A debate over circumcision


Christmas is a season to rejoice. While celebrating the festivity with friends and family, I often reflect on the events in the last twelve months, focusing on all the ups and downs. When it comes to all the articles that had been published this year, I also look back on the emails that I responded to, and reflecting on sexual health issues that concern many of the readers.

This week, I would like to discuss the point of contention a reader raised. When reading the email from David, I realised he "cut to the chase" and did not hold back on issues related to the preservation of the foreskin. I think it is only fair to publish David's comment in totality, so we all can reflect on the controversy of cutting the foreskin!

Dr. G,

I am shocked at your article responding to Dave in "To Cut or Not to Cut".

"Although the benefits of HIV prevention by the removal of foreskin are well documented," - to the contrary! How is it, do you think, that the U.S., the highest percentage of circumcised men in the world for non-ritual circumcision, has the highest rate of HIV? While Europe, almost universally intact, has the lowest? The AIDS epidemic in the U.S. raged like a wildfire through the gay community, in the 80's and 90's, affecting up to 80% or higher men who were cut! The African programme is proving to be a failure, as HIV rates increase in areas where the cutting campaign has been performed, and it was based on flawed studies!

"The moist glans of the penis can create the 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." - How is that 80% of men in the world are intact and these pathogens are not rampant? In fact, as you point out in your response to the Desperate Father in "Complications of Circumcision", you correctly state: "The bonded membrane acts like a protection for the inner lining of the glans until the detachment becomes spontaneous between three and 10 years old." That's why disease of the penis is rare among the intact, and the ones that do occur (even nature isn't perfect), antibiotics, not surgery, are in order. The moist glans of the penis is its natural state, and a critical feature in sexual intercourse, unlike a dried, keratinized head and shaft that create friction and loss of natural lubrication.

"In fact, one of the treatments for boys who get recurrent urinary tract infections is actually circumcision." - What other bacterial infection calls for surgery, amputation of a body part? This is instead of using antibiotics? What can you cut off a girl with a UTI, since girls are 10x as likely to have them? What kind of medical practice is surgery/amputation for bacterial infections?

"Clinically, circumcision itself does not interfere with libido, erectile or ejaculatory functions."

"Although some clinicians have advocated circumcision as the definitive treatment for premature ejaculation, in reality, such intervention plays little role in enhancing the intervals of intercourse." - This is simply not true. There is no follow up; no accountability for post-surgical complications in the U.S., the highest cutting country for non-ritual purposes. Yet, there are countless accounts (some known to me personally) of men who have skin tags, keratinized scars, skin bridges, painfully tight erections, deformed erections, etc. And premature ejaculation is more common, as is ED, among cut men, since the trigger response of the glans is more likely from the pounding thrusts of a cut penis, as opposed to the gliding function of a foreskin, filled with 20,000 nerve endings. (BTW, the U.S. and Israel are the biggest consumers of sexual lubricant gels - hmmm).

"In light of Universal Children's Day, it is important to highlight one myth that can no longer be disputed and must be completely clarified." - the issue is not about the right to anaesthesia, it is about the right to an intact body, to intact genitals. The Universal Convention on the Rights of the Child states this clearly. It is his body; his right, just like a girl, to natural genitals. If, as an adult, someone convinces him he should get rid of his foreskin, that's his choice - not a parents', not a doctor's, not anyone else. (And can you explain how the AAP has claimed for all these decades, that infants do not feel pain, when videos show a child screaming and going catatonic? What other signal of pain do humans need?)

I realise you are in Malaysia, and Muslim citizens are circumcised. The Chinese ethnic community is not. I wonder what kind of differences you see, as a urologist, in the pathologies between the two communities, trusting that you see patients from both. Regardless, I would expect that your columns would be based on solid, scientific research, which is available on the Internet, and often not available or taught in medical schools. Do you know that US medical textbooks depict the circumcised penis, not an intact penis? Do you know that US doctors are not taught the anatomy of the foreskin, its 16+ functions, and then are taught to cut it off in residency! Do you know that a 15-minute procedure yields $250+ in the U.S. ($1,000/hr)? To say nothing of the hospital charge, the sale of the foreskin to cosmetic and skin replacement businesses? This is an entrenched industry, relying on culture, tradition and power, to continue its very lucrative benefits, not unsupported medical benefits.

Yes, it is time to respect the Rights of the Child. It's his penis we're talking about here, not the parents, not some clinician's.

Thank you for listening.

Sincerely,

David J. Biviano, Ph.D.


Non-religious removal of foreskin has been a ritual in many societies including the USA. Until late 20th century, such practice is regarded as a tradition that can only bring benefit, and virtually no harm. In recent years, many parents and circumcised men began to ask the very important questions of "Is the surgery really necessary? If so, is it really bringing absolutely no short or long term adversity to men?" Although, I am tempted to argue with David many scientific merits that supported the benefits of circumcision; Equally, I agree with him certain flaws that brought about his concerns. On this morning of Christmas Day, I reflected on the email from our passionate reader, feeling proud that we are slowly progressing into a maturing society, having less and less barriers to discuss sexual health matters that affect all of us, including circumcision. On that note, I wish everyone Merry Christmas!

 

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