Dear Dr. Roach: I have some questions about adult men getting circumcised. I am 93 and of reasonably good health. I do take some medicines — a diuretic, a blood pressure control medication and a statin.
All my life, I’ve had problems with balanitis, but I’ve only had problems with posthitis in recent years. I have never been able to figure out what causes that, but have been able to keep it well under control by keeping my foreskin retracted (it won’t stay back) so that the area is exposed to the air. The only help I have received from my doctor is to never keep the foreskin retracted (I think he worries about paraphimosis, which is truly not a concern) and has prescribed betamethasone a couple times.
For most men, the person you would start asking these questions to would be their health care provider, but my doctor is dead set against anyone having the procedure done, for any reason. I won’t go through all the things that have been tried to solve the posthitis, but I really think my foreskin may just be allergic to the secretions that build up there.
I do not have a urologist. How do I find one, especially one who will work with me? Since my only problem is with the foreskin, I think removing it would resolve the problem. Normally, I would expect to have my doctor give me some names. (He also refuses to do any prostate screening, which I would like to keep up on.) Do I simply pick a urologist’s office, go in and tell the receptionist I want to be circumcised?
In this area, there are lots of urologists, but many only treat pediatric cases, which makes searching difficult. I am looking for a urologist who will circumcise me as an office procedure, using a local anesthetic.
Many people are not familiar with these medical terms, so let me explain them. Balanitis is inflammation of the glans of the penis alone, while posthitis is inflammation of the foreskin. Inflammation is often caused when there’s infection by bacteria or fungi.
Most older men get a combination of the two — balanoposthitis — and recurrent balanoposthitis is one of the reasons that adult men sometimes need circumcision, when other treatments have failed to alleviate symptoms. (My experience with recurrent balanoposthitis has mostly been in men with diabetes, so if you have not been tested, you should be.) Phimosis is the inability to retract the foreskin, and paraphimosis is a urologic emergency where the foreskin is trapped behind the glans. Phimosis can be caused by recurrent balanoposthitis.
Refusing circumcision under any circumstances is not a rational position for a physician. For example, circumcision is an appropriate treatment for most men with cancer of the foreskin. Similarly, prostate cancer screening may be controversial, and some men may certainly choose to forego screening. But it is inappropriate to withhold screening from a man who understands the risks and benefits and still chooses the screening. I can’t agree with your doctor’s absolute position here.
Most adult urologists are familiar with adult circumcision. Most of the time, the procedure can be done as an ambulatory procedure, whether in the office or a day surgery center. (The anesthesia used is typically a nerve block.) A telephone call to local urologists’ offices will let you know if this is a procedure they commonly perform. Then, the urologist can review your case (including all the previously attempted treatments) and tell you whether circumcision is an appropriate choice for you.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu