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12 Astonishing Facts About Male Circumcision

Circumcision has been associated with taboos about human sexuality, aesthetic values, sacrifice to fertility gods and the present-day and most commonly argued justification of hygienic practices. Circumcision is one of the oldest surgeries dating back to 4000 BC when the Egyptians were believed to practise this ritual. 

William E. Brigman suggests that anti-masturbation hysteria during the late 1800s lead to the popularity of circumcision. The fear was that a boy with a foreskin would learn to masturbate when he pulled it back to clean it. Masturbation back then was believed to lead to insanity and a number of other illnesses.

Currently, circumcision is so common in America that foreskins have significantly become rare, and may become more so. There is no consensus on the benefits of the procedure of circumcision; hence it is not advised for health reasons in Europe. Meanwhile, North American organizations are sponsoring circumcision in African to curb the spread of HIV.

12 The Debate - Is Circumcision Necessary?

The procedure of circumcision even if conducted for medical/health reasons is still an issue that continues to be debated. According to the American Academy of Pediatrics (AAP), the health benefits of neonatal circumcision definitely outweigh the risks, but then the benefits are not big enough that it calls for a universal recommendation. The procedure of circumcision is recommended only in older boys and men to treat an infection to their penis if any or to treat phimosis (the inability to retract the foreskin).

Researchers from the University of Montreal suggest that circumcision may help prevent prostate cancer. However, the actual findings as published in BJU International did not seem to be statistically significant and no evidence to back the claim has been found. A paper published in the Mayo Clinic Proceedings compared circumcision to vaccination and argued that it should be widely recommended.

11 Circumcision in Europe

The Council of Europe, a major human-rights organization, called for a ban on non-medical circumcisions in 2013. In early 2014, medical associations in Sweden and Denmark also recommended a ban on non-medical circumcisions. A consortium of international doctors published a paper in the journal of Pediatrics criticizing the AAP’s view on circumcision, accusing them of having a ‘cultural bias’ toward the procedure. One can see that a symbolic number of the world’s population of circumcised individuals live in the US.

10 World Rate of Circumcision

According to the World Health Organization, about 30% of males around the world in the age group of 15 and older are circumcised. The rate in Canada was also higher until provinces stopped funding circumcision in the early 1990s.

9 What the Government Thinks About Circumcision

Routine infant male circumcision is an avoidable, unnecessary and irrevocable procedure. Therefore, many consider it to be an ‘unwarranted mutilating surgery’. The ‘Canadian Charter of Rights and Freedoms’ and the ‘United Nations Universal Declaration of Human Rights’ states that an infant has rights that include security of person, life, freedom and bodily integrity. However, few others may argue that this viewpoint violates the parents' right to religious or cultural expression, and that adherence to their religious and cultural practices would be in the best interests of the infant.  

8 What's Normal for the Foreskin?

The normal physiology (not phimosis) for infant boys is to be born with a foreskin, that sometimes means being born with a foreskin that does not retract and it may not do so until after puberty. Spontaneous full retractability occurs in 90% of the boys by age 16 and in 99% of males by 18 years of age. 

Parents should be instructed against repeated forceful retraction of the immature foreskin for ‘cleaning’ of smegma as it would invite fibrosis and development of ‘true’ phimosis or preputial stenosis. The production of smegma, a cheese-like substance that naturally builds up in the genital, helps in natural separation of glans from the foreskin as the child matures. 

Avoiding external irritants (chemicals contained in bubble bath to name one) and regular washing off of the gathered excrement (dirt and urine) under the foreskin all through childhood will definitely prevent recurrent balanitis and/or tearing of the delicate preputial opening, thereby preventing acquired phimosis.

7  Benefits of Male Circumcision

Non-religious, routine neonatal circumcision is commonly proposed for a number of reasons:

  1. Avoidance of phimosis and paraphimosis in later life
  2. Improvement in penile hygiene
  3. A reduction in the incidence of neonatal UTI
  4. Prophylaxis against balanitis (inflammation of the glans penis) or balanoposthitis (inflammation of the glans penis and prepuce)
  5. Avoidance of penile carcinoma
  6. A reduction in the incidence of cervical cancer
  7. A reduction in the incidence of sexually transmitted diseases (STDs) including HIV infection, and/or
  8. Social reasons.

These reasons have turned the procedure into medical belief and so has infant male circumcision been promoted over time. Centre for Disease Control and Prevention (CDC) too cited in its recent statement, its studies showing that circumcision does reduce these risks and further went on to note benefits for women with circumcised partners, as in having a lower risk of cervical cancer linked to human papillomavirus. 

6 Why Did Circumcision Become so Popular?

Circumcision has become dominant due to its antiseptic practices that have rendered it quite safe and anaesthesia has made it painless. Today circumcision is among the most common surgeries in the US: an estimated 1.2 million infants are circumcised each year, at a cost of up to $270 million. The CDC’s most recent estimate puts the current rate at 60% of newborns. 

