Male circumcision has been performed for many centuries for a variety of reasons, many of which are non-medical in nature. Although there are few instances when a circumcision is an absolute necessity, there is increasing evidence that supports the practice. These include things such as fewer infantile urinary tract infections, lower rates of penile cancer and decreased risk of sexually transmitted infections, including HIV transmission.

Circumcision is one of the earliest surgical procedures known to man. Historically it has been performed for a variety of cultural, religious and social reasons. In early Egypt, it was performed prior to a man becoming part of the priesthood. In the Jewish faith, circumcision is a commandment and in Islam, circumcision is considered a rule of cleanliness.

It was not until the 19th century that the concept of circumcision evolved from a ritualistic act to a procedure associated with medical benefits. Some articles from the 19th century indicated that being circumcised would provide better health, greater capacity to have children, longer life and fewer doctor bills.

Some early physicians felt the constriction of the penis led to irritation that caused general anxiety disorders.

For some adult men, the benefits of circumcision are obvious, such as in cases of severe phimosis, a condition in which the foreskin can no longer be retracted backwards during urination leading to chronic inflammation.

In some situations, this can lead to an acute inability to pass urine.

Overtime, the inability to retract the foreskin makes daily hygiene difficult. This chronic inflammation leads to changes to the foreskin, including some precancerous conditions.

As stated above, there is substantial evidence that being circumcised offers prevention in penile cancers and cervical cancers in women. Human papilloma virus has recently come to light as a major risk factor for the development of certain gynecologic malignancies as well as cancers of the head and neck.

Circumcised men are at less risk of developing penile HPV infections. There is also less risk of developing syphilis and herpes simplex virus in circumcised men.

In parts of sub-Saharan Africa where HIV infections have reached pandemic levels, there have large public health initiatives in recent years attempting to promote male circumcision because of studies that have shown that the procedure could be instrumental in reducing transmission of HIV/AIDS in heterosexual couples.

Circumcision in adult men is a surgical procedure most commonly performed in the operating room. Like all surgeries, there is potential for complications and risks associated with anesthesia.

Thus, not all men need to be circumcised. Those that are not should retract the foreskin daily while bathing in order to clear skin secretions which can accumulate over time to create risk factors for the aforementioned conditions and complications.

Dr. Jay Carpenter is a practicing urologist at Red River Urology in Paris. His health articles are published every other Friday.

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(1) comment


First off, I'd like to say that I am deeply disappointed in the editor's irresponsibility by platforming this piece of native advertising.

I have four points of contention with Dr. Carpenter: infectious disease, physical ailments, non specificity of circumcision, and ethics.

Dr. Carpenter entirely avoids the question of morality in his article. He implies that the procedure is justified by the alleged and contested health benefits that have been manufactured in the last fifty years. Where is his condemnation for the American doctors who performed the procedure before the world first understood the viruses of Syphilis in 1932(by performing human experimentation on poor, illiterate, rural, black men), of HPV in 1977, HIV in 1981? The Nobel Foundation awarded Dr. Harald zur Hausen with a Nobel Prize for his work in HPV and cervical cancer. In interviews about fighting the virus, he recommends condom usage and publicly funded health checks. Nowhere has he said circumcision is a good measure for public health. Send him an email if you want to know more The media parrots circumcision and HIV talking points as does Dr. Carpenter. When you apply a thimbleful of scrutiny to the HIV health claim, you get a gallon of doubt. Eric Clopper of Colgate and Harvard University found in at least one RCT that took place in South Africa, the men who had their foreskin severed also were taught to use condoms, something the men who were left whole did not. We know condoms are protective against HIV transmission. In essence, the researchers cheated and got the result they wanted. I invite you to compare the rate of HIV prevalence in the USA and India. We have every conceivable advantage over them. Higher standard of living, easier access to condoms, education, a religious history that has a negative view on extramarital amorous congress, and a circumcision rate that is nearly 800% of India's rate of circumcision! You will find that we have the same prevalence of HIV infection 0.3%. The issue of STIs is more complicated than the solution presented by the scar of circumcision.

This article does not answer how parents are supposed to care for their son. The condition mentioned, phimosis, may even be caused by forced retraction of the foreskin. Dr. Carpenter fails to even mention conservative treatments of phimosis. Watchful waiting, stretching, topical medications, and preputioplasty are nowhere to be found.

Dr. Carpenter is uncritical in his appraisal of the different forms of circumcision and the different professions that carry them out. Nurse Practitioners and medical doctors have different rates of complication. You can find endless information of boys in Sub Saharan Africa that have lost their member and in many cases their lives due to circumcisions. This happens to a limited extent in our country. Dr. Aaron Davidson lopped off a significant portion of his infant patient's member in two separate occasions in 2013 and 2018! Further, should we cut off the frenulum? A third of circumcised men lose this anatomical feature while the rest retain it. Should we get the circumcision done with metzizah b'peh? There are no guiderails whatsoever in this piece.

I'll rattle off a few child body modifications. Circumcision, subincision, superincision, pricking. The onus is on adults in America to take out our cultural garbage. To keep sharp objects away from children. Get informed, get indignant, get politically organized.

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