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Adult Circumcision: A Delicate Decision Weighing Pros & Cons

Dr. Lisa Lawless

Dr. Lisa Lawless, CEO of Holistic Wisdom
Clinical Psychotherapist: Relationship & Sexual Health Expert

Banana Used To Show Circumcision

What We Will Cover

The decision to undergo circumcision as an adult is one rife with personal, cultural, and medical nuances. Circumcision is a medical procedure as ancient as civilization and continues to be a topic of immense debate. Delving into the intricate web of cultural, religious, medical, and personal beliefs surrounding this practice, this guide will shed light on the myriad aspects of adult circumcision.

While some consider it an essential rite of passage or a medical necessity, others view it as an unnecessary intervention or genital mutilation. Let's dive in to unravel the complexities and controversies surrounding circumcision.

Basic Penis Anatomy

The foreskin provides ample loose skin for the penis to occupy when erect. It is a movable skin sheath for the penis during intercourse, reducing chafing and the need for artificial lubricants, and allowing the glans and foreskin to stimulate each other naturally.

What Is Circumcision?

Circumcision is the surgical removal of the sleeve of skin and mucosal tissue that usually covers the glans (head) of the penis. This double layer, sometimes called the prepuce, is more commonly known as the foreskin.

The decision to circumcise is often influenced by religious, cultural, ethical, and personal beliefs. Some groups oppose circumcision on ethical grounds, arguing that the procedure should not be performed on infants or children who cannot provide informed consent.

Circumcision Diagram

Why Are Men Born With Foreskin?

The evolutionary purpose of the foreskin is debated among scientists. It's hard to know with certainty why the foreskin evolved as it did. One possible function of the foreskin was to protect the head of the penis from long grass, shrubbery, etc., when humans wore no clothes thousands of years ago.

The foreskin allows the tip of the penis to stay moist to allow quick penetration vaginally, where lengthy foreplay and intercourse would be a danger to one's survival. The risk from predators and human enemies was greater the longer they were engaged in sex.

Why Do Certain Cultures Remove Foreskin?

The reasons for circumcision across cultures vary greatly, and the ones listed here are some of the most commonly historically discussed reasons. However, it's important to mention that many cultural, religious, and traditional reasons might not always align with modern medical understanding.

  • Historically, it was not uncommon for soldiers to be circumcised in preparation for active service because it was believed that infections, initiated by the aggravation of dirt and sand, are not uncommon under such conditions and have crippled entire armies' health and functioning. This would be especially true during a prolonged battle.
  • Egyptians are thought to have circumcised themselves and their slaves to prevent schistosomal infection. Urinary tract obstruction and hematuria are common in localities such as the Nile Valley, inhabited by infectious organisms. The foreskin can possess the ability to hold infected water, allowing parasites to infect the entire body.
  • The perpetuation of the Jews' procedure may have subsequently been driven by a desire to maintain cleanliness in an arid, sandy desert environment.
  • In Madagascar, many associate circumcision with cleanliness or other positive attributes. It's not uncommon for communities that practice circumcision to have cultural or traditional beliefs about its benefits that influence perceptions of desirability or masculinity.

What Is Smegma?

Both men and women produce smegma. Smegma is a combination of shed skin cells, skin oils, and other bodily fluids. In the penis, smegma accumulates around the glans and under the foreskin, if present. In females, it can accumulate around the clitoral hood and the folds of the labia minora.

Regular hygiene practices are sufficient to clean and remove smegma. It's important to note that while smegma is natural and not harmful, excessive buildup can cause discomfort or odor and could contribute to infections in some cases. Regular washing with water (without aggressive scrubbing or strong soaps) is generally enough to manage it.

Washing The Penis & Foreskin

The skin, including that of the penis and foreskin, has a natural pH level of around 5 – 5.5. The foreskin and the area beneath it (the glans or head of the penis in uncircumcised individuals) can be sensitive to disturbances in pH.

