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Circumcision: To Cut or Not to Cut

To cut or not to cut? The debate has been going on for years with no conclusive answer. In many cultures, circumcision is done for religious reasons rather than medical benefits. According to an estimation, about one third of world’s male population is circumcised making it the most widely performed surgical procedure without any medical indications. As per World Health Organization, about 30 to 33% of world male population aged 15 and above is circumcised.

However, some people consider it to be unnecessary genital mutilation. A huge number of male adults feels violated and unhappy because of procedure performed on them without their consent when they were still an infant. Now the question arises whether the benefits of circumcision
outweighs its negative effects? Before we dive into that, let’s have a look on what exactly circumcision is.

What is Circumcision?

It is a surgical procedure performed to remove all, or a part of penis called prepuce or foreskin. It is usually performed after birth during the first week of male infant’s life. It is a minor procedure and usually takes 5 to 10 minutes, performed under local anaesthetic. The medical experts suggest that performing the procedure on an infant older than two months and boys and men increases the risks associated with it. However, the age when the procedure is performed usually varies in different cultures.

What are the Medical Reasons for Circumcision?

During the past century, the procedure became popular in many parts of the world, even in cultures not mandated by the religion. In the modern world, it is usually performed before the infant is discharged mainly for hygienic reasons. The medical evidence supporting circumcision’s protective
role against several diseases is available, however, not sufficient to establish it as a standard process to be performed.

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Many studies suggest that circumcision reduces the risk of urinary tract infections in boys under two years of age by a factor of 3 to 10 times. The 2012 Technical Report of the American Academy of Paediatrics Task Force provides a reasonable scientific explanation on how circumcision does that. According to the report, the urethra or the orifice at the tip of the penis harbours more bacteria that cause UTI in uncircumcised boys than that of circumcised ones, especially in infants under 6 months. Hence, circumcision reduces the risk of UTIs by reducing the population of these bacteria.

According to another report, “Childhood or adolescent circumcision is associated with a reduced risk of invasive squamous-cell carcinoma.” Studies have also suggested that the procedure is protective against penile cancer in men and cervical cancer in women who they copulate with. However, another report suggests an association between circumcision and increased risk of invasive penile carcinoma. There may be some discrepancy in the results as the procedure is thought to be opted by male adults in an attempt to cure their penile cancer, hence not cause by circumcision itself.

Research also suggests circumcision is protective against STDs/STIs which is a highly sought after medical benefit of circumcision. Studies carried out on circumcised and uncircumcised African males showed that the prevalence of AIDS was three times greater in uncircumcised males than their circumcised counterparts. Other studies have shown greater incidence of other STIs too such as syphilis in uncircumcised males.

The plausible explanation behind greater risk of STIs/STDs in uncircumcised males is that during intercourse, the delicate foreskin of uncircumcised males is more likely to sustain tiny cuts which allows the HIV to access blood vessels and enter the blood stream causing the disease. Circumcision also serves as a treatment of phimosis which is a condition prohibiting the foreskin to retract over the head of penis making the intercourse painful and even impossible.

The Cons:

Many doctors around the world consider circumcision as an outdated practise which should become obsolete now. Many reputed doctors argue that the procedure is supported by poor evidence and should be out of practise. They argue that the high incidence of diseases in uncircumcised males is due to build-up of smegma, a substance secreted by the foreskin. When the personal hygiene is not maintained and the matter is allowed to accumulate it can serve as a fertile ground for the growth of bacteria causing diseases. Likewise, the claims of low prevalence of penile carcinomas in circumcised male populations are rejected by critiques attributing them to the maintenance of personal hygiene and keeping the number of sexual partners limited.

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Another notable disadvantage of circumcision is reduction in sexual pleasure both due to masturbation and intercourse as a study published in British Journal of Urology International demonstrated. Just like any other surgical procedure, certain risks are associated with circumcision such as
excessive bleeding, pain, infection, increased risk of inflammation of orifice at the tip of the penis etc. Although very little, there is a chance of major damage to the penis, having serious physical and psychological implications. Circumcision trauma is also real and many adult males seek therapy for that as they consider it genital mutilation performed against their will. Removing foreskin sometimes also results into deformed erections that can severely affect the self-esteem.

The Rates Are Declining!

The American Academy of Pediatrics does not recommend circumcision as a routine procedure for a new born as new studies are pouring in nullifying the previously thought benefits of circumcision. In the recent years, the number of male population going for circumcision, voluntarily or
involuntarily, is declining, especially in modern world. It is recommended to educate the parents and provide them valid information backed by science before they make a decision. Since the decision still resides in the hands of parents, the least they can do is ensure if the surgeon they are opting for is experienced. They should also ensure that their infant is getting suitable local anesthetic to block or at least reduce the sensation of pain.

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