08 December 2008

The lowdown on circumcision

An expert looks at circumcision, phimosis, paraphimosis and balanitis.

Circumcision is a safe procedure. For adult men, it is usually performed on an outpatient basis with local or regional anesthesia.

The health care professional (often a urologist) will inject anesthetic around the base of the penis to numb the entire genital region. Once the area is numbed, the foreskin covering the glans is removed, usually by electrocautery. Stitches close the area from which the skin has been removed, and the penis is wrapped in gauze bandages that are typically left in place for the first 24 to 48 hours after the procedure.

Barring any complications, a man can go back to his normal routine within a day or two after circumcision, but needs to refrain from all sexual activity, including masturbation, for four to six weeks, since erection can dislodge the stitches and interfere with healing.

Potential complications of adult circumcision include infection, bleeding or bruising, the removal of too much or too little skin, or dissatisfaction with penile appearance. In addition, some men who've been circumcised as adults report altered sexual feeling, including decreased penile sensitivity and changes in sexual response and arousal patterns. You might want to think about how changes in the appearance and/or sensitivity of your penis could affect you before choosing to be circumcised.

Men are often circumcised for religious, social, or cosmetic reasons. Some believe that circumcised penises are easier to clean or are more appealing to potential sexual partners, and can decrease cervical cancer risk in women who have sex with "cut" men. Adult men also might become circumcised for medical reasons; for example:

This is when the foreskin cannot be properly retracted (pulled back) over the glans (head of the penis). This naturally occurs in infants and young boys who are not circumcised, usually resolving on its own with age. If this condition remains in adulthood, some men may develop a tight ring of scar tissue around their foreskin that makes retraction difficult, and can make erections and sex painful.

With this condition, the foreskin that has been retracted over the glans becomes "stuck" and cannot be returned to its natural position. Paraphimosis can occur when foreskin is forcibly retracted (during sex, bathing, or medical procedures) and then not returned to its normal position. Penile piercings can cause this condition if the placement of the piercing causes irritation to the glans or forces the foreskin to stay retracted. Paraphimosis can cause swelling and an interruption of the blood supply to the glans, and is a medical emergency that can require immediate circumcision to save the tissue of the penis.

An inflammation of the glans, balanitis is often caused by phimosis or lack of proper hygiene that allows smegma or other discharge from the penis to accumulate underneath the foreskin. This can cause recurrent penile or urinary infections that might be treated with circumcision.

As with any medical procedure, it's important to talk candidly with your health care provider about the potential benefits and possible complications to the procedure before you make your decision.(Dr Elna McIntosh, Health24 sexologist)

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