When circumcision is warranted

Men with an overly tight foreskin are prime candidates for circumcision. When the foreskin is too tight – a condition known as phimosis – it can be difficult or even impossible to pull back the flap of skin over the glans or the head of the penis for cleaning. This can increase the risk of urinary tract infections and recurrent inflammation of the foreskin, because urination can be a problem and the foreskin can balloon with trapped urine.

“When phimosis is coupled with a loss of skin colour and thickening of the foreskin and glans, it can lead to a condition known as balanitis xerotica obliterans,” Dr Gan said. The condition, which has been associated with penile cancer, can be treated with circumcision. The protective effect against penile cancer, however, is only seen in circumcision performed on infants.

“Keep in mind though that penile cancer is very rare and circumcision to prevent cancer alone is not warranted,” Dr Gan said.

Prevention of other diseases

Three large studies done in Africa, she said, have shown that circumcision reduces the risk of HIV infection in heterosexual men, possibly because the inner foreskin is susceptible to tears and ulcers, and is rich in HIV-target cells with minimal keratin protection.

Other studies have shown that circumcision is good for the female partners of circumcised men as well; this group of women had a lower cervical cancer rate because circumcision reduced the prevalence of cancer-causing strains of the human papillomavirus (HPV).

However, for other sexually transmitted diseases like syphilis, herpes, gonorrhea and chlamydia, the jury is still out on whether circumcision has a protective effect, Dr Gan said.

Ref: S13