Circumcision – To Snip or Not to Snip

David was a thirteen year old who lived in the early part of the twentieth century. He played ‘nocturnal games’ that most boys his age indulged in. One day as he was going about his nightly ritual, he was chanced upon by a prying relative who spread the word around. It was unanimously decided that he be saved from ‘sinning’ further- that he be circumcised.

Circumcision is the excision of a part, or all, of the foreskin of the penis, to prevent its smooth gliding over the penile head or glans.

Circumcision jokes are aplenty, and one such joke doing the round says that males go through circumcision because females would grab anything that is 20% off. In reality, it began as an effort to control masturbation.

Ancient world had an unrealistic view of sex. It was earlier thought that masturbation was the root cause of various illnesses and was, therefore, worthy of punishment.

Efforts were on to dampen the zeal associated with indulging in masturbation and other forms of non-reproductive sex. Several techniques were adopted such as the spiked chastity belts, genital cages, bruising genital parts or suturing or sewing the foreskin. Circumcision arrived as a sequel to these ‘byproducts of barbarism’.

The pain of the procedure, along with reduced sensitivity, deterred even the most- determined.

History

Advertisement

Circumcision dates back to six thousand years as was evidenced by the ancient wall carvings of Egypt. The Egyptians were snake worshippers, who implicitly believed that when the snake sloughed off its skin to glow anew, it was, in reality, undergoing rebirth. What prompted them to equate snakeskin with foreskin is anyone’s guess!

‘No pain, no gain’- the saying goes and, in a bid to circumvent mortality, ‘the peelings’ began.

Advertisement

From the Egyptians, circumcision spread to people of the Semitic faith, such as the Jews and the Arabs, who faithfully adopted it as a tenet of their own doctrines. Male circumcision, for religious reasons, is a common practice among Jews, Muslims and also among a few Christian sects.

With time, the popularity of the custom transgressed geographical boundaries. It enjoyed a revival during the Victorian times, when purity of the body and of the mind was the most pursued goal. The penis became a ‘soft target’ for penalty, because of its ‘popular’ function, as circumcision seeped through the various layers of the societal stratum. The procedure was accepted for medical, moral, religious or hygienic reasons.

The practice of social circumcision is uniquely North American where it became rampant in the 1940s, after World War II.

Today, circumcision is one of the most common surgeries and is carried out on millions of babies the world over. It may, however, surprise many to know that there is very little understood about this global phenomenon.

The AIDS controversy

A spate of studies carried out recently in Kenya, Uganda and South Africa has evoked wide interest. It has been discovered that the risk of contracting HIV infection in circumcised men, through heterosexual sex, was reduced by 50-60 percent, compared to uncircumcised men. The National Institute of Health (NIH) published this fact in The Lancet. These studies led the WHO and UNAIDS, in 2007, to acknowledge male circumcision as a preventive measure against AIDS.

Let us try to understand the reason for this advocacy of circumcision. It has been understood that the Langerhan’s cells located in the foreskin are highly prone to the AIDS virus and hence removing the foreskin reduced the chances of HIV infection. However, it must be noted that these cells, which are a part of the immune system, are prevalent all over the penis and other parts of the body too.

Circumcision retains a 40% risk of infection, which is not a commendable back- up for the sexually ‘hyper charged’! Besides, the false sense of security that the study generates in the circumcised is likely to boomerang in the future, raising the incidence of AIDS in Africa and other sensitive nations.

The African study accounts only for heterosexual African men and fails to impact the ‘gay’ population. The study needs to be extended to non- Africans too.

Benefits

Circumcision is touted as an effective measure to treat or to prevent other medical conditions too.

• Penile cancer, phimosis, paraphimosis, balanoposthitis, glans inflammation and other penile problems can be effectively treated with circumcision.

• Several studies have documented greater incidence of cervical cancer in women who have enjoyed the company of at least one uncircumcised partner. This adds to the merits of circumcision.

• Rate of penile cancer is 3 - 22 times higher in men who are uncircumcised than in men who are circumcised.

• Circumcision decreases the risk of Sexually Transmitted Diseases (STD)

• Urinary Tract Infection (UTI) is ten times greater in boys who are uncircumcised compared to circumcised ones.

• Circumcision is believed to provide better hygiene. An ‘intact’ foreskin is a hot bed of microbes. This is due to the accumulation of smegma, a cheesy matter made up of dead cells and secretions. The odor due to the pile-up can ‘cheese off’ even the most resilient.

Disadvantages

• The foreskin is home to 10-20 thousand nerves that are uniquely designed to pleasure the male during sex. During circumcision, these nerves are removed along with the foreskin, leading to reduced sensitivity. It curtails the broad range of potential pleasure that a man may experience during sexual activity.

• With time, a bare organ becomes dull and keratinized, leading to abrasion and soreness in the male and the female partner. This may also lead to injury of the vaginal walls in the female. Contrary to the WHO recommendation, this injury caused by a circumcised penis could cause the AIDS virus to enter the blood stream.

• In about 96% of children aged 4 years and below, the foreskin is conjoined to the penile head in a manner similar to the fingernail being attached to the finger. Circumcising an infant may cause infections, which could lead to even kidney damage.

• It may also permanently injure the penis.

Voices of Dissent

The American Academy of Pediatrics (AAP) opines that the benefits of circumcision are not significant enough to recommend it as a regular procedure. They further go on to state that routine circumcisions are not a medical necessity. In the United States, circumcision rates have dipped from a whopping 90% in 1980 to below 60% in the year 1995.

George C. Denniston, M.D, the president of Seattle-based ‘Doctors Opposing Circumcision’, states, ‘Foreskin protects against disease; it doesn‘t cause disease. If foreskin is unhygienic, eyelids should be considered unhygienic.’

On December 9th, 2007 the Australian Medical Association backed a ban on circumcision although they do recognize that there are rare situations when the procedure needs to be carried out. Medical associations in countries such as US, Australia, and Canada have raised their voice of dissent against regular, non-therapeutic circumcision of newborns.

Ironing out uncertainties

Circumcision is carried out in various parts of the world for various reasons despite the fact that there is no evidence in the medical field that warrants its routine application. Several people, including men of science, believe that it is unlikely that nature would produce a body part that has the potential to be harmful. As a result an anti-circumcision lobby is promoting the concept of ‘uncircumcision’, which helps to undo the act of circumcision. Several products that aid uncircumcision are being churned out in the market.

Although a few studies do recommend circumcision, they do not promote the procedure as a foolproof method to prevent sexually transmittable diseases, including AIDS. It may prompt the ‘ill-informed’ to indulge in sexual activities without fore thought.

The need of the hour is to promote safe sex through the use of condoms and by limiting sex partners. Circumcision, if required, should only be carried out with the consent of the individual, after the age of 18.

It is important to note that there is nothing defiling about the male ‘member’. The ‘disinfected and deodorized’ attitude helps and a dose of hygiene is mandatory. Nevertheless, it would help to remember that the singular care the organ needs is to ‘leave it alone’.

Source-Medindia
Dr.REEJA THARU/P