Circumcision, where the foreskin of the penis is surgically removed, is an extremely common procedure performed in both pediatric and adult urology practices. Outside of religious reasons (common among pediatric patients), adults may choose to be circumcised for a variety of other reasons such as visual aesthetic, penile cancer, and to prevent infections.

Historically, manual circumcision was and remains the “gold standard” in practice and has improved cosmetic outcomes and procedural efficiency over time while also reducing risk of complications. Device-assisted circumcision may improve surgical outcomes, reducing time and risk of complications. Despite an additional cost and risk of mechanical failure, device-assisted circumcisions have been shown to improve cosmetic outcomes and patient satisfaction.

Between 2021 and 2022, researchers aimed to assess patient satisfaction with aesthetic outcomes of both manual and device-assisted circumcisions. They assessed 200 European adult males (100 per type) based on aesthetic satisfaction, pain, overall satisfaction, post-operative complications, and surgeon’s aesthetic satisfaction. Those who received the device-assisted procedure had an average age of around 38, and those who received the manual procedure had an average age of around 50. Researchers believe this average age difference between the two groups may be attributed to availability of information and generational beliefs about surgery.

Additionally, the motives of each group were widely different. The device-assisted group wanted the surgery primarily for sexual bothers (45%) or aesthetic purposes (21%), whereas the manual group wanted the surgery for hygiene-related reasons (40%). This may also contribute to the reasoning behind each procedural choice between groups. Device-assisted circumcisions are supposedly more aesthetically accurate, providing higher chances of symmetry and reducing the risk of excessive tissue removal.

During one-week follow-up assessments, post-operative complications were addressed. Of the device-assisted group, 9% experienced some sort of complication, mostly the surgical site re-opening and causing bleeding. Conversely, only 6% of the manual group encountered complications, also mainly the surgical site re-opening. These cases required the re-stitching of the surgical site. At the one-month follow-up assessment, 24% of the device-assisted group needed about 7 stitches removed, as they hadn’t yet detached themselves. These results are to be expected, researchers say, as they are in line with previous research and the surgical history of each procedure type.

Satisfaction Ratings

Also after a month, aesthetic and overall satisfaction with treatment were assessed. Aesthetically speaking, 67.4% of the device-assisted group reported that they were “satisfied” or “very satisfied” with the results of their surgery on the 5-point Likert scale. Conversely, only 36.7% of the manual group reported these ratings. When surgeons were asked to rate their satisfaction with the aesthetic outcome of each procedure, 88% reported “satisfied” or “very satisfied” with the device-assisted procedures, while only 55.6% reported this for the manual procedure.

This could be attributed to the precision of circumcision devices which reduce the risk of asymmetry and excessive tissue removal which is supported by previous research. It may also be due to the motives of the device-assisted group, who wanted the procedure to help mitigate sexual bothers and for aesthetic purposes.

As far as overall satisfaction is concerned, results were similar to aesthetic satisfaction. A total of 70.65% of the device assisted group reported they were “satisfied” or “very satisfied,” as opposed to 38.89% of the manual group. Researchers believe this may be linked to quicker recovery times associated with the device-assisted technique. It may also be linked to the ages of each group. Because the manual group is older, the elasticity of their skin may not be as strong as the younger, device-assisted group, and therefore might make recovery a bit more difficult. Additionally, their hygiene – the manual group’s main motive for surgery – may have also influenced recovery.

Conclusion

Overall, the device-assisted circumcision group reported higher satisfaction levels than the manual circumcision group in terms of treatment and aesthetic outcome. Surgeons also appeared to be more satisfied with aesthetic outcomes of the device-assisted circumcisions they had performed. Complications during surgery were less prevalent in the device-assisted group (3% vs. 5%), and the pain scores out of 10 were lower (1.5 vs. 4.2). The speed of the surgery (11.2 minutes device-assisted vs. 23.2 minutes manual), combined with minimized complications and pain during operation add to an overall lean toward device-assisted circumcisions.

Researchers emphasize the World Health Organization’s statement that circumcision devices may be able to accelerate programs in resource-limited locations with high HIV rates due to their efficiency, simplicity, and adaptability. Despite limitations such as sample size and lack of randomization, this study provides great insights into the future of adult circumcisions and their usefulness in a broad spectrum of healthcare.

References:

• García Rojo, E., Alonso Isa, M., Manfredi, C., Lo Re, M., Belli, S., García Gómez, B., Fiorillo, A., Celada, G., Justo Quintas, J., Bozzini, G., Fraile, A., & Romero-Otero, J. (2025). Device-assisted versus manual circumcision: A prospective, comparative, Multicenter Study. The Journal of Sexual Medicine, 22(3), 500–507. https://doi.org/10.1093/jsxmed/qdaf008