Circumcision

Definition

Circumcision is a surgical procedure, performed without anesthetic, that removes the foreskin hooding the end of the penis, thereby exposing its tip, the glans.

Procedure

The operation of circumcision is usually done within days of birth, preferably before the age of two months, with or without local anesthetic or painkillers, at the surgeon's discretion. Some Jewish families have the circumcision performed by a specially trained rabbi called a mohel, as part of a ceremony held on the eighth day of life. After the operation, the scar is protected with gauze and petroleum jelly. Overall, circumcision is a safe, low-risk procedure, provided the operator is well trained and experienced.

While certain religious groups, notably Moslems, Jews and some Africans, routinely circumcise new boys, many of the world's peoples have never practiced it. Circumcision was introduced into the English-speaking world in the 19th century for hygienic reasons and as a possible "cure" for masturbation. Widespread during the 1940s and 1950s, the practice is now declining. The British, Americans and New Zealanders no longer routinely circumcise boys; the custom is also waning in Canada.

Arguments For

• Religious beliefs

• So that the child should look like his father, or brothers

• To resemble friends at school (in the shower)

• To enhance cleanliness

Earlier in this century, when circumcision was almost the norm in North America, most medical experts supported the practice. But in 1975, The American Academy of Pediatrics stated that "there is no valid evidence for routine circumcision of the neonate." This pronouncement was followed by a downturn in numbers circumcised.

More recent research showed that circumcision may prevent or reduce penile inflammation, certain penile infections, phimosis (inability to retract the foreskin,) and may reduce the risk of urinary tract infections in infancy. In addition, circumcision may lessen the chances of acquiring sexually transmitted diseases such as AIDS, and reduce risks of penile cancer. In a 1989 statement, the American Academy of Pediatrics' outlined benefits of circumcision, recommending that parents be told about them before deciding whether to have their infants circumcised.

The known benefits of circumcision are:

• Prevention of infant urinary tract infections. This is the strongest medical argument in favor of circumcision. Several studies have shown that uncircumcised boys aged one week to eight months were more likely to have urinary tract infections than those circumcised.

• Possible avoidance of some sexually transmitted diseases. Several reports suggest lower risks of contracting gonorrhea, herpes, candidiasis and AIDS among circumcised men.

• In the U.S. the incidence of penile cancer is 2.2 per 100,000 in the uncircumcised, but only three isolated cases have been reported among circumcised men in the past 20 years.

Arguments Against

Arguments against circumcision relate to its possible complications, which include bleeding, post-operative infection and scarring, and to uneccessary trauma for the infant.

Those who advocate against circumcision also contend that in order to justify a medical procedure the benefits must outweigh the risks. Infant urinary infections, they state, are rare, arising in about one to four percent of male babies, and deaths from them are unusual.

They argue that the number of boys who would have to be circumcised in order to prevent one serious case of urinary tract infection does not justify the cost or complications of the procedure.

They also maintain that given cleanliness, penile cancer is not a major problem. They argue that introducing a surgical procedure to prevent a condition that can be avoided simply with soap and water (after the foreskin is naturally able to retract easily) is simply not appropriate.

In March 1999, the American Academy of Pediatrics stated that evidence of the benefits of circumsision "... are not sufficient to recommend routine neonatal circumcision."

Conclusions

There are tiny risks involved in retaining a foreskin and equally tiny risks in having it cut off. Those who decide to have their son circumcised should make sure it is done by a well-trained, competent individual.

Questions to Ask Your Doctor

What is your view about circumcision?

Please explain, in detail, how a circumcision is performed?

What happens if the circumcision is unsuccessful? can it be repeated?

Will an unsuccessful circumcision cause permanent dysfunction (i.e., difficulty urinating, infections, sexual dysfunction)?

After the circumcision, what should be looked for in terms of possible infections?

When does the gauze come off the penis?

Does any type of medicine need to be applied to the penis after the circumcision?