In the past, circumcision was only done by the Muslims and it was performed as a rite of passage for boys when they were about five to 11 or so. Today, people of other faiths are also having their sons circumcised and, in the big cities, it is something done right after birth.
According to upper GI & laparoscopic surgeon Dr Mohd Faisal Jabar, the majority who go for circumcision in Malaysia are Muslims. However, he does see a significant number of Buddhists and Hindus getting their children circumcised as well. And, it's even for older children, not just infants. The reason for this is that they believe it's more hygienic.
In certain parts of the world, particularly in Europe, the number of circumcisions is dwindling down. In North America, where they prefer their children circumcised, the number is pretty much the same. There, virtually everyone gets their babies circumcised within the first week of life.
“Culturally, the Malays want to have a ceremony, call the Tok Mudim, invite the family over to attend the ceremony of the rites of the boy becoming a man. However, I believe this is happening less within the Klang Valley. I suspect it's because the current generation have been abroad and seen their friends' children circumcised at birth. Or, they have been influenced by older brothers and sisters who have had their children circumcised.
“There is a tendency nowadays in the Klang Valley to have Muslim males circumcised within the first week of their life. It's easier to be performed compared to a child who is 10 years old.
“I would say that two-thirds of male babies born here who are Muslim or of North American ancestry would get their babies circumcised. The other one-third would usually ask their elders and the mother or mother-in-law would say No,” says Dr Faisal.
He explains that the only medical reason to perform a circumcision is true phimosis - a medical condition where the foreskin narrows down to a pinhole. When the baby passes urine, the foreskin balloons up and the baby will cry because it stings.
In later adult life, the reasons to have a circumcision include a condition called BXO (Balanitis xerotica obliterans) or early cancer changes which require the foreskin to be removed but these are not very common.
Preparations for circumcision
There are several conditions that must be met before a baby can be circumcised. They are:
* Both parents must agree to the procedure.
* The baby must be of normal weight (preferably over 3kg, but definitely not under 2.5kg) and full-term.
If the baby is a pre-term or too small it would be unsafe to perform the circumcision and the baby's penis will not fit any of the standard-sized Plastibell circumcision devices. If the baby is too small, the parents will be told that it's not a suitable time and they would be advised to come back when the baby is bigger. Dr Faisal would also dictate a note to the paediatrician to send the parents back to him for the baby's circumcision when the baby is bigger.
* The baby's penis is not too sunken, there is reasonable shaft and no webbing of the penis.
If the penis is sunken, sometimes it's just the head that is visible and you can't perform a circumcision. One of the drawbacks of trying to do a circumcision in such a situation is that you can take off too much skin. It is more advisable to wait and do it at a later date.
* The baby should have normal genitalia (no hypospadias, epispadias or ambiguous genitalia) with both testes present.
Hypospadias is a medical condition whereby you do not offer circumcision because the foreskin is needed to repair the condition.
Dr Faisal has two preferred methods for doing the circumcision – the Plastibell method and the open surgery.
The Plastibell method is the most popular circumcision method in North America and in the Middle East. It is probably the most popular choice in hospitals in the Klang Valley as well.
Dr Faisal uses five sizes of Plastibell – from 1.1cm to 1.5cm in diameter. The common sizes for local infants would be 1.2cm and 1.3cm.
The surgery
Unlike other surgeries where the patient is asked to fast, this one requires the patient's stomach to be full.
Explains Dr Faisal:
“The fuller the patient is, the quieter they will be. I will insist on the mother being around or if the mother has just finished breastfeeding the baby, she can bring the baby down to the operating theatre.”
The baby is then exposed under a well-heated incubator so that they don't feel cold.
The surgeon would also have to duck under the incubator.
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