Friday, February 17, 2012

Circumcision - I Wouldn't Do It To My Child If You Paid Me

This will be a series of blogs, I hope you will read them all, and that I will be able to explain many things of which you may not have been aware. 

A young friend asked if I would do a blog about circumcision.  In my complete ignorance I replied "of course!"  Little did I realise what was in store.  This blog has been months in the making, and has given me more nightmares, tears and headaches than I anticipated.   The debate amongst the medical fraternity about male circumcision runs hot and furious. 

As a layperson I looked at what statistics are quoted, anecdotal evidence presented, and reams of learned submissions online.  And at the end of it all my heart says the same as it did before I started.  I do NOT believe in male circumcision.  At all.  Reading of the complications (many of them hidden - more on this later) and of the deaths and mutilations from 'routine' circumcision has made me feel ill, and made me weep.  This is just in USA and Australia, not in somewhere like Africa.

My friend actually pointed me to a very informed blog (anti-circumcision) and for a moment I was quite disheartened.  The blog said many of the things I had planned, quoted similar statistics and the like.  When I stepped back for a minute it occurred to me that this is a 'so what?' situation.  My voice can be heard as well, and if we are on the same side, all the better!

I do understand that circumcision has been undertaken for religious and cultural reasons for thousands of years and is an important ritual in some religious and cultural groups. It was interesting to see that there is actually a movement amongst member of the Jewish religion, to stop circumcision of their young boys.

In Australia and New Zealand, thankfully, the rate of circumcision has recently declined, and it is estimated by the RACP (The Royal Australasian College of Physicians) that  in 2010, ten to twenty percent of newborn male infants were circumcised.  This is, thankfully, a much lower percentage than, for example, in the 1960's, when there were 70% of boys circumcised.

There is a growing public movement against female genital mutilation, which has many prominent  figures (including the model Waris Dirie)speaking out, making films, media appearances etc.  Why then is it fine, and apparently largely accepted to perform male genital mutilation? This is what it amounts to, and I don't see how anyone can argue their way around that.  The male foreskin is there for a reason, no?  Else why would men be born with a foreskin?  Women have the labia, which is like our own foreskin - and there for a specific reason.  The scarring caused by circumcision is not just physical either.  There are serious psychological problems in many men who have been forcibly circumcised.

I say forcibly deliberately - circumcision of  a neonate, or a young boy equates to a serious breach of human rights, and to me is totally unethical.  If a child is too young to be given the right to consent in a case of non-therapeutic surgery then that surgery should not be carried out.

Reasons parents have given for having their baby circumcised vary from "it is healthier"  and "it is cleaner" to something along the lines of "all the other men in the family are circumcised" - and similar.  Very few of them seemed to be informed beforehand of the dangers associated with circumcision, and many of them were told something along the lines of "it's only a little snip and it's done".  NOT SO.

In Australia, we apparently followed the lead of England and the USA, where doctors, in the Victorian era of prudery, espoused the belief that circumcision, hysterectomy and clitoridectomy (removal of the clitoris)would prevent or cure various illnesses.  These included masturbation, mental illness and tuberculosis among others.  There was, however, a dissenting group of British doctors, and in 1867 circumcision of females was banned.  At this time it was recognised that it was a woman's right to make decisions about her own body.  Male circumcision continued into the 1900's, with physicians misguidedly believing that both sexes could thereby be protected from sexually transmitted diseases, and cancer, and that all cases of phimosis in male infants made circumcision necessary. When will we recognise that it is a man's right to make decisions about his own body?

Before I go further I will just put in a little about the foreskin, and the penis, so that we understand the full horror of what is done to the baby during circumcision. 

