If you’re undecided about whether or not to have your child circumcised, we’ve outlined the advantages and disadvantages so that you can make a more informed decision. By Xanet van Vuuren, Living and Loving Magazine, .

Choosing whether to circumcise one’s child isn’t an easy decision for most parents. Many grown men are unhappy that they were circumcised as infants, especially if it wasn’t done for medical or religious reasons. Research shows that the foreskin isn’t just a flap of unnecessary skin as previously believed, but is, in fact, the most sensitive part of the penis.

The worldwide stance on circumcision

Circumcision has been a religious and cultural tradition for thousands of years in many parts of the world, and forms an important part of the Muslim and Jewish faiths. Medical Associations in most parts of the world, including Australia, Canada and America, no longer recommend non-therapeutic, routine infant circumcision. The South African Medical Association’s stance on the topic is that there’s no medical justification for routine circumcision in babies and children.  This statement has led to doctors refusing to circumcise infant boys unless it’s for religious reasons or if there’s a valid medical reason for the procedure to be performed. The new Children’s Act in South Africa also protects babies and children under the age of 16 from being circumcised without a medical or religious reason. Living and Loving’s resident babycare expert, leading midwife and author, Sister Lilian adds that she believes culture and tradition must be respected, as this often helps children to feel part of a community; it strengthens their identity and gives them pride in their culture and family. “However, practices that are harmful to children must not be upheld just for the sake of tradition. Circumcision can be done under anaesthetic, but is often done without it, and therefore the procedure can be extremely frightening and painful.”

When is circumcision medically necessary for a child?

Pretoria-based general practitioner Dr Sheraaz Ganchi says that medical circumcisions are rarely necessary. “In newborns and even young pre-pubertal boys, the foreskin is generally adherent to the glans (the head of the penis). As the child gets older, hormonal influences allow the foreskin to become more retractile. Sometimes the foreskin can be very narrow at the tip of the penis, which can impede urination or make it painful. This is referred to as phimosis. A circumcision will thus be necessary to relieve the obstruction.” Sheraaz says that another reason for medical circumcision in a child would be because of a specific trauma to the foreskin.

The role that the foreskin plays

Circumcision in simple terms can be described as the removal of the foreskin from the penis through surgery. The foreskin is attached to the glans. This loose fold of skin protects the penis from urine, faeces and abrasions from nappies during infancy. The foreskin is also known to fulfil protective, sensory and sexual functions. A study published in April 2007 in the British Journal of Urology International, called “Fine-touch Pressure Thresholds in the Adult Penis”, discovered that the foreskin actually plays an integral role in sexual pleasure. The study stated that intact men enjoy four times more penile sensitivity than circumcised men. The aim of the study was to compare circumcised and non-circumcised men by mapping fine-touch pressure thresholds of the adult penis. The study measured 17 specific sites of fine-touch sensitivity of the penis on the non-circumcised penis, and the remaining nine sites and two scar sites of the circumcised penis. Lead researcher Morris Sorrells and his team were surprised by the results. He said: “The most sensitive part of the penis is the opening at the tip of the foreskin. The results confirmed that the frenulum (an elastic band of tissue under the glans) and the ridged band of the inner foreskin are highly erogenous structures that are routinely removed in circumcision, leaving the penis with only one quarter of the fine-touch sensitivity it originally possessed. Five sites on the penis – all regularly removed by circumcision – are more sensitive than the most sensitive site remaining on the circumcised penis.” If it has to be done, when is the best time?  Sheraaz says that most families have their children circumcised at birth or within a few weeks following birth. “The procedure can, in fact, be safely performed immediately after birth, or it can be electively booked as soon as the parents are willing to have the procedure done. The same applies to medical circumcisions which should be done as soon as possible,” explains Sheraaz.

The pros and cons of circumcision

Advantages

  • A decreased risk of penile cancer
  • It’s easier to maintain hygiene, and therefore there are fewer infections.
  • Circumcision prevents phimosis (the inability to retract the foreskin); paraphimosis (the painful inability to return the foreskin to its original position); and balanoposthitis (inflammation of the glans and foreskin).

