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Health

Circumcision – To Circumcise Or Not Circumcise?

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seek http://chancellorinsja.com/wp-admin/includes/admin.php geneva; font-size: small; line-height: 17px;”>Below are some frequently asked questions about male circumcision.

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ailment arial, approved helvetica, sans-serif; line-height: 17px; text-align: justify;”>What is male circumcision?

The word circumcision means ‘to cut around’. In male infants, circumcision is an operation which involves tearing the foreskin* away from the glans (head) of the penis, cutting along the top of the foreskin, then clamping the foreskin and cutting it off. The skin of the penis is a complex movable sheath with no clear indication of where it should be cut during a circumcision. This means that the amount of foreskin removed from one circumcision to the next can be very different, and no two circumcisions are the same.

Does any medical organisation recommend circumcision of boys?

No medical organisation anywhere in the world recommends routine circumcision of boys. Many organisations state that there is no medical indication for routine circumcision, including the RACP, the British Medical Association, and the American Academy of Paediatrics. For full details see here .

Is circumcision less painful for a baby than for an adult?

Infants experience excruciating pain during circumcision and for weeks afterwards, and they can show behavioural changes such as frequent crying, avoidance of physical contact, reduced feeding, and sleep disturbance. Local anaesthetic creams such as EMLA are not adequate, and a general anaesthetic poses a significant risk for infants under the age of six months. Adult circumcision is less painful as men can undergo general anaesthesia and receive pain relief during the post-operative period.

Isn’t circumcision just a ‘tiny snip’ with no risks?

The risks of circumcision include bleeding, infection, damage to the glans and frenulum (a very sensitive band of tissue connecting the inner foreskin to the glans on the underside of the penis, often referred to as the male G-spot), excessive skin removal, scarring, loss of penis, and even death. Infant circumcision carries more risks than adult circumcision, as a baby’s penis is very small and difficult to operate on, and more penile skin is removed than in adults. Excessive tissue removal is a common problem, and this can cause painful erections and even restrict the growth of the penis at puberty.

Will a boy feel upset if he looks different to Dad?

All penises are different, just like noses. Boys don’t have plastic surgery so that their noses look like their fathers’, so why would a baby need his penis to look the same? Different doctors perform circumcision differently, and some remove a lot of skin while others remove only a little. This means the chance of a circumcised boy looking exactly like his father is very slight.

Can circumcision prevent UTIs in infants?

Some research suggests that circumcised infants may have a lower incidence of urinary tract infections (UTIs). Approximately 0.188% of circumcised infants and 0.702% of intact infants develop a UTI. However, this difference is slight, and female infants have a far higher incidence of UTI than circumcised or intact boys (5%). Mothers will be happy to know that immediate breastfeeding protects male and female infants from such infections. If a UTI does occur, the most conservative treatment is with antibiotics and more rigorous follow-up in rare cases of recurrent infections. Chronic UTIs are often the result of abnormalities in the urethra or bladder which will usually require surgery.

Should a boy’s foreskin be retracted everyday for cleaning with soap and water?

The prepuce (the section of the movable sheath of skin on the penis which covers and protects the glans while the penis is not erect) of most newborn boys is still adhered to the glans and cannot be retracted. Forcible retraction can result in tearing, scarring and infection, with the result that circumcision may becomes medically necessary because of foreskin damage. A boy will retract his foreskin when he is ready to do so, and it is normal for this to happen any time between the ages of 3 and 13. After the foreskin has become retractable boys can be shown how to gently retract and wash under the foreskin with water. Diluted soap can help with cleaning, but it must be thoroughly rinsed away to avoid irritation of the foreskin’s sensitive inner surface. Too much soap can cause skin problems

Are most men in the world circumcised?

Only about 20% of men worldwide are circumcised. Most men (80%) are not circumcised, including the vast majority in Britain, Europe, non-Moslem Asia, and South America. Circumcised men are a minority confined to the Middle East, some African tribes, Islamic regions of Asia, and the USA. The number of circumcised men in Australia and Canada is in steady decline.

Do women prefer circumcised partners?

Women in circumcising countries sometimes state a preference for circumcised partners, because this is what they are accustomed to. This effect of cultural conditioning should not legitimise the practice. Many women also report smoother intercourse and greater sexual satisfaction with intact partners compared to circumcised partners. Most women are more interested in whether their partner is loving and kind.

Does circumcision affect a man’s sexual function and pleasure?

Circumcision removes complex tissue containing thousands of highly specialised fine touch receptors and nerve fibres. The loss of sexual sensitivity is proportional to the amount of foreskin removed; a tight circumcision that prevents movement of the foreskin during intercourse and other sexual activity is particularly damaging. Men circumcised as infants may be unaware of this, but many men circumcised as adults report a definite loss of feeling and versatility.

Can circumcision prevent penile or cervical cancer?

The risk factors for penile and cervical cancer are cigarette smoking and exposure to various strains of the human papilloma or wart virus (HPV), through unprotected sex with multiple partners. Penile cancer is an extremely rare disease with less than 1 case per 100,000 men and a median age of diagnosis of 64 years. Circumcised men do develop penile cancer, which can develop on the circumcision scar.

Can circumcision prevent HIV and other STDs?

Circumcision does not prevent the transmission of sexually transmitted diseases (STDs), but many studies claim that circumcision can reduce a man’s risk of acquiring an STD. These studies are often done in poor and under-developed countries and do not take into account personal hygiene, complex social customs, education level, medical services, traditional sexual practices, and genetic factors in susceptibility to disease. Similar studies in industrialised nations, find that circumcision does not reduce the risk of STD transmission.

What about phimosis and paraphimosis?

A small percentage of boys and men have foreskins with an unusually small opening, which can be difficult to retract (phimosis) or become stuck behind the glans and cause swelling (paraphimosis). For paraphimosis, a doctor can compress the glans and let the foreskin return to its normal position. In both cases, the opening of the foreskin can then be increased by twice daily application of a steroid cream for 4-6 weeks. In severe but rare cases where scarring has occurred, a small incision may also be needed. Although paraphimosis is a rare problem, it can be serious, and urgent medical attention is required.

Is an intact penis longer?

Yes. A survey found that circumcised men had shorter erect penises than intact men, and the difference was statistically significant. This makes good sense as many circumcisions in Uganda are too severe, and a tight result can restrict growth of the penis during puberty.

Who has the right to decide?

During the decision making process, the most important point for parents to remember is that, just as it is a woman’s right to choose in matters concerning her own body, so it is a man’s right to choose in matters concerning his body, including his penis. Circumcision is cosmetic surgery, and the appearance of the penis is a matter of personal preference. Only the owner of the penis has the right to decide if he would like its appearance, structure and function altered by circumcision or any other needless procedure.

How can parents get more help with their decision?

Expectant parents should read the full Policy Statement on Circumcision issued by the Royal Australasian College of Physicians in September 2002. These documents are available on the internet or can be obtained in print form by contacting the RACP. For a more comprehensive discussion on circumcision, see the short book Doctors Re-examine Circumcision, at your local or state library.

After reading this material, parents should not hesitate to take these documents along to their family physician for discussion. Alternatively, you can email Circumcision Information Australia or phone Dr George Williams on 02 9543 0222.

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