Simply put : The foreskin covers the tip of the penis, or the glans. It extends from the skin that covers the shaft of the penis, and it has a thinner and more sensitive inner surface.  This inner surface is attached to the shaft of the penis where it joins the glans.  The foreskin protects the inner surface as well as the tip of the penis. Under the foreskin,  the skin of the glans is moist, and thin. At birth it is normal for the the inner layer of the foreskin to be attached to the glans.  The foreskin cannot be retracted (pulled back) at this age. There is a very sensitive band of tissue called the frenulum which connects the inner foreskin to the glans,  under the penis.  This is often referred to as the male G-spot. As a boy grows, the inner skin separates and the opening becomes more elastic, so that by the time he is grown, he should be able to retract it without discomfort.  This separation can occur at between 3 to 13 years of age. 

From Circumcision Reference Library

The foreskin (prepuce) has a sheath of smooth muscle tissue inside the skin which is called the peripenic muscle. The muscle fibres are arranged in a whorl at the end of the foreskin to form a sphincter. The muscle fibers keep the foreskin snugly against the glans penis. The outer surface of the prepuce is skin, however the inner surface is mucosal membrane although it resembles skin in appearance. There is a muco-cutaneous boundary just inside the tip of the prepuce. The prepuce normally covers the glans penis and protects it from foreign matter, friction, drying, and injury.

The prepuce is usually tethered at the bottom by the frenulum. The frenulum's function is to provide pleasure by stretching during sexual intercourse. In fact, the frenulum is colloquially known as the "sex nerve" in France and perhaps throughout Europe. By destroying this stretching action, circumcision completely destroys this fundamental means of sexual pleasure in the human male. There is a hypothesis that stretching of the frenulum during intercourse provides stimulus for ejaculation.

As with other neurologic structures such as the brain, the tip of the prepuce is richly supplied with blood by important vascular structures. The glans penis receives blood through the frenular artery. The prepuce serves as a conduit for several important veins. Circumcision may contribute to erectile dysfunction by destroying these blood conduits.

The prepuce is naturally equipped with several defenses against infection. The infant prepuce has a pronounced tight tip with a sphincter formed by the whorl of muscle tissue that stays closed to keep out foreign matter but opens to allow the outflow of urine. The sub-preputial wetness contains lyzosyme, a secretion that acts to destroy harmful microorganisms. The prepuce contains Langerhans cells which may provide resistance to HIV infection.

The prepuce is profusely innervated (has many nerves) especially near the tip in the ridged band area where the muco-cutaneous boundary occurs. It is now understood that this junction is the most sensitive and erogenous part of the penis.   The accumulation of sensation triggers the ejaculation reflex. Diminution of the available nerve supply would make achievement of orgasm more difficult. 

The ridged band is located near the tip of the prepuce on the inner layer of the foreskin near the muco-cutanaeous boundary. The ridged band merges smoothly with the frenulum. Taylor states that the ridged band is sensitive to motion. The foreskin slides back and forth over the glans during foreplay and intercourse. Typically, the ridged band area of the prepuce is stretched when it passes over the glans penis and, by this stretching action, the multitude of pleasure sensors in Taylor's ridged band are stimulated.
The ridged band area, which is stimulated by motion, is the most highly innervated and pleasure producing region of the prepuce. They clearly have an important, but not yet well understood, function in human sexual response.
The prepuce of the typical complete male may protect the corona from direct stimulation during intercourse and so tends to prevent premature and unwanted ejaculation. 
Other primates. Cold and McGrath described the variations in the prepuce between human males and females and other primate species, concluding from an evolutionary perspective that the prepuce is highly evolved and has a specialized function in each species.
In summary, the prepuce is a unique specialized structure with important immunological, protective, mechanical, erogenous, and sexual functions. The prepuce is essential to normal copulation.
The word "circumcision" comes from the Latin circumcisione, from circum (meaning "around") and c├Ždere (meaning "to cut").

In  infants, circumcision is an operation which involves tearing the foreskin away from the glans of the penis,  then cutting along the top of the foreskin,  clamping the foreskin, and cutting it off.  The amount of foreskin removed from one circumcision to the next can be very different, and no two circumcisions are the same, as the skin of the penis is movable, a sheath with no clear indicator as to where it should be cut.

The amount of skin to be removed is estimated.

The next blog will be about the methods used to circumcise a baby boy.

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