Circumcision is the
surgical removal of the sleeve of skin and mucosal tissue that normally covers
the glans (head) of the penis. This double layer, sometimes called the prepuce,
is more commonly known as the foreskin.
Parents are
encouraged to read as much as possible about circumcision. They should make
themselves aware of the complexities of the circumcision procedure itself.
Speak to your doctor about the step-by-step procedure. If possible, ask to
observe a circumcision at your hospital, so that you will know fully what is
involved.
The International
Coalition for Genital Integrity has classified circumcision as
a type I genital mutilation. Pictures and
video of a circumcision are available on the Circumcision
Information and Resource Pages (CIRP) website.
The foreskin serves
three functions: protective, sensory, and sexual.
In most cases, the
foreskin is still fused to the glans at birth and will separate over a variable
period of time over the first few years. During the diaper period, the foreskin
protects against abrasion from diapers and feces. Throughout life, the foreskin
keeps the glans soft and moist and protects it from trauma and injury.
Parts of the
foreskin, such as the mucosa (inner foreskin) and frenulum, are particularly
sensitive and contribute to sexual pleasure. Specialized nerve endings enhance
sexual pleasure and control [19].
The foreskin
provides ample loose skin for the penis to occupy when erect. It is a movable
skin sheath for the penis during intercourse, reducing chafing and the need for
artificial lubricants, and allowing the glans and foreskin to naturally
stimulate each other. Warren and Bigelow described some of the physiological
functions of the foreskin in sexual activity. [1]
Circumcision is
primarily performed for cultural or religious reasons.
Because a large
number of men in English-speaking Western countries are circumcised, many think
of the foreskin as an unnecessary part of the penis. Many circumcisions are
performed because a circumcised father often does not want to feel that he is
different from his son.
It is often said that a circumcised
penis is cleaner, or easier to keep clean, than an intact penis.
Smegma (a natural substance composed of dead skin cells, normal flora, and
secretions containing the natural antibacterial agent lysozyme) is more likely
to accumulate when the foreskin is present.
Medical grounds for
circumcision that are most commonly cited are: Reduced risk of urinary tract
infections (UTI); reduced risk of penile cancer; reduced risk of cervical
cancer in partners; reduced risk of sexually transmitted disease (STD).
There is
contradictory evidence in the research literature as to whether circumcision
reduces UTI [16,17], but this seems to be the strongest
of all medical claims in favor of circumcision, because UTI can have serious
consequences. These infections can, however, in most cases be treated by
antibiotics. The frequency of UTI in US male infants is approximately 1%, but
is higher for females. There is evidence that babies who are breastfed have a
lower incidence of UTI. [8]
Penile cancer is an
extremely rare form of cancer. It occurs mostly in older men, and most doctors
will not recommend infant circumcision as a preventative measure. Penile cancer
can occur in both circumcised and intact men: The Maden study (an ongoing study
of penile cancer at
The theory that
wives of men with intact foreskins are more prone to cervical cancer has been
disproven [12]. The theory that the presence of a
foreskin may cause an increased risk of sexually transmitted diseases was
disproved by a new study [22]. The question of HIV warrants further study [20],
[7].
Although there is an apparent
geographical correlation between male non-circumcision and HIV
infection on the African continent, this is not true globally, and the pattern
seen in
The only known
effective means of preventing HIV infection are fidelity, condom use and
abstinence.
The foreskin is easy to care for and
the intact penis is easy to keep clean. The foreskin usually does
not fully retract for several years and should never be forced. When the
foreskin is fully retractable, boys should be taught the importance of washing
underneath the foreskin every day.
Gently rinsing the
genital area while bathing is sufficient. Harsh soap and excessive washing can
irritate the penis, which can lead to inflammation of the glans (balanitis). [24]
Smegma is a white
waxy substance, consisting of natural secretions and shed skin cells, that may
occur around the folds of the genitalia in both males and females. In the past
it was feared that smegma might be carcinogenic (and this fear was used as a
justification for circumcision), but this fear has been disproven. Good general
hygiene and common sense are key to preventing infection.
Abnormalities or
diseases of the foreskin can be treated conservatively, if and when they occur,
on a case-by-case basis.
Probably the most
common abnormality of the penis is "phimosis",
or tight foreskin. (This is not the same as the natural attachment of the
foreskin to the glans in very young children, which is completely normal.) The
foreskin can normally be retracted by adolescence.
