Adolescent and adult circumcision

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Adolescent and adult circumcision is rare when compared to the millions upon millions of medically-unnecessary, non-therapeutic circumcisions of boys that are carried out in Islamic nations, Israel, the United States, and elsewhere.

Reasons for circumcision

All circumcisions are injurious because they amputate a multi-functional body part, but in rare cases the benefit obtained by removing a deformed, diseased, or damaged foreskin may be of more value than the amputated foreskin.

  • Deformed foreskins — The common type of deformed foreskin is the narrow non-retractable foreskin of phimosis. Circumcision is the traditional treatment for phimosis, however circumcision is less performed today because newer conservative treatments are now available that preserve the foreskin and its many useful functions.
  • Damaged foreskins — This includes any type of physical trauma and injury that is beyond surgical repair. Zipper injury does not require circumcision.[2] [3]

Some adult males may seek non-therapeutic circumcision because of a conversion to Judaism or Islam. Others may simply want a circumcision because they like the physical appearance, to fit into a society where most men are circumcised, or for some personal whim.[4]

A word to intact teens

Boys are born with a foreskin that is non-retractable for reasons of protection. The inner surface is fused with the glans penis by a synechia (similar to a fingernail that is glued to the nail bed of the finger). Also the tip of the foreskin is too narrow to retract. As a boy gets older, the synechia disintegrates and releases the foreskin and the foreskin gets wider as a boy ages, so the foreskin gradually becomes retractable. Some boys go through puberty but find that their foreskin is still too narrow to permit retraction. The traditional way of addressing this issue was to consult a urologist and get a circumcision, however we now understand that in the vast majority of cases, manual stretching over a few months will widen the foreskin by tissue expansion, make the foreskin retractable and eliminate the need for a destructive circumcision.

Methods of adult circumcision

Dorsal slit

Dorsal slit is a cut on the top of the foreskin to widen the operning, allowing the foreskin to retract and fall below the shaft of the penis. Dorsal slit does not cut around and does not remove tissue, so it is not a true circumcision. Dorsal slit is a first step in the circumcision of a phimotic foreskin by the sleeve technique.[4]

Sleeve technique

Holman & Stuessi (1999) said patients should be advised of alternatives to circumcision.

They reported the indications for adult circumcision are uncommon. The most common is phimosis.

They recommended dorsal penile nerve block or ring block local anesthesia for the pain of circumcision surgery.

Informed consent must be obtained. They stated:

Specifically, the patient should be told about the risks of bleeding, hematoma formation, infection, inadvertent damage to the glans, removal of too much or too little skin, aesthetically unpleasing results and a change of sensation during intercourse. The patient should also be informed that, during the postoperative period, erections can cause pain and disruption of the suture line that may require replacement of the sutures. Full recovery following circumcision generally requires four to six weeks of abstinence from all genital stimulation and sexual activity.[4]

In regard to complications, Holman & Stuessi reported:

As with any surgical procedure, bleeding and infection are probably the most common complications of circumcision in adult patients; however, accurate statistics are not available. Other complications include hematoma formation, diffuse swelling, pain from inadequate anesthesia, poor cosmesis, tearing of the sutures due to erection before healing is complete and anesthetic complications. Some patients may also note an unpleasant heightened sensitivity during intercourse. Infection can be treated with local or parenteral antibiotics, depending on the severity of the infection. Bleeding can be controlled with pressure, an absorbable gelatin sponge product (i.e., Gelfoam), electrocautery or ligatures. None of these techniques can be preferentially recommended based on differences in complication rate or severity.[4]

Circumcision with a plastic ring device

Adolescent and adult circumcision may also be carried out with one of several plastic, one-use, disposable ring devices. These devices work by clamping the foreskin tightly so that it is crushed and flow is cut off completely. Ischemic necrosis ensues and the foreskin dies. It may then be cut off or left to fall off. Ring devices include the Tara KLamp, the PrePex, AccuCirc, and the Shang Ring.

Permanent adverse effects

  1. Circumcision is a surgical amputation of functional tissue. The various functions cease to operate. If the patient does not like the results, it cannot be reversed or undone.
  2. Recovery from adolescent or adult circumcision is slow and painful. Erections are painful because the skin is stretched and the sutures are stressed. Wound dehiscence may occur.
  3. The foreskin is protective of the glans penis. After the foreskin is amputated, the glans penis is exposed so that it touches clothing and other things. Some men report this causes extreme pain so that they cannot wear pants for an extended time. The pain subsides when the glans penis start to build a layer of keratin to protect itself. The keratinization of the glans penis causes loss of sensation in the glans.
  4. The foreskin has immunological functions that protect from disease. Circumcised populations have a higher incidence of HIV than intact populations.
  5. The heavily innervated ridged band is located on the foreskin and is always amputated along with the foreskin. The most sensitive regions in the intact penis are those parts ablated by circumcision.[5] There is great loss of sensation caused by the amputation of this structure. It appears that many intact males are unaware of the source of sensation and are shocked by the loss of sensation after circumcision.
  6. The abundance of skin in the foreskin allows gliding action. Gliding action facilitates masturbation and intercourse. The shortening of penile skin reduces or eliminates gliding action. The loss of gliding action may cause dyspareunia.
  7. Painful erections may occur due to lack of sufficient skin to allow for expansion of the penis.

Videos

Here are five videos in which men who had an adult circumcision express regret.

Rite of passage

In some cultures, circumcision is viewed as a rite of passage, and a male may not be considered a privileged adult until he has undergone circumcision.

Aborigines

The indigeous people of Australia, the Aborigines, have variously practiced subincision and circumcision on adolescents and adults since before the first contact with Europeans.

Ulwaluko

Traditional Circumcision and Initiation into Manhood (ulwaluko) is an ancient initiation ritual practiced by the amaXhosa of the Eastern Cape. The ritual is traditionally intended as a teaching institution to prepare boys for the responsibilities of manhood. The principles that lie at the very core of the ritual are respect for self (including self control and integrity), respect for family (not to bring shame to them), and respect for community (to protect them from harm).

Every single initiation season the media writes about complications accompanying the ritual of Traditional Circumcision and Initiation into Manhood (ulwaluko). The magnitude of these complications is horrific, from 1995 till 2014, 919 boys have lost their lives in the mountains and hills of the Eastern Cape. Many others were mutilated or even lost their manhood.

See also

External links

References

  1. ↑ REFjournal Verma SB, Molina U. Looking through the cracks of diabetic candidal balanoposthitis!. Int J Gen Med. 7 July 2011; 4: 511-3. PMID. PMC. DOI. Retrieved 19 December 2020.
  2. ↑ REFjournal Flowerdew R, Fishman IJ, Churchill BM. Management of penile zipper injuries. J Urol. May 1977; 117(5): 671. PMID. DOI. Retrieved 20 December 2020.
  3. ↑ REFjournal Chalfin L. Win one for the zipper. Emerigency Medicine. 30 March 1989; 21(6): 05. Retrieved 20 December 2020.
  4. ↑ a b c d REFjournal Holman JR, Steussi KA. Adult circumcision. Am Fam Physician. 15 March 1999; 59(6): 1514-8. PMID.
  5. ↑ REFjournal Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS. Fine‐touch pressure thresholds in the adult penis. BJUI. 19 March 2007; 99(4): 864-9. PMID. DOI. Retrieved 10 January 2021.
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