Many soaps, especially those not specifically designed for sensitive areas, can alter the pH balance and strip the natural oils from the skin. This can lead to irritation or an increased risk of infections, such as bacterial or fungal infections, as well as cause the skin to become dry, leading to irritation, itching, or discomfort.

Rinsing with just water can often be sufficient to clean the foreskin and the area underneath. Gentle retraction of the foreskin and rinsing with water can help remove natural secretions and prevent build-up. For most, this is adequate for daily hygiene.

If one does want to use soap, it's often recommended to choose a mild, fragrance-free soap or a cleanser specifically designed for sensitive areas and is pH balanced. Always rinse thoroughly after using any cleanser.

Arguments Against Circumcision

Whether or not circumcision should be performed is a controversial question, especially as religious issues may be involved. The practice of circumcision is far older than recorded history. Certainly, it is far older than the Biblical account of Abraham (Genesis 17) and seems to have originated in eastern Africa.

There are claims that it is genital mutilation or a physical assault and that those in favor of it are barbaric. Some also think that the clinicians who perform the surgery are criminals. There have been reports of harassment of medical professionals to stop them from having this procedure carried out. 

A San Diego based group that calls itself a health and human rights organization recently submitted a proposed bill to Congress called the Male Genital Mutilation Bill ("MGM bill"), which was not adopted.

Nonetheless, it raises crucial questions about the relationship between children's protection, gender equality, and religious freedom, questions that have ramifications beyond the proposed bill itself. Reportedly, more than half of the baby boys born in the United States undergo circumcision at this time. For most of these infants, a doctor performs the procedure.

For a minority, however, circumcision is a religious ceremony. It ordinarily occurs on the eighth day of a Jewish baby's life. For Muslim children, it may occur on the seventh or eighth day of the boy's life, sometime in his first five years, or during adolescence.

Circumcision & Trauma

Some men do feel a sense of loss or trauma from being circumcised, and their feelings are valid. But it's important to remember that individual reactions can vary greatly.

The idea that circumcision results in somatic trauma is a perspective some hold, but it is not currently universally accepted in the psychological or medical communities. However, experiences are subjective; thus, what one person experiences or recalls might differ.

Reasons Why Individuals Keep Foreskin

Risk of Infection

Any surgical procedure, including circumcision, carries a risk of post-operative infection. Proper surgical technique, post-operative care, and sterile conditions can mitigate these risks.

Some studies have found that traditionally performed circumcisions (not in a medical setting) might have higher rates of complications, including infections. There are also other potential risks, such as unsatisfactory cosmetic results.

Natural Protection

Parts of the foreskin, such as the mucosa (inner foreskin) and frenulum, are protective and enhance sexual control. The foreskin can protect the glans penis from friction and abrasion throughout life.

Longer & Better Sex

Some believe that circumcised men are slower at sex than uncircumcised men to ejaculate due to decreased sensitivity, thus giving greater sexual satisfaction. Others believe it makes sex feel better and easier.

Natural Lubrication

The foreskin keeps the glans moisturized and soft with emollient oils.

Aids In Masturbation & Penetration

The natural lubrication that the foreskin provides also provides an aid to masturbation and foreplay and serves as an aid to penetration.

Compared To Female Circumcision

Female Circumcision, also known as Type I (Clitoridectomy), is a classification under Female Genital Mutilation (FGM). It is a practice that varies in its procedures and is classified into four major types by the World Health Organization. Removing the clitoral hood, anatomically analogous to the male foreskin, is the least invasive type.

Type I (Clitoridectomy)

This involves partial or total removal of the clitoris and/or the prepuce (clitoral hood). It's the least extensive form of FGM.

Type II (Excision)

This involves partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. The amount and part of the genitalia removed can vary widely from one community or practitioner to another.

Type III (Infibulation)

This is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora and/or the labia majora, sometimes through stitching, with or without the removal of the clitoris. This is the most severe form and can lead to significant complications.

Type IV

This is a broad category that includes all other harmful procedures to the female genitalia for non-medical purposes, e.g., pricking, piercing, incising, scraping, and cauterizing the genital area.

