To cut or not to cut?

Circumcision is the only solution for sufferers of  Balanitis Xerotica Obliteran (BXO). 

The beginning of June always brings the air of excitement to many households during the school holidays, especially the ones who had missed the chance for a vacation.

Although, many may choose to have a trip abroad, others take the chance to plan for the children to undergo elective operations such as circumcisions during this period. Needless to say, the air of holiday excitement is often descent to terror for the “victims”. 

If there is a season for a specific operation, the June holidays is the spell for “parting of the foreskins”.  Usually, the parents would have attended consultations with the doctors months’ ahead. 

Of course, the usual questions about the risks and complications of the operations are raised in front of the boys who are usually “sweating” in fear. When the dates are set, the lads dread that day of terror to eventually “say goodbye” to the body part they hardly know. 

Parents request for “the cut” for different reasons; some would obey the commands of various religions, and others will follow the footsteps and traditions of their fathers and forefathers.

Parents who have the choice to put the boys through the interventions (or not), are often faced with the dilemma of weighing out the pros and cons of the surgery. “To cut or nor to cut?” this is the big question. And there may be other reasons for the “cut”.

Dear Dr G, 

I am 45-year-old diabetic who has been having a lot of trouble with the infection of my foreskin. 

I started having trouble retracting the skin about a year ago, as it is very tight.

Several times after intimacy, the skin  cracked and resulted in inflammation and pain. 

After seeing my family doctor, I have been treated with antibiotics that resolved the inflammation temporarily. 

Sadly, the problem recurred after intercourse. 

My doctor has been asking me to go for a circumcision. Although, I know that is the solution, I am not keen to have the operation as I hear it is very painful if a man has the operation in adulthood. 

Is it true that children have no pain with circumcision and recovers faster? 

I am keen to have alternatives for my condition. Can you help? 



The repeated infection and inflammation of the foreskin is usually the result of poor hygiene or trauma during sexual activities.

Many men started off having tight foreskin (phimosis) that prevents them from cleaning the glans penis thoroughly. The result of the accumulation of the smegma under the skin will provoke further infection (balanitis) and scaring. 

The vicious cycle of infection and disfiguration will result in Balanitis Xerotica Obliteran (BXO). Although the name of this medical condition sounds rather exotic, the reality is,  such deformity is rather debilitating for the sufferers like Alan. BXO is more common in diabetics who will experience pain on intercourse and cracked foreskin.

In severe cases, the inflammation of BXO may even cause complete occlusions of urinary flow that results in acute retention of urine. In men who endure such chronic insults of the foreskin, there may even be an association with penile cancer! 

Despite such incapacitating symptoms of BXO, many men will choose to have a “short cut” instead of the “real cut”. Of course, many will opt for alternatives such as steroid cream, preputioplasty and dilation. Such suboptimal interventions often result in transient efficacy and long-term undesirable cosmetic outcome. 

It is ludicrous and absurd to think children don't suffer pain, as adults during and after circumcision. The reality is we all the same pain fibers in our “vital organ” and therefore it is inhumane to even consider not managing intra and post-operative pain for children. 

In short, the only definitive solution for BXO is circumcision - a short-term pain that will ensure long-term gain for most men.


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Dr George Lee

Dr George Lee

Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. The column “Ask Dr G” is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. You can send him questions at


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