Circumcision by itself is done as a ritualistic procedure in many religions. They consider it a family tradition besides other reasons cited as preventive health care and good practice of personal hygiene. Medical circumcision is also considered necessary for several medical reasons.
Anatomy and Medical indications- Male circumcision involves removal of the outer fold of the skin that would overlap the glans penis. The penile skin is a smooth and hairless skin which is the continuation of the lower abdominal wall. It is folded upon itself on the corona and forms a foreskin called prepuce. This prepuce overlies the glans and the smooth muscle which consists of the subcutaneous connective tissue of the scrotum and the penis is called dartos fascia. The prepuce protects the glans against kertanization and dryness.
Paraphimosis –When the retracted foreskin cannot be reduced to its natural position is indicative of a urologic condition called paraphimosis. It has a risk of arterial occlusion, venous engorgement and edema if not treated on time. Considered an emergency manual reduction of the prepuce on the glans might be invited with a dorsal incision and selective circumcision.
Urinary Tract Infections- It is believed that urinary tract infections are more common and that uncircumcised males are at a greater risk of developing UTIs against their female counterparts. A meta-analysis revealed that most uncircumcised 95% of male infants were not affected by UTI. Circumcision is thereby a common preventive measure though it is to be noted that the absolute risk of newborn males developing a UTI is relatively low.
Sexually Transmitted Disease- In uncircumcised males, non-keratinized prepuce increases susceptibility to trauma during intercourse which allows pathogens to enter the minute abrasions. These microorganisms tend to thrive in the smegma collected in the area due to the warm microclimate generated by the preputial pouch. Consistent evidence proves that circumcision drastically reduces the transmission of genital ulcerative diseases and HIV.
Human papilloma virus and cervical cancer- Classified as oncogenic and nononcogenic – nononcogenic HPV can cause genital warts in both men and women. Oncogenic HPV is known to cause cervical, vaginal, vulvar, anal and penile cancers. Circumcision reduces the risk of HPV infection in both male and female partners especially those who practice high risk behaviours. Intact foreskin is most responsible for penile cancer and circumcision provides a significant prevention against it.