More often people here about circumcision as a religious rite among Jews and Muslims and less likely this procedure is discussed from a medical point of view. There is no consensus about its feasibility and even doctors can not determine whether this procedure needed or not. According to statistics, about 1/7 of the world male are circumcised and, in most cases it is for religious reasons. In Europe, male circumcision is not very popular, unlike the U.S., where more than 50% of boys are circumcised, mostly for reasons of hygiene (Rosen, 2010). There are vivid reasons for this procedure the same as effects which should be thought out thoroughly.
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The tradition of circumcision appeared in a primitive society, when the transition of boys into the group of adult men was accompanied by a rite of initiation. During the initiation, young men were not just receiving the traditions and intimate knowledge of the tribe, but also subjected to physical tests, among which the circumcision was perhaps not the most painful.
European and American part of the population is very ambivalent about this process. For example, in the early ’60s in Western countries there was the so-called “the boom of circumcision.” Through the process of cutting off the foreskin were going almost all male – adult and newborn babies. However, in the 70ies-80ies the “boom” finished and there was a time to sum up the results (it should be noted that according to statistics, nowadays about 80% of American men are circumcised) (Joseph, 2010).
In the modern world circumcision is made in some peoples of Australia, Oceania, and Africa. The most widespread, circumcision is in the religious rites of Judaism and Islam. So in some religions, circumcision is an obligatory ritual; for example Muslims circumcise children when they are 8-13 years old, while Jews do it already on the 8th day after the birth (Anwar, 2010).
Circumcision is a minor surgery aimed to remove the foreskin of the penis. The result of the complete removal of the foreskin is an open glans penis; as a result of partial removal of the foreskin, an opening of glans penis is achieved (Castellsague, 2002).
The question of circumcision is very discussible and has a lot of proponents and opponents.
Doctors have sounded positive and negative effects of circumcision. Discussing the positive effects, the most vivid are: the reduce of probability of occurrence the reproductive system malignant tumors; increased duration of coitus – due to the absence of the foreskin, the glans penis becomes less sensitive during the frictions that contributes to delay of ejaculation (though this point may not always be considered as positive); improvement in the appearance of the penis.
It is also proved that there is a connection between inflammation in the area of the foreskin and urinary tract infection. Thus, while examining of 100 children with urinary tract infection in age from 5 days to 8 months, it was noticed that 95% of them were boys and all of them were not circumcised (Ginsberg CM, 1982). The survey of U.S. military showed that the incidence of urinary tract infections is 10-20 times higher in men who haven’t been circumcised (Wiswell TE, 1987).
One more positive medical effect of circumcision is that penile cancer is found only in men who previously did not have circumcision. Mortality in cases of penile cancer in the U.S. is 25% (Castellsague, 2002). Circumcision significantly reduces the likelihood of developing penile cancer in men. Also the connection between circumcision and sexually transmitted diseases is also acknowledged (Rosen, 2010). These diseases, which typically include the integrity of the epithelium, or ulcers (genetalny herpes, syphilis, AIDS) are more common in men who were not circumcised (Waldeck, 2003).
In addition, Australian researchers have found out that circumcised men are much less likely to get AIDS and other infectious diseases of the reproductive system. Scientists have discovered that immunodeficiency virus penetrates the foreskin much easier than other tissues of the male organism (Ferris, 2010). Also, a group of U.S. researchers, working in India under the leadership of Dr. Stephen Reynolds, made this conclusion, surveying more than 2 thousand men. The report of the Surgeon General is published in the medical journal Lancet (D’Arcy, 2011).
The article says that the risk of getting the deadly virus for circumcised men is six times less than for those who did not pass this procedure. However, scientists announce that from other sexually transmitted infections, circumcision does not protect. The reason may lie in specific cells of the foreskin, which are very susceptible to HIV (D’Arcy, 2011).
