Adult Circumcision: Procedure, Benefits, and Considerations

Table of Contents

Adult circumcision is a surgical procedure that involves removing the penile foreskin. People may choose to undergo circumcision later in life for several reasons, including medical, social, or personal reasons. The surgery typically takes 30 to 60 minutes, during which a healthcare professional cleans the patient’s genital area and surgically removes the foreskin. After the procedure, the patient can recover at home. They can expect to return to work or school within 1-2 weeks, often making a full recovery within 2-4 weeks. During this period, it is essential to avoid sexually stimulating the penis, such as through masturbation or sexual intercourse, to prevent complications. People who receive a diagnosis of phimosis, balanitis, or other conditions that may require circumcision should speak with a healthcare professional.

Circumcision refers to the process of surgically removing the penile foreskin. While most people undergo circumcision for religious or social reasons, it may also help individuals who experience health problems associated with their foreskin. Many babies are circumcised; however, the procedure may also be performed on adults. This article discusses the medical uses and potential risks of circumcision in adulthood and explains the procedure step by step. It also introduces the recommended recovery process and answers some frequently asked questions.

Definition and Purpose

The surgical procedure for adult circumcision is very individual. Many share a few important aspects: it is very unlikely any man is going to want to go ‘under the knife’ without some form of anesthesia, it usually means general anesthesia, and the patient is going to need someone to drive him home afterwards, rather contrary to the outpatient procedure many are describing it to be. It is wise to plan a couple of days to be spent nursing oneself back to general health and wellbeing, and to be able and willing to rest from daily activity at least a week or so. After the surgery, pain and discomfort depend on the individual patient and the method by which the procedure was completed.

Adult circumcision is a relatively simple procedure, but that doesn’t mean it is without hazards. There are risks for new circumcision patients as well as for men who have been circumcised for years. Before undergoing elective adult circumcision, a man should be aware of these risks. If you have good reasons for wanting the procedure, talk with your doctor. Together, you can make a knowledgeable determination about whether or not this operation is appropriate, and to ensure your own health after the procedure is completed.

Medical Reasons for Adult Circumcision

People should expect some bruising, pain, and swelling immediately after adult circumcision. They will need downtime during the recovery. People should also be prepared to discuss other treatment options with a doctor to ensure circumcision is the best way to resolve their medical condition. If people want to explore the possibility of circumcision, and depending on their country and medical history, they may encounter some challenges. Working with a knowledgeable and supportive healthcare provider will be valuable.

Circumcision is common for religious, cultural, and family reasons. In some countries, circumcision in adulthood is common. People who were not circumcised at an early age might wonder if they should be circumcised later in life. Adult circumcision can be a personal choice. However, some people have medical reasons for needing it. Medical reasons might include phimosis, foreskin damage, and checking for penile cancer and sexually transmitted infections (STIs). Circumcision is typically not a requirement, but for some people, the surgery is essential. A healthcare professional can help people who are not sure if circumcision is medically necessary. A full medical check and discussion about the reasons for circumcision can offer the necessary support.

Phimosis

Special attention needs to be given to the patient with retractile penis and phimosis observed during the neonatal period. It is indicated that the parents of these patients be advised on how to clean the glans with simple retraction of the prepuce during bath time. Although adequate hygiene has to be done, careful attention should be taken to avoid forced foreskin retraction among children, especially as there is no need to do that before the age of 3 years old. Forced retraction may lead to fissures, local inflammation, and even paraphimosis. For retractile penis patients, not always a partial circumcision is enough to resolve their symptoms. The total resection of the foreskin isolates the coronal sulcus from local inflammation and infection.

Phimosis is a condition in which the prepuce, or foreskin, of the penis is abnormally tight or constricting, preventing adequate exposure of the glans. This may prevent one from maintaining a proper level of hygiene and predispose the area to local inflammation and infection. Treatment of the condition through circumcision should be considered, considering frequent complications such as balanitis, posthitis, pustulous balanitis, lithiasis, and retention cyst of glans or coronal sulcus, infections, and rarely but severely, gangrene of the penis may develop. Another important indicator for dosing circumcision is the pain due to phimosis during erection, urination, cleaning the skin, intercourse, and self-pleasant sensations.

