To Be Or Not To Be–Circumcised, That Is!
Let’s cut right to the chase. From a urologist’s perspective, it is better (on balance) for a newborn male to be circumcised than not to be. There are many specific reasons for me to draw that conclusion, but more about that in a moment. In order to make a rational decision regarding neonatal circumcision, yes or no, one has to put aside a plethora of emotional, moral, ethical, cultural, and religious “biases.”
Health & Safety
Let’s talk first about safety. Circumcision is the most common “surgical” procedure performed in the USA. More than 20 percent of the world’s male population is circumcised. Complications are rare.
In its most simplistic form, it is all about hygiene. If an uncircumcised man does not regularly retract the foreskin and wash underneath it, the natural secretions from the skin can produce a smelly, cheesy substance known as smegma. Lack of cleanliness can lead to irritation, pain, and even infection. Many women complain about the odor that results from a man’s failure to wash frequently and thoroughly under the foreskin.
Generally speaking, circumcision remains a healthier choice. Uncircumcised men have a vastly greater chance of getting penile cancer. In fact, cancer of the penis, which is rare in any case, is virtually unheard of among circumcised men. Recent studies of AIDS prevention in Africa suggest that male circumcision can reduce the chance of HIV in men and perhaps in women. The validity of this theory is still being tested. Research shows that cells on the underside of the foreskin are prime targets for the virus; tears and abrasions in the foreskin serve as easy points of entry for the retrovirus. Studies have estimated that circumcised men have a greater than 40 percent lower risk for HIV infection. I think it is fair to conclude that circumcision for men should be promoted at least with regard to HIV prevention.
Assuming a man reaches puberty uncircumcised, I do not recommend adult circumcision unless the foreskin is problematic—meaning it is not easily retracted. Other medical problems such as persistent irritation, infection, rash, or even moderate difficulty in retracting the foreskin for cleaning may justify circumcision in the adult.
Another legitimate reason for circumcision in an adult male is if a man’s sexual partner requests that he have one as a matter of personal preference.
With regards to penis health, the importance of hygiene, particularly in uncircumcised males, cannot be emphasized enough. If an uncircumcised male has a foreskin that is easily retracted and meticulously cleaned, the likelihood of problems is reduced. Interestingly, in the Scandinavian countries, where very few men are circumcised but meticulous penile hygiene is taught, practiced, and promoted, the incidence of penile cancer and other such problems is extremely low. It is all about genital hygiene, a retractable foreskin, and meticulous attention to genital cleanliness.
The concept of penile sensitivity is always added to the mix in the debate for or against circumcision. There are no scientifically controlled experiments regarding the sexual performance of circumcised versus uncircumcised men. Based on my clinical experience, there is no difference. Some people assume that a circumcised man has greater sensitivity because he has no foreskin covering the glans. Others believe that an uncircumcised man has greater sensitivity because he has a foreskin. Neither theory is true. The fact is that the foreskin retracts when an uncircumcised man has an erection. So in the aroused state, the penises are virtually the same.
In the final analysis, all bets are off if the adult foreskin is tight, non-retractable, or problematic. That adult needs a circumcision as soon as possible. In spite of that admonition, the debate goes on.
Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).