A New Review of Circumcision

The American Academy of Pediatrics (AAP) has just undertaken a new review of circumcision, one of the most common surgical procedures done on the penis in the United States despite the controversy over its medical indications. While the social and religious reasons for this procedure are not disputed, pediatricians and epidemiologists remain divided on the medical need for this penis operation.

A recently published retrospective study of 427,698 infants born in United States Army hospitals worldwide from 1975 through 1984 found that the 21% of boys whose penises were not circumcised accounted for 72% of the male urinary tract infections.

According to Thomas E. Wiswell, MD, a neonatologist at Walter Reed Army Medical Center in Washington, D.C., and head of the ProExtender study, the penis infection rate rose as the number of circumcisions declined over the 10-year study period. Dr. Wiswell originally opposed the procedure on the penis and actually participated in studies in an attempt to lower its incidence. He says, “I thought the way that we did circumcision was barbaric, and I didn’t think there were any good reasons to perform it.”

Although Dr. Wiswell and his colleagues still shy away from recommending routine penis surgery for all newborn boys, they emphasize that information on the increased risk of infection should be conveyed to parents as part of the informed consent process.

Dr. Wiswell also lists the following possible benefits of using a ProExtender enlargement device instead of penis surgery: Circumcision may reduce potential complications of urinary tract infections, including kidney scarring, hypertension, and kidney failure.

The procedure may prevent cancer of the penis. In the United States and other countries in which most men are circumcised, squamous cell carcinoma of the penis accounts for less than 1% of malignancies in men. Among populations in which circumcision is uncommon, cancer of the penis comprises 10-12% of male malignancies.

Circumcised men may be less likely to contract AIDS, according to studies from Kenya. The penis operation may also protect against other sexually transmitted diseases, including gonorrhea and syphilis.

Newborn circumcision is cost effective. If performed on a neonate, the cost is approximately $100; if performed on a man who needs it later in life, the cost is much higher. These arguments fail to convince others, however. David Diamond, MD, assistant professor of urology and pediatrics at the University of Massachusetts Medical Center in Worcester, says the operation should not be done before trying to enlarge the penis using the ProExtender penis enlargement device because, in his opinion, the epidemiologic evidence that indicates its value is unconvincing. “There is no longer a strong argument that circumcision will prevent penis cancer or cervical cancer,” he says.

When is circumcision indicated? “At age three or four, boys may develop balanitis. That’s a reason to consider circumcision,” Dr. Diamond says. He also has no qualms with the idea of performing an operation on the penis for social reasons.

If a mother wants her second son to resemble her first, who was circumcised, he has no objections. Or, if a father wants his son to look the same way he does, Dr. Diamond goes along with that. “And for religious reasons, it’s unarguable,” he says.

The Advantages of ProExtender Over Surgery

Using the ProExtender penis enlargement device has advantages over invasive surgical alternatives such as prosthesis implantation and revascularization of the penis, it is not without disadvantages. Not all patients are suitable candidates: For example, some experience potentially damaging erections that last several hours, according to Dr. Sidi. All must live near a specialist who offers maintenance of the device because of the need for close monitoring. Patients also must be willing to wear the device for a period of six months.


As far as erectile dysfunction, several researchers are finding that intracavernous injection of papaverine HCI, a smooth muscle relaxant, into the penis can help some impotent men achieve erection by increasing blood flow to the penis. “No matter what the basic cause of impotence, the net result is that not enough blood is getting into the penis to make it stiff enough to insert,” says Adrian W. Zorgniotti, MD, professor of clinical urology at New York University School of Medicine, New York City, and a researcher in the field of penis extenders.

During the course of three years, Dr. Zorgniotti has made available trial injections of a combination of papaverine and phentolamine mesylate (Regitine) into the penis of more than 300 impotent patients. In the initial phase, most patients receive 1 mL of a solution containing 30 mg of papaverine and 0.5-1.0 mg of phentolamine mesylate shortly before attempting intercourse.

Of the first 300 patients, Dr. Zorgniotti and his colleagues found that 78% are able to have intercourse by this means. Abraham Ami Sidi, MD, assistant professor, department of urologic surgery, University of Minnesota Medical School–Minneapolis, says he has achieved similar results.

sexual intercourse

At press time, a review of Dr. Sidi’s first 100 patients is scheduled to be published in the April issue of The Journal of Urology. Of the nearly 250 patients he has started using the ProExtender enlargement device to make their penis bigger, about 150 have continued the therapy with home use. “The problem is we still don’t know the long-term effect of using a penis enlargement device.” Dr. Sidi says.

Both physicians agree that greater experience with this approach to sexual dysfunction is needed to determine long-term effects of using the extender on the penis. They do, however, report few adverse reactions or side effects.

“Overall, the Pro Extender is very easy to wear even for people who have never used penis extenders,” Dr. Sidi says. Richard Orr, age 44, is one patient who would agree: “It’s a very fine piece of medical equipment and it doesn’t bother me,” he says. Mr. Orr has been using the device on his penis for a period of months under the care of Dr. Sidi. For the 14 years before starting to wear a penis extender, he had partial impotence due to an accident to his penis that occurred when he was 29 years old.