Circumcision: Discussions
What is circumcision?
It is a fairly common procedure, usually performed on young boys by removing the skin covering the tip of the penis. This is usually done due to social norms, the father of the newborn wanting his baby to mirror his own penis, religious or cultural reasons. (1) Can you imagine that at least 1 in 3 men worldwide are circumcised? That’s a lot of men who got under the knife. (3) Although this procedure has been performed on ⅓ of men in the world, some of it is not even done by medically trained professionals. (3)
The most common side effects of this procedure are infections and bleeding, even then it is still a very prevalent practice all around the world by people in Africa, the Middle East and some parts of Asia. (3) Some studies have cited that the median rates of complications were from 2-6% with any serious adverse events ranging from 0-3%. (3)
For a long time, circumcisions were seen as a way to keep hygienic, helps prevent the risk of disease and keeps a newborn from needing to have a circumcision later on in life due to medical reasons. (2) Although the foreskin is quite attached to the penis, over time this detaches and by six years of age, half of boys can retract this skin. (2)
It is important to note that the foreskin starts to develop intrauterine during the third month of gestation. And although the general purpose of this has been hotly debated, there are some general consensus that it may have been developed in evolution to help keep the glans penis moist in utero and for protection.
One common medical purpose of a circumcision is a condition called phimosis. Phimosis is the restriction of the glans penis by the foreskin due to scarring and thickening. (1) Another medical reason might be when the foreskin and penis are swollen or when there might be a risk of penile cancer due to the shrinkage of the tissue around the foreskin and glans penis. (3). These conditions can really benefit from circumcision as it prevents further damage of the remaining skin around the penis as well as further infections. (1)
Pros of Circumcision:
According to the Canadian Paediatric Society, meta-analysis of multiple studies show that UTIs (urinary tract infections) decreased in at least 90% of infants that were circumcised. Keep in mind that the prevalence of UTIs in infants do decrease with age, with no real difference in risk between circumcised and uncircumcised infants. And the studies of the overall prevalence of UTIs in men in this meta-analysis is limited as it was only studied with a subject size of 78 men. (1) It’s been concluded that the general population of infant boys’ risk of UTIs were about 1-2% which means risk is low. However infant boys’ that have histories of recurrent UTIs or urinary tract physiological anomalies may benefit from a circumcision. (1)
Another benefit of circumcision observed is the decrease in STI transmission of HIV to men. Many large studies done in Sub-Saharan Africa were conclusive to show this. The underside of the foreskin has immune cells called the Langerhans as well as cells targeted by HIV, this has been speculated to increase HIV transmission during sexual intercourse. (1) But just because this is highly observed in multiple studies in Africa, this might not transfer to developed countries with different circumstances (3).
One last documented benefit is the reduction of cancer for the female partners of circumcised partners dependent on the sexual behavioural level of their partner although the risk of cervical cancer in women (in Canada) is less than 0.02%. Penile cancer happens primarily in uncircumcised men and genital hygiene and treatment of men with anomalies is important. (2)
Regardless of circumcision status - the prevalence of HPV with penile cancer is about 80% and to prevent the spread of HPV, vaccination of girls to prevent HPV is the most effective way to decrease risk of cervical cancer and HPV transmission. (2)
Cons of Circumcision
Exposure of newborns to procedural pain may alter their response levels to other procedures such as vaccination later in life. There is that acute risk of infection and bleeding as well, ranging from 1-6%. The risk of disliking the look of the circumcision should be acknowledged as well. (2) Although the foreskin has bundles of sensory nerves, studies do not support that there are negative experiences in men who have gotten circumcised. (2)
As the glans penis is now exposed, there is an increased likelihood of irritation and injury. (4) With the procedure, there is a chance of accidental injury through improper techniques and meatitis (5) - which is an inflammation of the opening of the penis.
Although there are some benefits with circumcision and it is a highly debatable topic in the medical community - most healthcare professionals do not advocate for universal circumcision where it is advised for all populations born with a penis. (4) This is something that should be talked about with your healthcare provider.
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