Circumcision; His Body, His Choice!!

Imagine being cold, scared and unable to move. Wanting comfort and not getting it and then having a healthy portion of your body removed for the sake of image or hygiene. Not knowing what is going on as you are only a few hours old, yes as in a newborn infant. As parents, the last thing you want to do is cause your child unnecessary harm and pain. You wouldn’t put your child under the knife for cosmetic surgery, least of all at a few hours old would you? Or so you think. Circumcision is in fact, deemed to be a surgery that is not needed to maintain physical health. Yet, 2% of Canada’s infant boy population and a staggering 56% in the United States were circumcised in 2010. Up until 1996, Female Genital Cutting was a procedure that was practiced. Many people felt this wrong and had a law put in place to stop “Female Genital Mutilation”. Why do we as a people, think that cutting a girls genitals is wrong, but cutting a boys is right? We’ll start at the beginning.

History

Circumcision goes back to the 1830’s, when an anti-sexual Victorian initiative was first introduced in the USA. It was advocated from the 1830’s - 1970’s, as a means to prevent masturbation and to permanently desensitize and immobilize the penis. There were many claims of health benefits given along the way, tailored to the anxieties and fears of the day. Such as:
-Cure for Epilepsy -Paralysis -Clubfoot -Mental Retardation
-Convulsions -Elephantasis -Tuberculosis -Hydrocephalus
-Bed Wetting -Hip Joint Disease -Eczema -Poor Eye Sight
-Rectal Prolapse -Wet Dreams -Fecal Incontinence -Insanity
-Nervousness -Hysteria -Hernia -UTI’s
-Headaches -Idiocy -Strabismus -STD’s/ STI’s

People accepted these claims as there were no known cures for these ailments at the time.

Female Genital Cutting

Female Genital Cutting or FCG has a very similar history in the USA. It was offered as a means of curbing sexual activity, which was thought to cause disease. Although as of September 30, 1996 it was banned in all western countries up until 1977 blue cross (blue shield) did cover it.

April 26, 2010. American Academy of Pediatrics (AAP) changed their stance on the practice of FGC in order to try and avoid people taking their girls to their home countries to have this performed. It was often performed in less than optimal conditions, leading to a host of infections and diseases. Some people practiced FGC as a part of their religion or culture, and it has a very deep symbolic or ceremonial meaning to many. By May 1, 2010 due to a large backlash they were forced to retract their statement. It is now illegal to take a girl outside of the USA to have an FGC procedure performed.

What is Circumcision?

Circumcision is defined as the surgical removal of the foreskin. Some may leave it at that, although it has so much more to it. In North America it is generally performed as an infant with little to no anesthetic given. In other countries around the world, it is performed as an adolescent as a right of passage.

Currently, no professional association of physicians recommends routine infant circumcision, some bodies have even discussed if neonatal circumcision is ethical. This includes;

-The Royal Dutch Medical Society
- The British Medical Association
- The Canadian Pediatric Society
- Royal Australian College of Physicians
- The American Academy of Pediatrics

The American Urological Association is also in agreement that there are no proven benefits that would outweigh the risks.

What are the Risks?

As with any surgical procedure there are risks involved, they are usually outlined in the consent forms that you must sign before going into the operating room. Circumcision is no exception.

With circumcision, anesthetics are only used in a small number of cases. Anesthetics however, can only reduce the pain not remove it completely. General anesthesia cannot be used for this procedure because of the nature of risk involved.  According to a study performed by the Mayo Clinic, exposure to anesthesia as an infant can increase the risk of a child developing a learning disability,by the age of 19. The procedure of circumcision ca also cause long and short term behavioural and developmental problems, such as; altered perceptions of pain, Post Traumatic Stress Disorder, also linked to adult destructive behaviour.

There is also the risk of immediate complications, such as cutting more than just the foreskin, otherwise known as botched circumcision. Infections are common as it is an open wound created in an area that is commonly dirty with feces and urine. In some cases the infant boy has also died by bleeding out. It takes a matter of seconds for a child to bleed out. One ounce of blood lost in an infant would cause them to become hemodimicly unstable, two ounces would be almost dead and three ounces is too late. One ounce, is equal to a shot glass. That’s not much, and it would take no time for that much blood to accumulate. With babies it is hard to see just how much has accumulated as well, as one ounce in a diaper looks like nothing and disposable diapers will wisp away moisture (blood) making it hard to notice until it is too late.  Approximately 2-10% of Routine Infant Circumcision procedures are botched every year, and in 2010 an estimated 117-229 infant boys died.

No respected medical board in the world recommends circumcision for infants, not even in the name of HIV prevention.

