Pros and cons of circumcision

Today, we're talking all about circumcision. There are tons and tons of questions about is it safe

to get a circumcision, why should I get one or should I not get one and so today we're going

to delve deep into exactly the pros and cons about circumcision and is it really good or is it bad.

today we're going to break it down first off we're going to talk about the reasons to get a

circumcision then we're going to talk about the benefits and risks of undergoing a circumcision

we're going to talk a lot about the controversies that people talk about specifically the nerve

fibers on the foreskin that's removed and we're going to answer the question will a circumcision

change your sex life and lastly if you decide to get a circumcision what should you expect so in

this video we're going to focus specifically on adult circumcision i'm not going to talk about

circumcising infants or babies this is going to focus on adult circumcision so reasons that

people get circumcised well there's three major reasons one is any sort of dermatologic condition

like lichen sclerosis that can cause changes on the skin that can make it painful or difficult

to urinate it usually looks like scarring or white changes in the tissue the second reason is

balanitis or inflammation of the foreskin that can sometimes get infected often that's due to poor

hygiene or difficulty retracting the foreskin and not being able to clean underneath there

and over time that can lead to some scarring and pain and discomfort particularly if you're

getting this over and over again this may be a good reason to consider a circumcision

and lastly paraphimosis so paraphimosis is when someone retracts the foreskin on the penis

and it gets stuck and if it gets stuck then you got start having a significant amount of pain

because it acts like a ring that's really really tight on the penis and it stops getting blood flow

to the tip of the penis this then causes the glands of the penis to have a lot of swelling

and it becomes more and more difficult to retract that foreskin back over the glans

this is a surgical emergency if you have this problem you need to come to the emergency room so

we can try to retract it manually and if not then you have to go to the operating room to be able

to retract the foreskin and oftentimes this may require a circumcision other reasons that people

consider getting a circumcision are for cosmetic reasons and also to reduce the risk of things like

human papillomavirus or hiv in fact they found that people who've been circumcised have a 60

lower risk of getting hiv or transmitting it to a partner that's because there's less risk of

tearing in the foreskin and less excess foreskin where the virus can get stuck also getting a

circumcision can virtually eliminate your risk of penile cancer so if you don't have a foreskin it's

very unlikely that you will get a penile cancer so what are the risks that we talk about when we're

counseling a patient about a circumcision we talk about bleeding sometimes this can actually result

in what's called a hematoma after surgery if the bleeding continues underneath the foreskin

and you can get some bruising and swelling usually that will subside over time and very rarely does

it mean that you have to go back to open up the circumcision incision to get take care of

a bleeding area other common complications are people feeling uncomfortable with how much skin

was removed or how little and there's a change in sensitivity so i've talked about this before

in a previous video i made about circumcision but essentially sensitivity for the very first

month or two or three can sometimes be very very different because that glands that's usually been

covered by foreskin is now wide open so a lot of times people will become hyper sensitive after

undergoing a circumcision the biggest thing i worry about and i counsel my patients on is regret

you have to be 100 sure that this is something you want and be willing to accept the risks so now

let's get down to the question does it change your sexual function the best data on how circumcision

affects sexual function and sensitivity and ejaculation and orgasm and everything that

essentially people are worried about has been done in what's called systematic reviews and

meta-analyses and what these are is they look at a bunch of studies that have looked at all sorts of

different components of circumcision in particular in the most recent meta-analysis i found they

looked at sensitivity sensation pleasure and function and they looked at 49 different studies

and specifically they looked at what's called high to moderate quality studies meaning that either

there are other systematic reviews or they're what we call randomized controlled trials so it's when

people are randomized into two groups where one groups get a circumcision and the other one does

not and there's actually been two major randomized controlled trials in kenya and uganda which is an

adult men so we can extrapolate this information for men who undergo circumcision as adults also

another important part of high quality studies is that there is no or very low risk of bias meaning

that they've tried to look at these groups without allowing other confounding factors or things

that might make it more likely or less likely that they're going to have sexual dysfunction

so for example if you have one group that gets a circumcision but also has high blood pressure and

diabetes and the other group that doesn't get a circumcision but doesn't have high blood pressure

and diabetes you will probably find that in the group that had circumcision with those medical

problems they're more likely to get erectile dysfunction because those comorbidities or

those conditions high blood pressure and diabetes puts you at higher risk of erectile dysfunction if

you want to learn more about that check out my last video on erectile dysfunction so when they

looked at these 46 studies specifically at the high to moderate quality studies what they found

was that there was no difference in ejaculation erection premature ejaculation sensation function