If retraction is
not possible, a number of newer treatments are available which do not involve
circumcision: Steroid creams, stretching, and preputioplasty. [18]
Some of these treatments have only been published recently, and not all doctors
are aware of them.
If your son has a
serious problem with his foreskin, such as a severe infection (balanitis
xerotica obliterans) or gangrene, perhaps related to diabetes, removal of the
affected area may be a medically advisable option.
Children can be
cruel, and will find things to pick on another child about, whether it be his
chubbiness, glasses, or freckles. Some parents think that their son should be
circumcised so that he will "match" his father, brothers, or friends.
As parents, we can help our children to feel good about their bodies and to
respect individual differences.
Parents often
express a fear that their son will "feel different in the locker
room" if he is intact. There is good evidence that proper education is the
answer. Boys who are taught from an early age that they are normal, whole and
healthy will have a lesser chance of suffering embarrassment in the locker
room, especially if some of the other boys are also intact.
Nonreligious infant
circumcision is not an issue in European, Asian or South American countries. In
Your son's foreskin
is a healthy, natural part of his body. Any part of the body may develop
problems. It is possible, though very unlikely, that the foreskin will develop
problems. However, most foreskin problems are easily treatable.
When your son
becomes an adult, he may choose circumcision for himself. However, there is a
good chance he will prefer not to be circumcised. Leaving your baby's foreskin
alone preserves his right to a whole and intact body.
Circumcision will
be painful for the baby (see below).
The medical
evidence in favor of routine circumcision of healthy babies is not persuasive.
If your son has a problem with his foreskin, such as a severe infection
(balanitis xerotica obliterans) or gangrene, perhaps related to diabetes, your
doctor may recommend partial or complete circumcision or removal of the
affected area. Phimosis (nonretractable foreskin, if it persists much longer
than normal) can usually be treated by gentle stretching and/or steroid creams.
The vast majority of boys will never have any foreskin problems that
necessitate surgery. [18]
The often repeated
statement that babies can't feel pain is not true. It is documented in the
medical literature that babies are as sensitive to pain as anyone else, and
perhaps more so. [13,14]
Most circumcisions
are performed without anesthetic, because there are risks involved with using anesthetics
on babies. Sometimes local injections are used, but this does not eliminate
pain. Most babies will show signs of pain during the procedure and in the week
or ten days following circumcision. Recent studies have shown that the pain is
remembered long beyond the time of the procedure itself. [23]
While pain may help
parents decide against circumcision, parents should look at the long term effects
of their decision first, not only during infanthood, but all the way to
adulthood. Your decision will affect your son for the duration of his life.
Circumcision is surgery, and like all
surgery it has risks. These include:
Up to 20% of
circumcised males will suffer from one or more of the following complications,
to some degree:
The surface of the
glans becomes dry if not protected by the foreskin. It is believed that dryness
and abrasion may cause progressive loss of sensation in the glans, especially
in later life. Circumcised men on the whole do enjoy sex and are able to
orgasm.
Circumcision does
not need to be done right away. There is no need to feel pressured by your
doctor. Take your time.
If you intend to
ask your doctor to have your son circumcised, ensure that the procedure is
carried out by an experienced surgeon. Sometimes circumcision is considered
"minor surgery" and inexperienced residents are given the task of
performing it. This leads to a higher rate of serious errors and complications.
You may desire that
your son will retain some inner foreskin, and especially the frenulum, to
preserve as much sexual sensitivity and function as possible. Another method is
the dorsal slit. This method does not involve the removal of tissue, but allows
the glans to be exposed.
Your doctor can
help you decide how much skin will be removed and how much of the glans should
remain covered if desired. However, in most cases, once your signature is on
the consent form, the physician has absolute license to execute the
circumcision as he/she sees fit. You must ensure that your intentions are in
writing before the operation occurs.
To lessen the pain,
speak to your doctor about the use of an anesthetic for your baby. Note that
some doctors who use anesthetic may not allow sufficient time for the
anesthetic to take effect: It is important to ensure that this does not happen.
Doctors in the
English-speaking countries started circumcising babies in the mid-1800s to
prevent masturbation, which some doctors claimed caused many diseases,
including epilepsy, tuberculosis and insanity. Of course, these arguments are
not accepted today.
The organization
NOCIRC can provide help and advice, as well as free telephone referral of
physicians in your area who are trained in the proper care of the intact penis.
Telephone (415) 488-9883, or write to: NOCIRC,
