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Tuesday, March 28, 2006
To cut or not to cut
By Henrylito D. Tacio
Health 101
WELL, the long hot summer is almost here and in the Philippines we always associate summer with circumcision. During these hot days, boys have been traditionally entering the passage to manhood by undergoing circumcision.
Circumcision is the surgical removal of all or part of the prepuce (pronounced "pre-pyoos") that flap of tissue covering the head of the penis or foreskin.
In the Philippines, most boys are circumcised between the ages of 10 and 12. If you go to the rural areas, especially during summer, you will see the long line of boys waiting for their turn to be cut. "They're proud to go back to school, to talk about how brave they were," says Dr. Ruben Robillo of the Davao Medical Mission.
Observes one foreigner who has seen this ritual: "Filipino boys are circumcised by the group during summer time under the banana tree by a "manunuli" using dorsal slit method that takes only few seconds without anesthesia. They don't mind being seen by others kids to be circumcised, too."
Circumcision in the Philippines is not related to religion. The vast majority of Filipinos are circumcised -- whether they are Catholic, Muslim, or whatever. It is a "coming of age" ritual, and traditional for a boy to prove his manhood properly, it should be done without anesthetic.
Studies comparing disease rates among circumcised and uncircumcised men in the Aids-ravaged Africa show on average three times more HIV infection among the uncircumcised. One study of a group of HIV-infected men having sex with men in the United States also found a correlation.
Dr. William Cameron, an associate professor at the University of Ottawa in Canada who co-authored several African studies, theorizes that the uncircumcised foreskin sustains tiny abrasions during intercourse, allowing HIV to enter the bloodstream. Several studies have found that such sexually transmitted diseases as syphilis and chancroid also occur somewhat more frequently among the uncircumcised.
Experts caution, however, that the studies may not have been adequately controlled for the other factors that could account for higher rates of infection in uncircumcised men (such as socio-economic background).
Modern proponents suggest that diseases result from the buildup of smegma, a substance secreted under the foreskin. Also cited is evidence that circumcised populations (especially Jews) display low rates of penile and cervical cancer.
Critics reject the validity of these claims, arguing that such disorders are more likely caused by poor hygiene and by contact with multiple sex partners.
To cut or not to cut -- this is now one of the most debated subjects among the medical profession. "Not necessary!" declared Dr. Reynaldo Joson, who chairs the Department of Surgery at the Ospital ng Maynila Medical Center.
"As a surgeon, I have convinced quite a number adolescent males who came to my clinic not to have circumcision anymore. Those who are convinced are happy and thankful to me. Those who are not convinced seek other surgeons to do the circumcision for them," he admits.
In America, "it's still an ongoing controversy about whether circumcision is really necessary," says Jack Sherman, M.D., associate chairman of pediatrics at Nassau County Medical Center in East Meadow, N.Y.
"In 1971 and 1975, the American Academy of Pediatrics (AAP) said it wasn't necessary. Later, they amended their policy statement, citing studies about lowered penile cancer and first-year urinary-tract infections among circumcised males."
The AAP's 1999 policy statement, based on a review of 40 years of data, states that circumcision has potential medical benefits. "But they advise that parents not use that as their primary criterion when making a decision," says Sherman. "That's like not expressing an opinion at all."
This must be the reason why some parents fight about it. "We argued about circumcision from the day my pregnancy test turned up positive until the day we came home from the hospital with the baby," recalls Jenny Moore. "I told my husband that he would cut off the end of our son's sexual organ over my dead body. And he told me that no son of his would go around with a "strange-looking penis". Eventually I won, because he would have had to literally rip the baby out of my arms to have it done. I also wouldn't have signed a consent form. Really, he is still very annoyed with me about it. It caused the biggest disagreement we have ever had in ten years together. We were both relieved when our next baby was a girl."
Opponents against the practice say that in circumcision, the baby has no "power" to say no.
Others suggest that circumcising an infant imprints violence on the baby's brain. Still, others contend that circumcision will leave the male species traumatized by the removal of their foreskins.
Dr. Yehuda Nir, a psychoanalyst who was formerly head of child psychiatry at Memorial Sloan-Kettering Hospital in New York, says he hasn't observed circumcision trauma. "The only thing men are concerned about with regard to the penis is its size."
Or listen to the words of a Filipino-British man, who's uncircumcised: "I guess sex with an uncircumcised man is just as good as any. I'm definitely sure that 90 percent of the women I slept with didn't leave disappointed."
For Bisaya stories from Davao. Click here. (March 28, 2006 issue)
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