What is Circumcision?
Circumcision is a simple procedure in which the foreskin that sheathes the head of the penis is removed. Since foreskin traps bacteria and other infectious agents, its removal may improve genital hygiene and reduce risk of disease over the lifetime of the boy and his future sexual partners. In 2012, the American Academy of Pediatrics issued a statement that the health benefits of circumcision outweighed the risks. The Canadian Pediatrics Society acknowledges the potential benefits of circumcision but stops short of routine recommendation for newborns. Thus, circumcision for your son is a personal decision that you must make with your partner after weighing the benefits and risks and often involves religious or cultural preferences as well. For adults, it is a personal decision based on personal, cosmetic or health reasons.
What is the Ideal Age for Circumcision?
The ideal age is within the first two weeks of birth, but at our clinic we provide circumcision for males of all ages including older children, adolescents, and adults. See our recent blog post for more information on why the timing is important.
What are the Potential Benefits of Circumcision?
- Improved hygiene – It is well known that microorganisms accumulate under the foreskin which fosters inflammation which can lead to conditions such as balanitis/balanoposthitis (inflammation of the head of the penis). The incidence of balanitis is twice as high as those who are uncircumcised. Smegma, which is a cheesy like secretion, can also accumulate under the foreskin combining with bacteria to produce an offensive odor.
- Reduced risk of urinary tract and bladder infections – Because microorganisms can accumulate under and adhere to the foreskin, bacteria has a greater chance of migrating up the urethra causing urinary tract infections (UTIs) especially in infancy. Studies suggest an over 10-fold decrease in risk of urinary tract infection in circumcised infants. UTIs are a potentially painful and dangerous condition as it can result in kidney inflammation and scarring. Studies suggest that the protective effect of circumcision against UTIs when done as a newborn continues into adulthood.
- Reduced risk of phimosis – Phimosis is a condition where the foreskin becomes so tight that it cannot be pulled back fully, resulting in UTIs, local skin infection, pain when passing urine, retention of urine, kidney stones, and sexual dysfunction. Circumcision eliminates the risk of phimosis, which affects 1 in 10 older boys and men.
- Reduced risk of penile cancer — Studies have shown an over 20-fold reduction in the risk of invasive penile cancer which is thought to arise from adherence of high-risk human papillomavirus to the foreskin and smegma causing chronic inflammation and recurrent infections resulting in phimosis. Invasive penile carcinoma is highly associated with a history of phimosis.
- Reduced risk of prostate cancer – Uncircumcised men have a 1.6-2.0-fold higher incidence of prostate cancer, which is thought to correspond with a higher chance of sexually transmitted infections resulting in a chronic state of inflammation.
- Reduced risk of HIV/AIDS – Circumcision reduced the risk of getting HIV/AIDS by 3-fold during sex with an infected woman. This is because the HIV virus enters through the inner lining of the foreskin which is thin and vulnerable. Ulceration and tearing are also more common in uncircumcised men, adding to the risk of HIV entry.
- Reduced cervical cancer in women – Circumcision reduced cervical cancer risk of a man’s female partner by 5.6 times as there is less risk of adherence and colonization of human papillomavirus.
What are the Risks of Circumcision?
- Bleeding – in 1 in 500 circumcision there may be some bleeding that is usually stopped with pressure or less commonly with stitches. If a bleeding disorder such as hemophilia, then our doctors will need advice from a pediatric hematologist prior to proceeding.
- Infection – there is always a possibility that there could be a generalized infection requiring antibiotics after the surgery (1/4000). Serious infections are rare (1/5000).
- Concealed penis – when there is a good amount of fat around the penis (pubic fat), the penis may retract inward and increase the chances the penis gets partially buried and requiring medical intervention (1/800).
- Meatal stenosis – this is a narrowing of the urethra that may occur after the procedure requiring medical intervention (1/1000).
- Phimosis – this is a narrowing of the shaft skin opening over the head of the penis requiring medical intervention (1/500)
- Trauma resulting in permanent damage to the head of the penis (never in our practice)
- Suboptimal cosmetic result (1/500)
- More serious complications including death (never in our practice).
Do I Need a Physician Referral in Order to Book an Appointment?
No. If you are booking for your son, it is a parental decision and we only require consent from both parents to proceed. If you are an adult, you may book online or call us directly.