We live in an age of daring, often unwise, sexual freedom, talking openly about all manner of sexual matters. We know about sexually transmitted infections (STIs) which are rapidly increasing, and the threat of HIV and AIDS. We can talk of gay and straight, lesbian, transexuals and more. We are used to seeing naked women on TV, in magazines and newspapers - but not naked men! We men are very private, both in pictures and talk. We don't talk about the penis, let alone circumcision. Most of us are ignorant. These are strangely taboo subjects in this sexually enlightened age.
This is an operation as old as mankind, highlighted today by Jewish and Muslim tradition in which all males are usually circumcised as part of their faith. It is performed worldwide by many tribes and cultures as an initiation rite and, despite some aggressive opposition, it is routinely done at birth for the majority of boys in the USA as well as many in Australia, Canada, New Zealand, South Africa and much of the English speaking world - except, latterly, in the UK. Overall it is estimated that a quarter of the male population is circumcised - about 750 million males. They cannot all be wrong! Yet in Europe today there is widespread ignorance of its value.
As part of being untaught we take the attitude: If it ain't broken, don't fix it, ie, if there is no immediate problem do nothing. Only circumcise if something goes wrong - often reluctantly as a last resort after painful and prolonged treatment. This is in stark contrast to the rest of healthcare where the motto: Prevention is better than cure is stressed. There is a problem with thinking as we do. When does circumcision become necessary?
There are a few situations where it is clearcut. If there is only a small opening in the foreskin so that passing urine is difficult, or when the foreskin is painful to pull back during an erection or won't return forward again. The latter is an emergency situation needing urgent surgery to avoid really serious consequences.
But there are many other situations where circumcision helps prevent future disease or discomfort. We should seek to prevent problems arising, rather than deal with the problems once they occur. Let us look at some of these, in no particular order.
1 Where the foreskin cannot comfortably be pulled back over the glans (knob) of the penis. Now, up until the age of five or six, many boys cannot retract their foreskins - mums and dads beware - if you try too early you may do some damage. Above the age of six or seven, it is important that boys be taught how to clean under the foreskin, making sure the skin is pulled right back. If your son cannot do that he may need circumcising. Boys frequently forget or deliberately avoid this routine and run into difficulties.
2 If the foreskin cannot easily be moved when the penis becomes hard, or if that causes pain - this is not only a childhood problem. At puberty, as the penis grows and masturbation begins, problems may emerge. Some men have pain on intercourse, which they then try to avoid for that reason. If so, you (and your partner) will benefit from your circumcision just as many boys do. Some men are afraid to admit to this problem, but it is curable by circumcision.
3 Where you and your partner keep getting 'thrush' infections.Some call this 'sexual ping-pong'. One keeps passing it back to the other. Of course, you may first try creams or tablets from your doctor or chemist, but if it keeps coming back, circumcision will cure it. It did for me. The foreskin is a warm and moist incubator under which infections can easily develop.
So as you can see, although things aren't actually broken, they may need fixing to eliminate misery and promote a more comfortable trouble-free life. How long does it take to fix? About 20 minutes!
There are several:
1 Many older men, who have bladder or prostate gland problems, also develop difficulties with their foreskins due to their surgeon's handling, cleaning, and using instruments. Some of these patients will need circumcising. Afterwards it is often astonishing to find some who have never ever seen their glans (knob) exposed before!
2 Some older men develop cancer of the penis - about 1 in 1000 - fairly rare, but tragic if you or your son are in that small statistic. Infant circumcision gives almost 100% protection, and young adult circumcision also gives a large degree of protection.
3 Cancer of the cervix in women is due to the Human Papilloma Virus. It thrives under and on the foreskin from where it can be transmitted during intercourse. An article in the British Medical Journal in April 2002 suggested that at least 20% of cancer of the cervix would be avoided if all men were circumcised. Surely that alone makes it worth doing?
4 Protection against HIV and AIDS. Another British Medical Journal article in May 2000 suggested that circumcised men are 8 times less likely to contract the HIV virus. (It is very important here to say that the risk is still far too high and that condoms and safe sex must be used - this applies also to preventing cancer of the cervix in women who have several partners.)
A BBC television programme in November 2000 showed two Ugandan tribes across the valley from one another. One practised circumcision and had very little AIDS, whereas, it was common in the other tribe, who then also started circumcising. This programme showed how the infection thrived in the lining of the foreskin, making it much easier to pass on.
5 As with HIV, so some protection exists against other sexually transmitted infections. Accordingly, if a condom splits or comes off, there is some protection for the couple. However, the only safe sex is to stick to one partner or abstain.
