Definition
Circumcision of the man is the removal of the foreskin of the penis. The foreskin is a movable fold of skin that surrounds the glans of the penis. In circumcision, it is partially or completely removed by means of a small operation. While about ten percent of all men in Germany are circumcised, the proportion of circumcised men worldwide is estimated at 30 percent.
Indications
There are various causes for male circumcision, whereby a large part of circumcision is based on religious reasons. For example, circumcision in Judaism is explicitly demanded and scheduled for the eighth day after the birth of a boy. Also in Islam it is customary to circumcise boys in childhood or youth.
From a medical point of view, the indication for circumcision is most often based on an existing phimosis (narrowing of the foreskin), which causes discomfort. The removal of the foreskin by circumcision eliminates the cause of the disease and the quality of life of the affected person can be increased enormously. Another medical cause of circumcision is the treatment of penis cancer, if it has manifested itself on the foreskin of the penis. In addition, although rarely, circumcision on the patient’s request is considered for aesthetic reasons.
Procedure
The surgical removal of the foreskin can be carried out using various techniques. On the one hand, there are procedures that aim at a complete removal of the foreskin (radical circumcision) and on the other hand, circumcision can also be planned in such a way that there are still remnants of the foreskin, which is called a foreskin cuff. This is a small surgical procedure of about 15 minutes duration.
Common to all types of circumcision performed by doctors is the anaesthesia of the operating area. Usually, adults are given a local anaesthetic. Alternatively, the operation can also be performed under general anaesthesia if the patient wishes so.
Immediately before the operation a disinfection of the operating area is performed. This is followed by the actual circumcision. In the most common way of performing the operation, the foreskin is removed in a ring-shaped (circular) fashion with a scalpel.
For this purpose it is pulled over the glans and grasped with a clamp. Then a vertical incision is made in the ring plane with a scalpel until the individually determined length of the foreskin to be removed is reached. This incision is followed by a ring-shaped incision around the glans. After the operation, the patient should rest physically and the wound surface should not come into contact with water for up to three weeks after the operation. Sexual intercourse should also be avoided during this period.
Risks and consequences
Although circumcision in men is associated with only very low risks, general complications can occur, as with any other surgical procedure, for example during general anaesthesia. Pain on the penis or inflammation of the injured skin may occur, so that under certain circumstances a new operation may even be necessary. A further risk is the development of swelling in the freshly operated condition.
In some cases there is also an intolerance to the anaesthetic. The potency remains unaffected by the circumcision and sexual intercourse can be perceived as much more pleasant after circumcision in case of a pre-existing phimosis. The removal of the foreskin reduces the risk of infection, especially against urinary tract infections and HPV (human papilloma virus) infections, because without the foreskin intimate hygiene is easier.
Since the HPV virus is a risk factor for the development of the rare penis cancer, circumcision reduces the probability of developing this type of cancer in men. There is a persistent rumour that circumcised men have a changed sensitivity to touch compared to the time before the operation due to the missing foreskin. This occurs until about one month after circumcision, because the glans is more sensitive. After this time the sensation returns to its original state.
