Adult circumcision is performed much less commonly than infant circumcision. It is more commonly done for medical reasons, such as phimosis, paraphimosis, recur¬rent balanitis or posthitis.
What the **** are these, you say? Phimosis is a very tight foreskin that will not retract back over the glans penis. This may cause pain during erection or intercourse (and, of course, you can’t have intercourse without an erection).
Paraphimosis is a retracted foreskin that won’t slip back over the glans. This causes a painful swelling of the glans and when this happens acutely—say, after a bee sting while pissing in the bush—paraphimosis can be a urological emergency because it can seriously interfere with the ability to urinate. Michele’s most memorable case of paraphimosis was that of a small boy who peed on an electric fence—the electricity arced back and burnt his glans. Balanitis is inflammation or infection of the glans, and posthitis is an inflammation of the foreskin itself. None of these is very common—the most common is phimosis followed by paraphimosis.
As an adult, it is important that you understand the risks of circumcision before consenting to the procedure: these include bleeding, hematoma (a large bruise), infec¬tion, inadvertent damage to the glans, the taking of too much or too little foreskin and cosmetically displeasing results. Obviously, too, parents should be aware of these risks before formally consenting to circumcision for their newborn sons. As far as adult circs are concerned, it must also be understood that the sensations of intercourse may be different from before, not as sharp, it has been said, and that erections may be painful in the post-op period and, in fact, may disrupt the stitches, so sex is a no-no at this time. Full recovery and return to sexual activity may take four to six weeks.
Local anaesthetic, blocking sensation to the whole penis, is used in adults, and the operation is usually done as an outpatient. Aftercare involves loose briefs and, if desired, petrolatum gauze dressings.
Once in a while, a man may have social or cultural reasons for requesting circumcision. Jeremy wanted to marry the love of his life, Rachel, but her family would not consent unless he converted to Judaism. Jeremy converted and included a semi-ritual circumcision con¬ducted by both a physician and a rabbi. (Our urologist colleague Dr Arthur Cohen has helpfully informed us that ritual in this situation, rather than requiring full circumcision, can be served by a token surgical event— which he describes as ‘a prick on a prick’. Thanks, Arthur!)
