Dear Dr Mitchell,
A friend of mine is having a baby boy and she is determined to have him circumcised against the wishes of the baby's father. I have learnt that 60 per cent of a man's sexual pleasure is lost after circumcision and some babies have even died from the operation. Please help stop this old and outdated barbaric ritual.
Defender of the Foreskin

Dr Sharmaine Mitchell

Dear Defender of the Foreskin,
Trying to decide whether or not to circumcise a newborn male infant may be a difficult decision for parents. Factors such as culture, religion and personal preference will affect their final decision.

Circumcision is a surgical procedure which removes the foreskin that covers the tip of the penis. It is usually performed during the first or second day after birth. Sometimes this operation is performed in infants over two months and in boys and men and the risks associated with the procedure is greater then. It is a short operation usually lasting approximately five to 10 minutes and involves the use of a local anaesthetic to reduce the pain associated with the procedure.

Eighty-five per cent of men in the world are not circumcised, but for some parents circumcision has a deep religious significance and is important in establishing the newborn male's identity.

There is no right or wrong decision on the issue of circumcision and ultimately the decision rests with the parents who should be appropriately advised about the procedure, the risks involved and the potential benefits.

The existing scientific evidence of the potential medical benefits of circumcision is not sufficient to recommend routine neonatal circumcision.
The procedure is not vital to the child's immediate well-being at birth and ultimately parents should decide what they think is in the best interest of the child.

Circumcision has existed for centuries and is typically a part of the religious faith for Jewish and Muslim families. It was also practised by soldiers in the field in the 1930s because they had limited access to water and had difficulty maintaining adequate personal hygiene.

However, the rate of routine circumcision is decreasing and opinion has changed over the years. There are several arguments in favour of circumcision, including:
. lower chance of Urinary Tract Infection in the first year of life. Studies show a one in 1,000 chance of UTI in circumcised versus one in 100 chance for uncircumcised boys. However urinary tract infection is rare in boys and is easily treated on diagnosis.

. Cancer of the penis is three times more common in uncircumcised men than circumcised men. However, penile cancer affects only one in 100,000 older men and is related to high-risk sexual behaviour.

. Some studies have shown that the risk of Sexually Transmitted Infections (STI) and HIV are lower for circumcised men. However, the risk is only slightly lower and high-risk sexual behaviour is a much more important risk factor for contracting STIs, including HIV.

. Uncircumcised males have a higher risk of infection of the foreskin but education about good hygiene eliminates this risk.
. Medical conditions such as Phimosis (a tight foreskin, which is impossible to pull back) is prevented by circumcising the newborn male. This is usually painful and result in more complications when done in older boys and men. However, phimosis is not common enough to recommend routine circumcision.

There is no medical reason for routine circumcision of a newborn and it is mutilating. There is also the fear of complications which includes excessive bleeding, infections or injury to the penis.

The skin of the penis can sometimes be cut too long or too short or can heal improperly. These complications are rare though. When the foreskin is removed, the glans may become irritated, causing the urethra (opening of the penis) to become too small. This ultimately leads to urination difficulties and may require surgery.

Problems such as tight, painful erections, adhesion or skin tags may develop. It is also felt by some individuals that the glans (head of the penis) becomes hardened without its protective cover and the penis loses its sensitivity.

It is also felt that because of the lack of consent for a potentially life-changing operation that the boy should be allowed the chance to choose for himself.
However, circumcisions are more painful and more dangerous if done later in life and it is felt that it is the parents' option to make life-changing decisions on behalf of their infants.

Parents who decide to circumcise their son should discuss it with their obstetrician first and make sure they understand all the factors involved. Try to get a doctor with experience in circumcisions to do the operation to reduce the complications involved.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist.
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Trousers in Denim

Cream of the 'Crop'

Cheeky's World