Circumcision

Circumcision

Whether or not to circumcise a baby boy remains controversial. While many experts agree that the procedure is not necessary in the absence of religious tradition, many proponents still tout the procedure as a way to prevent the spread of sexually transmitted diseases.

Polynesians, Africans and Aboriginals have circumcised boys for centuries as a rite of passage into manhood. The ancient Egyptians practiced circumcision to promote hygiene and reduce the spread of infection and disease in the population. Jews and Muslims circumcise their sons in observance of the covenant between God and Abraham in the Bible.

Circumcision gained popularity in the late eighteen hundreds as a way to curb masturbation in boys. Western physicians blamed masturbation for everything from deviant sexual behavior, laziness and mental retardation to tuberculosis and epilepsy, and they believed circumcision stopped these maladies.

In 1971 The American Academy of Pediatrics Committee on Fetus and Newborn Health published Standards and Recommendations for Hospital Care of Newborn Infants. They found no connection between whether a man is circumcised and increased or deviant sexual behavior or illness.

As far as circumcision reducing the spread of sexually transmitted diseases and penile cancer, the American Cancer Society, the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians do not recommend newborn circumcision for these reasons. They advise proper hygiene, limiting sexual partners, and educating people to refrain from first intercourse at an early age as the means to reduce the spread of sexually transmitted diseases. They also recommend men use barrier forms of contraception (condoms) to prevent transmission of Human Papilloma Virus (a leading cause of cervical cancer) and HIV/AIDS.

The following conditions make circumcision medically necessary in older boys or men.

Tight foreskin-Phimosis

After infancy the foreskin should be loose enough to be drawn back so as to completely expose the whole penis head and to be pulled forward again without pain or difficulty. In the mature youth this action should be possible with the penis erect. If it cannot be retracted at all (phimosis), washing is not possible and smegma accumulates. Phimosis also makes sexual intercourse unsatisfactory and low deposition of semen in the vagina due to poor penetration may cause infertility. Occasionally the opening becomes so small that even passing water becomes difficult. If a tight prepuce is forcibly drawn back (e.g. during intercourse) it may become jammed and incapable of being pulled forward again (paraphimosis). In this painful condition the foreskin strangulates the glans and emergency treatment is necessary.

Phimosis may follow injury (e.g. zip-fastener!), inflammation, or it may be a developmental abnormality. Parents are often surprised to learn that their teenager needs a circumcision, having been assured he was perfectly normal earlier in life. The explanation is that before puberty the opening in the prepuce was large enough to allow the glans to pass through but during the rapid growth of the penis after puberty only that part of the foreskin which covers the glans enlarges. In consequence, the tip of the prepuce which lies beyond the glans does not grow, the opening stays the same size and the much enlarged glans will no longer pass through (puberty phimosis). A tight prepuce cannot be cured by stretching at any age because this only causes little splits which heal with scarring making the condition worse than before.

Inflammation-Balanitis

In spite of adequate hygiene one may suffer from persistent or recurrent soreness, itching or redness of the inner aspect of the foreskin and penis head, a condition called balanitis. Occasionally there may be an acute attack with a discharge of pus which resembles gonorrhoea.

Balanitis may also occur before the prepuce has fully separated from the glans in childhood when washing is not possible. A long prepuce tends to retain moisture predisposing to this condition which is often precipitated by warm weather (summer balanitis).

Balanitis occurs especially in sportsmen and others who sweat a lot. One or more acute attacks or recurrent mild attacks heal with scarring of the foreskin and phimosis develops. Similarly, inflammation affecting the glans may heal with scarring and narrowing of the water pipe opening (meatal stenosis). If passing water becomes difficult an operation (meatotomy) to enlarge the opening may be necessary. A variety of germs will flourish under a damp prepuce and they are difficult to permanently eradicate until the area is rendered permanently dry by circumcision. Thrush or Monilia, a fungus infection, is quite common in the vagina of women on ‘the pill’ and their male consorts are liable to get ‘thrush balanitis’. Due to the presence of sugar in their water diabetics are also prone to balanitis. Similarly warts under the prepuce, which are caused by the Human Papilloma Virus, are difficult to cure until circumcision is performed. If you suffer from balanitis seek medical attention.

Torn or tight frenulum.

The frenulum is a band of skin containing a blood vessel and some sensory nerves which joins the inner aspect of the prepuce to the glans on the under surface of the penis. Drawing back the prepuce pulls upon the frenulum and in full penetration during sexual intercourse the frenulum is quite taut. If the frenulum is short or tight, full penetration may cause discomfort which may last for several days; or the structure may tear causing a painful wound for a longer period.

Surgical division of the frenulum usually cures the trouble and this can easily be done under local anaesthesia. Sometimes circumcision has to be done as well to relieve the tension in the frenular area.

For more information

International Circumcision Information Reference Center- www.circinfo.com