A Violation Of Rights

FGM is internationally recognized as a violation of the human rights of girls and women. The practice has been outlawed in many countries, including the USA, because of its health risks and ethical concerns. This makes one consider how it is not perceived as genital mutilation when done to young boys.

While some communities or individuals might claim religious or hygienic reasons for the practice, neither Islam nor any other major religion mandates FGM. However, it's important to differentiate between cultural practices and religious doctrines.

Reasons Why Some Opt For Circumcision

It seems that some favor a circumcised penis for appearance and hygiene. Those in favor of circumcisions have indicated that they were not attracted to the smell of the uncircumcised penis, which can be caused by excess bacteria and other microorganisms that proliferate under the foreskin. However, if proper hygiene is adhered to, this should not typically be an issue. 

Some simply prefer a circumcised penis, and some research through various polls taken reflects this preference. This may be because of how popular it is in some regions. Below are why some supporters of it indicate they favor a circumcised penis:

Visual Appeal

The glans is exposed in both the erect and un-erect state.

Cleanliness

For some, it is easier to keep clean, and the lack of smell is preferred. 

Sexual Satisfaction

Some men claim that there is increased sexual pleasure from the exposed head, while others say the opposite. Women were 3.9 times more likely than men to believe that being circumcised was better for men’s health and 9.1 times more likely to report that circumcised men were more likely to please women sexually.

Paraphimosis Prevention

This is the inability to position the foreskin back over the head of the penis after it has been retracted; this is usually associated with phimosis, which in some cases can be a surgical emergency since blood flow to the penis's head can become impaired.

Genital Warts Prevention (Condylomata)

Genital warts can become quite large and unresponsive to topical medications and, if located on the foreskin, may be best treated with circumcision.

Penile Cancer Prevention

If caught early enough, it may be treated with circumcision. However, treatment depends on the stage, location, size, and extent of the cancer. For more advanced cancers or those not located on the foreskin, other treatments such as surgery, radiation, and chemotherapy may be required.

Studies have shown that circumcised men have a lower risk of developing penile cancer than uncircumcised men. This might be due in part to the reduced risk of conditions like phimosis (an inability to retract the foreskin) and chronic inflammation in circumcised men. 

Avoidance Of Zipper Injury

In uncircumcised men, the foreskin can become accidentally entrapped in zippers, resulting in pain, trauma, swelling, and scarring of this appendage.

Less Chance Of Infections

Numerous studies have shown that uncircumcised infants have a higher risk of UTIs than circumcised infants. However, the absolute risk of UTI in all male infants, whether circumcised or not, is still low. Some argue that this difference in risk doesn't justify routine neonatal circumcision for all boys.

The foreskin can create a moist environment that might be more conducive to yeast overgrowth, leading some to believe that uncircumcised men may be at a higher risk for yeast infections (balanitis) than circumcised men. Some studies have shown an association, however, proper hygiene can significantly reduce the risk of yeast infections in uncircumcised men.

Aesthetics & Sexual Pleasure

Perception of attractiveness is highly subjective and varies across cultures, individuals, and personal preferences. In some cultures and societies, a circumcised penis might be regarded as more aesthetically pleasing due to prevalent norms. In others, the opposite might be true.

Some studies suggest that circumcision has no significant effect on sexual function, while others indicate potential benefits or drawbacks. 

Post Surgery

Getting circumcised will result in having to go through a minor surgical procedure that carries with it minor risks.

Less Chance Of Disease?

Circumcision has been associated with a reduced risk of urinary tract infections in infancy, less risk of penile cancer, and a reduced risk of transmission of some sexually transmitted infections, including HIV (for heterosexual men). There are also claims that there is a lower chance of Phimosis, which also increases the risk of penile cancer.

The World Health Organization (WHO), along with other entities, has conducted  studies in sub-Saharan Africa that demonstrated that male circumcision can reduce the risk of heterosexual HIV acquisition in men by approximately 60%.

As a result of these findings, voluntary medical male circumcision (VMMC) has been promoted as part of a comprehensive HIV prevention strategy in countries with high HIV prevalence and low male circumcision rates.

