Circumcision

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Circumcision (also called prepucectomy) is the surgical removal of a portion of the prepuce or foreskin of the penis of male human beings.

It probably started in drier countries of the world where lack of water and ignorance of the benefits of regular bathing caused problems such as infections and undesirable odors due to the collection of smegma under the foreskin. Over time, the practice has developed support by several religions, notably Judaism and Islam. The Jewish ceremony of circumcision is called a Brit milah (Hebrew), or Bris (Yiddish).

Approximately one-third of human males in the world have been circumcised, though that percentage is falling. The practice of this procedure predates written history. In recent times, with increased medical knowledge of bacteria and the benefits of cleanliness, many are now considering its practice unnecessary. A few even consider it barbaric, especially when performed without anaesthesia on the infant, as is common. Current medical opinion1 is that, given proper hygiene, the small health benefits from circumcison do not outweigh the risks. As such, routine circumcisions are no longer recommended. Circumcision may still be indicated in cases of recurrent balanitis or paraphimosis.

Neonatal male circumcision is the most common paediatric operation carried out in the U.S. and in Australia today, though only on a minority of newborn males. The United Kingdom also practices circumcision on a minority of males. The practice is almost unknown in the rest of Europe and all of Asia, except as a religious ritual. The only country that still routinely circumcises a majority of male infants is Israel. Today, most paediatric surgeons will discourage this common practice.

Some studies show that circumcised males have a slightly reduced risk of penile cancer, or that their mates have a lower risk of cervical cancer. Many question the conclusions of these studies, but in any case the health advantage that they show appears to be minimal. Many are concerned that the potential risk does not outweigh the benefit. The incidence of penile cancer is very low, and the number of deaths annually in the United States from penile cancer is less than the annual number of fatalities from complications of circumcision operations. The risks from circumcision, although small, are definite and can be severe. Complications of circumcision can include lifelong sexual dysfunction, severe mutilation of the penis, and most seriously death.

Penile hygiene is equally effective as circumcision: "Clearly it is good hygiene, not the presence or absence of the foreskin that matters." (J.S. Black, Patient Management, March 1992, p. 71); "the relationship of circumcision to cancer of the penis seems real, but even minimal hygienic standards are probably just as effective in prevention." (M L Sorrells, Still More Criticism, Paediatrics Vol 56, 1979, p. 339).

In recent years the American Cancer Society has come out against routine circumcision. "We would like to discourage the American Academy of Pediatrics from promoting routine circumcision as a preventive measure for penile or cervical cancer...Perpetuating the mistaken belief that circumcision prevents cancer is inappropriate." The AAP no longer promotes routine circumcision.

There are men who regret having been circumcised. Some are activists who try to inform people that the procedure is no longer necessary. Some seek to regain their foreskin through medical procedures. More of them attempt nonmedical methods such as stretching the frenum down over the glans penis through techniques such as wearing weights on it. This process is known as foreskin restoration. They report to have some success, although a great deal of patience and consistency is required to have any permanent affect. Cosmetic surgical procedures to repair the foreskin also exist; but none of these methods can repair the erotogenic nerves that are severed during circumcision. Some have tried to challenge the legal status of circumcision.

Despite the euphemism under which it is sometimes called, "female circumcision", female genital mutilation is a much more invasive and damaging procedure.


Notes:

1 The American Medical Association, the British Medical Association Guidelines, the American Academy of Family Physicians, American Academy of Pediatrics, the Australasian Association of Paediatric Surgeons, the Australian College of Paediatrics, and the Canadian Paediatric Society, among others, now no longer recommend routine circumcision.

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