Should You Consider Circumcision? the Need for Foreskin Removal - Urology

Dr. Li Yilun reply Urology

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1.
What is the foreskin? The foreskin is an anatomical structure that extends from the coronal sulcus at the back of the glans penis and covers the glans itself.
The foreskin is characterized by its looseness and excellent elasticity, providing sufficient space for the penis to expand.
2.
How is phimosis defined in medical terms? If the foreskin cannot be retracted to expose the glans, this condition is generally considered phimosis.
It is normal for newborns and infants to be unable to retract the foreskin.
However, by the age of 3 to 4, about 90% of children can easily retract it, with only a small percentage needing more time to do so.
If the foreskin remains non-retractable after puberty, it is classified as complete phimosis, which may require surgical intervention.
3.
What is the function of the foreskin? In primitive times, the foreskin served to protect the glans.
Since the advent of clothing, the foreskin may seem redundant.
However, it still holds significant value.
For instance, modern infants are often diapered for convenience, and without the protection of the foreskin, the urethral opening may frequently rub against the diaper, potentially leading to scarring and narrowing of the urethra.
In cases of hypospadias, the foreskin can be used for urethral reconstruction surgery.
In adults, a loose and elastic foreskin facilitates the free movement of the penis, reducing pain or injury during intercourse or masturbation.
4.
Under what circumstances is circumcision necessary? Circumcision can be indicated in several situations:
a.
If the opening at the tip of the foreskin is very small, preventing the glans from being visible even when retracted, and urination resembles inflating a balloon, prompt intervention is necessary.
b.
If the foreskin can be retracted to fully expose the glans without tightness or adhesion, and cleaning allows for observation of the coronal sulcus, circumcision may not be required.
c.
If partial exposure of the glans occurs with tightness or adhesion, making cleaning difficult and leading to smegma accumulation, circumcision may be cleaner but is not urgently needed.

Other indications include recurrent inflammation of the glans and foreskin more than twice within a year, paraphimosis, or if an encircling band constricts the glans during erection, causing edema.
However, circumcision is not suitable for individuals with buried penis, hypospadias, or bleeding disorders.
5.
How should the foreskin be properly cleaned? Generally, instructions on caring for the foreskin are unnecessary.
At most, rinsing the area around the opening with water during bathing can reduce redness and swelling caused by urine residue.
Adults should retract the foreskin to clean the internal area, minimizing smegma buildup.
6.
What is smegma? When the foreskin is not easily retractable, smegma can accumulate between the foreskin and the glans, sometimes forming pearl-like structures.
This smegma does not affect health, and one should not forcefully retract the foreskin for cleaning, as excessive force can cause pain and scarring.
Circumcision is only necessary if, after age ten, the foreskin remains non-retractable, causing ballooning during urination, or if it is too tight to clean properly, leading to recurrent urinary tract infections, or if it adheres to the glans.
7.
What are the benefits of circumcision? Research indicates that circumcision can reduce the risk of penile cancer and cervical cancer in partners, as well as provide some protection against urinary tract infections, though it does not decrease the risk of sexually transmitted infections.
There is no definitive conclusion regarding its effects on sexual function, premature ejaculation, or penile development, particularly regarding the timing of the procedure in childhood or infancy.
However, performing the surgery under local anesthesia is considered an appropriate timing.
Finally, we recommend that parents of boys thoroughly understand the benefits and drawbacks of circumcision, engage in comprehensive discussions with healthcare providers about the indications for the procedure and potential postoperative complications, such as pain, bleeding, and temporary swelling of the penis.
Many public perceptions and expectations differ from actual medical considerations, so it is essential to communicate with a physician before deciding on circumcision.

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Reply Date: 2007/10/27