human health

Circumcision: Complications and Reflections

Complications

It is not possible to outline an objective picture on the possible post-circumcision complications: the success of the operation varies according to the doctor, the clinic, the patient, the age and the type of instrument used to exclude the foreskin. In third world countries, circumcision is often imposed for purely religious reasons: it is clear that when the operation is not performed by expert personnel and in places that are not perfectly sterile, the risk of post-operative infections increases greatly.

However, considering the statistics, the most frequent complications include infections, hemorrhages, frenulum ulcers, preputial adhesions and meatal stenosis [from clinical Andrology By Wolf-Bernhard Schill, Frank H. Comhaire, Timothy B. Hargreave].

Some Jewish testimonies show that, following circumcisional rites evidently not respecting the hygienic conditions of the environment and of the instrumentation, some newborns were struck by tuberculosis of the penis (reported following an oral metzitzah : oral suction of the small infant's penis purpose of suspending the bleeding generated by circumcision), hepatitis B and C.

Some patients, after a few weeks of circumcision, claim to have both masturbatory difficulties and problems in achieving pleasure during the sexual act; Frequently, patients complain of genital hypersensitivity, especially caused by continuous rubbing with undergarments, and dyspareunia.

The rare complications of circumcision include septicemia (blood infection), meningitis, gangrene, neonatal tetanus and lymphedema.

Reflections

Circumcision, when imposed, represents a trauma in all respects, especially for those children forced into this religious practice (cruel, from a certain point of view). To practice a forced circumcision to the child means to find an irreversibly mutilated adult body, with the awareness of being different from the others. As can be guessed, circumcision has been and still is the subject of debate, when the end is not therapeutic.

If for some the circumcision is synonymous of greater sensibility and of greater "duration" during the sexual performances, for others, the removal of the prepuce can make the sexual act itself painful, as well as the marturation, depriving the man of a natural pleasure, of a physiological fulfillment separated from difficulties and pain. Of course, these unpleasant side effects do not occur in all circumcised subjects, but the probability, in fact, exists.

To overcome these "drawbacks", some protest movements were born against circumcision, when this is not essential for the resolution of problems at the genital level. In Finland, to give an example, male circumcision is considered illegal, when practiced for rituals, religious ceremonies or initiation rites.

Summary

Circumcision: in short

Circumcision

An ancient surgical practice that involves the total removal of the foreskin

Postectomia

Partial removal of preputial leaflet

Incidence

20% of men are not circumcised

13 million men undergo circumcision every year, of which 80% are satisfied with the operation

Circumcision and cultures

  • Muslims: circumcision is a ritual index of fertility, an initiatory ceremony to "belong to a culture" and a desire to respect one's religion
  • Muslims: circumcision is almost a moral as well as a religious obligation. The uncircumcised keep the impurities in the body making prayers vain
  • Italy: circumcision is useful almost exclusively for treating infections or genital diseases
  • USA: drastic decrease in the number of circumcised in recent years (-90%)
  • Korea: circumcision was widely practiced during the war
Reasons for circumcision

  • Religious purpose
  • Promotes greater intimate hygiene
  • Improves genital aesthetics
  • Desire to perceive more excitement during the sexual act
  • Resolve anatomical genital disorders (phimosis, paraphimosis)
  • Treatment of premature ejaculation
  • Care / remediation of penile lichen sclerosus, hypospadias (incomplete development of the urethra), urethral stricture, chronic penile lymphedema, penile cancer
Intervention
  • Scrupulous specialist examination (urologist, andrologist and, when necessary, dermatologist)
  • Surgical practice performed in a day hospital
  • Surgical removal of the skin flap that covers the glans, using a laser or scalpel
  • Local anesthesia by inoculation of xylocaine 1% directly into the nerves of the penis (in the child, general anesthesia is preferable)
Circumcision and premature ejaculation

Glans hypersensitivity: the most known cause of premature ejaculation

→ circumcision + glandular neurotomy → decrease in sensitivity to the glandular level → remedy for premature ejaculation

Circumcision and sexually transmitted diseases

  • Circumcision: a valid aid to reduce the risk of infection from sexually transmitted diseases (in particular: AIDS, Trichomonas vaginalis)
  • In women with circumcised partners the risk of contracting bacterial vaginitis is very low
  • The foreskin appears to be the ideal habitat for the HIV virus: by removing the part, the virus does not find the ideal conditions to settle
  • Male circumcision: it is not used as a prophylaxis against chlamydia, syphilis and gonorrhea.
  • Contrasting theses for the prevention of papilloma virus by circumcision
Complications of circumcision

Post-circumcision complications: they vary according to the doctor, the clinic, the patient, the age and the type of instrument used to exclude the foreskin:

  • Frequent complications: infections, haemorrhages, frenulum ulcers, preputial adhesions, meatal stenosis, masturbatory difficulties, problems in achieving pleasure during sexual intercourse, genital hypersensitivity (rubbing with undergarments)
  • Rare complications: tuberculosis of the penis, hepatitis B and C, septicemia, meningitis, gangrene, neonatal tetanus, lymphedema