Should men be circumcised?

Are you circumcised?
Should you circumcise your son?
What are the benefits and disadvantages?

Read on for answers to these questions.
The ancient Egyptians and Ethiopians practised circumcision for cleanliness. The Hebrews introduced the practice for religious reasons from the time of Abraham. Muslim boys are also circumcised as part of a religious ritual. In the United States and England, during the 1800s, Victorian physicians believed that circumcised penises would be less sensitive and would therefore prevent masturbation and hypersexuality.
Since the 1950s, it has become less popular with only a quarter of boys in English-speaking countries being routinely circumcised. Only in the United States of America are the majority of boys circumcised for non-religious reasons. Also, circumcision is performed as a puberty rite in some cultures as in some South Pacific Islanders and central Australia.

The foreskin story
The skin of the penis is very loose to allow for expansion during erection. At birth, the foreskin folds over the penis and should not be forcibly retracted for several months. Glands found underneath the foreskin secrete an oily substance that gets mixed up with dead cells to form a cheesy-looking substance called smegma. This smegma causes the foreskin to adhere to the smooth round end of the penis called the glans. Boys must be taught to retract the foreskin and wash away the smegma, which might encourage the growth of bacteria.

Circumcision controversy
Circumcision involves the surgical removal of the foreskin. Although it causes temporary discomfort, complications such as bleeding, and scarring are rare. The only clear medical requirement for circumcision is the inability to retract the foreskin after age three, also called phimosis.
Proponents of circumcision point out that urinary tract infections are more common in uncircumcised baby boys (one in 100) compared to circumcised boys (one in 400). Men who are circumcised at birth are less likely to have penile cancer. This cancer usually occurs in the elderly and is associated with poor penile hygiene and uncontrolled diabetes.
Circumcision and STis

Some studies have found that uncircumcised men are more likely to have sexually transmitted infections. However, other studies have found the same for circumcised men. Among heterosexual men, it was reported that not being circumcised was linked to increased transmission of HIV. On the other hand, among homosexual men, circumcision was associated with greater transmission for HIV among men who were the receptors.

Reasons for circumcision
Sometimes, the foreskin of the child is retracted and then not pulled forward to its usual position. The foreskin then becomes swollen and forms a tight ring around the penis. This painful condition is called paraphimosis. It is usually resolved by reducing the skin under sedation and rarely requires circumcision.
Boys and men may choose circumcision to facilitate proper hygiene especially if the foreskin tends to get infected. The medical reasons for circumcision are phimosis, repeated infections of the foreskin and sometimes paraphimosis. The other reasons for circumcision include religious and cultural beliefs as well as personal preferences.

Dr Pauline Williams-Greenis a family physician and president of the Caribbean College of Family Physicians;
email: yourhealth@gleanerjm.com