Dr. Reynolds says that circumcision can be a serious tool in the fight against AIDS – especially in developing countries, where condoms are not equally shared (D’Arcy, 2011). Previously, scientists believed that circumcised men were less susceptible to AIDS due to the special patterns of sexual behavior – their upbringing did not permit to have casual sexual acts. However, it is clear now that the reason is just physiological and has nothing to do with ethics or religion (Brooks, 2010).
The effects of circumcision have not only positive points, but negative also. One of the main effects is a severe pain. Previously, infants were circumcised without anesthesia, which in turn led to a painful shock, but nowadays local anesthesia is used almost always during such procedures. One more strong negative effect is unnecessary intervention in human anatomy. There is nothing superfluous in humans; in fact the foreskin performs the same role for the glans penis as the eyelid to the eye. It protects the glans penis. The opponents of circumcision believe that it is far from inconsistency to ethical standards. Since the infant can not decide himself whether he needs circumcision or not, human rights advocates say that decisions made by parents, are inhuman.
Like most surgeries, the procedure of circumcision has a number of postoperative complications, the most common of which are the following: hematoma (bleeding in the tissue, or a bruise) and wound infection. To eliminate these negative effects, in most cases is possible through the most thorough dressing and postoperative area care. There are also possible such negative effects as contagious infection, the formation of excessive scar tissue, mechanical damage to the urethra during surgery, various strains of penis, swelling and inflammation of the urethra. Never the less such problems happen rather rare. A more serious consequence, requiring repeated surgical intervention is painful erections that are also considered as possible medical effects of circumcision.
It is important to mention that the presence of the foreskin makes the surface of the glans penis moist corresponding humidity of woman’s vagina and that physiological. Penis after circumcision does not have such natural advantages, and circumcised men often have to use special lubricants during sex. Medical practice shows that children whose foreskin was cut are affected by infectious disease of the penis during the first years of life five times more often then children who were not circumcised. This is explained by the fact that smegma contains lysozyme, which reduces the risk of urinary tract infection.
The infant is not asked whether he wants to have such surgery or not. Adults decide everything for him. However, any surgery is a trauma, the psychological consequences of which can persist for life. Americans, carefully, even reverently care about their mental health, combined into society under the slogan of opponents of circumcision: “Circumcision – mutilation and violence against child’s personality.” At the same time, the surgeons quite successfully develop techniques that allow pulling the skin of penis to form a new foreskin.
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Many people believe that circumcised foreskin impoverishes sexual feelings, and this view has the right for existence. Foreskin moves during the frictions, making the experience richer be the most natural way, without using any appliances from the store of intimate accessories. There is no doubt that circumcision is sometimes a necessary therapeutic measure during frequent inflammatory diseases of the foreskin, phimosis and paraphimosis. However, as a preventive operation, it is hardly justified, although not so long ago people practiced across-tonsillectomy as a preventive measure of angina, and cutting the appendix to avoid possible appendicitis.
Here’s what a well-known pediatrician, Dr. Hugh Jolly says: “There is no doubt that the best thing you can do with the foreskin of your infant son, is to leave it, you just need to give it time to separate itself from the glans, and it will easily pull back. It happens at the age of 4. It is best to try to move the foreskin during bathing. However, if the glans is exposed difficultly, do not hurry, there is no need… If you try to pull the foreskin before it happens naturally, you can damage skin and cause bleeding. The scar occurs at the place of injury. In cases where the foreskin is fused with the glans, circumcision can not be longer avoided” (Morris, 2010).
Until the natural separation of the foreskin, it protects the glans from infection. In infancy the cleansing of the glans penis in boys, as well as the clitoris in girls occurs itself, naturally. The irony is that it is after the cutoff there is an urgent need for careful care of the glans penis. Deepening and skin folds in the bridle and the corolla are ideal for bacterial growth.
