Do you need circumcision?

I have been asked this question on many occasions by my patients. And each time I find it hard to give a straight forward answer.  You can ask numerous doctors you want, read journals and articles; you will still find as many experts who vote for circumcision as you will find opposing it. 

Why is circumcision a controversial topic and what makes it hard to take this simple decision?

1. Circumcision prevents infections: Many experts who vote for circumcision believe circumcision prevents infections. Smegma gets collected under the foreskin and has potentials to harbor infective organisms. It infects surrounding tissues and also plays a role in transmitting the same infection to your partner. One needs to keep cleaning under the foreskin regularly to reduce risks of infection. Perhaps due to ignorance or inability some experts vote for circumcision prophylactic. Others believe with time and education cleanliness is never going to be an issue. 

2. Circumcision prevents penile cancers: As most penile cancers start from the foreskin it is certainly evident that removing it early reduces chances of penile cancers significantly.  However the opposition’s claim is that penile cancers are not very common. According to historical data, rate of penile cancer is fairly low and circumcising every man is not the radical decision. In fact breast cancer which is more common is not dealt by prophylactic mastectomy, therefore prophylactic circumcision is injustice. 

3. Circumcision reduces risks of HIV and sexually transmitted disease: A few years ago there was a consortium of experts under WHO, that performed trials in parts of Africa. The consortium agreed that HIV and sexually transmitted disease are more common in circumcised than in uncircumcised men. Opposing experts’ views are circumcision doesn’t provide absolute protection and use of safe sexual practice is still recommended even if you are circumcised. 

4. Circumcision lowers sexual sensation: Foreskin is a highly innervated area and excising it cuts sensations during sexual intercourse. This perhaps is the most fear–inducing argument. However opposing experts claim that reduced sensation delays ejaculation which leads to much better sexual satisfaction in both partners. 

5. Circumcision does more harm: Besides pain, circumcision risks your penis to infection and scarring.  Opposing it, are experts’ claim that given that modern science is advanced, the amount of pain, infection and scarring is significantly lower than before. 

It is quite intriguing that a procedure as simple as circumcision has equally opposing opinions. Therefore the decision and the final verdict lies in your hands. And whatever is your decision there are going to be both supporting as well as opposing groups. If you ask me, I would say that circumcision is not absolutely required unless the foreskin is obstructing normal urine outflow or it does not slide on the glans easily. 

If you choose to get circumcised, choose the right specialists who are trained well with this procedure.