Circumcision

Overview

Circumcision is the process by which the prepuce of the foreskin – the skin which covers the tip of the penis – is removed. Some cultures practice circumcision as a religious ritual, but it is also an extremely common and mainstream medical procedure. Generally transpiring within a few days of a male child’s birth, circumcision is a simple process which is usually performed less than five minutes.

Immediately following a circumcision, mild penile swelling is normal, as is a small amount of clear discharge. It can take about a week for the penis to completely heal. It is essential that the post-circumcision penis be kept clean, to prevent infection; but penile hygiene is important at any stage, whether or not the penis is circumcised.

Many medical organizations, such as the American Academy of Pediatrics, have concluded that circumcision is not medically necessary. However, it is generally acknowledged that there are a number of benefits, as well as risks. Most physicians agree that the decision of whether or not to circumcise should be made carefully, by parents, doctors, and religious leaders who are sensitive to all concerns.

Benefits of Circumcision

Circumcision has been proven to help prevent urinary tract infections in infants. Among male babies up to six months old, the incidence of urinary tract infections is at least ten times higher in uncircumcised boys. Also, because the foreskin is more susceptible to cancer than most other parts of the body, circumcision is believed to help prevent penile cancer in adult men.

Some studies have shown that an uncircumcised penis is more susceptible to infections and unwanted swelling. Circumcision prevents phimosis and paraphimosis – conditions wherein the foreskin becomes “stuck” over or behind the glans (penile head).

Circumcision can also reduce the risk of sexually transmitted disease. This is principally because an uncircumcised penis is more difficult to keep clean, as germs and bacteria can easily become trapped between the glans and the foreskin. Most medical authorities agree that an uncircumcised penis, if thorough cleaning is maintained, need not necessarily increase a man’s chances of contracting an STD. However, because of the special hygienic attention a foreskin requires, circumcision is often seen as an effective means of facilitating the cleanliness of the organ.

In a recent national survey, circumcised men reported less sexual dysfunction than uncircumcised men. It is not clear whether this is due to circumcision status itself, or to social anxieties. Although circumcision is somewhat less common now than in previous eras, circumcised penises are still generally seen as “normal,” and many uncircumcised boys may feel ashamed of their “different” penises. (It is important for parents to stay attuned to their sons’ developing sexual identity, and answer any questions the child may have about his body.) In some circles, there is an assumption that heterosexual women and gay men prefer sexual contact with a circumcised partner. While this is no truer than any other generalization, it does contribute to a stigma, to which boys and men are particularly sensitive.

Risks Associated with Circumcision

Among those who argue against circumcision, the most common refrain is that the procedure causes the neonatal boy an unnecessary amount of pain, so early in life. Although it is difficult to determine just how painful circumcision is for a newborn, it should be noted that in many religious contexts, and all clinical ones, a local anesthetic is commonly applied prior to the procedure.

The most common problem is penile bleeding. A small amount of penile bleeding is normal following circumcision, but in rare cases, bleeding may continue for days in greater than trace amounts. In this event, a healthcare provider should be consulted immediately. It is also possible for the circumcised glans to become irritated, due to the tenderness of the newly-exposed skin, the friction of diapers, and ammonia in the urine. Such irritations can be treated with a topical ointment and usually disappear within one week.

In addition to these immediate risks, there are other possible risks of circumcision which may be recognized later. “Buried penis” is a condition in which a normal-sized penis remains hidden within the pubic fat pad. It can often be exposed easily by gently pulling on it, or by pressing down on the area around it. The condition almost always vanishes during puberty. Meatal stenosis, a narrowing at the end of the urine channel, can result from circumcision, as can chordee, an abnormal downward bend of the penis during an erection. These complications occur in less than three percent of circumcised males.

The American Urological Association notes that while the risks and disadvantages of circumcision are encountered early, the advantages and benefits may be prospective.

Circumcision and Judaism

As a religious ritual, circumcision is associated with Judaism more than any other faith. Most religious Jews circumcise their sons because of their belief that the practice was demanded by a covenant established in Biblical times between God and the Jewish people. The traditional Jewish circumcision ceremony, known as a bris, is performed by a mohel, who may also be a rabbi, cantor, or other spiritual leader. A bris is generally a festive family occasion, similar in many ways to a baby shower.

In previous eras, circumcision was so closely associated with Judaism that circumcised men were assumed to be Jewish. Since then, the practice has become the secular norm, but there are many Jews and Jewish groups which oppose it. The Circumcision Resource Center, whose directorship is predominantly Jewish, does not advise circumcision – mostly on the grounds that it is needlessly traumatic for the child. Rabbi Eugene Borowitz, who maintains that “Judaism has never demanded uniformity of belief and practice,” argues that Jewish parents should understand that circumcision is a choice, not a commandment, and it should be made only after considering every factor.

In New York, Jewish circumcision recently made headlines due to the disturbing case of Yitzchok Fischer. Fischer is a rabbi and mohel who practices a highly unusual form of circumcision called metzizah bi peh. Practiced only by the most extreme and isolated sects of ultra-Orthodox Judaism, this form of circumcision requires that the mohel perform the procedure using his mouth. A city health investigation was launched after it was determined that several babies circumcised by Fischer had contracted herpes – a fatal disease for an infant. Although religious legislation is a difficult issue, it is obvious that a circumcision must be performed with a sterile instrument, under the most hygienic conditions possible.

Author: Noah Diamond

Links

American Academy of Family Physicians:
http://familydoctor.org/042.xml

American Urological Association:
http://www.urologyhealth.org/pediatric/index.cfm?cat=10&topic=350