Recurrent Balanitis

Other reasons: Although the main reason for adult circumcision is religious belief, obtaining better penile hygiene and being able to wear different clothes, there are also other reasons. If you are asking about the benefits of circumcision, men say that they have received tremendous benefits, and there is no harm not performing circumcision, such as religious belief or customs. However, if you are asking why many people choose to be circumcised from a medical perspective, additional health benefits beyond improving penile hygiene will not force you to perform surgery right away. Adult circumcision should be carefully considered. In summary, the most common conditions that cause men to undergo adult circumcision are penile lichen sclerosis, recurrent balanitis, and preferred toilet hygiene.

This infection can occur in male infants or adults. Balanitis can be painful and can cause groin pain in men. It can also be embarrassing and can cause problems with sexual intimacy. Adult men may want a circumcision to prevent recurrent balanitis. In the past, it was believed that older uncircumcised men were not at risk of recurrent balanitis unless they had diabetes or other illnesses. Now, men are also more concerned about their personal health and choose adult circumcision for better penile hygiene. They realize that good penile hygiene is the best option. However, for some men, having a circumcision may reduce the risk of further balanitis if recurrent infections keep appearing frequently.

Procedure of Adult Circumcision

After the first week of recovery, newly circumcised patients should be able to tell which clothing hurts. Feeling some pain after adult circumcision is normal, but intense and extensive pain is not typical and should be monitored by a physician. Also known as male circumcision, circumcision is a procedure in which a physician or nurse removes the foreskin from either the sides or through a surgical cut of a man’s penis. In the operation, swelling or pain may occur, but they are expected to subside. The circumcision of a man is a significant operation, so discussing cons and potential issues with a provider before making a decision is important.

According to the Urology Care Foundation, patients should expect some temporary pain and discomfort from the procedure. To facilitate post-operative care and healing, some surgeons may prescribe patients designated analgesic drugs and advise them to apply an antibiotic ointment or place petroleum jelly on the incision site. The point is to prevent anything from getting stuck and infected under the stitched-up foreskin. During the first few days of the procedure, the use of baths and therapeutic cleaning methods is recommended. Patients are advised against wearing tight or irritating clothes, such as those made of synthetic materials.

Preparation and Anesthesia

Local anesthesia for circumcision has been used since its introduction. The method is simple and does not require special apparatus. It permits a variation of postural position during surgery. The use of a dorsally applied preputial block has been shown to reduce pain during shaving, retraction, and cutting of the foreskin after 20 minutes. Although the administration of sedation is unnecessary for most men, anxiety-producing is the opening case from anticipation of pain and discomfort. History taking and careful explanations to relieve the patient’s fears, reduction of stimuli such as drowning irritating noise or providing the patient with an epidural anesthetic solution providing relaxation, anxiety, and pain control. The type of local anesthesia may be added with a vasoconstrictor to the local anesthetic in order to increase local anesthesia and reduce the risk of bleeding in patients with coagulation abnormalities. The identified outcome shows no significant differences in the patient’s perception of postoperative pain intensity or quality during dressing changes between groups receiving a 12-minute liquid nitrogen spray frozen the dorsal penile nerve or the 22-gauge needle for infiltration of the dorsal penile nerve with local anesthetic. At 12 minutes, there is no difference in the mean pain or anxiety scores during injection of the anesthetic, significantly less pain and anxiety injections of anesthetic were found in the group of patients treated with the liquid nitrogen spray. A second reduction in both pain and anxiety was observed in group two during excision of the prepuce.

Pre-operative testing should be performed regardless of the choice of anesthesia or operative technique. Patients can shower normally the day before the surgery or on the morning of the operation. During penis cleaning before the surgery, the foreskin should be retracted adequately. Sometimes in older patients, especially those with diabetes and who smoke, exposure can be difficult. A low-pressure bulb syringe with soap and water can help during the shower, retraction of the foreskin, and cleaning with a Q-tip. Proper cleaning can also prevent secondary infection of the surgical wound during the postoperative period.

Surgical Techniques

There are several different methods currently employed for adult male circumcision. These include standard sleeve, sleeve with a V-Y flap, the placation technique, or dorsal slit with a combined suture and tissue removal technique. All procedures involve the removal of the excess penile foreskin. The standard sleeve technique does not involve a dorsal slit. Instead, a patient with a longer penile foreskin will have a redundant ventral nap as well. The incisions are made so that the dorsal incision is 1.0-1.5 cm from the coronal sulcus, the ventral midline incision is longer, and the redundant ventral naps are excised.

