Circumcision, the surgical removal of the foreskin (prepuce) covering the glans penis, is one of the oldest known surgical procedures in human history. While it is widely practiced in newborns and children for cultural, religious, and preventive health reasons, adult circumcision is increasingly being recognised as a medically relevant and beneficial procedure in certain conditions. Despite its long history, circumcision in adults remains surrounded by myths, misconceptions, and hesitation.
In recent years, advances in surgical techniques, such as stapler circumcision (ZSR technique) and laser circumcision, have made the procedure safer, quicker, and less painful than ever before. This article aims to provide a detailed, evidence-based understanding of adult circumcision—covering medical benefits, clinical indications, myths, and the latest trends in surgical management.
Understanding Circumcision in Adults
Adult circumcision involves surgically removing the foreskin under local, spinal, or general anaesthesia, depending on the patient’s medical condition and comfort. Unlike circumcision in children, adult circumcision requires more precision due to fully developed anatomy, higher vascularity, and the need for a cosmetically acceptable outcome.
Two major approaches are commonly used today:
- Conventional Circumcision (Open method) – performed with scalpel and sutures.
- Advanced Techniques – such as stapler circumcision (ZSR) and laser circumcision, offering reduced bleeding, quicker healing, and better cosmetic results.
Medical Indications for Adult Circumcision
While routine circumcision in adults is not mandatory, several medical conditions warrant the procedure.
1. Phimosis
Phimosis refers to the inability to retract the foreskin fully over the glans. In adults, phimosis can lead to painful intercourse, recurrent infections, and difficulty in passing urine. Studies (Kong et al., Urology Journal, 2018) show circumcision is a definitive treatment for pathological phimosis.
2. Paraphimosis
A urological emergency where the retracted foreskin cannot be returned to cover the glans, leading to swelling and pain. Recurrent paraphimosis is a clear indication for circumcision.
3. Recurrent Balanitis and Balanoposthitis
Chronic inflammation or infection of the glans (balanitis) and foreskin (balanoposthitis) is common in uncircumcised men. Circumcision prevents recurrence by improving hygiene and reducing bacterial load.
4. Sexually Transmitted Infections (STIs) Prevention
WHO and multiple clinical trials (Bailey et al., Lancet, 2007) confirm that circumcision reduces the risk of HIV transmission by up to 60% in heterosexual men. It also reduces risk of HPV and syphilis.
5. Urinary Tract Infections (UTIs)
Recurrent UTIs in men are rare but, when associated with foreskin pathology, circumcision lowers recurrence risk significantly.
6. Penile Cancer Prevention
Research highlights that circumcision lowers the lifetime risk of penile cancer, especially when performed before persistent infections or premalignant lesions develop.
7. Cosmetic or Personal Preference
Some men opt for circumcision for cosmetic, hygienic, or cultural reasons even in adulthood.
Medical Benefits of Circumcision in Adults
- Improved Hygiene
Circumcision removes the environment in which smegma accumulates, lowering risk of infections and unpleasant odour. - Reduced Risk of STIs
Meta-analyses confirm reduced risks of HIV, HPV, herpes simplex virus (HSV-2), and syphilis. - Easier Sexual Function
In patients with phimosis or recurrent balanitis, circumcision relieves pain and discomfort during sexual activity. - Cancer Prevention
By reducing chronic inflammation and HPV infection, circumcision lowers the chances of penile cancer and indirectly reduces cervical cancer risk in female partners. - Better Quality of Life
Studies (Journal of Sexual Medicine, 2014) report improved satisfaction and reduced anxiety in men who underwent circumcision for medical conditions.
The Procedure: How is Adult Circumcision Performed?
Preoperative Preparation
- Evaluation: History, examination, and basic investigations.
- Anaesthesia: Local or spinal anaesthesia is most commonly used.
- Counselling: Patients are educated about benefits, risks, and recovery.
Surgical Steps (Stapler/Conventional)
- Marking the foreskin for excision.
- Application of stapler device or scalpel incision.
- Foreskin removal with immediate haemostasis.
- Closure with absorbable sutures or natural stapling.
- Dressing applied.
Duration
- The procedure usually takes 15–30 minutes.
Postoperative Recovery
- Mild swelling and discomfort for a few days.
- Resumption of routine activities in 2–3 days.
- Full healing within 2–3 weeks.