6 Lots of men, and their partners, prefer the appearance of their penis after circumcision, It is odour-free, it feels cleaner, and they enjoy better sex. Awareness of a good body image is a very important factor in building self confidence.
7 Balanitis is an unpleasant, often recurring, inflammation of the glans. It is quite common and can be prevented by circumcision.
8 Urinary tract infections sometimes occur in babies and can be quite serious. Circumcision in infancy makes it 10 times less likely.
Dads - you are responsible for discussing these matters with your sons as soon as they reach an age when you can communicate with them. And, single mums - so are you, because nobody else will do so. There is no examination of the penis in school medicals.
Your teenage sons, especially the younger ones, will have almost total ignorance. They may secretly be having problems. Maybe they wish they had been circumcised for either body image or medical reasons. Help them to be informed and aware of their options. Don't cop out, there are leaflets available to help you.
You need to check your younger sons (age 5+) and teach them hygiene and be sure all is working properly. Try to cultivate a situation in which they will be comfortable to share any concerns they may have - like soreness. Remind them to pull back their foreskins whenever they pee as it helps to keep the foreskin clean. It also makes it easier to aim and assists them to avoid spraying the toilet - just as circumcision does.
You need to think about this calmly, because some people are getting angry about it in the USA, even using inflamatory words like 'genital mutilation'. Make sure you are fully informed because you as the parent have the responsibility to make decisions on behalf of your child - like the big decisions about vaccinations, knowing that for long term benefit to the child and others, the pain of the injection and often the fever which follows are worthwhile.
Having read this leaflet, you are in a better position to make decisions. Circumcision can become an emergency, or the foreskin may cause considerable problems, not least when sexual intercourse starts or in older age. Remember, it may be a taboo subject for most people - but it should not be so for you.
You may feel you could help your son avoid some of these problems once and for all by having him circumcised early in life (the best time in the healthy baby is 7-10 days old). Not only is it a simpler procedure, needing no stitches, but he will not remember the event. He will also grow up never knowing anything different. Boys circumcised later in life may find it a more embarrassing experience. For a while afterwards they will feel the sensitivity of the permanently exposed glans, but will gradually adapt to it. Thus, circumcision in babyhood can be a very sensible decision - especially for a single mum with a boy and no man around the house. If you do circumcise your son, you must explain as soon as he is old enough to understand, what happened and why it was done. This helps acceptance and avoids ignorance. (I used to think some of my friends were born with a very different penis from mine until I learned about circumcision at age 13.)
You might equally sensibly decide to wait and see, but do be ready to take action quickly if problems start to arise.
If you are thinking about infant circumcision, there are leaflets describing it in detail. You would need to discuss it with the midwife or doctor before birth to plan it. You may encounter opposition - there is currently an irrational anti-circumcision culture in the medical profession. Remember- it is your choice to do what you think best for your son in the long term. If you have any difficulty arranging circumcision on the NHS, the local Jewish circumciser, (môhel - pronounced 'moil') will often oblige you (as may a Muslim doctor). Some even offer to visit and do it in your home. You can contact the Circumcision Helpdesk for a list of circumcising doctors and môhels. The procedure takes only a few minutes.
Most men won't talk about their sexual problems, or even their desire to be circumcised. Try discussing it with your partner who may have definite views! Sexual pleasure is not diminished but often enhanced by the slightly reduced glans sensitivity making it easier to control orgasm. If circumcision is the right decision for you, do make arrangements. You will never regret it.
The adult procedure takes 20-30 minutes under local anaesthetic. Any embarrassment will quickly pass. Afterwards there can be some pain, as with any cut, but it can be managed with Paracetamol. Some of us felt no pain at all. The stitches will dissolve, but if any are left after 2 weeks, the practice nurse should remove them. Sure, it will be swollen at first, but intercourse can resume after 4 weeks and careful masturbation earlier.
If you have a good medical reason, your doctor may refer you for circumcision under the NHS. Recurring use of creams or pills will only briefly help, so don't be put off with these if you would rather be circumcised. Trying to persuade your GP may be difficult as not all are sympathetic for their own reasons. Though you should listen to his/her advice, you have the right of a direct private approach to a doctor for a second opinion - a doctor known to be sympathetic towards circumcision. If you encounter resistance, contact the Circumcision Helpdesk who will try to put you in touch with someone more supportive. It is important to be able to discuss everything with a sympathetic surgeon,and make sure you have a full, not partial, circumcision, which should leave your glans exposed at all times to get maximum benefit.
If your circumcision is mainly for aesthetic reasons you will almost certainly have to go and pay privately. Again The Circumcision Helpdesk can provide a list of doctors who will circumcise you.
Your penis a very important part of you. Make the most of it!