Disadvantages

Sheraaz says that if circumcisions are performed in a hospital or medical practice by trained practitioners, the complication rate is as low as 2%. He says the most common problem of this procedure would be bleeding post circumcision. “This rarely results in death and can be adequately managed. Infection is possible, but has an almost nil occurrence in hospital.” He says that, although pain is experienced, adequate anaesthesia, which can last up to eight hours, and analgesics are extremely effective. Another disadvantage of circumcision is when too much foreskin is removed. The individual may experience painful erections, and skin grafting may then become necessary. If too little foreskin is removed, a re-circumcision may be needed.

Caring for an intact penis

Sheraaz says that usually no special care is required for a newborn apart from normal bathing with soap and water. He says no cotton buds should be used to clean beneath the foreskin. “The foreskin should not be retracted at all, as it is adherent to the glans, and such a movement may cause pain, bleeding, infection, scarring and adhesions of the foreskin. A substance called smegma, which lies under the foreskin of babies and pre-pubertal boys, acts as a lubricant. From the age of five, and even in some adolescent boys, hormonal influences allow the foreskin to become loose and retractile. At this point, the skin can be retracted and washed with soap and water when bathing,” explains Sheraaz.

Elective snips

There are grown men who opt to go for an elective circumcision. Johannesburg-based paediatrician Dr Mirjana Lucic says elective circumcisions among the black population have increased in the last few years due to the World Heath Organization saying that circumcision prevents the transmission of HIV. “These men also often have the same traditional and cultural circumcision rites.” Mirjana says the incidence of elective circumcision is, however, decreasing in the white population.

What are the emotional aspects affecting the decision?

Clinical psychologist and director of PsychMatters Family Therapy Centre in Bedforview , Joanna Kleovoulou, says that an aspect of self can be identified with a body part, and masculinity is typically identified with the penis. “When that part is wounded, there will often be a corresponding psychological wound to the self and a loss of esteem.” She adds that low self-esteem often evokes feelings of shame which isolates us from others. Joanna says parents therefore need to acknowledge that part of their children’s development and deciding to circumcise needs to be taken into account.  She says that the long-term psychological effects associated with circumcision can be difficult to establish because the consequences of early trauma are rarely recognisable to the person who experienced the trauma. “However, lack of awareness does not necessarily mean that there has been no impact on thinking, feeling, attitude, behaviour and functioning, which are often closely connected. In this way, an early trauma can alter one’s whole life, whether or not the trauma is consciously remembered.” Joanna says that these days, people’s knowledge and awareness about circumcision is beginning to change, and their understanding of the psychological and social effects of circumcision will now allow for new investigation into the pros and cons of circumcision. “The most important question that parents need to ask themselves is: do the reasons you have for wanting to circumcise your child outweigh the potential risks?” She says much more research is needed before we can fully understand the psychological and social consequences of this life event.

Does circumcision prevent HIV transmission?

According to a pamphlet on the National Organization of Circumcision Information Resource Centres, (www.nocirc.org), circumcision cannot prevent the spread of HIV. The pamphlet states that anyone who engages in high-risk behaviour, such as having multiple sex partners, failure to use condoms, and the use of contaminated needles, is in danger of contracting HIV and other sexually transmitted diseases, whether circumcised or not. Although some studies reported that fewer circumcised men contracted HIV than intact men, both circumcised and intact males contracted HIV during the course of the studies. Numerous studies have been performed around this topic and have shown a variety of results. “Some found higher rates of HIV in non-circumcised populations, while others either found the opposite to be true or found no difference between circumcised and intact males. One recently published study found that Langerhans cells, which are prominent in the foreskin, actually help to protect against HIV.”

Circumcision should not be promoted as an HIV prevention strategy as this can provide a false sense of safety and can place sexually active men and women at an increased risk.

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