or anything else that would be concerning so overall from the high quality data that we have

we can surmise that there should be no difference if you get a circumcision versus if you don't

however ultimately if you're the one undergoing the circumcision you want to know there are risks

of possibly having changes in your sexual function and knowing that this is a possibility a lot of

people say well that foreskin that you remove has lots of nerve endings and that can change

the amount of pleasure that you derive from having intercourse and a lot of people state that these

specific nerve endings are in what's called the frenulum when they've looked at anatomic studies

and they've studied the nerve endings on the penis overall they found that there's a specific type of

nerve ending that's responsible for erotic sensation and these are called the genital

corpuscles and these corpuscles are located in the glands of the penis specifically at the ridge

of the glands so when you feel pulling on the frenulum it will be highly pleasurable which

makes a lot of men think that the frenulum is actually very important for erogenous sensation

in fact when you look at the foreskin on the penis itself and you look at the nerve endings

in that foreskin they're actually very similar to the nerve endings anywhere else in your body

which means they respond to light touch firm touch pressure vibration and temperature just

like anywhere else in your body so removing a small piece of the foreskin shouldn't have

any change on your ability to perceive erotic sensation but regardless of this data that

i've presented i don't want to minimize anyone who's suffering after getting a circumcision

certainly there are people who perceive these horrible symptoms after having a circumcision

and i want to be empathetic that this can happen to people people can have bad outcomes and have

regret after undergoing a circumcision however it has not been seen in the literature that has been

studied about circumcision so if you decide to get in circumcision let's talk about what

you can expect at the urologist when you come to the urologist you'll start with getting the area

prepped so it'll be washed with soap and water and then they will essentially put a drape on top of

you are sterile draping so they can keep that area very clean while they're performing the procedure

then they will use some numbing medication so you feel it one or two pokes which will numb

the nerves that go to the penis you may also feel an additional poke around the penis which

will help numb another set of nerves to the penis and after that you shouldn't feel anything else

in fact i've had patients fall asleep during the circumcision procedure because the block

is so good the procedure itself will take about 30 minutes and afterwards you'll have stitches

around the glass that will absorb on their own so nothing that you have to do or has to be removed

you will have a dressing that goes around the penis that your doctor will tell you to keep on

for one or two days the thing to know is that after you take down that dressing it will look

extremely swollen and it will not look nice and that's okay that's completely normal and

the swelling will go down over the course of the next week or two things that you can do

at home is to use ice packs covered in a towel or even just frozen peas on the area to help

reduce the swelling pain is usually not a huge issue particularly the day of the procedure

most urologists will use a long-acting numbing medication that can numb the penis for a period of

six to eight hours after the dressing is off you can take a shower and let soapy water run down the

area you'll typically want to avoid taking a bath for about two to four weeks after the procedure

some urologists may also ask you to put some bacitracin or vaseline around the incision

twice a day typically pain can be handled with over-the-counter pain medications like tylenol

or motrin or acetaminophen or ibuprofen and you'll have to avoid masturbating or having

sex for four to six weeks if you get an erection on your own during this healing period it's not

a problem at all and shouldn't cause any issues with the healing process itself also during the

healing process you'll want to avoid any strenuous activities heavy lifting exercising running or

heavy weight lifting as far as the appearance or how much foreskin is removed a lot of people

ask me about this and some people do have preferences and they will describe this as how

where exactly they want the cut on the penis as well as how much foreskin they want removed

and typically the position of the cut can be described as either high or low low meaning

that it's close to the glands of the penis and high means a little bit further away also the

tightness of the foreskin can be determined by how much foreskin is removed so if it's tighter

that means that more foreskin is removed and if it's looser that means less foreskin is removed

most urologists won't have a specific discussion about this preference with the patients

so if you do have a preference of what it's going to look like afterwards discuss it with your

urologist however it's important to understand that if you make that foreskin too tight it can

actually cause pain or discomfort when you get an erection or make you have difficulty getting

erections because the foreskin is too tight if you make it too loose then you still may have

to retract the foreskin and clean underneath the foreskin and also during the healing process if

that foreskin is not pulled back from the glands it can actually get stuck to the glands itself

and cause what we call adhesions that need to be fixed at a later date most urologists will opt

for a just right approach so we want to remove enough foreskin that you will be able to have

full erections and not have any pain but we don't want to be so loose that you're going to have

issues with healing all right well i hope this answers a lot of your questions about circumcision

if you have more questions please leave them in the comments below i'll try to look through them

all and answer as many as i can as always remember to take care of yourself because you're worth it