One study showed that the risk of contracting HIV during anal sex was 0.11% for circumcised men and 0.62% for uncircumcised men.

Are The Claims About Disease Really True?

However, another study indicates that none of this is true. Many believe circumcision reduces the risk of sexually transmitted infections due to the frequent repetition of this claim.

A thorough review found that circumcision doesn't significantly impact the risk for several infections like chlamydia, gonorrhea, genital herpes, and HPV, while its effect on others like syphilis and genital ulcerative disease is mixed.

In general populations, there's no consistent evidence that circumcision significantly impacts the risk of sexually transmitted infections.

Sexual Pleasure & Circumcision

Urologists perform many circumcisions, both for medical reasons (e.g., phimosis, balanitis, recurrent urinary tract infections) and for personal or cosmetic reasons.

The most sensitive area of the penile skin is the frenulum, the area just below the head of the penis on its underside. Even with efforts to preserve as much of this skin as possible, some men notice less sexual satisfaction after circumcision, while others notice increased sensitivity.

Penile Adhesions

Natural Adhesions

In infancy and early childhood, the foreskin is often naturally fused to the glans. The adhesion serves a protective role, preventing contaminants like feces from getting into the urinary tract.

Forced Retraction

Forcibly retracting the foreskin before it's naturally ready to retract can cause problems such as pain, bleeding, and may lead to issues like scarring, which can, in turn, lead to pathological phimosis.

In countries or cultures where knowledge about the natural non-retractability of the foreskin in young boys is widespread, forced retractions are less common. Such knowledge might reduce the incidence of problems associated with forced retraction, such as phimosis However, it's important to note that phimosis can occur for other reasons as well, including infections, inflammation, or scarring.

Knowledge and practices regarding the care of the intact penis have evolved in the U.S. over the years. In recent years, pediatric and medical organizations have provided guidelines that advise against forced retraction.

For example, the American Academy of Pediatrics (AAP) has guidance on this issue, suggesting that the foreskin should never be forcibly retracted.

Medical Reasons For An Adult Circumcision

Adult circumcision is not uncommon. Physicians often recommend when there is a chronic medical condition present, such as balanoposthitis (inflammation of the head of the penis and overlying foreskin) or phimosis (difficulty retracting the foreskin).

Both problems are more often seen in people with diabetes but can occur in any uncircumcised man. Symptoms include chronic irritation and scarring and can usually be prevented with careful cleaning beneath the foreskin.

While mild to moderate phimosis might benefit from manual stretching or the use of stretching devices combined with topical steroids, severe phimosis or recurring phimosis might not respond to these methods.

Thus, surgical intervention, such as circumcision or preputioplasty, may be necessary in some cases. It's essential to consult with a medical professional to understand the appropriate treatment.

Phimosis Diagram


Prior to a recommendation of circumcision, a urologist will most likely prescribe an anti-fungal and anti-inflammatory ointment, which may help clear up the problem. Yeast infections are also common as they thrive in the warm, moist environment created beneath the foreskin. When these conditions often recur, a circumcision may be suggested.

Other medical reasons for an adult circumcision are below:

  • Phimosis (tight foreskin)
  • Paraphimosis (inability to pull the retracted foreskin back over the glans)
  • Balanitis and balanoposthitis (inflammation of glans and foreskin)
  • Frenulum breve (short frenulum which tears with intercourse)
  • Diseases of the foreskin, including cancer
  • Reduced risk of herpes simplex virus type 2 (HSV-2), the cause of genital herpes, and human papillomavirus (HPV), which can cause cancer and genital warts.

Adult Circumcision Surgery

Undergoing a circumcision as an adult can be intimidating, but it is generally safe. The procedure is usually performed under general anesthesia, but it can also be performed under local. Surgical risks include:

Excessive Bleeding

This is treated with pressure or locally-acting agents.

Infection

Local infections occur in 1 in 100-1000 and are easily treated with local antibiotics.

Subsequent Surgery

Needed for 1 in 1000 because of skin bridges or removal of too much or too little foreskin. Repair of injury to penis or glans required for 1 in 15,000.

