Adult Circumcision: A Difficult Decision

Medical Reasons to Be Circumcised as an Adult

"For men who can't retract their foreskin or who have recurrent infections, there's a clear indication," says Ira D. Sharlip, MD, a San Francisco urologist. "Actually, it's not just an indication, it's a need."

Dr. Sharlip says that if men are facing the prospect of circumcision, they are probably suffering from at least one of a number of medical indications.

• Phimosis

  The number one reason for circumcision after infancy is phimosis , a tightness of the foreskin that prevents it from being retracted. Phimosis can be normal in boys less than six months old. In males older than that, however, it can make urination and hygiene difficult and erection painful.

• Paraphimosis

  In paraphimosis , "the second most common reason for post-infancy circumcision," the foreskin is permanently retracted, constricting the shaft of the penis and causing swelling and pain.

• Recurrent infections

  Balanitis (infection of the head of the penis, often caused by accumulation of secretions) and posthitis (infection of the foreskin) can be treated without surgery. As a first measure, a urologist will likely prescribe an anti-fungal and anti-inflammatory ointment, which may help clear up the problem; there is often an associated yeast infection, which thrives in the warm, moist environment created beneath the foreskin. Unfortunately, these conditions often recur, and when they do, a circumcision is advisable.

• Other foreskin problems

  Tumors of the foreskin, loose foreskin, and tears in the fold of skin of the penis that attaches to the foreskin are all conditions that can be treated non-surgically. However, tumors of the foreskin—which occur very rarely—are often managed in part by circumcision

In addition, there has been research published recently that shows that circumcision reduces the risks of HIV transmission. The initial two studies that showed the clear advantage in this regard were done in Africa, where HIV infection is rampant and standard methods of prevention are not widely utilized. In fact, the two studies were stopped early by NIH in light of clear benefit of circumcision. The protection rate is estimated to be about 65%

Circumcision for Sexual Reasons

In Dr. Sharlip's experience, less than 5% of men who undergo circumcision do so for non-medical reasons. Some of these men are prompted by the request of their sexual partners or by expectations that being circumcised will provide enhanced feeling during sex. One 1997 study found that in comparison to circumcised men, uncircumcised men over 45 years of age are significantly more likely to lack enjoyment of sex, be anxious about their performance, and have difficulty maintaining erection. These differences were not present in younger men. No studies have compared mens’ sexual functioning before and after circumcision.

The Procedure

In newborns, circumcision takes only a few minutes, but the procedure in older children and adults is a more intricate operation. General anesthesia for adult circumcision was once routine, but now local pain blocks are usually used, and the procedure itself is usually done on an outpatient basis, even in older men.

If phimosis or paraphimosis has caused a lot of swelling, the circumcision may require two procedures: one to make a slit in the foreskin that relieves the pressure and the pain, and another at a later date to finish the circumcision after the swelling has gone down.

The Recovery

In most cases, men should refrain from sexual intercourse or masturbation for about six weeks after circumcision—until the incisions are healed and the sutures are removed. Some men experience frequent and prolonged erections in the first days after the surgery. After the first 48 hours or so, ointments or bandages aren't usually needed, but wearing loose clothing for a few days is recommended.

As with any surgical procedure, bleeding and infection are risks. Rare complications include blood clots, tearing of the sutures (usually due to erections), and complications from the anesthesia.

Making the Decision

If your medical condition warrants a circumcision, then surgery may be the right choice. But if you're considering the procedure solely for aesthetic reasons, think again. Dr. Al Cooper of the San Jose Marital and Sexuality Center in San Jose, California, warns, "Remember that there is no turning back." He adds that, although a sexual partner may claim to prefer a man with a circumcised penis, your decision to have this procedure should not be based on another person's preference.