“Current understanding of the benefits, risks and potential harm of this procedure no longer supports this practice for prophylactic health benefit. Routine Infant Male Circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention.” - College of Physicians and Nuses, British Columbia

“[We] Do not support recommending circumcision as a routine procedure for newborns.”

-Canadian Pediatric Society

What is the foreskin?

The foreskin is a double fold of skin that is actually two times as big as it appears, and can make up about 80% of the penile skin covering (mobile skin system). The foreskin provides a set of crucial sensory, immunological, protective, hygienic and sexual functions. It includes a specialized sheet of dartos muscle which, can produce sustained contractions of great force that stimulate the foreskin and glans. Another function of the mobile skin system is to glide up and down the shaft of the penis to facilitate non-abrasive, stimulation during sexual intercourse; thereby avoiding the need for artificial lubrication.

When the foreskin is removed, what was once an internal organ has now been forced to become external. As a result, Keratinization begins to take place. Keratinization is the process of the surface of the glans and remaining mucosa of the circumcised penis becoming toughened, dry and hard. Normally, the glans is soft and supple. Removal of the foreskin externalizes this glans and as a result is subjected to every day environmental factors, such as constant abraisonfrom clothing. The areas dry out and layers of keratin build up, making it dry and leathery.

It was once believed the layers of keratin on a circumcised penis would help to prevent transmission of HIV. Studies have shown this to be false, showing no difference. The Idea of HIV prevention from circumcision was invented by Valiere Alcena, before any research was available to back up the theory.

1986, California Aaron J. Fink (1926-1994) adopted and promoted this theory without proof. He sent a letter to the New England Journal of medicine entitled “A Possible Explanation for Heterosexual Male Infection with AIDS” He said that in Africa there was a high rate of HIV cases, where circumcision was not widely practiced. Where, in America Routine Infant Circumcision  was practiced and there was a lower instance of HIV cases. He claimed that the Keratinized glans acted as a defense against the virus. The softer uncircumcised glans was an entry point. He abandoned this theory in 1991, and later died in 1994.

According to demographic health studies performed in Africa, HIV was also prevalent in circumcised men in at least 6 countries.

Country	% Circumcised	Ratio of Cut men to Whole men who contracted HIV
Cameroon	91	4.1 : 1.1
Ghana	95.3	1.6 : 1.4
Lesotho	23	22.8 : 15.2
Malawi	20	13.2 : 9.5
Rwanda	-	3.8 : 2.1
Swaziland	-	22 : 20
-	-	-

In Malaysia, 70% of Aids sufferers are Muslim. Most if not all Muslims in Malaysia are circumcised. In Israel, despite the large Jewish population and the practice of circumcision in their religion, there is a large and growing population of HIV cases. 80% of the United States is circumcised, where as in Europe this is a very uncommon practise. HIV continues to grow at a higher rate in the United States than in Europe.

Immunological and Hygiene Function

The foreskin acts like an eyelid in that it serves a set of protective and immunological functions. It protects the glans and creates a distance between the urethra and the external environment. When a boy is born, the foreskin is sealed to protect the glans, which is extremely vulnerable to the urine and feces, present in his diaper. The foreskin protects the glans from foreign contaminants as well as shielding the penis from injury. The inside of the foreskin is a mucous membrane, that is comparable to those of your eyes, mouth, and other bodily orifices including the female genitalia. These mucous membranes perform many immunological and hygienic functions. Langerhans cells, plasma cells, apocrine cells, and sebaceous glands collectively secrete emolliating lubricants rich in enzymes. Such as, lysosomal enzymes, chymotrypsin, neutrophil elastase, immunoglobulin, cytokine, cathespin B, and langerin which kills the HIV virus. All these substances function to help ward off unwanted pathogens from entering the urethra.

The foreskin is responsible for production, retention and dispersal of pheromones such as Androsterone. The intact penis is naturally clean, and maintains a level of hygiene that is optimal when compared to the cut penis. In fact, many studies show that circumcision is often associated with an increased risk and occurrence of bacterial infections, viral infections and major STD’s or no significant difference. At the same time, forceful retraction can be just as dangerous. As the boy grows, the foreskin begins to loosen and retract naturally, just about the same time he is potty trained. Forceful retraction can leave the glans exposed to external elements and can leave the boy susceptible to UTI’s and other infections. It is fair to say that cut men have been denied the normal bodily functions associated with the anatomically correct penis.

Urinary Tract Infections

Urinary Tract Infections or UTI’s are caused by Escherichia Coli (E.Coli) bacteria. The infant has no known immunities to this bacteria. In a female infant, a UTI usually generates in the colon, in a male infant they are usually generated by the external environment, which induces the assumption that such infections are latrogenically caused.

