“I think I need to be cut, Doc.” He was 18-years old and his sexuality was flowering. I really couldn’t think of even half a reason to do a circumcision on him.
But then he went on: “It’s getting hard to pee, and it hurts to have sex.” Ok, so maybe something really is going on. I had a look. When I tried to pull the uncircumcised skin back on his penis, I couldn’t. No one could. All I could see was a pinhole opening and glimpse of a penis beneath it. Yup, phimosis. And a pretty bad case at that. The ring of skin around the hole was pale, like scar tissue. It’s likely that he had it since birth. And now it was restricting the flow of urine and possibly semen.
“Will sex feel the same after I’m cut?” he asked.
Normally, during sex, the uncircumcised penile skin rolls back and forth over the head of the penis, which is a part of normal sexual pleasure. But his skin wasn’t rolling anywhere; it was stuck in one place. “It might be different, but certainly less painful.” I answered, and suggested that he read about the uncircumcision movement and the issues it raises.
“Any problem if I leave it alone?”
Another great question. Urination may or may not get worse but the skin could start ballooning up behind the pinhole due to restricted flow and make things even more uncomfortable. He’ll probably still be able to ejaculate and so fertility may not be affected. One thing he is at higher risk of is balanitis, or inflammation of the head of the penis. This could cause his penis to itch or hurt and is very difficult to clear when it’s constantly covered in moist tissue. More worrisome is the inability to reliably clean the area around the head of the penis of natural secretions called smegma. Poor penile hygiene is the most important risk factor for developing cancer of the penis. And, trust me, surgery for penile cancer is definitely one of those things you’d like to avoid in life if at all possible.
More recently, being uncircumcised (at least in Africa) is also associated with higher transmission rates of HIV and other venereal diseases, including Herpes and warts (HPV). These findings have been so compelling that medical circumcision is being offered to prevent the spread of HIV in Africa. There appears to be something unique about the thinner skin of the hood being more susceptible to viral infections than the rest of the penis.
Clearly, whether or not to circumcise a young man is a complicated discussion with many arms and legs to it. He chose to do it. It was done swiftly, painlessly and artfully and he is extremely pleased with the result. And I have a feeling that this young man’s sexuality is about to reach new heights. Onward and upward.