Circumcision is the surgical removal of the sleeve of skin and tissue that normally covers the glans (head) of the penis. This double layer is commonly known as the foreskin. There are many myths and misunderstandings about circumcism. You should find out as much as possible about circumcision. You should be aware of the complexities of the circumcision procedure itself. Speak to your doctor about the what is involved in the procedure, so that you will know fully what is involved.
What is the foreskin there for?
The foreskin has three functions: protective, sensory, and sexual. In most cases, the foreskin is still fused to the glans at birth and will separate over a variable period of time over the first few years. During the diaper or nappies period, the foreskin protects against abrasion from diapers and feces. Throughout life, the foreskin keeps the glans soft and moist and protects it from injury. Parts of the foreskin, such as the mucosa (inner foreskin) and frenulum, are particularly sensitive and contribute to sexual pleasure. Specialized nerve endings enhance sexual pleasure and control. The inner foreskin (mucosa) is the skin directly against the glans or knob of your penis. Like the lining of the mouth, this tissue is thinner and of a different texture and color than the remainder of the skin covering the penis (shaft skin). The foreskin provides ample loose skin for the penis to occupy when erect. It is a movable skin sheath for the penis during intercourse, reducing chafing and the need for artificial lubricants, and allowing the glans and foreskin to naturally stimulate each other. Warren and Bigelow described some of the physiological functions of the foreskin in sexual activity.
What are some reasons that circumcision is performed?
Circumcision is primarily performed for cultural or religious reasons. Because a large number of men in English-speaking Western countries are circumcised, many think of the foreskin as an unnecessary part of the penis. Many circumcisions are performed because a circumcised father often does not want to feel that he is different from his son.
It is often said that a circumcised penis is cleaner, or easier to keep clean, than an intact penis. Smegma (a natural substance composed of dead skin cells, normal flora, and secretions containing the natural antibacterial agent lysozyme) is more likely to accumulate when the foreskin is present.
- Medical grounds for circumcision that are most commonly cited are:
- Reduced risk of urinary tract infections (UTI);
- reduced risk of penile cancer; reduced risk of cervical cancer in partners of intact males;
- reduced risk of sexually transmitted disease (STD).
Experts disagree about whether circumcision reduces UTI, but this seems to be the strongest of all medical claims in favour of circumcision, because UTI can have serious consequences. These infections can, however, in most cases be treated by antibiotics.
The frequency of UTI in US male infants is approximately 1%, but is higher for females. There is evidence that babies who are breastfed have a lower incidence of UTI. Penile cancer extremely rare. It occurs mostly in older men.
Most doctors will not recommend infant circumcision as a preventative measure. Penile cancer can occur in both circumcised and intact men. The theory that wives of men with intact foreskins are more prone to cervical cancer has been disproven .
The theory that the presence of a foreskin may cause an increased risk of sexually transmitted diseases has also been disproved. Hygiene The foreskin is easy to care for and the intact penis is easy to keep clean.
The foreskin usually does not fully retract for several years and should never be forced. When the foreskin is fully retractable, boys should be taught the importance of washing underneath the foreskin every day. Gently rinsing the genital area while bathing is sufficient. Harsh soap and excessive washing can irritate the penis, which can lead to inflammation of the glans
Smegma is a white waxy substance that can appear under the foreskin. It consists of natural secretions and shed skin cells. In the past it was feared that smegma might be carcinogenic, but this has been disproven. Good general hygiene and common sense are key to preventing infection and disease.
If my son isn't circumcised, won't it have to be done later?
Abnormalities or diseases of the foreskin can be treated conservatively, if and when they occur, on a case-by-case basis.
Probably the most common abnormality of the penis is "phimosis", or tight foreskin. (This is not the same as the natural attachment of the foreskin to the glans in very young children, which is completely normal.) The foreskin can normally be retracted by adolescence. If retraction is not possible, a number of newer treatments are available which do not involve circumcision:
Steroid creams, stretching, and preputioplasty. Some of these treatments have only been published recently, and not all doctors are aware of them.
If your son has a serious problem with his foreskin, such as a severe infection (balanitis xerotica obliterans) or gangrene, perhaps related to diabetes, removalof the affected area may be a medically advisable option.
If my son isn't circumcised, won't he be teased?
Children can be cruel, and will find things to pick on another child about, whether it be his chubbiness, glasses, or freckles. Some parents think that their son should be circumcised so that he will "match" his father, brothers, or friends.
As parents, we can help our children to feel good about their bodies and to respect individual differences. Parents often express a fear that their son will "feel different in the locker room" if he is intact. There is good evidence that proper education is the answer. Boys who are taught from an early age that they are normal, whole and healthy will have a lesser chance of suffering embarrassment in the locker room, especially if some of the other boys are also intact.
What are some reasons not to have my son circumcised?
Your son's foreskin is a healthy, natural part of his body. It is possible, though very unlikely, that it will cause serious problems during his life. When he becomes an adult, he may prefer not to be circumcised.
Leaving your baby's foreskin alone preserves his right to a whole and intact body.
Is circumcision painful?
The often repeated statement that babies can't feel pain is not true. It is documented in the medical literature that babies are as sensitive to pain as anyone else.
Most circumcisions are performed without anaesthetic, because there are risks involved with using anaesthetics on babies. Sometimes local injections are used, but this does not eliminate pain.
Most babies will show signs of pain during the procedure and in the week or ten days following circumcision. Recent studies have shown that the pain is remembered long beyond the time of the procedure itself.
Does infant circumcision have risks?
Circumcision is surgery, and like all surgery it has risks. These include:
- Excessive bleeding
- Injury to the glans Infection (raw wound is exposed to feaces and urine in diaper)
- Complications from anaesthesia, if used
- Surgical error, including removal of too much skin
In rare cases, complications can be life-threatening. Many circumcised males (up to 20%) will suffer from one or more of the following complications, to some degree: - Meatal stenosis (narrowing of the urethral opening due to infection and subsequent scarring, that occurs almost exclusively in circumcised boys)
- extensive scarring of the penile shaft skin tags and skin bridges bleeding of the circumcision scar curvature of the penis tight,
- painful erections
- psychological and psychosexual problems
If you intend to ask your doctor to have your son circumcised, ensure that the procedure is carried out by an experienced surgeon. Sometimes circumcision isconsidered "minor surgery" and inexperienced residents are given the task of performing it. This leads to a higher rate of serious errors and complications. You may desire that your son will retain some inner foreskin, and especially the frenulum, to preserve as much sexual sensitivity and function as possible.