Family traditions cut deep


Dear Dr G,

I am 15-year-old teenager and my father wants me to be circumcised.

We are not Muslims, but undergoing this procedure is a something of a family tradition.

My mother, on the other hand, reckons that the circumcision should be my own decision.

I can retract my foreskin for daily cleaning in the shower.

The doctor explained that this is an elective operation. He explained all the benefits and its short and long-term risks.

Personally, I am not keen to have anyone messing with me down there.

What are the benefits for elective circumcision? Do they outweigh the risks?

Are there any long-term complications such as abnormal scarring and loss of sensation that can affect my sex life in the future?

Let me know the facts so I can convince my father to let me avoid the cut.

Regards,

Reluctant Ryan

Circumcision is the removal of the foreskin from the glans penis. This is even documented evidence of this dating back to the ancient Egyptian civilization.

The exact origin of the practice is uncertain but it could have started as a form of religious sacrifice or a celebration of passage when a boy turns into a man.

It is estimated that one in every three men worldwide are circumcised, most having had it done due to religious reasons, such as Muslims and Jews. Elective non-religious circumcisions are also commonly performed in countries like the United States and parts of South-East Asia.

The removal of the foreskin may be a centuries-old practice, but it remains one of the most controversial and hotly-debated topic. This is reflected by the positions of the world's major medical organisations' stands on circumcision. These range from "elective circumcision has a modest benefit that outweighs the risks", to "elective circumcisions carries significant risks with minimal long-term benefits".

A moist glans penis can create an ideal environment for pathogens to incubate, making it susceptible to infections. This may include bacteria, fungus and sexually transmitted infections such as herpes and HIV.

The World Health Organization (WHO) recommends circumcision as part of HIV prevention as medical trials concluded it reduced the risk of HIV infection amongst heterosexual men in sub-Sahara Africa by as much as 50%. Sex partners of men with foreskins are also recognised to have higher risks of bacterial vaginosis. And one of the treatments for those who get recurrent urinary tract infections is circumcision.

Although the benefits of circumcision in preventing HIV and UTI is well-documented, issues surrounding the differences in sexual pleasure and true impact of hygiene is not so clear-cut.

Circumcision itself is not known to interfere with libido, erectile or ejaculatory functions. However, many clinicians believe the moist glans of the penis is its natural state and a critical feature in sexual intercourse, unlike a dried, keratinised head and shaft that creates friction and little or no natural lubrication.

Scientific evidence has also demonstrated there is some loss of fine touch neuro-receptors. One study from Denmark actually showed women are twice as likely to report dissatisfaction in the bedroom with a circumcised partner – but yet, other studies have reported the opposite.

A 2010 review concluded that circumcisions performed by medical providers have a typical complication rate of 1.5% for babies and as high as 6% for older boys. Although the long-term complications are rare, some have reported meatal stenosis, keratinised scars, skin bridges, painfully tight or deformed erections from botched circumcisions.

The decision to undergo elective circumcision is often a dilemma for parents and definitely a nightmare for teenagers themselves. Despite weighing out the risks and benefits of a life without foreskin, the decision is still difficult as it impinges on culture, personal experience, religions and preconceived ideas about its long-term impacts.

For teenagers facing the knife putting Dr G on the spot for support against the cut, he cuts to the chase and advises: "If you take short cuts and not doing your research, your foreskin will definitely be cut short!"

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Dr George Lee

Dr George Lee

Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. The column “Ask Dr G” is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. You can send him questions at askdrg@thestar.com.my

   

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