MEN'S HEALTH MATTERS:Although still popular in the US and Canada, circumcision should be avoided unless absolutely necessary
Q I am 34 and was born in the US. As was normal practice at that time I had a circumcision as a child. Should I arrange for my new son to have a circumcision?
A Circumcision is the surgical removal of the skin covering the tip of the penis. The procedure is fairly common in certain parts of the world, including the US and Canada.
For some parents, circumcision is a religious ritual. It can also be a matter of family tradition, personal hygiene or preventive healthcare.
For others, however, the procedure seems unnecessary or disfiguring. In 1999, the American Academy of Pediatrics (AAP) issued a policy statement that says the benefits are not strong enough to recommend routine circumcision for all male newborns. Today, the AAP leaves the decision up to parents. Circumcision makes it easy to wash the penis – although it’s simple to clean an uncircumcised penis, too.
The risk of urinary tract infections in the first year is low, but these infections may be more common in uncircumcised baby boys.
Circumcision may decrease the risk of sexually transmitted infections. Safe sexual practices remain essential, but circumcised men may have a slightly lower risk of certain sexually transmitted diseases.
Circumcision also has its drawbacks as it is an operation. Excessive bleeding and infection are uncommon, but possible. The foreskin may be cut too short or too long or fail to heal properly. If the remaining foreskin re-attaches to the end of the penis, minor surgery may be needed to correct it. You may be inflicting unnecessary pain or suffering on your son.
Circumcision does not affect fertility, nor is circumcision thought to enhance or detract from sexual pleasure for men or their partners. After a circumcision, it may be impossible to re-create the appearance of an uncircumcised penis. It is not normal practice for male infants to have a routine circumcision and it should be avoided unless absolutely necessary.
Q I am 38 and recently noticed that the left side of my scrotum was very lumpy. I went to my doctor and he said that I have a varicocele and I should have this embolised. What exactly is a varicocele and does it require treatment?
A A varicocele is a network of tangled blood vessels (varicose veins) in the scrotum. They are very common and may be present in up to 20 per cent of the adult male population. They tend to occur in young men, usually during the second or third decade of life.
Normally, blood flows to the testicles through an artery, and flows out via a network of tiny veins and a series of one-way valves in the vein which prevent the reverse flow of blood back to the testicles. These one-way valves sometimes fail. The reverse flow of blood stretches and enlarges the tiny veins around the testicle to cause a varicocele which may make the scrotum look lumpy so it resembles “a bag of worms”.
More often than not, varicoceles cause no symptoms and are harmless. A dull ache may be present particularly after standing or sitting for an extended time as pressure builds up in the affected veins. Heavy lifting may make the symptoms worse and, in some cases, can even cause varicoceles to form. Usually (but not always) painful varicoceles are prominent in size.
There is an association between varicoceles and fertility problems. However, it is difficult to be certain if a varicocele is the cause of fertility problems in any one case.
Atrophy, or shrinking of the testicles, although uncommon, is another of the signs of varicoceles. The condition is often diagnosed in adolescent boys during a sports physical exam. When the affected testicle is smaller than the other, repair of the varicocele is often recommended. The repaired testicle will return to normal size in many cases.
Varicoceles can be diagnosed on physical examination and an ultrasound examination may be required in selected cases. Typical varicocele symptoms are mild and many do not require treatment but intervention may be necessary if the varicocele is causing discomfort or associated with fertility problems.
Varicocele treatment has traditionally involved open surgery, but in recent years, a safe and effective nonsurgical alternative called varicocele embolisation is becoming the treatment of choice for many patients. Varicocele surgery is usually performed under general anesthesia and the affected veins are tied off.
Varicocele embolisation is an outpatient procedure. A small tube is inserted into the groin through a small nick in the skin. The skin is numbed and it is not painful. Next, a small catheter, or tube, is painlessly guided up into the abdomen and into the varicocele vein under the guidance of X-ray imaging. The veins are then occluded with coils and the swelling usually subsides over a few weeks.
- This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin