What is circumcision?

Circumcision in men involves the cutting off of the foreskin protecting the head (or glans) of the penis. As the only moving part of the penis, the foreskin facilitates sexual activity. It contains nerve endings that play a part in sexual pleasure and its glands produce lubricants that help protect both the head of the penis and the female vagina. It is generally removed for religious reasons but may take place for medical ones.

Stop you're making my eyes water. Why is it such a controversial subject?

Circumcision is a painful subject in more ways than one. Wars have even been fought over it. Because of its religious associations, it can be difficult for people to talk about circumcision on health terms alone. Men's Health Forum, however, deals only with the health side.

Many men are happy with their circumcisions but we've had emails from men who are suicidal because of the problems resulting from their circumcision. We even heard from a terrified fifteen year-old who had been told at school that if his glans was not visible when he had an erection he would have to be circumcised. Our doctor's reaction? 'Who is teaching this guff?' If you're considering circumcision for yourself or a child, you'll want to know all the facts not just the religious ones.

Fact number one is that the foreskin is perfectly healthy and harmless and, like any other human tissue, should only be removed for a good reason. Whatever your personal views on what constitutes good reason, remember that no surgery is without risk and that circumcision is surgery in a very delicate place that can fundamentally effect both physical and psychological well-being.

How many men are circumcised?

Nobody really knows but organisations campaigning against it estimate that worldwide about one in four males are circumcised. National rates vary widely from about 80% of males in the USA to 2% in Sweden, where non-medical circumcision is now illegal in children. In the UK, the number of circumcisions for medical reasons has fallen from 35% of English boys in the 1930s to 6.5% in the 1980s and today some 12,200 such circumcisions are performed annually. Some doctors consider that this is still far too many.

What are the medical reasons for circumcision?

There are three main reasons for circumcision but doctors disgree on how promptly circumcision should be offered as the treatment. Some see it as a last resort; others will suggest it sooner.

• Phimosis In babies, the foreskin and the glans develop as one, only separating during childhood. As a result the infant foreskin is frequently tight and inelastic. Some doctors may suggest circumcision in these circumstances. Others say that generally the foreskin loosens by the age of three and that true phymiosis, which affects fewer than 1% of boys, is very rare before the age of five.

  If possible, watchful waiting is sensible in suspected phimosis because the vast majority of foreskins loosen themselves naturally. While only 4% of baby boys have a retractable foreskin, 98-99% of 18 year-olds do. The figures are from the British Medical Journal, 1993, the same article that revealed that many surgeons simply cannot tell the difference between an everyday tight foreskin and true phimosis. 

• Balanitis In Balanitis the glans and/or the foreskin become inflamed. It can affect men of all ages including boys (most commonly around the age of three or four).

  Poor hygiene, a tight foreskin), skin disorders allergy to products such as soap or washing powder or to the latex or spermicides in condoms can all damage the skin and, if this becomes infected, balantitis can develop. Balanitis is not transmitted sexually but a bacteria called candida which can cause it is. Sex may also damage the skin. It is best avoided by keeping the penis clean, especially under the foreskin but in recurrent cases circumcision might be offered. 

• In adults it may be offered as a treatment if a tight foreskin is making sex painful.

Can circumcision help prevent cancer?

There is little evidence of this. Circumcision in childhood - but not as an adult - may reduce the risk of penile cancer but this disease is very rare anyway and the real risk factors are poor personal hygiene and smoking. Indeed, the countries with the highest rates of circumcision (USA, for example) are also those with the highest rates of penile cancer.

Can circumcision reduce the risk of a sexually transmitted infections (STI) or HIV/AIDS?

Another controversial area. Some sexually transmitted infections appear more common in uncircumcised men, others in circumcised men.

Two particular concerns for circumcised men are that:

• they are less likely to notice the symptoms of the STI chlamydia - the incidence of which is increasing in the UK - so heightening their risk of passing it on; and,
• they appear more likely to develop penile warts.

As regards AIDS, the international not-for-profit health organisation the Cochrane Collaboration has reviewed all the research into circumcision and HIV and concluded that that there is insufficient evidence to support the idea that circumcised men have less chance of contracting HIV. However, it should be said that not all scientists agree with this.

What everyone agrees on is that all men can reduce the risk of an STD or HIV by using a condom.

Is circumcision safe?

It is generally accepted that there are serious complications in perhaps 2% of medical circumcisions — 1 in 50. (Figures are obviously higher if the surgeon or hygiene practices are below hospital standard.) Complications include bleeding, infection, ulceration and psychological and sexual problems.

The operation is generally carried out under local anaesthetic for boys and general anaesthetic for men. Usually, the patient is discharged the same day but many describe the operation and its aftermath as painful.

Is it reversible?

Some men think so. There are videos and packs available which claim to show circumcised men how to restore themselves but these should be approached with caution.

Are there alternative treatments for a tight foreskin?

Yes. These include steroid creams, stretching methods and less-invasive surgery. Most physicians will try these before resorting to circumcision.

Dr Ian Banks, former president of the Men's Health Forum says: 'In the UK we circumcise boys and men more than most other European countries with no real evidence to support the practice.

You should lubricate your penis well with a water based jelly and pull the foreskin increasingly further back until you can achieve a full retraction while the penis is flaccid. Do not do this with an erect penis as it may prove difficult to bring the foreskin back to its rightful place. Real eye watering stuff. Once you can achieve this, and it may be painful, try doing it with the penis in various stages of increasing erection. Always return the foreskin immediately. If you leave it retracted while very tight it can cause the blood to remain inside the penis making it get even bigger (the basis of 'cock rings' and the vacuum device for impotence).'

• 15 Square (Norm UK) provide information and advice on phimosis and unwanted circumcision UK.

How can I avoid a tight foreskin?

You'll like this one. There's one very easy way. A study in the British Journal of Sexual Medicine in 1997 of men aged 18-22 found that those with a tight foreskin either never masturbated or used an unusual technique. Once they did masturbate in a more conventional way (ie. an up and down motion mimicking sex), the problem righted itself in a few weeks.

Just so I know, what are the religious reasons?

The majority of religious circumcisions are carried out among Jewish, Muslim and African tribal communities.  

To Jews, the practice, which is usually carried out when a boy is eight days old, represents the covenant between Abraham and God. To Muslims, it as a sign of submission to God although most do not regard circumcision, which is not mentioned in the Koran, as obligatory.

Those who oppose religious circumcision say it is a painful, psychologically damaging and oppressive tradition designed to subjugate the individual and his or her sexuality.

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