Overview of Adult Male Circumcision
Adult Circumcision Statistics/Trends
Adult male circumcision is much less common than infant circumcision. The most common reasons for adult circumcision are medical and include the following:
- Paraphimosis (can't return a retracted foreskin to its normal position)
- Phimosis (foreskin is too tight; can't retract from the head)
- Recurrent inflammation of the foreskin (e.g., balanitis, posthitis)
Nonmedical reasons for adult circumcision include social, cultural, personal, and religious factors.
Benefits of Adult Circumcision
Most of the benefits of adult circumcision involve treatment of an existing medical problem. However, two studies conducted in Kenya and Uganda have shown that circumcision can reduce the risk for acquiring HIV/AIDS through heterosexual sex.
Risks/Complications of Adult Circumcision
As with all surgical procedures, there is a risk for bleeding and infection. Other risks include severe bruising (hematoma), poor cosmetic result, and a change in sensation during sex.
Adult Circumcision Procedure
Adult male circumcision is more complicated than infant circumcision, and is commonly performed using one of the following techniques:
- Guided forceps
- Dorsal slit
- Sleeve resection
Before surgery, the pubic area is thoroughly scrubbed, and pubic hair may be shaved or clipped. An anesthetic cream may be applied and a local anesthetic is injected into the base of the penis. This may be followed with additional injections in a ring around the shaft.
The guided forceps is the simplest technique. In this procedure, the foreskin is pulled forward over the glans with a pair of forceps, and the foreskin is then snipped, using the edge of the forceps as a guide.
The dorsal slit is often preferred when treating phimosis or paraphimosis. In this procedure, a slit is made from the opening of the foreskin to a point a few centimeters in, and then a circle is cut around the glans.
Sleeve resection is more complicated, but often preferred when there is a risk for excessive bleeding. In this procedure, two parallel cuts are made along the shaft of the penis, resulting in a thin band or sleeve of detached foreskin. When this is removed, the top and bottom portions of the foreskin are attached with dissolving sutures.
Following circumcision, an antibiotic ointment is applied and the area is wrapped in loose gauze.
Complications following adult circumcision include the following:
- Buried penis (penile shaft buried below the surface of the pubic skin)
- Chordee (abnormal downward bend of the penis)
- Complications from the anesthetic
- Meatal stenosis (narrowing of the urine channel [urethra] at the top of the penis)
- Poor cosmetic appearance
- Skin bridges (foreskin reattaching to the glans)
- Tearing of the sutures, usually due to erection
Adult Circumcision After-Care
If light bleeding occurs, apply pressure to the area with a clean cloth for 10 minutes. Once the dressing is removed (24 to 48 hours after surgery), the area should be washed with plain soap and water for the next 5 to 7 days. It is usually fine to bathe or shower normally. Sexual activity, including masturbation, should be avoided for 6 to 8 weeks.