Today, we're talking all about circumcision. I get 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.
I'm Dr. Rena Malik, urologist and pelvic surgeon, and if you're new here I make
content on urologic health, bladder health, sexual health, and much much more so if you
like what you see make sure you subscribe and share this channel with your friends
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