Circumcision is one of the oldest human surgical operations. What is this procedure, why is it performed today? Answers in the MedAboutMe article.

Cut off excess?

The human body may not be cut and sewn in the best and most rational way, but there is still nothing superfluous in it. This also applies to the foreskin, or prepuce, which is removed during circumcision. What is the function of this piece of skin?

The foreskin flap covers the head of the male genital organ, it is very mobile and elastic, and also very sensitive. Meissner’s and Pacini’s bodies, vibromechanoreceptors, are «responsible» for this. The number of bodies is not the same throughout life: in adolescence it reaches a maximum, after 50 years it begins to slowly decline. However, with phimosis, a decrease in sensitivity begins after 30 years.

In newborn boys, the head is not exposed, since normally there is an fusion of the inner leaf of the prepuce with the skin of the head. By 2-5 years, the fusion disappears. The secret of the skin glands accumulates in the preputial sac, providing constant moisture to the head. This environment is favorable for the development of bacteria, so it is quite common to believe that circumcision can serve hygienic purposes. There is also an opinion that the removal of the foreskin with its complex innervation is intended in one way or another to influence the sexual life of a man and the sensations received from it.

The attitude to this area of ​​​​the skin has always been different. The ancient Hellenes, for example, considered it an adornment of the male organ, and the longer the prepuce was, the more beautiful. And the naked head in their understanding was something completely indecent — with all their respect for the naked human body and admiration for its beauty. Other peoples thought differently — that the foreskin must be removed shortly after the birth of a boy. Among the Jews, this rite is extremely important, as it is one of the immutable religious prescriptions, a symbol of the covenant, and is performed on the 8th day after the birth of the child.

On the 7th day, boys born in Muslim families are circumcised, also according to religious traditions. Although this is not a strict religious prescription, but only desirable and recommended. This procedure is carried out at a later age.

In other nations, this procedure was carried out, and in some places it is still being carried out during initiation — the rite of initiation of adolescents into men.

Circumcision for medical reasons

Circumcision for medical reasons

In addition to religious traditions, there are other reasons for having an operation.

With insufficient hygiene of the penis in the preputial sac, inflammation is possible — balanitis, or balanoposthitis. As a result, cicatricial phimosis may develop, that is, the narrowing of the foreskin to such an extent that it does not allow the head of the penis to be released. Circumcision is the only method of treating this pathology with a guaranteed result.

In addition to cicatricial phimosis, there is also a simple phimosis, in which with age, due to structural features, the head is not released. This can cause not only inconvenience to the young man, but also pain during erection and sexual intercourse. Circumcision solves this problem; in many cases, plastic surgery of the foreskin is sufficient instead of circumcision.

Circumcision is also practiced with premature ejaculation. Removing the prepuce somewhat reduces the sensitivity of the head and allows a man to better control the duration of sexual intercourse.

Although significant differences in the degree of sensitivity, many researchers do not find.

Recently, many doctors are beginning to recommend circumcision as a preventive measure. Some studies show that circumcised men are less at risk of contracting human papillomavirus (HPV), human immunodeficiency virus (HIV), genital herpes, and other infections. There are also statistics pointing to the fact that women who are in relationships with circumcised men are less likely to get cervical cancer.

Expert comment

Cindy Liu, microbiologist, immunologist

Male circumcision reduces the risk of HIV transmission from a woman to a man. The exact reasons for this action have not been elucidated, but we hypothesize that it may be due to changes in the microbiome of the penis after circumcision surgery.

Our study included adult men from Uganda, both uncircumcised and those who underwent this operation as adults. At the initial stage, the coronal sulcus microbiota was comparable in both groups. However, after one year, the analyzes showed a decrease in the total bacterial load and a decrease in the biodiversity of the microbiota in the group of men who underwent circumcision, while this did not occur in the control group. In particular, the number and diversity of anaerobic bacteria has significantly decreased. The decrease in the number of specific anaerobes is associated with a decrease in the activation of HIV target cells. Accordingly, the risk of infection is also reduced.

If we gain a better understanding of the processes that reduce the risk of sexually transmitted infections, new intervention strategies can be identified to reduce the risk of HIV transmission. At least in those populations where HIV infection is especially common, and circumcision is not perceived as something unacceptable.