Adult circumcision procedures are the removal of a portion of the foreskin of an uncircumcised male. Circumcision should be performed with proper pain control and patient counseling to alleviate the anxiety regarding dealing with this sensitive region of the body. At this time, three methods of circumcision widely performed include the sleeve, placation, and dorsal slit or trade tissue circumcision. As awareness of the infectious risk of the procedure grows, patients may have greater cause for concern. Care should be taken to explain to each patient the risks and benefits of the procedure so he may make an informed decision weighing his own individual need for the procedure.

Benefits and Risks of Adult Circumcision

The main risks include bleeding, wound infection, and reduced sensation that may arise. Most bleeding is minor, but severe bleeding or hemorrhage can occur. Wound infection is relatively uncommon when the surgery occurs under sterile conditions. Others could notice this discomfort, and it can be a concern even after healing has occurred. These risks are generally considered minor. More severe complications are possible, but they are rare. Some older men may worry about the potential increased risk of erectile dysfunction with adult circumcision. They fear that the loss of foreskin sensitivity could reduce sexual pleasure and make it harder to achieve and keep an erection. However, there is no compelling evidence to demonstrate that adult circumcision increases the risk of erectile dysfunction.

Though adult circumcision has risks, including bleeding, infection, and decreased sensation that can make it harder to sustain an erection, the procedure has many potential benefits. Adult circumcision can result in a lower risk of urinary tract infections, reduced risk of sexually transmitted diseases, prevention of penile problems, decreased risk of developing cancer of the penis, and prevention of infections under the foreskin. Any surgery or medical procedure has risks. However, circumcision is considered to be a relatively low-risk procedure that is safe when performed by an experienced and qualified specialist under sterile conditions. Treatment to manage any complications from adult circumcision is available, should they occur.

Health Benefits

Circumcision provides no protection against any of the infections when the circumcised man has sex with a man or during oral sex with a woman or man. Among gay and bisexual men, it may instead increase the risk of infections with syphilis and HIV, particularly for a man who acquires a large number of sexual partners soon after circumcision.

Other studies have shown that medical male circumcision also provides men with some protection against syphilis and human papillomaviruses, including some strains which cause genital warts and anogenital cancers in men and women. It also helps to protect partners of the circumcised men from bacterial vaginosis, trichomonas, and HPV. Other STIs from the male partner, and possibly HIV.

HIV, other sexually transmitted infections, and reproductive tract infections

Three trials in Kenya, Uganda, and South Africa have provided strong evidence of the benefits of medical male circumcision to protect men from HIV infection. These trials showed that circumcised men were approximately 60% less likely to contract HIV from HIV-positive women during penile-vaginal sex than uncircumcised men. The trials were stopped early because an interim analysis showed that the three studies had met the stringent criteria established by an expert review committee and, in response to these results, the data and safety monitoring board of each trial recommended stopping the trial and the immediate provision of circumcision services to control participants.

Male circumcision has been shown to protect men over their lifetimes from several diseases, with substantial benefits for their sexual partners. In 2011, circumcision was included as part of a comprehensive package of HIV prevention services for adults and newborns by WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS), and recommended for men at higher risk of HIV

Potential Complications

The most common complaint that circumcised men make is that they have lost some penile sensitivity, which plays an important role in sexual arousal. At the same time, however, it should be noted that the ability to maintain the role of efficient pain control throughout the procedure will have a direct influence on the patient’s experience. Differences exist in the perception of pain intensity as well as in the reflected control of this pain, and this is why all of the medical jargon must be explained to the patient before the operation is carried out. This can go some way in preventing potential pitfalls and also help build up useful knowledge as to how patient satisfaction can be achieved.

Should you choose to have this procedure, you are certainly well-advised to do your homework first. Some men, especially those who have an active sex life, consider the temporary reduction in sexual function to be too serious a detriment to having the procedure carried out. Another risk factor, albeit small, is that a man’s erectile response to sexual stimulation may be reduced. Research has shown, however, that these sorts of potential complications are almost always temporary and that penile sensitivity levels usually return to pre-surgery levels in a relatively short period of time. Few blood vessels or nerves are damaged during the process and the outcome is usually positive.