Two procedures that would increase the risk of a male infant obtaining a UTI are; circumcision and forced retraction of the foreskin. This is because both procedures would tear away the synechia, this is what fuses the foreskin to the glans as an infant. This would create an open wound for which E. Coli would have the opportunity to enter the system through the urine and feces already present in his diaper. Thereby, increasing the chance of UTI. If left undetected a UTI can cause a kidney infection. This can lead to permanent kidney damage, possibly leading to further complications later in life.
“ Circumcision does nothing to prevent UTI and may actually cause it.” The American Academy of Pediatrics, 1999

Sensory Function

The tissues that make up the foreskin are made up of a large number of nerve endings, more than any other part of the penis. These nerve endings enable the foreskin to feel the slightest pressure, lightest touch, heat or cold, even a pin prick. An estimated twenty thousand fine touch nerve receptors are lost during circumcision. Unnatural exposure of the penis will desensitize the glans, which has very little sensation to begin with. The function of the foreskin is to keep the glans healthy, clean, shiny, warm, soft, moist and sensitive. When the foreskin is removedit causes the glans to be scarred, dry, cracked and pitted. Most notably, is the decrease in sensitivity to vibration in the glans.

A 2006 study showed that “5 locations on the uncircumcised penis that are routinely removed at circumcision were more sensitive to fine-touch pressure, than the glans of the uncircumcised male. The most sensitive location on the circumcised penis is the circumcision scar on the ventricle surface. When compared to the most sensitive location area on the circumcised penis several locations on the uncircumcised penis that are missing from the circumcised penis were significantly more sensitive.”

Circumcised men are, on average, 8mm smaller than their non-circumcised counterparts when erect. As according to a 1995 Australian study done to better understand condom sizing. This also meant that girth was reduced by 22 at the coronal ridge and 4mm at the glans. The ability to perform sexually, as nature intended is forever gone. Approximately 50% of the mobile skin system is removed or compromised with the tissue removed during circumcision. The average adult foreskin would measure 15 square inches if unfolded and spread out. That is about the size of a 3X5 index card.

What is the Glans?

The glans is the head of the penis, in an uncircumcised male it is covered by the foreskin. It is the portion of the penis that becomes externalized through circumcision. Surprisingly enough, the glans has virtually no fine-touch sensation. It is the least sensitive part on the body. It is insensitive to heat, cold, light touch and pin pricks. It can only sense deep pressure and pain at high thresholds. It is the dartos muscle sheet in the foreskin that produces contractions that are slow, and sustained that may produce great force as in cold temperatures. The innervation of the glans responds to pressure, hence the glans are meant to be stimulated with the foreskin as it’s medium.

Researchers at the Department of Pathology in the Health Scientists Centre, at the University of Manitoba discovered, the corona of the glans contains scattered nerve endings, genital end bulbs, and pacinian corpuscules. These transmit sensations of pain and deep pressure. They also discovered the glans is nearly incapable of detecting light touch.

A study conducted by Dr. Christopher Cold and Dr.Kenneth A McGrath demonstrate that, the human foreskin is more sophisticated and responsive than their comparative anatomy in other primates. In monkeys and apes, the glans is more sensitive than the foreskin, in humans the opposite.

He should look like his father and it’s cleaner!!

While I agree that every child should look like where they came from, image isn’t everything. For example if two parents, both brunette were to have a child and that child was a red head, should they die the childs hair so as not to be made fun of? His nose looks different than his fathers, should we “take a little off the top” in order for his nose to resemble his fathers? No. Truth is, no one should be looking in your child’s pants and if they are there’s a problem there. A child may have a question or two about how come their father looks different than him, and telling the truth is the best method. In my experience though, most males will not even question this. In the end he will thank you for not taking any of the aforementioned risks, and when he fully understands what you in fact did (or did not) do for him, he’ll also thank you. He’ll thank you for not removing half of his mobile skin system, and for not destroying the nerves in his penis. He’ll thank you for having the opportunity to perform as nature intended him to. If one day he decides to have a circumcision performed on himself, he’ll thank you then too. For not taking that choice away from him, and allowing him to make a decision that important on his own. As for it being cleaner, you wouldn’t cut off his toes because they make toe jam would you? Or how about cutting off his butt cheeks to avoid the mess that happens back there, and keep his anus clean? It’s simple, with proper hygiene the body isn’t dirty.

In the end, all parents want to do what is right by their children. All parents want to keep their children from as much harm as possible. Don’t let circumcision be that exception! Follow your heart and do what is right, no one can take that from you. If you’re questioning if circumcision is right perhaps, it’s not. Perhaps taking your sons freedom of choice away from him isn’t the best option. Perhaps you should allow his body to be as nature, or God, if you will intended.