It is a surgery that has been practiced for thousands of years.
Historians believe that circumcision existed as long ago as 15,000 years in Egyptian society and has survived to this day, with approximately one in 3 men circumcised in the world.
Most of these circumcised men -that is, those who have the foreskin of their penis cut off, leaving the glans exposed- are Muslims, since in Islam it is practiced as a rite in newborns as well as in the Judaism.
In second place are men born in the US (80.5%, according to 2016 data) because in that country circumcision has been a medical intervention considered beneficial for decades.
Most circumcisions in the world are performed immediately after birth. In those who are not circumcised it may be necessary later for health reasons.
Here we tell you in 4 questions what science says about circumcision.
1. What is the biological function of the foreskin and what happens when it is cut?
The foreskin is the part of the skin of the penis that covers the glans. Unlike the rest of the skin of the penis, which is attached to the organ, the foreskin is detached and, if there is no problem, it should be able to be removed until the entire glans is exposed, both in a flaccid state and during an erection.
The inner surface of the foreskin is a lubricated mucosa similar to the inside of the mouth or vagina in women.
“Its function is to cover the organ, to serve as a cover,” urologist Ana María Autrán, from the American Confederation of Urology, tells BBC Mundo.
Experts also believe that it may have some immunological function.
The man can, however, do without the foreskin.
But the glans is a very sensitive area of the penis. When the foreskin is removed for health reasons in childhood, adolescence, or adulthood, the glans penis, which was previously protected, comes into direct contact with the air and clothing.
For this reason, in the first weeks the patient feels discomfort due to the rubbing of the glans penis with the garments. He may, in turn, feel pain during erections.
Over time, the skin of the glans penis hardens and loses some sensitivity.
Surgery is generally performed in two ways: the traditional way, cutting the foreskin with a scalpel, or with a staple gun. Only local anesthesia can be applied, although many times the patient is sedated before pricking such a sensitive area.
2. When should a circumcision be done?
Leaving aside religious reasons and focusing on health, there are different visions.
On the one hand, there is the majority position in the United States that it is preferable to circumcise babies at birth. According to the American Academy of Pediatrics (AAP), “the health benefits of newborn male circumcision outweigh the risks.”
Among the advantages, he mentions the prevention of urinary tract infections, penile cancer and the spread of some sexually transmitted diseases, including HIV.
“Male circumcision performed during the neonatal period has considerably lower complication rates than when performed later in life,” he adds.
The organization qualifies its opinion by saying that there are not enough elements to request that it be a routine intervention for all babies. “It is a decision that parents have to make, always helped by a doctor,” pediatrician Ilan Shapiro, a member of the AAP, explains to BBC Mundo.
An opposite position is held, for example, by the Royal Dutch Medical Association, which states that babies should not be circumcised because “there is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene”, and therefore “it is not justifiable except for medical/therapeutic reasons”.
“Contrary to popular belief, circumcision carries the risk of medical and psychological complications. The most common complications are bleeding, infections, meatal stenosis (narrowing of the urethra) and panic attacks.
The main medical reasons that can lead to circumcision are phimosis, paraphimosis and balanitis.
Phimosis occurs when the foreskin is so narrow at the end that it does not allow it to slide as it should until the entire glans is exposed. Detected at an early age, it can be cured with creams so that it is not necessary to go through the operating room.
Paraphimosis occurs when the foreskin slips off completely but then doesn’t come back.
And balanitis is swelling of the glans penis, almost always caused by poor hygiene. To avoid it, from a young age children should remove the foreskin and clean the area well with soap and water to remove the smegma -thick white discharge- that occurs under the foreskin.
These complications can appear at any stage of life, from childhood to old age.
3. Does it have any impact on sexual life and sensitivity?
According to Shapiro, this is a difficult question to answer, since statistically there are few cases of men who can compare their sexual activity before and after circumcision, so there are no conclusive studies on the matter.
While the penis adjusts to its new physiognomy after circumcision, the patient has increased sensitivity in the glans penis that can cause discomfort, says Autrán.
Then the skin of the glans -which was protected by the lubricated foreskin- changes when it is in direct contact with the air.
“It starts to get dry, and when the skin gets a lot tougher, that sensitivity changes,” Shapiro explains. He adds that the foreskin is also an area full of nerves that is lost when the foreskin is removed.
Some patients come to the office asking the doctor to circumcise them for cosmetic reasons: they understand that their penis will look more beautiful without the protective hood.
These types of interventions are also done, but first knocking down some myths: the penis will not look bigger, nor longer, nor will it have more power when it comes to sex. And the ejaculation will be the same as before.
A warning that specialists give to patients is not to have sexual relations in the four or five weeks after surgery to avoid pain and complications in healing.
4. Does it help prevent HIV and other sexually transmitted diseases?
One of the benefits that supporters of circumcision promote is that it helps prevent sexually transmitted diseases (STDs), such as HIV.
Even the UN, from its program to fight against HIV, carries out massive circumcision campaigns in countries of eastern and southern Africa that have high levels of prevalence of this virus.
Removal of the foreskin has shown reductions in HIV infection rates, but only in heterosexual men and in areas of high transmission.
“That the relationship between circumcision and HIV transmission is, to say the least, unclear is illustrated by the fact that the US combines a high prevalence of STDs and HIV infections with a high percentage of routine circumcisions. The Dutch situation is precisely the opposite: a low prevalence of HIV/AIDS combined with a relatively low number of circumcisions,” says the medical association of the European country.
In men who have sex with other men and are active, the protection of circumcision against HIV is partial, while among those who are passive no differences have been found.
Other STDs such as gonorrhea, syphilis, chlamydia, herpes, human papilloma virus or genital ulcers have been studied by medicine because they believed that circumcision prevented their infection. However, there is no evidence to prove it.
It may interest you:
* Is adult circumcision recommended?
* What are the pros and cons of circumcision?
* He entered the hospital for bladder surgery, but was circumcised by mistake
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