A 20-year-old Xhosa man undergoing a traditional initiation process, which includes circumcision, in South Africa. Males might choose to be circumcised as adults due to medical, cultural or aesthetic reasons. — AFP Filepic
There are a variety of reasons why an adult male would want to get circumcised.
These can be broadly split into medical and non-medical reasons.
When we look at medical reasons, one common indication for a circumcision would be the treatment of recurrent infections of the foreskin and glans penis, also known as balanoposthitis, or simply, balanitis.
In patients with recurrent balanitis, the removal of the foreskin helps the patient keep the head of penis clean and dry, thus reducing the probability of the infection.
Another common medical reason for a circumcision is to treat tight foreskin, a condition also known as phimosis, which can be acquired or congenital in nature.
Patients with phimosis are unable to retract the foreskin behind the glans penis due to tightness of the skin.
Recurrent infections can scar up the foreskin, making it tighter and tighter with every bout of infection.
In patients with phimosis, it is difficult to wash the glans penis and foreskin on the inside, and such patients are at higher risk of foreskin infections.
There are also some patients who want to prophylactically get a circumcision for the health benefits.
A circumcised man has reduced risk of urinary tract infections, sexually-transmitted diseases (STDs) and penile cancer, and has an easier time maintaining hygiene.
There are also religious and cultural reasons as to why people may get a circumcision.
In certain regions, such as Muslim countries, North America and certain parts of Africa, a good majority of men are circumcised from an early age.
There are also men, or their partner(s), who prefer the cosmetic look of a circumcised penis, and thus, undergo the procedure.
It is important to note that there are downsides to a circumcision.
The most obvious would be the risks of the surgery itself: pain, bleeding, infection, wound breakdown, scarring and unsatisfactory cosmesis (i.e. cosmetic improvements).
There is also the cost of the surgery and follow-ups.
Of course, the skin on the glans penis does desensitise after a while.
Many ways to circumcise
There are many ways to do a circumcision.
There are traditional methods where the skin is cut and stitches are introduced.
There are laser methods that use a laser to remove the skin.
There are also medical device-assisted methods, such as clamp or ring devices.
The principles of each method are the same: To be as sterile as possible, while adequately removing the outer and inner foreskin layers.
Additionally, these devices focus on control of bleeding, protection of the glans and urethra, and cosmesis.
Depending on the method, circumcisions require between 10 to 45 minutes, and may be done under local or general anaesthesia.
In general, recovery from most circumcisions will take about a month.
The amount of post-procedure pain will vary depending on the person’s tolerance for pain and the method used.
The type of circumcision that I do the most is the Shang Ring method, a relatively bloodless 5-10 minute procedure that can be done under local anaesthesia.
In this procedure, two concentric rings are used to clamp the foreskin.
With the rings applied, blood flow to the distal foreskin stops, which allows it to be excised without any significant bleeding.
The ring is removed after being left on for about two weeks.
The underlying wound then takes a few more weeks to fully recover.
Most patients do not report significant pain during either the procedure or the healing process.
Medications given after the operation include antibiotics and painkillers.
There are some patient-specific considerations that we must assess.
Diabetics tend to run into more complications, such as poor wound healing, wound breakdown and wound infections.
Older patients also tend to heal a little slower, compared to younger ones.
However, younger patients are more likely to get stronger morning and night erections, which may cause the wound to stretch or tear.
Every doctor has their personal preference as to the type of circumcision they prefer doing or are most familiar with.
Each method has its pros and cons, and some methods of circumcision may not be suitable for foreskins with different anatomies.
It is good to have a frank discussion with your doctor about his or her preferred method for your condition.
There is no “best time” to do the operation.
To me, the best time to do the operation is when the patient is mentally and physically ready for it.
He must clear out his schedule for a month post-procedure and has to be ready to take care of the wound.
I tell my patients to seriously consider a circumcision if there is a medical indication for it, i.e. tight foreskin or recurrent infections.
But for non-medical reasons, the patient has to weigh the pros and cons, and the decision to undergo a circumcision should be guided by sound medical advice.
Dr Chester Lan is a Singapore-based general practitioner. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