Here’s a Video
Myths Surrounding Adult Circumcision
1. Circumcision reduces sexual pleasure.
Myth. Evidence suggests no significant long-term impact on sexual satisfaction, sensation, or erectile function (Cox et al., BJU International, 2015).
2. It is an unsafe surgery in adults.
Myth. With modern techniques like ZSR stapler circumcision, risks are minimal, and recovery is quick.
3. Circumcision guarantees infertility.
Myth. Circumcision has no effect on fertility.
4. Circumcision is only for religious reasons.
Myth. While religious practices exist, medical benefits and global guidelines strongly endorse circumcision in many clinical scenarios.
5. Healing is extremely painful.
Myth. Modern methods significantly reduce pain. Analgesics and local care ensure smooth recovery.
Risks and Complications
Like any surgical procedure, circumcision carries some risks, though rare:
- Bleeding
- Infection
- Excessive removal or inadequate removal of foreskin
- Delayed healing
- Cosmetic dissatisfaction
These risks are minimised in high-volume, experienced centres with modern equipment.
Current Medical Trends in Adult Circumcision
- Stapler Circumcision (ZSR Technique): Quick, safe, minimal bleeding, and excellent cosmetic outcomes.
- Laser Circumcision: High precision and rapid recovery.
- Day-Care Procedure: Most patients are discharged the same day.
- Patient-Centric Approach: Focus on personalised treatment, addressing specific conditions such as phimosis, infections, or cosmetic preference.
Global and Indian Context
Globally, circumcision prevalence in adults is rising for both health and preventive reasons. In India, though primarily practiced for religious reasons, more men are opting for circumcision to treat medical conditions like phimosis and recurrent balanitis. Increased awareness and availability of advanced techniques in specialised urology centres have contributed to this change.
Conclusion
Adult circumcision is a safe, effective, and medically beneficial procedure in properly indicated cases. From preventing recurrent infections to reducing risks of STIs and penile cancer, the advantages extend beyond hygiene and cosmetic appeal. With modern surgical advancements like stapler and laser circumcision, patients can expect faster recovery, minimal pain, and excellent cosmetic outcomes.
Best Hospital for Circumcision in Jaipur – Institute of Urology
At the Institute of Urology, Jaipur, circumcision is performed with the latest techniques such as ZSR stapler circumcision and laser methods, ensuring precision, safety, and patient comfort.
The institute is led by Dr. M. Roychowdhury, with over three decades of unparalleled expertise in advanced urological surgeries, and Dr. Rajan Bansal, known for his modern, precise, and minimally invasive approach. Together, they provide world-class care for patients with foreskin-related conditions and all other urological problems.
With state-of-the-art infrastructure, advanced diagnostic facilities, and thoroughly trained staff, the Institute of Urology offers a comprehensive one-stop centre for consultation, investigation, surgery, and follow-up. Having successfully performed tens of thousands of urological surgeries, the hospital has earned its reputation as one of the most trusted urology super-speciality centres in Rajasthan.
References:
- Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369(9562):643–56.
- Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007;369(9562):657–66.
- Cox G, Krieger JN, Morris BJ. Histological correlates of penile sexual sensation: does circumcision make a difference? BJU Int. 2015;115(6):916–22.
- Kong X, Liu T, Zhou T, Zhang Y, Yang J, Wang H. Efficacy of circumcision in the treatment of adult phimosis: a systematic review. Urol J. 2018;15(3):166–72.
- World Health Organization, UNAIDS, JHPIEGO. Manual for Male Circumcision Under Local Anaesthesia. Geneva: WHO; 2008.
- American Urological Association. Circumcision policy statement. Linthicum, MD: AUA; 2017.
- Tobian AA, Serwadda D, Quinn TC, Kigozi G, Gravitt PE, Laeyendecker O, et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med. 2009;360(13):1298–309.
- Larke NL, Thomas SL, dos Santos Silva I, Weiss HA. Male circumcision and penile cancer: a systematic review and meta-analysis. Cancer Causes Control. 2011;22(8):1097–110.
- World Health Organization. Male circumcision: global trends and determinants of prevalence, safety and acceptability. Geneva: WHO; 2007.
- Rizvi SA, Naqvi SA, Hussain M, Hasan AS. Religious circumcision: a Muslim view. BJU Int. 1999;83 Suppl 1:13–6.
