MEN'S HEALTH MATTERS:A circumcision is the most definitive treatment for a tight foreskin
Q I am 29 years of age and have a very tight foreskin which I find very difficult to retract. It can be painful during sexual intercourse. I went to see my doctor and he diagnosed it as phimosis and suggested that I might benefit from a circumcision. What is a phimosis? What is a circumcision and do I need to be circumcised?
APhimosis is a condition characterised by difficulty in retracting the foreskin to expose the glans penis. Physiological phimosis is often seen in infants and generally does not require any treatment as it often resolves spontaneously before these boys reach adolescence. It may not settle spontaneously and require a circumcision in early adult life. Occasionally, a circumcision will be required in children where the phimosis may be a cause of recurrent urinary tract infections.
Acquired phimosis occurs in men often as a result of chronic infections, repetitive forceful retraction of foreskin or poor hygiene that leads to scarring and inability to expose the glans penis. Phimosis is associated with increased rates of recurrent bacterial and yeast infection, and pain during sexual activity.
It can also develop into paraphimosis, a condition in which a retracted tight foreskin is trapped below the head of the penis leaving it exposed. Pain and swelling may follow and emergency treatment may be necessary.
Occasionally, older men may develop pre-cancerous lesions on their foreskin. This is known as Bowen’s disease or Leukoplakia, and appears as red or white patches or plaques, irritated areas, or as a sore or lump on the penis. As these conditions are recognised as pre-cancerous, it is recommended that the lesion is removed.
A circumcision is a surgical procedure that involves removal of the foreskin, the skin that normally covers the “head” or glans penis. It has been performed for many centuries and may have originated in ancient Egypt, possibly around 6000 BC.
From here the practice spread and was adopted into other cultures. It is performed for a number of reasons, including hygiene, as a rite of passage into manhood, as a mark of cultural identity or ceremonial offering to the gods.
Cultural and religious beliefs along with medical disorders of the foreskin are the commonest indications for circumcision. Circumcision under Jewish law is obligatory and is a mitzvah aseh or positive commandment. In Islam it is extremely popular, with over 80 per cent of Islamic men having had a circumcision.
The World Health Organisation estimates that approximately 30 per cent of adult males worldwide have undergone the procedure.
A circumcision is the most definitive treatment for a tight foreskin and is the procedure of choice where there is evidence of scarring or infection of the foreskin. It is often thought that it is an operation only performed in children, but it is also commonly carried out in adults.
If a circumcision is recommended by your general practitioner, you will be referred to a urological surgeon for assessment. It is usually performed as a day procedure, often with a local anaesthetic, leading to improved recovery time, post-operative nausea and sickness. A general anaesthetic is more often not necessary.
The procedure takes about 30 minutes and after the operation the wound will be dressed in bandages which stay on for 24 hours, but often fall off sooner. It is advisable to bathe the area every day in the immediate post-operative period to keep it clean and free from infection.
Absorbable sutures are used, which will fall out after a number of weeks, and any sexual activity should be avoided for at least a month and sometimes even longer.
Complications are rare, but bleeding from the wound site may occur immediately after the circumcision and an infection may develop after a couple of days. Antibiotics are rarely required and simple cleansing of the area will generally suffice.
The operation is an “amputation” of the foreskin and that means the head of the penis will be exposed at all times. It usually takes between four to six weeks for everything to settle and for the foreskin to attain its long-term cosmetic appearance.
Alternatives to a formal circumcision are possible in selected cases if you want to preserve your foreskin. These have been discussed in a previous column (April 29th, 2008). If you are keen to preserve your foreskin it is very important to discuss these issues with your surgeon before you make any decision.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin, with contributions from Derek Hennessey, urology registrar, St James’s Hospital, Dublin.
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