Considerations and Decision-Making

Even for men who are interested in the protection offered by circumcision in a context of high-risk sexual behavior, the discussion has shown that the real benefits would not accrue until years later. A point could therefore be reached in the discussion, as suggested by one participant, especially in a counseling session, in which doubts about the importance of the foreskin’s presence are set aside, and men who are genuinely interested in circumcision receive clear information about the procedure. It is important to keep in mind, however, that circumcision should not serve as an easy solution to policy-makers’ and societies’ concerns about the sexual behavior adopted by their members, whose health is at stake. The goal of safer sex policies is for adult circumcised men with knowledge to change their behavior, their knowledge of the surgery constituting in fact a good type of prevention. All public health interventions, regardless of their nature, attempt to influence the target populations and motivate them to adopt behaviors that are in their best interest. Adult or adolescent male circumcision represents only one additional possibility in this arsenal.

The medical reasons to consider circumcision in adult men include prevention of infection and treatment of phimosis, paraphimosis, and balanoposthitis. However, the infection-prevention aspects of circumcision may not be as strong as they have been made out to be. In some settings, for example, it may be possible to maintain adequate penile hygiene whether or not a man has been circumcised. In populations with a lower prevalence of sexually transmitted human immunodeficiency virus and higher levels of knowledge and risk perception regarding this infection, male circumcision is not likely to influence high-risk sexual behaviors or the acquisition and transmission of sexually transmitted infections. Adult men should bear this issue in mind when considering circumcision for preventive reasons. The fact remains, however, that circumcision is an effective prevention tool and represents a promising complement to preventive strategies based on risk-reduction counseling, condom promotion, and the treatment of sexually transmitted infection.

Cultural and Religious Factors

Being a more simple surgical operation, the circumcised life of Muslims in many tribes living in different parts of the world is also notable in comparison with Judaism. Despite this simplicity, circumcision has been delayed because there is no chronological time like Jews. While performing circumcision operations in extraordinary ways with people who think that children who do not have circumcision or are late in circumcision need moral support is their mission in life for people from all walks of life converted to Islam of their choice, presenting neighborhoods to new fathers and helping some of them concerning, performing religious ceremonies make up a part of personal acceptance.

Being a medically unnecessary procedure, adult male circumcision is undergone by many males around the world for social, cultural, and religious reasons. The principal reason in 85-90% of cases is religious beliefs. In many Jewish and Islamic communities, circumcision at one time or another during a boy’s life cycle is an initiation rite. Adult male circumcision via surgical methods is sometimes seen as treatment in cases of denial into religious observance because of incomplete religious male circumcision in early childhood or as personal choice about fidelity to religious beliefs or as strengthening of male identity. These groups generally cause demand for ritual circumcision and prayer (Bris) in adult males converted to Judaism. In tribes, people have also performed induction ceremonies, as well as circumcision.

Personal Choice and Consent

It is very important to consider a man’s autonomy over his own body as carefully as a female’s autonomy. The man must fully understand the aims and limitations of the procedure and give consent for any operation if phimosis or other anatomical pathologies are not present. Consent may not always amount to autonomous authorization; so providers must make sure that their patient fulfills the basic criteria of informed consent and then act under specific rules.

To perform male circumcision, a good level of quality training for the specific common method in a suitable environment is necessary. A good relationship between the genital area and the abdominal or lower extremity core muscle balance should be established. Male circumcision may be planned in adult life due to medical or personal reasons. Although some religions impose circumcision at any stage, it is not ethically true from the medical point of view to impose them on a male without a medical reason.

To ensure respect and avoid harm, parents should be counseled concerning the potential long-term physical and psychosexual harm that their decisions for their child may produce. In phimosis cases, circumcision is the easiest and fastest solution, but many of them can be conservatively managed. The orthopedic experience with parental questioning about the timing of reconstructive surgery over recent years has been significantly higher than in the past.

While circumcision removes the foreskin and its specific function, it does not affect a man’s sexual activity or satisfaction. Some other cultural practices do cause issues with sexual activity and satisfaction. It should be noted that what is viewed as penile anatomy and what is viewed as sexually attractive appearance and behavior are culture dependent.

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