1) Dear Alice,

I am a male in his twenties, and I am considering circumcision. Is it safe to be circumcised at my age? And how many days do I need to recover?

2) Dear Alice,

I'm a guy who's considering being circumcised. What sort of health benefits are there to the procedure? Are there any drawbacks? Also, how much of the foreskin is removed? A little bit? Most of it? All of it, right down to the base of the head? Or what?

— Considering Clipping

Dear Reader and Considering Clipping,

Adult circumcision, which is the surgical removal of all or part of the adult prepuce (foreskin), has both benefits and risks, so it can be helpful to know what you’re in for before making the snip. Some folks opt for circumcision because they may find it more aesthetically pleasing or due to the ways in which it helps reduce the risk of a number of health conditions. On the other hand, some of the complications may occur right after the procedure, such as bleeding or bruising, but there may also be long-term effects. The ways in which and how much of the foreskin is removed depends on the method that's used. The method can additionally determine the recovery time. Full steam ahead for more about what to consider when it comes to circumcision. 

Circumcision has a number of benefits. Being circumcised can reduce the number of urinary tract infections (UTIs) a person experiences, as well as reduce the transmission of sexually transmitted infections (STIs). For example, it can reduce the risk of HIV transmission by 60 percent. Additionally, although rare, it can decrease the risk of penile cancer. Some people may also choose to get circumcised to alleviate other penile conditions such as phimosis, paraphimosis, or balanitis. In addition to reducing the risk of various health conditions, some people find that being circumcised makes it easier to keep their penis clean or they prefer the appearance. While there are benefits, there are also some risks associated. Some of the complications from the procedure itself include bruising, bleeding, the foreskin not being cut to the appropriate length (too long or too short), or it not healing properly. In the long term, the remaining skin may attach to the end, which may require repair through minor surgical procedures. Some other effects many include decreased penile sensitivity, changes in arousal and sexual response patterns, and dissatisfaction with the appearance of the penis. 

Once you’ve weighed the potential risks against the benefits, you might want to know more about the procedure itself. For adults, it's usually performed on an outpatient basis with local or regional anesthesia. The health care professional will inject anesthetic around the base of the penis to numb the entire genital region. Once the area is numbed, they'll likely perform one of a number of potential methods, depending on which they're most comfortable with and the characteristics of the foreskin with which they're working. The methods might be one (or a combination) of the following:

  • Sleeve technique: This is the most common technique used for adult circumcision. Cuts are made around the circumference of the foreskin, near the head of the penis, so that a tube (or “sleeve”) of the foreskin is cut away from the shaft.  The tube is then pulled over the glans and removed.
  • Dorsal slit technique: The dorsal slit technique is commonly used for penises with phimosis (when the foreskin doesn’t retract properly). Clamps are placed on either side and the top of the foreskin to prepare it for incision, then a cut is made along the upper side of the foreskin, from the tip to the corona, to allow for foreskin retraction.
  • Ring device: The World Health Organization (WHO) developed this technology to be used by people with less surgical training, generally in HIV-endemic countries. This requires a device being placed on the penis that causes the foreskin to die so it can then be removed. The device needs to remain in place for approximately a week in order to be effective. This method doesn't require sutures, but the healing process is longer than other methods.

After the procedure, it takes about four weeks for the penis to heal. It’s recommended that patients take it easy for the first two to three days, after which they can go back to their usual activities (although sexual activity can only be resumed after the sutures are completely reabsorbed). When a ring method is used, healing takes about two weeks longer than surgical methods, and abstaining from sexual activities is recommended for six weeks following the procedure. Showering is low risk, both with the original dressing, and once the dressing is removed.

If you'd like to pursue a circumcision, a good place to start is with your health care provider. As with any medical procedure, it's a good idea to talk candidly with your provider about the potential benefits and possible complications of the procedure before moving forward.

Here's hoping some key information about circumcision has now been uncovered!

Alice!

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