Reviewed by: Chen Shanwen (Huashan Hospital, Fudan University)
Circumcision has been around for more than 4,000 years, and available medical data suggest that circumcision is beneficial to human sexual and reproductive health.
In children, circumcision eliminates the harm of phimosis, avoids affecting penile development, and reduces the incidence of penile, foreskin and urinary tract infections;
For adult men, circumcision helps maintain penile hygiene, reduces the incidence of foreskin and balanitis, reduces the incidence of penile cancer, and helps reduce the risk of sexually transmitted diseases such as syphilis, human papillomavirus, and AIDS;
For spouses or sexual partners, it can also reduce the incidence of vaginal infections and cervical cancer caused by hptovirus.
Image source: Stand Cool Helo
So far, however, there is no agreement on the best age for circumcision.
First, there is controversy about whether infants and young children need surgery, because the phimosis before the age of 3 years is mostly physiological phimosis, and most of them gradually heal with age.
After the age of 3 years, the phimosis is mostly "true" phimosis, especially in patients with recurrent foreskinitis and balanitis, surgery is recommended.
If the foreskin is simply too long (not accompanied by symptoms of discomfort and does not affect daily life), surgery may not be used. However, if the foreskin is too long and the following conditions are combined, surgery is recommended:
Although the foreskin can be flipped, there are more obvious narrow rings, which are easy to cause incarceration of the foreskin;
Recurrent foreskinitis, balanitis, resulting in different degrees of adhesion between the inner foreskin plate and the head of the penis or secondary phimosis;
Chronic inflammatory thickening of the foreskin, erection of the penis can cause cracking of the foreskin, affecting sexual intercourse or a tendency to incarceration of the foreskin;
Surgery is requested for cosmetic reasons, religious beliefs, etc.
Some patients with excessively long foreskin also have lesions such as benign foreskin tumors or genital warts, which can be removed at the same time.
Circumcision should not be performed if:
Abnormal penile development, such as occult penis, hypospadias, penile curvature, poor penile rotation, etc.
Acute foreskinitis, urethritis, penile cepharitis, etc.
Patients with abnormal coagulation function and a pronounced tendency to bleed.
Secondary phimosis due to foreskinitis, balanitis, or inability to separate the head of the foreskin penis is not suitable for instrument-assisted circumcision.
Suspicion of foreskin malignancy (inability to locally resect at the same time).
However, the above criteria are not absolute, and specific to individuals, whether circumcision is required also needs to be determined in light of the specific circumstances.
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