To cut or not

IN THE Philippines, summer is always associated 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. It is an ancient operation of unknown origin, performed originally with flint (stone) knives prior to the use of metal. The earliest known artifacts from Egypt are dated at about 4000 BC, centuries before circumcision’s adoption by the ancient Hebrews.

For thousands of years, circumcision has been widely practiced as a religious rite. Circumcision, particularly among males, appears widely among tribal peoples of Africa, the Malay Archipelago, New Guinea, Australia, and the Pacific islands. Some form of genital surgery was ritually performed on males or females among certain South and Central Native American groups.

In tribal settings, circumcision is nearly always associated with traumatic puberty rites. Occasionally the severed part is offered as a sacrifice to spirit beings. According to Encarta Encyclopedia, the operation certifies the subject's readiness for marriage and adulthood and testifies to his or her ability to withstand pain. Circumcision may also distinguish cultural groups from their uncircumcised neighbors.

In Jewish religious tradition, infant male circumcision is required as part of Abraham's covenant with God. The Levitical law says that every Jewish male infant had to be circumcised on the eighth day after birth, under penalty of ostracism from the congregation of Israel. Jews employ a mohel to perform the rite. After a ritual prayer, the mohel circumcises the infant and then names and blesses the child.

Among the Arabs, circumcision existed before the time of Muhammad (before AD 570). Although the Koran does not mention it, Islamic custom demands that Muslim males be circumcised before marriage; the rite is generally performed in infancy.

Meanwhile, Herodotus, Philo, and other ancient Greeks first suggested that circumcision might have hygienic benefits (ironically, the Greeks did not adopt the practice). Some theories have it that circumcision probably originated as a hygiene measure in communities living in hot and dry environments.

Since the 19th century, many English-speaking peoples have adopted the custom of circumcision, primarily for medical reasons. In modern medical practice, circumcision of males is a minor operation usually performed in infancy for hygienic purposes. It is currently estimated that 85 percent of North American males are circumcised. The incidence among non-Jewish populations of continental Europe, Scandinavia, and South America is low.

The medical case for circumcision is unproved and controversial, says Dr. Donald F. Tuzin, American Professor of Anthropology at the University of California in San Diego. He says that physicians in the 19th century advised the operation for many ailments, including hysteria, sexually transmitted disease, hypersexuality, and even hiccups.

Removal of the foreskin also precludes phimosis or the inability to retract the foreskin. Louis XVI of France, a famous phimosis sufferer, was unable to have sex with his wife Marie Antoinette until he was circumcised at age 21.

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 in the United States. "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."

I think I will agree with that!

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