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.

Contents

Consent

Male circumcision is an elective surgical amputation of the foreskin part of the penis. Legally, the patient or his surrogate (proxy) must grant informed consent before the surgery can be performed.

The surgeon most provide all material information to the patient before informed consent can be granted. There is a strong tendency for the surgeon to omit telling the patient anything about the nature and function of the foreskin, which would be lost through amputation if consent should be granted.

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 was 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]

Elective non-therapeutic circumcision

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.

Beaugé (1997) reported that boys, who masturbate by pulling their foreskin away from the body, will not stretch the tight part of the foreskin so non-retractile foreskin will persist. He advised changing the method of masturbation to the more conventional method of pulling the foreskin toward the body so that the narrow orifice gets stretched.[5]

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 opening, 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.

Pain during and after circumcision

Circumcision is a surgical amputation of part of the penis. It is normal to feel pain during the surgical amputation, however this is usually eliminated by general or local anesthesia.

One may expect pain after surgery until the incision heals. Ask your doctor for a two-week supply of an opioid pain reliever.

One may also expect pain when the sensitive glans penis is exposed to friction from clothing, etc. It is no longer protected by the foreskin, so there is not much one can do about it.

One may also expect painful erections, depending on how much skin was removed. Depending on how much skin was removed, there may not be enough skin left to allow for shaft expansion during erection and this may cause painful erections.

One may also experience phantom pain from neuromas that form at the incision where nerves were severed.[6]

Masturbation after circumcision may be painful if one doesn’t use lubrication because of lack of gliding action.

Lymphoedema

Lymphoedema of the penis is a normal and expected complication of male adult circumcision due to the adverse effect on blood circulation. Ferhatoglu et al. (2019) reported edema in 108 of 198 patients or 54.5 percent.[7] It frequently lasts for months.

Permanent adverse effects

Loss of sensation

The human foreskin has long been noted for its high level of erogenous sensation. Winklemann (1959) early identified the foreskin as a specific erogenous zone.[8] Falliers (1970) called attention to sensory pleasure induced by tactile stimulation of the foreskin, which is almost totally lost after its surgical removal.[9]

Money & Davison (1983) reported "diminished penile sensitivity, less penile gratification, more penile pain, and cosmetic deformity" as the effect of circumcision, however they considered that a "prolongation of the period prior to ejaculation" was a possible benefit.[10]

Money & Davison thought the loss of sensation is "secondary to diminished sensory input from stretch receptors in the less mobile skin of the shaft of the penis, as well as loss of foreskin stretch receptors".[10]

Denniston (2004) carried out a survey of 38 adult males who were circumcised at least 2 years after they commenced sexual intercourse. Thirteen men felt that sexual intercourse was better after circumcision, but 22 felt that intercourse was worse and would not have the circumcision again, because of loss of sexual pleasure.[11]

Masood et al. (2005) suggested "before circumcision, men should be warned of the long-term consequences (penile sensations and effect on erectile function) as well as be talked through the more traditional subjects (peri-operative complications)."[12]

Kim & Pang (2007) studied the effect of adult circumcision on 138 males in South Korea. They concluded:

There were no significant differences in sexual drive, erection, ejaculation, and ejaculation latency time between circumcised and uncircumcised men. Masturbatory pleasure decreased after circumcision in 48% of the respondents, while 8% reported increased pleasure. Masturbatory difficulty increased after circumcision in 63% of the respondents but was easier in 37%. About 6% answered that their sex lives improved, while 20% reported a worse sex life after circumcision.[13]

García-Mesa et al. (2021) reported the foreskin has an abundance of Meissner's corpuscles which provide pleasant sexual sensation when mechanically stimulated by motion of the foreskin.[14]

Other 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. Some circumcised men complain of discomfort due to the head being permanently exposed.
  4. The foreskin has immunological functions that protect from disease. Circumcised populations have a higher incidence of HIV than intact populations.[15][16]
  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.[17] 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.
  8. The erect penis may be shorter due to lack of sufficient skin to allow full expansion.
  9. There always will be a circumcision scar that encircles the shaft of the penis.
  10. The exposed glans penis will protect itself from friction by developing a layer of keratin and become cracked and hardened. The keratinization of the glans penis will reduce its sensitivity.
  11. There are possible emotional issues secondary to a partial loss of the penis through circumcision.