Local Anesthetic

The only risk is when the type of anesthetic used is a dorsal penile nerve block, with 1 in 4 having a small bruise at the injection site. This will disappear.

Post Surgery

The healing can potentially be complicated by nocturnal erections, which put pressure on the incision and can cause bleeding (this is usually self-limiting but can create swelling and bruising). People with diabetes have a greater risk of postoperative infection, which is generally a low risk after this surgery.

Cost Of Adult Circumcision

Circumcision is amongst the 40 most frequently performed surgical procedures, occurring more commonly than a tooth extraction. Most health insurance will cover circumcision for any of the conditions listed above except cosmetic appearance. Fees will vary from patient to patient depending on the degree of complexity; however, a good approximation is $1,000.00.

Types Of Practitioners

For adults, consulting a urological surgeon or a general surgeon is usually recommended. It's important to note that not all doctors are qualified to perform surgeries. When looking for a specialist, consider starting with your known contacts or reaching out to your primary care physician.

Regenerative Foreskin

Some companies promote using regenerative medicine to regrow foreskins for men who have undergone circumcision and wish to reverse its effects. There are different ways this can be done:

Tissue Expansion

This technique stimulates the growth of additional skin to cover the glans (head) of the penis, similar to an intact foreskin. This is done by applying tension to the residual shaft skin.

Manual Tugging

Some men use manual tugging techniques by pulling on the remaining skin to encourage it to stretch and grow. This method requires consistent effort over time.

Devices

There are various devices on the market designed to assist in non-surgical foreskin restoration. They generally work by maintaining tension on the skin for extended periods. Examples include the DTR (Dual Tension Restorer), TLC Tugger, and various weights.

Coverage

Over time, as more skin becomes available, some men choose to keep the skin pulled over the glans to encourage dekeratinization, which can make the glans more sensitive by reducing the buildup of keratin (a protective protein layer) on its surface.

Surgical Restoration

There are surgical methods for foreskin restoration, but they are less common due to the risks associated with surgery, the potential for scarring, and the high costs.

Stem Cell Research and Regeneration

There has been interest in using stem cells or other regenerative medicine techniques to truly "regrow" a foreskin, but this is currently unavailable.

Foreskin Cells In Cosmetics Research

Foreskin-derived fibroblasts have been used in various forms of medical research and cosmetic applications. For example, fibroblasts from foreskin tissue are known to be used in the development of skin grafts and in testing the effects of products on skin.

The term "cruelty-free" usually refers to products not tested on animals. However, it's a controversial and nuanced topic whether the use of human-derived materials, especially without explicit consent, is ethical or "cruelty-free."

There was a media buzz about a facial treatment referred to as the "foreskin facial" or "penis facial" due to its use of epidermal growth factors derived from the progenitor cells of the human foreskin. There were celebrities mentioned in interviews that they had tried this treatment. The name was catchy and controversial, leading to many headlines.

To clarify, the treatment doesn't use foreskins directly but rather a serum that contains growth factors derived from cells that were cultured from foreskin cells. Those cells can be reproduced in the lab indefinitely, so it's not like a new foreskin is used for every treatment.

One Man's Adult Circumcision Story

One of our readers kindly reached out to share their personal experience with undergoing a circumcision in their adult years. We are sharing this with you in case anyone is considering this procedure for medical or personal reasons and wishes to gain insight from a firsthand perspective. If you have a story you would like to share, feel free to reach out and let us know.

Here's his story in his own words:

I used to get very sweaty under my foreskin, and it was sometimes quite unpleasant. In addition to that annoyance, when I had a very firm erection, my tight frenulum not only hurt but also pulled on the back of the glans and made my urethra point down at right angles to my shaft. These were the two main reasons that I decided to get a circumcision. The following is how it went down.

My genitals were first swabbed with iodine-based antiseptic, and then I was given the local anesthetize (Bupivacaine), which was injected into the base of my shaft. The first two injections were quite painful, but I have never liked having any injections, which could have intensified by my psychological aversion to shots.