Expert comment

Brian Morris, physiologist

Our group analyzed 297 publications containing criticism of the circumcision operation. The following conclusions were the result of the work:

  • Statements about circumcision as an operation associated with a high risk of complications and negative consequences were contradicted by data on the low frequency of undesirable consequences.
  • Allegations that the operation causes psychological harm have also not been substantiated. True, subject to circumcision in a medical institution by an experienced specialist, with anesthesia and proper subsequent care.
  • Statements about the deterioration of sexual function, a decrease in the pleasure of sexual intercourse are also not confirmed: not a single high-quality study found such side effects.
  • There is also a large body of evidence supporting the medical benefits of circumcision, such as a reduced risk of contracting sexually transmitted infections, including HIV infection, a reduction in the incidence of various dermatological problems, and cancer of the genital organs.​

In general, the identified benefits outweigh the potential risk by 100-200 times. Moreover, the best ratio is possible when the operation is performed at an early age.

This position is disputed, opponents argue that circumcision at an early age is unethical, since a small child does not make the decision to be circumcised. However, this can be countered by the fact that children have the right to be provided with high-impact and low-risk interventions to improve health. This is confirmed by experts in the field of law. Another argument in favor of circumcision at an early age is the cost savings of the health care system.

Is infant circumcision ethical or not?

Is infant circumcision ethical or not?

The opinions of doctors on the ethics of circumcision at an early age diverge radically. There are those who believe that the operation is possible and permissible only with the consent of the patient himself, and it is necessary to prohibit the circumcision of infants.

Expert comment

Brian D. Earp, Associate Director of the Yale-Hastings Program in Health Ethics and Policy

If the foreskin is anatomically normal and is a healthy functional tissue, its removal is undoubtedly a detriment. At least if this happens without the informed consent of the patient, which the baby, for obvious reasons, cannot give. Ritual surgery on a child’s genitals, even if performed in a sterile clinic setting, constitutes physical abuse and violates the child’s right to bodily integrity. From a moral point of view, all such operations are unacceptable.​

This assertion is not without foundation. In particular, Dagestan scientists studied the issue of the impact of circumcision on the health of infants with perinatal lesions of the central nervous system. Among those who underwent circumcision in the first week after birth, the prevalence of various neuropsychiatric pathologies is statistically significantly higher than among children who did not undergo circumcision.

However, there are also strongly opposing views. Many physicians believe that circumcision can indeed serve as a means of preventing disease, especially in regions and sections of society with an increased risk of contracting HIV and other infections. And at an early age, this procedure, carried out in a medical institution by a qualified specialist with proper anesthesia, is the least traumatic and almost never causes undesirable consequences and complications. Sparing techniques for circumcision, including seamless ones, have been developed. Both a conventional scalpel and a radio wave knife or laser are used. The choice of instrument affects the result of the operation less than the qualifications of the doctor.

However, there is still a tradition of circumcision for religious reasons not in the clinic, but in places unsuitable for this, by insufficiently qualified people, using a dubious instrument. Accordingly, and with a higher risk of postoperative complications.

As for adult circumcision, there are no questions here: the man himself decides what to do with his body. It should be noted that in recent years quite a lot of circumcision operations have been performed for aesthetic reasons: it has become fashionable.

To learn more about how you can change your body, read the article «Top 5 Risky Body Modifications: From Piercing to Snake Tongue».

Posted on 03/06/2022 20:57

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Used sources

Features of neuropsychiatric pathology in circumcision in children aged 3 to 14 years (based on the materials of the Republic of Dagestan) / Alibekova N.A., Damadaeva A.S. // MNIZH 2015 №7-5

Complications of the rite of circumcision and the seamless method of circumcision surgery / Murtuzaaliev Z. N., Makhachev B. M., Murtuzaaliev N. P. // Pediatric surgery 2014

Surgical treatment of acute purulent balanoposthitis in children / Muratov I.D. // Far Eastern Medical Journal. 2002

Newborn Circumcision Techniques and Medical Ethics. / Earp BD, Mishori R, Rotta AT // Am Fam Physician 2021

Critical evaluation of arguments opposing male circumcision: A systematic review / Morris BJ, Moreton S, Krieger JN // J Evid Based Med 2019

American Academy of Pediatrics Task Force on Circumcision / Male circumcision // Pediatrics 2012

Experience and outcomes for PAs in a neonatal circumcision clinic / Colón-Sanchez K, Middleton T, Ellsworth P. // JAAPA 2020

Male circumcision significantly reduces prevalence and load of genital anaerobic bacteria / Liu CM, Hungate BA et al // mBio 2013

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