performed on females. 

 

Concluding Remarks 

Male circumcision continues to be a controversial issue: many believe there are more benefits to removing the foreskin, while others feel it is better to leave it intact. In the end, both circumcised and uncircumcised males can lead satisfying sex lives. However, when the presence of a foreskin leads to a serious medical condition, circumcision should be considered as a viable option. 

 

References

  1. Jimoh, Bioku Muftau et al. “Plastibell Circumcision of 2,276 Male Infants: a Multi-Centre study.” Pan African Medical Journal, 23(25), 2016. 
  2. Elgendy, Hesham. “Evaluation of Gomco Clamp in Neonate and Early Infant Male Circumcision.” The Egyptian Journal of Surgery, 35(20), January 2016. 
  3. Abdulwahab-Ahmed, Abdullahi, and Ismaila A. Mungadi. “Techniques of Male Circumcision.” Journal of Surgical Technique and Case Report, 5(1), 2013. 
  4. “Newborn Circumcision: Caring for your child at home after the procedure.” About Kids Health, 10 June 2016. 
  5. “The Circumcision Procedure.” My Virtual Medical Centre, 27 July 2018. 
  6. Massry, Shaul G. “History of Circumcision: A religious obligation or a medical necessity.” Origins of Nephrology, 24(17). 2011. 
  7. Clark, Father Peter A. “To Circumcise or Not to Circumcise?” Catholic Health Association of the United States. Journal of the Catholic Health Association of the United States, 2006. 
  8. Morris et al. “Estimation of country-specific and global prevalence of Male Circumcision.”Population Health Metrics, 14(4), 2016. 
  9. Warner et al. “Impact of Health Insurance Type on Trends in Newborn Circumcision, United States 2000 to 2010.” American Public Health Association, American Journal of Public Health, 105(9), September 2015. 
  10. Dubrovsky et al. “Visibility of the urethral meatus and risk of urinary tract infections in uncircumcised boys.” Canadian Medical Association Journal, 2012. 14 May 2018. 
  11. “Phimosis.” UCSF Department of Urology, n.d. 
  12. “Draft CDC Recommendations for Providers Counseling Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, STIs, and Other Health Outcomes.” U.S. Department of Health and Human Services. E1-3. Centers for Disease Control and Prevention. 2 Dec. 2014. 
  13. Friedman, B. et al. “Pros and cons of circumcision: an evidence-based overview.” Clinical Microbiology & Infection, 22(9), 2016. 
  14. “Male circumcision.” Pediatrics 130.3 (2012): E756-785. Centers for Disease Control and Prevention. Web. 8 Jan. 2014. 
  15. Morris, Brian J. and John N. Krieger. “Does Male Circumcision Affect Sexual Function, Sensitivity, or Satisfaction? —A Systematic Review” The Journal of Sexual Medicine, 10(11), November 2013. 
  16. Friedman, B. et al. “Pros and cons of circumcision: an evidence-based overview.” Clinical Microbiology and Infection, 2016.
  17. LeVay, Simon, Janice I. Baldwin, and John D. Baldwin. Discovering Human Sexuality. Sunderland, MA: Sinauer Associates, 2012. Print.
  18. Mahmoud, Manal Ibrahim Hanafi. “Effect of female genital mutilation on female sexual function, Alexandria, Egypt.” Alexandria Journal of Medicine, 52(1), March 2016. 

Last Updated: 14 May 2018.