Tuesday, February 11, 2003.

Is circumcision in males necessary?
By Reynaldo O. Joson, MD and Rafael R. Castillo, MD

Publish Date: [Tuesday, February 11, 2003]

Until recently, no one—including doctors—ever bothered to take a closer look at this issue. We always thought it was a long-answered question and that it was really medically necessary to have all males circumcised. But is it?

Circumcision in males usually consists of removing part of the prepuce or foreskin of the penis. Its practice has various origins, both religious and non-religious, medical and non-medical. The reasons for the practice of circumcision in males have evolved from biblical practice.

There is still the medical basis, especially for the Jews and Muslims (but this is not absolute anymore because there are now Jews and Muslims who object to male circumcision).

There is still the medical basis, particularly the belief that circumcision can prevent urinary tract infection, penile and cervical cancer, and sexually-transmitted diseases. The sexual arguments for circumcision are based on the belief that circumcision offers more sexual enjoyment to both male and female partners.

However, the predominant driving forces for circumcision in males are tradition and peer pressure. Male newborns are circumcised because of the parents' belief in the traditional practice. Male adolescents and even adults are also circumcised because of the traditional need ("passage rite to manhood") and peer pressure (afraid to be teased as supot).

An objective, scientific and dispassionate look is therefore necessary to answer the question: Is circumcision in males really necessary?

On the basis of medical reasons, routine circumcision in males is NOT necessary. The American Academy of Pediatrics has done extensive critical analysis of all published papers on the topic and has come out with a stand in 1999 that routine circumcision in males is not necessary.

On the issue of urinary tract infection, penile and cervical cancers, circumcision may have a potential benefit in terms of prevention but its actual value is minimal because of the low occurrence of these dreaded consequences. In other words, the risk is extremely low if circumcision is not done and thus, routine circumcision is not necessary.

On the issue of sexually-transmitted diseases, prevention should focus on the behavioral factors —that is, avoiding promiscuity and careless sex —rather than relying on circumcision. On the question of hygiene, promotion can be done with meticulous mechanical cleansing without having to resort to the invasive and painful procedure of circumcision.

The most common and most clear-cut medical indication for male circumcision is now limited to patients with urinary infection secondary to phimosis (extremely small opening of the prepuce or foreskin of the penis).

Paraphimosis (tightness of the foreskin that tends to strangle the penis) can be another medical indication if it occurs. Other than these situations, medical-wise, circumcision in males is not necessary.

In the Philippines, the Christian religions do not require routine circumcision anymore. For the Muslims and Jews, it may still be advocated but it is no longer an absolute requirement. There are even websites put up by Jewish and Muslim authors crusading against circumcision.

The debatable issue on sexual enjoyment maybe a myth after all. Although there are no conclusive findings yet, a most recent scientific article on the issue shows that more sexual enjoyment is felt by the female partners with non-circumcised than with circumcised men. The enjoyment is scientifically validated.

However, not only are the doctors the key opinion molders in this issue. The voice of the parents and even the children will be stronger—in fact, strongest. If they are convinced about the non-necessity of circumcision, they should also voice out their stand on it for the sake of their children, grandchildren, great-grandchildren, and great-great grandchildren.

Dr. Reynaldo Joson is chairman of the Department of Surgery at Ospital ng Maynila Medical Center. He is a member of the Charter Bureau, a non-stock, non-profit research foundation, headed by Dr. Rafael Castillo and based at the Manila Adventist Medical Center, formerly Manila Sanitarium & Hospital.

(File prepared 12 February 2003)