In men, adult circumcision consists of the surgical removal of the foreskin, the retractable skin fold that covers the extremity of the penis and is the extension of the skin that covers it completely. Circumcision surgery, practiced with current techniques, usually does not hurt and has no consequences in terms of fertility, ejaculation or sexual pleasure.
When is it Advisable to Practice Circumcision as an Adult?
Circumcision is a surgical practice that involves the complete or partial removal of the foreskin, the slippery skin flap that covers the glans. It is a common practice for Jews, Muslims and some people in Africa for whom it has religious value. In the Western world, on the other hand, it is considered a necessary intervention to solve certain health problems. There is no ideal age to perform this procedure. For example, in Western countries, where it is not practiced for religious reasons, circumcision in adulthood for health reasons is more common.
On the other hand, in communities where circumcision takes on a religious value, this procedure is carried out during the children’s first years of life.
Why is Male Circumcision Performed in Adults?
There are many reasons that adult circumcision is performed, ranging from medical to personal preference.
For medical reasons, circumcision is performed in the case of a non-retractive foreskin, a condition known as phimosis; sometimes, however, alternative treatments such as topical steroids (cortisone cream) are preferred.
For religious and cultural reasons: circumcision is a common practice in Jewish and Islamic communities, but it has also been adopted in many African communities; in most cases it is practiced in childhood.
HIV prevention: Circumcision has been shown to reduce the risk of acquiring HIV in heterosexual men, and therefore circumcision is encouraged as part of infection prevention programs in some African countries with high rates of HIV.
Cases where Adult Circumcision is Necessary
Circumcision in adulthood is considered necessary if:
- Extreme phimosis
- Partial phimosis, when it there is constriction and pain in the glans during sexual intercourse
- Relapse of balanoposthitis, recurrent infections that make it difficult to discover the glans gland
The Benefits of Circumcision
Circumcision allows for the maintenance of good intimate hygiene and therefore reduces the risk of genital infections; this would be facilitated by the absence of the foreskin, recognized as an anatomical pocket in which small amounts of urine or smegma can stagnate, causing inflammations such as balanites.
Indirectly, women whose partners are circumcised also have a lower risk of contracting bacterial and fungal vaginal infections during sex.
Circumcision also reduces the risk of contracting the HIV virus, a virus that finds its way into the foreskin, as it is an environment conducive to its growth and multiplication.
Finally, according to some authors, circumcision would improve genital aesthetics and increase the perception of excitement and pleasure during the sexual act.
How will the Circumcision be Performed?
The circumcision is usually performed on an outpatient basis, which means that the patient is operated on the day of admission and does not have to spend the night in the hospital.
Once admitted to the hospital, the patient is examined by the staff of the medical team who will perform the procedure, including the urologist, surgeon and anesthesiologist. This is an appropriate time to express concerns and doubts about any aspect of the intervention.
For adults, the surgeon may consider different anesthesia options:
- Local (injection of anesthetic directly onto the penis, but this is a rare option for adults),
- Loco-regional (for example by spinal anesthesia),
- General (in this case, the patient is required to fast and therefore will not be conscious during the operation)
Circumcision is a relatively simple procedure: the foreskin is removed just under the glans using a scalpel. Any bleeding is stopped by the heat and the remaining skin flaps are sewn together with resorbable stitches.
How to Prepare?
There is no special preparation required before the procedure. Shaving the genital area is optional. Although the operation takes about 30 minutes, you must make yourself available on site for a period ranging from 45 minutes to 1 hour. You may want to be accompanied, but that is not absolutely necessary. Please arrive on time for your appointment. All anticoagulants (blood thinners) should be stopped prior to surgery as recommended by your urologist and noted allergies.
Is circumcision painful in adults?
When circumcision occurs in adult subjects, anesthesia prevents any kind of painful sensation during the operation, while the discomfort that is experienced on the following days, mild analgesics are usually used.
The pain is apparent during the first 2 days, then it fades. Extra-strong Tylenol or a “mild” narcotic prescribed by your urologist is usually enough to control the pain.
In almost all cases, healing is done in 8 to 10 days, without any sequelae.
The skin of the naked glans ends up being «keratinized», that is to say, covered with a kind of dry skin. It takes about 1 month for the circumcised person to get used to this new sensation.
The Post-Operative Part of Circumcision
During the 3 or 4 days following the operation, it is common to feel discomfort and swelling around the tip of the penis, while the surgical wound heals completely in about a month.
It is recommended to contact the treating physician if the patient is experiencing:
- Redness only getting worse
- Persistent pain
- Pulsating sensation inside the penis
- All signs suggestive of infection
It is generally recommended to apply petroleum jelly to the penis, to prevent the operated part from sticking to clothes; wearing light and loose clothes for 2 or 3 days after the operation will help further to avoid irritation. Urinating usually causes no discomfort.
A dozen international studies on adult’s circumcision over the past six years have estimated its effectiveness against HIV transmission at 60%. This means that there is still a significant risk, and that other prevention methods, such as condoms, must be continued.