Warning

It is quite common for some urologists to push circumcision on any foreskinned male although conservative treatment would have been sufficient, since there is a nice fee attached to a circumcision amputation. There are many reports of false statements being made. It is totally unethical and akin to fraud, but it happens frequently.

Videos

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

Circumcised at 18

Why I Regret Getting Circumcised At 19

Circumcised Man: "I feel such a sense of loss"

Circumcised at 30

Got Circumcised as an Adult (Just saw the Penn & Teller episode)

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 region of South Africa. 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. Many of these mutilations are documented (graphic content).

Tuli

Tuli is a genital mutilation rite of boys and adolescents practiced in the Philippine Islands.

See also

External links

References

  1.   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.   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.   Chalfin L. Win one for the zipper. Emerigency Medicine. 30 March 1989; 21(6): 05. Retrieved 20 December 2020.
  4. a b c d   Holman JR, Steussi KA. Adult circumcision. Am Fam Physician. 15 March 1999; 59(6): 1514-8. PMID.
  5.   Beaugé Michel. The causes of adolescent phimosis. Br J Sex Med. 1997; (September/October): 26. Retrieved 21 April 2021.
  6.   Cold CJ, Taylor JR. The prepuce. BJU Int. 1 January 1999; 83 Suppl 1: 34-44. PMID. DOI. Retrieved 7 March 2021.
  7.   Ferhatoglu Mf, Kartal A, Gurkan A. Evaluation of Male Circumcision: Retrospective Analysis of One Hundred and Ninety-eight Patients. Cureus. 27 April 2019; 11(4): e4555. PMID. PMC. DOI. Retrieved 17 February 2022.
  8.   Winkelmann RK. The erogenous zones: their nerve supply and significance. Mayo Clin Proc. 21 January 1959; 34(3): 39-47. PMID. Retrieved 4 June 2021.
  9.   Falliers, CJ. Circumcision. JAMA. 21 December 1970; 214(12): 2194. Retrieved 4 June 2021.
  10. a b   Money, John, Davison, Jackie. Adult penile circumcision: erotosexual and cosmetic sequelae. J Sex Res. 1983; 19(3): 289-92. Retrieved 4 June 2021.
  11.   Denniston, George C., Hill, George. Circumcision in adults: effect on sexual function. Urology. December 2004; 54(5): 1267. PMID. DOI. Retrieved 5 June 2021.
  12.   Masood S, Patel HRH, Himpson RC, et al. Penile sensitivity and sexual satisfaction after circumcision: Are we informing men correctly?. Urol Int. 2005; 75(1): 62-5. PMID. DOI. Retrieved 5 June 2021.
  13.   Kim, DaiSik, Pang, Myung-Geol. The effect of male circumcision on sexuality. BJU Int. March 2007; 99(3): 619-22. PMID. DOI.
  14.   García-Mesa, Yolanda, García-Piqueras, Jorge, Cobo, Ramón, Martín-Cruces, José, Suazo, Iván, García-Suárez, Olivia, Feito, Jorge. Sensory innervation of the human male prepuce: Meissner's corpuscles predominate. Journal of Anatomy. October 2021; 239(4): 892-902. PMID. PMC. DOI. Retrieved 15 November 2021.
  15.   Denniston, George C.: World Health Organization, HIV, and male circumcision, Doctors Opposing Circumcision (D.O.C.). (29 June 2020). Retrieved 2 September 2020.
  16.   Fish M, Shavisi A, Gwaambuka T, Tangwa GB, Ncayiyana D, Earp BD. A new Tuskegee? Unethical human experimentation and Western neocolonialism in the mass circumcision of African men. Developing World Bioeth. 9 September 2020; 00: 1-16. DOI. Retrieved 13 February 2021.
  17.   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.