Reviewer: Shanwen Chen (Huashan Hospital, Fudan University)
Circumcision has been around for more than 4,000 years, and current medical information indicates that circumcision is beneficial to human sexual and reproductive health.
For children, circumcision can eliminate the harm of phimosis, avoid affecting penis development, and reduce the incidence of penile, foreskin and urinary tract infections;
For adult men, circumcision can help maintain penile hygiene, reduce the incidence of foreskin and balanitis, reduce the incidence of penile cancer, and also help reduce syphilis, human papilloma virus , HIV and other sexually transmitted diseases risk;
For spouses or sexual partners, it may also reduce the incidence of vaginal infections and cervical cancer caused by human papillomavirus.
Image source: Zhanku Hailuo
However, there has been no consensus on the optimal age for circumcision.
First of all, there is controversy over whether infants and young children need surgery for phimosis, because phimosis before the age of 3 is mostly physiological phimosis, and most of them will gradually heal themselves with age.
The phimosis after the age of 3 is mostly “true” phimosis, especially for those with recurrent foreskin and balanitis, surgery is recommended.
If the foreskin is simply too long (without discomfort and without affecting daily life), surgery is not required. However, if the foreskin is too long and the following conditions are combined, surgery is recommended:
Although the foreskin can be turned over, there is a relatively obvious narrow ring, which is easy to cause foreskin incarceration;
Recurrent episodes of foreskin and balanitis, resulting in different degrees of adhesion between the inner plate of the foreskin and the glans penis or secondary phimosis;
Chronic inflammatory thickening of the foreskin, penile erection can cause foreskin chapped, affecting sexual intercourse or prepuce incarceration;
Requires surgery for cosmetic reasons, religious beliefs, etc.
Image source: Zhanku Hailuo
Some patients with excessive prepuce also have benign foreskin tumors or condyloma acuminatum and other lesions, which can be removed at the same time.
Circumcision should not be performed if:
Abnormal development of the penis, such as concealed penis, hypospadias, curvature of the penis, malrotation of the penis, etc.
Acute foreskin, urethritis, penile capitis, etc.
Abnormal coagulation function and obvious bleeding tendency.
Instrument-assisted circumcision is not suitable for patients with secondary phimosis due to foreskin or balanitis, or the foreskin and glans of the penis cannot be separated.
Suspected foreskin malignancy (unable to concomitant local excision).
Image source: Zhanku Hailuo
However, the above criteria are not absolute. As for the individual, the need for circumcision needs to be determined according to the specific situation.
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