And what’s more remarkable is that American parents are the only ones in the Western world that desire to separate their boys from their foreskins for reasons other than religion.

On the other hand, the current consensus of medical opinion, including that of the Canadian Paediatric Society and the American Urological Society, is that there is insufficient evidence that these benefits outweigh the potential risks (the AAP too acknowledges some uncertainty surrounding the data on risks). Hence, routine infant male circumcision should not be recommended. 

5  Disadvantages/Complications of Circumcision

Contrary to the claims of circumcision advocates, circumcision does not protect against sexually transmitted diseases such as AIDS. In fact, both, the highest rate of routine circumcision and AIDS in the developed world is found in the US. 

Moreover, UTIs occur in only 1-2% of boys, and are conservatively treated with antibiotics. Phimosis, unless it is the result of balanitis xerotica obliterans (lichen sclerosus of penis), an extremely rare condition, cannot be diagnosed prior to puberty. But then later it can be easily treated using cortisone ointment and gentle stretching. 

Circumcised men without the protection of a foreskin are at greater risk of many sexually transmitted diseases.

  1. Neonatal circumcision apparently crushes an infant’s sensitive foreskin while the raw flesh is cut with scissors and/or forceps are inserted into the delicate foreskin thereby scraping, tearing apart and destroying the normal erogenous tissues of the child's sex organ.
  2. The process causes substantial pain and leaves the extremely sensitive penis glans open to infections.
  3. Circumcision removes 50% of penile skin and thousands of specialised nerve endings, fundamental to normal sexual response.
  4. Circumcision makes orgasm difficult, disrupts sexual satisfaction, curbs male and female sexuality, destroys genital integrity thereby compromising sexual function. Thus, in reality, the true complication rate of circumcision is 100%.
  5. Circumcision is believed to cause behavioural and neurological changes, low in confidence, morale, self-esteem and body image, loss of sexual desires, and often lifelong circumcision-related stress.
  6. Other complications of circumcision are quite uncommon. These include meatal ulceration or stenosis: traumatic penile injuries like injury to the soft tissues, amputation of the gland or shaft; formation of penile urethral fistulas; serious infection; and bizarre complications, such as gastric rupture or keloid formation at the operative site.

An occlusive dressing applied after circumcision can lead to dislocation of Plastibell rings, resulting in injury to the skin of the penile shaft, has been reported. Very rare reporting of inclusion cysts, penile lymphadenoma and/or uterocutaneous fistulas has been found. The eventual outcome/complication for any surgical procedure is death. 

Mortality rate of approximately 1–2 per 1,000,000 procedures in neonatal circumcision has been estimated owing largely to general anaesthesia or to the rare complications as in a serious infection. 

4  Avoiding Complications

Most of the serious complications of circumcision are related to the inexperience of the surgeon who conducts this surgery, undue haste in performance of the procedure, rare idiosyncratic reactions to drugs, or uncommon infections. Many, but not all of these problems are preventable. 

This procedure has to be performed by those who are experienced, aware of potential problems, and prepared to handle complications. The incidence of complications from circumcision in experienced hands could be extremely low.

3 Talking About Circumcision

Most of the serious complications of circumcision are related to the inexperience of the surgeon who conducts this surgery, undue haste in performance of the procedure, rare idiosyncratic reactions to drugs, or uncommon infections. Many, but not all of these problems are preventable. 

This procedure has to be performed by those who are experienced, aware of potential problems, and prepared to handle complications. The incidence of complications from circumcision in experienced hands could be extremely low.

Before deciding on getting circumcision done for baby boys, parents should discuss with their doctor the benefits and risks of the procedure and then should take into consideration other factors such as culture, religious beliefs, and personal preference. 

2 Do Health Plans Cover Circumcision?

Few health plans cover circumcision, but the procedure seems to be authorised by Medicare. Perhaps the best way to eliminate such an antiquated and unnecessary surgical procedure would be to completely take it out from the Medical Benefits Schedule. Evidence clearly indicates that the incidence of ritual male circumcision would reduce dramatically if not funded by Medicare or by any other such health plans.

1  Is Circumcision Right for My Child?

There will likely never be a consensus on circumcision. Parents should be strongly guided by the evidence to make a decision on whether to let their child undergo this procedure. Instead of coming down on one side of the debate, the Canadian Paediatric Society needs to further help parents by offering guidance that clearly spells out the potential advantages and risks of circumcision, without bias or omission.

Circumcision proponents must also recognize the weakness of some of the arguments made in the past to justify circumcision. Whatever be the reason, parents considering circumcision deserve careful and fair counselling regarding the potential benefits and risks of the procedure.

In short, the foreskin functions as a normal, natural, intact and healthy tissue. Circumcision has inherent risks, including haemorrhage, infection, mutilation and death. Circumcision is painful, even when an anaesthetic is used. Circumcision causes both physical and psychological scars. Most importantly, every human being has a basic, absolute and constitutional right to his own body. 

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