When circumcision may be necessary
Some conditions, such as paraphimosis, may benefit from circumcision. Others, such as balanitis xerotica obliterans, can only be cured with circumcision.
This section discusses the medical reasons why circumcision may be necessary. It's outside the scope of this topic to discuss religious or cultural reasons for circumcision.
Conditions that may benefit from circumcision
Paraphimosis is a medical emergency. The foreskin is pulled back underneath the tip of the penis, becomes trapped and can't be returned to its original position.
Paraphimosis sometimes occurs as a complication of a medical procedure that involves pushing back the foreskin for a prolonged period of time. Such procedures include:
- an examination of the penis
- a cystoscopy – where a thin, flexible tube (catheter) with a camera on the end is inserted through the penis and up into the bladder so that the inside of the bladder can be examined
- urinary catheterisation – where a catheter is inserted through the penis and up into the bladder to drain urine out of the bladder
Paraphimosis causes a band of swelling to develop around the penis, which can block the blood supply. If it isn't treated, the lack of blood supply will cause the tissue of the penis to die.
In most cases, paraphimosis can be treated using medication to reduce the swelling, or minimally invasive surgery to return the foreskin to its original position.
Paraphimosis is very rare in children and other treatments are preferred. Circumcision is usually only required in adults in rare cases when medication and surgery aren't effective. Occasionally, circumcision may be recommended if someone has repeated episodes of paraphimosis.
Balanitis is inflammation of the foreskin, usually caused by a bacterial infection.
Symptoms of balanitis include:
- pain when urinating
- a discharge of pus from the penis
- inflammation of the head or shaft of the penis
- an unpleasant odour
Balanitis can usually be effectively treated with antibiotics, and most people don't have further infections.
Circumcision is usually only recommended in adults in rare cases where someone has repeated infections (recurrent balanitis).
Urinary tract infections
A urinary tract infection (UTI) is an infection of the urinary system. It's estimated that one in 50 boys develop a UTI between their first and second birthdays. Around 1 in 2,000 men develop a UTI every year.
Research suggests that circumcised boys are around 10 times less likely to develop a UTI than uncircumcised boys. This is because many UTIs are thought to be caused by bacteria that gather inside the foreskin before spreading to the urinary system.
However, most UTIs are mild and don't cause serious damage. Circumcision is usually only recommended if a boy has a risk factor that increases the likelihood of repeated UTIs. Repeated UTIs can cause kidney damage.
An example of a pre-existing risk factor is a birth defect that causes urine to leak back up into the kidney. This carries the risk of bacteria spreading from the foreskin, through the urine, and infecting the kidney. In such circumstances, circumcision may be recommended.
Read more about urinary tract infections in children and urinary tract infections in adults.
Sexually transmitted infections
Circumcision is thought to reduce the risk of catching some types of sexually transmitted infections (STIs). These are:
Circumcision has also been shown to reduce the chance of certain conditions occurring in female partners, including:
Research carried out in Africa found that heterosexual circumcised men are 38-66% less likely to contract HIV than uncircumcised men.
It's thought that the foreskin contains special cells that attract the cells of the HIV virus. This means that uncircumcised men who have vaginal sex with an HIV positive woman are more likely to develop the infection.
However, it's still unclear whether circumcision has the same protective effect for men who have unprotected anal sex with men.
Circumcision is thought to reduce the risk of a man getting syphilis and chancroid because the foreskin:
- may provide a warm, moist environment that allows syphilis and chancroid bacteria to grow and multiply
- can sustain tiny cuts (micro-abrasions) during sexual intercourse, which allow the bacteria to pass into the bloodstream
It's estimated that uncircumcised men are twice as likely to get syphilis and 10 times as likely to get chancroid than circumcised men.
However, circumcision is nowhere near as effective as condoms in preventing STIs. If used correctly, male condoms are 98% effective in preventing STIs.
Cancer of the penis
Research has shown that men who are circumcised in childhood are three to four times less likely to develop penile cancer than uncircumcised men. This is because many cases of penile cancer develop in the foreskin.
However, cancer of the penis is very rare. On average, 550 new cases are diagnosed each year in the UK. It would therefore be very difficult to justify routine circumcision as a method of preventing penile cancer.
In some rare cases, a person may have an increased risk of developing penile cancer – for example, if they have a family history of the condition or a weakened immune system. In such cases, circumcision is often recommended as a preventative measure.
Conditions that require circumcision
Balanitis xerotica obliterans (BXO) is a skin condition that can only be cured with circumcision. It's rare in young children and tends to only affect children over nine years of age and adults.
BXO can cause hardening and inflammation of the penis, usually affecting the foreskin and tip of the penis. It causes symptoms such as:
- difficulty passing urine
- pain when passing urine
- itchiness and soreness of the penis
In cases of BXO that primarily affect the foreskin, circumcision is usually the most effective treatment, and often results in a complete cure. In some cases, BXO can affect the urethra and treatment to widen the urethra may be necessary (a meatotomy).
Page last reviewed: 29/09/2015
Next review due: 29/09/2017