As the anesthetic began to work, I didn't feel the remaining injections. The doctor clamped my foreskin and determined exactly where he was going to place the cut. He put a large pair of forceps across the foreskin, where he would cut it and clamped them tight.

One quick stroke of the scalpel along the side of the forceps removed my foreskin. The places where I was bleeding were found and sealed, either with simple pressure from small forceps or using an electric cautery device.

After most of these bleeding points had been sealed, the doctor released my frenulum from the back of the glans but didn't altogether remove it. I had expected that this would be done first to make the foreskin more mobile.

He used many small stitches close together, and it took much longer to stitch me up than it had done to do the initial circumcision. Dissolving stitches were used so that I would not have to return to have them removed.

Once the stitching was completed, the wound was covered with gauze and then tightly bound with a bandage from halfway down my glans to just short of my scrotum.

The whole operation had taken about an hour. The glans was bruised looking for about four days. The bandage had been put on very tightly, and it compressed my urethra somewhat so that when I had a pee, there was considerable resistance to it coming out. I took a couple of the more potent painkillers before turning in, but I was somewhat uncomfortable, and I didn't get a good night's sleep.

In the morning, however, there was no real pain. Although I had to take things easy, and for the first few days was walking with my legs apart as if sitting on a horse. The initial dressing was to be kept on for 48 hours, so I soaked it off in the bath.

It took about an hour to soak off, with me gradually unwinding it as each layer came free. The cut looked like a broad pink ring around the penis, with a wavy line of dried blood and the black stitches in it when the dressing was off.

The frenulum area, however, looked very bruised and sore. A new layer of antibiotic gauze was laid over the wound and held on with fresh gauze bandaging. I had no real pain and, apart from the first night, minimal serious discomfort, but I am glad that I took the week off work and recommend this to anyone whose job is active.

During the whole of the first two weeks, I only took four doses of the stronger painkiller and about the same paracetamol - mainly at night as a precaution rather than a necessity. The dressing was changed again on Thursday and Saturday nights.

Each time the cut looked nicer and cleaner. Of course, it was still very tender and was somewhat painful to try to lift up to examine the frenulum area. I went back to work a week after the circumcision.

The frenulum area still had a scab on it, and the scar line was still rather rough, but I was already delighted with the result. The stitches had all come out by the middle of the third week, and I had my first circumcised wank. I found this highly pleasurable and shot loads all over my chest!

The last scab finally came off the frenulum area the following Wednesday - three and a half weeks after the operation. The doctor has done the operation entirely to my satisfaction, and I think it is very neat. When I am erect, the color contrast in the skin is apparent. The scar line has been placed 1.75" behind the rim of the glans on a penis, which is 6" when erect.

My circumcised penis also no longer bends downwards when fully erect. I immediately found I was much more comfortable at work, and really experienced the full benefit during the following summer months when it got exceptionally hot. I would recommend circumcision to anyone who has any tightness in their frenulum or foreskin or regularly works in a hot and sticky place.

One year later, my glans is fairly sensitive, so it does not take long for ejaculation to happen, whereas it took longer before I was circumcised. When I look back at being circumcised, I am glad that I was done, especially since I work in a hot environment, and the weather last summer was sweltering. I found it much more comfortable without my foreskin than other summers with it.

- Anonymous

In Closing

In conclusion, the decision to undergo adult circumcision is deeply personal and multifaceted. For many, it is rooted in cultural, religious, or historical traditions, while medical reasons or personal preferences play a dominant role for others.

Opponents liken the procedure to genital mutilation, emphasizing the importance of bodily autonomy and the potential for lost sensitivity. Conversely, advocates cite health benefits and aesthetic appeal as valid reasons to opt for the procedure.

It's crucial to recognize the weight of this decision and the diversity of opinions surrounding it. Like many aspects of human health and sexuality, there isn't a one-size-fits-all answer in all situations and for everyone.

What is essential is informed choice, understanding both the pros and cons, and making the decision that aligns best with one's personal beliefs, values, and circumstances.

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