Pr. Angwafo III Fru Fobuzshi, Urologist in Yaounde, throws more light on male circumcision.

Is male circumcision very important?

Today, circumcision is no longer a ritual. It has proven value and most studies show that from a public health perspective, circumcision helps to diminish sexually transmittable diseases like HIV and hepatitis, amongst others. In a community where most males are circumcised, there will be less prevalence of HIV and other sexually transmittable diseases. Other studies have also shown that even the frequency of common urinary tract infections in male children has decreased with circumcision. However, only circumcision done by a trained mind and an expert hand can have a positive impact because circumcision done by the untrained comes with certain difficulties, complications and, in some instances, loss of life.

Is there a particular age for circumcision to be done?

No. But circumcision done in the neonatal period has to be done in a particular circumstance, where there is a trained team with different gadgets to be used.  When done during the neonatal period, precautions should be taken that it is done by a specialist in the area. The advantage of carrying out circumcision during the neonatal period is that studies have proven that people circumcised in the neonatal period have less risk of developing cancer of the penis. Circumcision is best done as early as possible because when you take off the preputial hood, there is no longer a hideout for that whitish material (smegma) which harbours viruses such as the Human Papillomavirus (HPV) Infection that causes cervical cancer in women.

The proper care of the penis through circumcision and good hygiene will decrease HIV prevalence, cervical cancer in women as well as other sexually transmittable diseases such as hepatitis virus which also causes tumours of the liver. However, there are no disadvantages in carrying out circumcision when the person is older. But it is said that it is best when general anaesthesia is going to be used during the circumcision of an older child since a baby’s liver cannot handle some of the medications used in anaesthesia.

But neonatal circumcision is done with local anaesthesia; the child has no pain and grows up without the physiological trauma of haven lost an important part of their body. There are pros and cons on whatever age circumcision is done. As an urologist, I do circumcision at the neonatal period because I have the gadgets and expertise needed.

What are those possible accidents that may occur during circumcision?

When an active child is circumcised without anaesthesia, there are accidents in which the glans penis is cut off and this decreases the length of the organ. Some of the children can bleed to death if it was done by an untrained hand. An accident can occur between the canal through which urine flows and the mid-shaft of the penis and this will cause the individual to pass out urine not from the tip of the penis but from anywhere below. This could also occur because of poor bandaging of the wound after circumcision.

How can severe circumcision accidents be managed?

If part of the penis is chopped off, this can be handled as an emergency by an urologist within 30 minutes after the accident. If the part of the organ is still viable, we can sew it up. But it is a complicated issue because it is not just putting it together but one needs to identify the vessels and nerves before sewing them up. However, most patients come 30 minutes after the incident with the tissues already dead. Such an individual will have a little knobbing of a penis which might function properly or not depending on the length chopped off. 

When there is a fistula during circumcision, the patient needs to be programmed for surgery in a bid to close up the hole and this needs some plastic expertise on how to cover the hole. A narrowing of the end of the urethra may occur in most cases. We usually open up the tract to enable the youngster to urinate freely. To avoid such accidents, we urge each person to do the job for which he/se has been trained to do and even those who are trained should go for regular continuous training.