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Sitcom plays adult circumcision’s fear factor for laughs

Siegel is an internist and an associate professor of medicine at New York University's School of Medicine.

“ ‘Til Death”

“Circumdecision” episode,

Fox, Oct. 8

The premise: Kenny Westchester (J.B. Smoove) loses his swim trunks at a water park, and his new girlfriend, Angie, seems concerned that he is uncircumcised. “It doesn’t quite work for her,” Kenny says. As Kenny approaches his third date with Angie believing they may be about to have sex, he considers circumcision. But when Eddie Stark (Brad Garrett) takes him to a bris at a synagogue to witness a newborn undergoing circumcision, Kenny becomes afraid of the surgery. Later he meets a urologist who, calling it a “tricky procedure,” offers an in-office option. Kenny becomes more and more afraid and ultimately demurs.

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The medical questions: Why is adult circumcision generally performed? Is it a tricky procedure? How does it compare to a newborn’s circumcision? What are the benefits and complications?

The reality: Circumcision, or removal of the foreskin of the penis, has been performed on newborns for religious and social reasons for thousands of years. More than 60% of newborns in the U.S. currently are circumcised. Adult circumcision has been described in surgical textbooks dating to the early 19th century. The most common reason for adult circumcision has always been phimosis, a condition in which the foreskin cannot be retracted easily behind the head of the penis. Studies show that 1% of uncircumcised males still are unable to retract their foreskin by the time they reach age 17. This is often due to poor hygiene, recurrent infection and scarring, and can lead to pain during erection; it’s generally cured by circumcision.

“Adult circumcision is a simple office procedure that can be done effectively with local anesthesia,” says Dr. Herb Lepor, chairman of urology at New York University Langone Medical Center. Specifically, a branch of the pudendal nerve to the penis is blocked with a local injection of lidocaine before the foreskin is removed.

Dr. Chris Saigal, associate professor of urology at UCLA, who performs 20 adult circumcisions per year, agrees that an office procedure is generally safe and successful, but adds that patients often prefer that the procedure be done in the hospital, where they can be put to sleep using general anesthesia.

Newborn circumcision is often done without anesthesia or stitches, Saigal reports, whereas adult circumcision generally uses absorbable sutures. Complications are rare but include bleeding and infection.

The procedure may lead to a decreased risk of infection, but the data on sexually transmitted diseases are conflicting. Three recent studies in South Africa, Kenya and Uganda, published in PLoS Medicine and the Lancet, showed a dramatic decrease in the heterosexual transmission of HIV among circumcised African men, but it is unclear if this benefit applies to heterosexual men in other countries. A summary of studies on the benefits of circumcision in preventing HIV transmission among gay men did not confirm an effect. Finally, 10% to 15% of uncircumcised men choose to have the foreskin removed because “they don’t like how it looks,” Saigal says.

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marc@doctorsiegel.com

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