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.