Hey there Guys,
Today I was reading the news and came across this disturbing news article in the Huffington Post.
A mother having recently been reading her bible was inspired to circumcise her 3 month old son after watching YouTube videos for training:
Peterson, inspired after reading the Old Testament, decided she wanted her son to be circumcised.
But because she believed he was too old to be circumcised by doctors, she decided to do it herself, after watching YouTube videos. She called 911 after the botched circumcision left her son bleeding uncontrollably and in great pain.
This disturbing act really hit home the common belief within the community that circumscision is a benign treatment, with little pain and no real consequences for the man in his future life.
Today I thought it was important to discuss what foreskins are, their function and to talk about some of the consequences of their removal.
What is the foreskin?
The foreskin is a continuation of the skin from the shaft of the penis. It consists of two layers, the outer layer consisting of skin the same as the shaft of the penis and the inner layer consisting of mucosal tissue that is thought to nurture and protect the head of the penis.
At the junction between the outer layer and the inner layer is a rigid band that is rich in nerve endings thought to contribute to enhanced sensation during sex.
In newborns this inner layer is adherent to the head of the penis and is usually fully separated by puberty allowing the foreskin to be retracted.
In most males the foreskin represents around one third of the skin of the penile shaft which contributes towards easier movement and reduced friction during sexual penetration.
What does the foreskin do?
The foreskin has four major roles in penile health: protection, sensation, to allow ‘glide’ during sexual intercourse provided by additional skin, and finally immune system functions with the presence of immune cells in the inner mucosal layer.
When the penis is flaccid the foreskin is designed to offer protection to the head of the penis, the glans. It is believed that this increases sensitivity of the glans and its many sensitive nerve endings.
As the penis becomes erect the skin of the foreskin layers form a longer tube enabling comfort with the erection and an additional gliding of the shaft skin. This is thought to reduce friction with penetration and increase sexual pleasure.
Does circumcision reduce HIV infection?
Because of the presence of immune cells susecptable to HIV in the foreskin, it was hypothesised that removing these cells, as well as the foreskin, would reduce HIV infections.
Three studies carried out in Africa were able to demonstrate that circumcision reduced the risk of HIV infection of men sleeping with HIV positive women by 60%. This benefit is not conveyed to HIV negative women sleeping with HIV positive men, however in the long term it’s thought that women would benefit by the reduction in numbers of HIV infected men.
When it comes to men having sex with men an Australian study showed a reduced risk of HIV infection for insertive partners practicing unprotected anal sex. Subsequent studies in the USA and Peru were not able to demonstrate any benefit of circumcision with HIV transmission.
These results have lead to the World Health Organisation (WHO) to suggest that circumcision is only really useful in countries where there is high levels of HIV in the heterosexual population. They still reinforce that safe sex practices is the main key to reducing HIV infections.
For gay men living in the first world the most important way to reduce HIV infection is the use of safe sex practices.
Are there other advantages to circumcision?
Some doctors report that there are significant advantages to circumcision with reduction in urinary tract infections, penile cancer and reduced risk of infections of the penis.
In reality the risks of these problems are already quite low and circumcision does not actually change this risk to a high degree.
Take for example the risk of urinary tract infections (UTI’s).
The risk of UTI’s in males is already very low, about 0.5% or 1 in 200. Circumcision decreases the risk, however when the numbers are reviewed there would need to be between 100 to 200 babies circumcised to prevent just one baby getting an UTI that can easily be treated with a short course of antibiotics. Compared to the risk of bleeding, infection and scarring of the circumcision it’s a risk I would prefer not to take.
This is the same case with infections of the foreskin. They are quite rare and if they do occur, they are easily treated with antibiotics.
When is circumcision appropriate?
Currently the main indications for circumcision outside of religious or cultural reasons include treatment of recurrent foreskin infections, pain with sex due to the foreskin being too tight, cancer of the foreskin, and to help hygine in foreskins that are not able to be retracted without pain, if at all.
Studies out of the USA show that post circumcision 4 out of 10 reported penile sensation improved, 2 out of 10 said sensation decreased, 7 out of 10 said that their sex drive stayed the same and the same amount reported a decrease in pain with sex.
It’s important to remember that circumcision is a surgical procedure that should include appropriate review with your doctor and surgeon if you are thinking about having the procedure done.
So guys, I hope you have found this brief round up of the role of foreskins and circumcision helpful.
If you have any questions please feel free to drop a comment below and join the conversations.
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Yours in good health.
Dr George
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