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Last updated 9:16 AM Friday 20 November 2009

Circumcision

Introduction 

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A paediatric surgeon describes the problems boys can have with their foreskin and the reasons to have a circumcision

Male circumcision is the surgical removal of the foreskin. The foreskin is a retractable fold of skin that covers the end of the penis. Sometimes, there may be a medical reason for performing a circumcision - for example, to prevent the foreskin from becoming infected (balanoposthitis) in individuals who do not respond to antibiotics.

So called ‘female circumcision’, or to use a more accurate term, ‘female genital mutilation’, has no medical benefits and is illegal under British law.

The history of circumcision

Circumcision is thought to be one of the oldest medical procedures in human history. There is evidence that circumcision was practised as far back as at least 6,000BC, and possibly as far back as 13,000BC.

Many cultures have practised circumcision for a number of reasons including:

  • as a mark of religious and cultural identity,
  • as a rite of passage into adulthood,
  • as an act of purification, and
  • as a symbolic offering to God (or ‘the gods’).

Ritual circumcision became commonplace in middle eastern cultures around 1,000 BC, and is still routine in the Jewish and Islamic faiths. Both religions have a long-standing tradition that all boys should be circumcised shortly after birth (in Judaism), or at some point during childhood (in Islam).

Routine circumcision of all boys, regardless of religious faith, became widespread in England during the nineteenth century for two main reasons:

  • it was thought that circumcision helped to reduce the risk of contracting syphilis (a type of sexually transmitted infection), which is actually true to a certain extent, and
  • it was thought that circumcision would ‘cure’ masturbation (the mistaken belief that masturbation could cause physical and psychological damage was widespread during the time).

Routine male circumcision gradually started to become less widespread as many members of the medical community argued that it had no medical benefit in the majority of cases. Due to this, when the NHS was founded in 1946, it refused to fund circumcision.

Today, outside of the Islamic and Jewish communities, circumcision is uncommon in the UK. However, it a remains a more widespread practice in other countries, such as the United States of America.

Last reviewed: 21/10/2009

Next review due: 21/10/2011

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Hugh7 said on 23 October 2009

The foreskin does not "cover" the end of the penis, it is the end of the penis, an integral and signifcant part, comprising not just skin but blood vessels, involuntary muscle and some tens of thousands of specialised nerves.

Ritual circumcision is not a medical procedure, any more than is drilling a hole in the skull to release evil spirits, which is about as old.

There is no evidence that circumcision protects against syphilis.

While it is true that Plastibell™ circumcision does not "require" an anaesthetic, neither does any other method, as long as the Velcro™ straps of the Circumstraint™ are strong enough, and the doctor's heart is hard enough. A Plastibell™, like other methods, requires the foreskin to be torn away from the glans (akin to tearing a fingernail from its bed) and a dorsal slit cut in it.

The foreskin is normally attached to the glans at birth and frees itself naturally over a period of years, sometimes not until puberty. Only after that should it be called "phimosis". Many infections (and consequent circumcisions) are caused by misguided attempts to retract the foreskin before it is ready. The boy himself is the best person to decide when that is.

True phimosis can be treated without surgery or less drastic surgery than circumcision, and BXO can also be treated medically, but too many doctors see circumcision as the first and only option. The true need is something less than one percent, as shown in countries where it has never been customary.

The only countries where non-ritual circumcision is commonplace are the US, the Philippines and South Korea. There is an ethical issue in performing non-therapeutic reductive surgery on a non-consenting person.

How about a whole page on the structure and function of the foreskin, with circumcision as a footnote?

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