Most men would shudder at the thought of a scalpel getting close to their penis. They would usually not go for circumcision in which the foreskin is surgically removed unless it is for ritualistic and cultural reasons. In a recent seminar, I was asked whether there is a link between fertility and circumcision.
Medically, there are 2 conditions when circumcision may help improve fertility. They are phimosis and balanitis.
In phimosis, the foreskin is too tight and becomes difficult to retract during an erection. This makes sexual intimacy painful.
In balanitis, there is infection of the head of the penis (Glans penis) which becomes inflamed, itchy and red. If the head of the penis is always covered with the foreskin, the infection would not subside and sexual intercourse would be difficult.
It is common for phimosis and balanitis to coexist together and they are more commonly found in patients with diabetes.
Other than the above conditions, circumcision probably does not affect fertility. It is also not certain whether the procedure improves or reduces sexual pleasure.
However, circumcision does have other health benefits. These include:
· Easier hygiene. Circumcision makes it easy to wash the penis.
· Reduce risk of urinary tract infection: The risk of urinary tract infection in babies under one year is low, but it may become more common in uncircumcised baby boys. Severe infections early in life can lead to kidney problems later in life.
· Lower the risk of penile cancer: Although cancer of the penis is rare, it is even less common in circumcised men. The foreskin is believed to act as a reservoir for the human papillomavirus(HPV) which can cause penile cancer.
· Help prevent the spread of HIV and HPV: Circumcision effectively eliminates the extra foreskin which traps the viral loaded secretions. This reduces the likelihood of spreading the disease. Research studies have found that HIV infection rates decreased by about 60 percent in circumcised men compared to those that were not.
But circumcision also has drawbacks. They include:
· Pain
· Excessive bleeding and infection: these complications are uncommon.
· The foreskin may be cut too short or too long
· The foreskin fails to heal properly. If the remaining foreskin reattaches to the end of the penis, minor surgery may be needed to correct it.
Some years after I was circumcised in adulthood, I realized that even when showering in very hot water for a long time, my scrotum no longer descended. Prior to my circumcision, it would descend a significant distance below my (normal-sized) penis. I wonder if the very richly innervated prepuce, neural sensors for temperature are found in the frenar, or ridged band, the very tip. This would seem logical, for the tip of the prepuce is the farthest from the body, thus the most receptive to ambient temperature. In the 1970's there was a well-publicized study of the low sperm count in American men.