The glans penis which is not circumcised has a smooth, slippery and wet surface. After the cutoff, it becomes matte and dry. The modern mentality often equates dryness and purity that is why from this point of view the untouched by the circumcision glans seen as dirty. That is a fallacy. Young people in the United States regularly go to the doctor for circumcision. Their decision, they often motivate by partner’s insistence, which is usually due to three factors: hygiene, aesthetics and traditions. The woman is afraid of dirt that can accumulate under a fold of skin, wrinkling her unpleasant appearance of the foreskin and, finally, she wants her partner looked like the rest men in her family.
The essence of the problem is that the excision of the foreskin causes severe pain. In most cases, operations are done without anesthesia, as it is commonly believed that in the first week of child’s life it is risky. It looks awful when a small, helpless creature is tied to a special table for cutting. The child lies on it; crucified and abandoned by all … He reacts with horror at the bright light of surgical lights, ringing metal tools, masks of doctors, shining knives and the terrible physical pain. None knows how long his continues continue. The psychological effects of such procedure are not studied yet, so none can tell how it affects a child.
Journalist Philip Baffle wrote in The New York Times: “Newborns experience pain. There is no need to explain it to parents; it’s not a mystery to many pediatricians. Unfortunately among doctors, who are operating babies without anesthetic or with minimal use, opposite opinion is dominated” (Gilliam, 2010).
Philip Baffle states that according to one of scientific researched, 77% of all infants who had surgery because of serious defects of the cardiovascular system in 1954-1983, were given only local anesthesia, and very rare with the interrupted supply of nitrous oxide (Gilliam, 2010). Meanwhile, really effective painkillers, which are suitable for children, have already passed into the category of available. Such a rare use of analgesics while operating newborn proves that medical practice is sometimes based on incomplete knowledge and false beliefs and that criticism contributes the truth.
The situation is changing. In most U.S. medical institutions doctors use painkillers during major surgery. However, some anesthesiologists stubbornly adhere to old beliefs and there are still surgical units where little children are operated without anesthesia in the case of simple operations, such as circumcision.
Considerations which make the routine practice of circumcision doubtful include pain and risk associated with small surgical interventions. Circumcision is a surgical procedure, and the pain that is brought to the baby is also real. Pain is manifested in grimace, cry, heart palpitations and lack of saturation blood with oxygen (Kaufman, 2001). Studies indicate that circumcision in the neonatal period is a stress, which causes behavioral and psychological pain reactions (Malnory, 2003). American Academy of Pediatrics (AAP) recognizes that there is a significant painful reaction during neonatal circumcision and recommends the use of analgesics (Gatrad, 2002).
One of researchers believes that the most important argument against circumcision is a permanent violation of anatomy, histology and functions of the penis, which are fraught with potential complications (Atikeler, 2001). The same study reports about complications including bleeding, stenosis, incomplete circumcision, penile edema, damage of the glands, adhesion, hypospadias and damage of urethra (Atikeler, 2001). The overall incidence of complications of circumcision according to the medical literature is 1.6% (El-Bhnasawy, 2002).
Adhesion of the penis is the most preventable and non-binding complications of circumcision. Among all the complications, an adhesion is observed in 71% of cases (Kebaabetswe, 2003). After neonatal circumcision, the majority of adhesions resolve sponatanno (Kebaabetswe, 2003).
Another risk associated with circumcision, is the lack or excess of skin that can cause problems such as recurrent phimosis (Gatrad, 2002). Phimosis happens in approximately 2.9% of cases (Blalock, 2003). In the UK, the circumcision is not practiced routinely, as the procedure has limited medical benefits. As a result, circumcision is a medical event, which is paid by insurance only in case of medical necessity (Shah, 1999).
Summarizing everything that was written above, it is worth repeating that circumcision is a surgically removal of the foreskin. It is dome more due to cultural traditions, than medical prescriptions. Circumcision is a kind of intervention in the very intimate area associated with family and religious traditions. Typically, the feasibility of circumcision causes active debates. Modern parents, before deciding to cut off their son, must carefully think about pros and cons of this procedure and related to this operation danger. Circumcision causes medical and psychological effects on children and they are worth consideration while taking decision.
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