Prepuce health and childhood circumcision: Choices in Canada

Abstract

Introduction: Worldwide, almost 100% of boys are born with penises with a “hood” called prepuce or foreskin. In the course of the boy’s life, the prepuce can be circumcised, can become affected by diseased (e.g., phimosis), or a can become infected and hurt the neonate (and his sexual partner) in adulthood. The objectives of this report are to: 1) review the state, function, fate, and care of the prepuce in childhood, with focus on the neonate, in Canada; 2) understand the current practice of childhood male circumcision in terms of age, indications, performers, techniques, outcomes, and education; and 3) consider ways to sustain a good healthcare professional-parental dialogue for safe practices that are accessible, acceptable, and culturally sensitive in the care of the prepuce.Methods: A literature review was carried out in the English language through the major databases: PubMed (MEDLINE), EMBASE, the Cochrane Library, CINAHL, Web of Science (WOS) Core Collection, LILAC, WHO/UNAIDS, Clinical Trials (www.clinicaltrials.gov), Google Scholar, and grey literature. Search words included: prepuce, diseases of prepuce, prepuce in the neonate, prepuce in the neonate in Canada, male circumcision, childhood male circumcision, neonatal circumcision, neonatal circumcisionin Canada, complications of neonatal circumcision in Canada, and circumcision adverse events.Results: From 1970‒1999, three of 10 Canadian newborn males were circumcised for religious, cultural, and medical reasons. The rest of the neonates, if alive, are living with their prepuce; <4% expected to require treatment for afflictions of the prepuce at some point. There are several providers of circumcision with different levels of training and competencies and using a diversity of devices and techniques. Neonatal and childhood circumcision in Canada is carried out to fulfill parental wishes, as well as for medical, religious, and cultural reasons. Appropriate informed consent and education regarding choices of care of the neonatal prepuce and genitals are vital.Conclusions: Going by current prevalent rate of circumcision in Canada, most Canadian newborn males are likely to live out their lives with an intact prepuce. Despite the age-old debate, childhoodcircumcision is likely to remain. There is need for careful and proper discussion of the potential risks and benefits, including alternatives, costs, and personal/psychological factors. Acceptance, access, andjudicious choices in a culturally sensitive environment will offer the Canadian neonate desirable care of the prepuce for life.

Circumcision in childhood and male sexual function: a blessing or a curse?

“…It is proven in many studies that MC reduces the risk of lower UTI, penile cancer and several STI. Also, it is important to address that the benefit of it is higher for those children with urological conditions, such as UH, vesicoureteral reflux and ureteropelvic junction obstruction [4,5]. Nevertheless, for the majority of uncircumcised children those medical benefits are also achievable through proper hygiene measures [6].…”

“…In the study performed by Ellison [32] Other medical benefits include reducing the risk of balanitis [30] and it also eliminates the risk of suffering lichen sclerosis, which is diagnosed in up to 40% of foreskins removed for phimosis [33]. Several STIs are also most common in uncircumcised male, including human papillomavirus (HPV) [34] Trichomonas vaginalis [4], Mycoplasma genitalium, [30] syphilis [34] and HIV [35]. Reduced risk of penile cancer and cervical cancer, the latter due to the reduction in HPV transmission are also arguments of many physicians to defend newborn MC as a public health policy [1,4,31].…”

“…Several STIs are also most common in uncircumcised male, including human papillomavirus (HPV) [34] Trichomonas vaginalis [4], Mycoplasma genitalium, [30] syphilis [34] and HIV [35]. Reduced risk of penile cancer and cervical cancer, the latter due to the reduction in HPV transmission are also arguments of many physicians to defend newborn MC as a public health policy [1,4,31].…”

“…Although from the medical point of view MC brings many benefits, these are not necessarily extended to all children, therefore controversial as an only reason to perform neonatal circumcision. Around 1% of the patients would experience complications, either acute or later in life due to cosmetic or medical reasons [4]. A negative psychological and sexual impact of circumcision has been argued, but solid, scientific data are lacking.…”

A survey of adult men who underwent circumcision in childhood for pathological phimosis

“…A recent study by Bronselaer et al argued that loss of the foreskin decreases glans sensation and sexual pleasure but their methodology was criticised and a recent systematic review concludes that circumcision has no adverse effect on penile sensation based on histology and correlates of sexual function [15][16][17]. Much of the literature on the subject focuses on non-therapeutic circumcision in neonates [18]. It is unknown if the combination of foreskin pathology and circumcision in childhood might influence feelings of sexual inadequacy in adulthood in a similar way to that reported by men who underwent non-therapeutic circumcision in their early years [19,20].…”