SUN STAR, General Santos, P. I., Monday, March 21, 2005.

Passage to manhood

By Rommel G. Rebollido

WITH eyes focused, an old man positions a "pinute" (knife) under my stretched foreskin while extending his other hand holding a wooden club.

In a blink of an eye, the man delivers a quick blow.

"Whack" goes the club as it hit the back of the blade and fresh blood dripped from between the legs of a boy as peers waited for their turn, anxiety painted on their face.

The boy, smiling yet visibly shaken, quickly jumped into a nearby stream.

That scene was in a rustic town in Cotabato City some 38 or so summers ago when I got my "rite of passage" to manhood.

Summer is again here and similar scenes will once more take the rural areas in this country where "tule" or male circumcision is widely practiced.

Interestingly, it is usually during these hot summer days when school is off that boys gather near a river or a stream to take on the tradition of entering manhood.

A "manunule" (experienced circumciser) normally performs the manhood rite using an extremely sharp knife or a labaja (barber's knife) and a "pukpok" (club).

A boy being circumcised is asked to chew guava leaves which extract he will spit on the cut as a means of medication.

Going through the entire process means mainstreaming into the vast majority of circumcised Filipinos and escape from that potential social stigma of being tagged "pisot" or "supot" (uncircumcised).

"Patuli gyud aron dili surahon (Get circumcised so you won't get mocked)," said office worker Jaime Lim.

The practice of circumcision seemingly started during the stone age as suggested by tools and artifacts that were recovered in Egypt.

In the Philippines, where it has been a tradition for over a century now, there is nothing definite as to how and when it really began.

But, common belief has it that the practice was introduced by western colonizers.

There have been talks that colonizers used circumcision to identify groups supportive to them, even as history books appear to have failed mentioning it.

In the United States, circumcision began during the masturbation hysteria of the Victorian Period, as a punishment to boys caught masturbating.

That practice of penile mutilation continued even after the masturbation craze as most US hospitals have institutionalized compulsory circumcision to newborns.

In recent years, however, there has been an ongoing debate on whether circumcision should be practiced or not.

Some in the medical field claimed that male circumcision is necessary for hygiene and disease prevention.

American medical reports said the procedure is said to prevent such ailments as epilepsy, convulsions, paralysis, elephantiasis, tuberculosis, eczema, bed-wetting, wet dreams, hip-joint disease, fecal incontinence, rectal prolapse, hernia, head-aches, nervousness, hysteria, poor eyesight, idiocy, mental retardation and even insanity.

Studies comparing HIV-infected men in Africa show a high prevalence among the uncircumcised.

According to a study by Dr. Stephen Moses, ethnic groups where adult HIV levels were below one per cent in sub-Saharan Africa, 97 percent of the males are circumcised, and where the levels were above 10 per cent, only six per cent of males are circumcised.

Moses said similar situations have been observed in the more than 30 studies carried out among more than 40 circumcising and non-circumcising communities across Africa.

Sub-Saharan Africa represents 68 per cent of the global infection, according to the World Health Organization.

Clinical studies point to increased susceptibility of the flesh under the foreskin to inflammation, abrasions during intercourse and prolonged viral survival due to warmth and moistness under the "sheath" of the uncircumcised.

On the other hand, Dr. Robert S. Van Howe of the Department of Pediatrics, Marshfield Clinic, Lakeland Center in the United States, said recommending routine circumcision as a prophylactic measure to prevent HIV infection is scientifically unfounded.

He said that a meta-analysis performed on 29 published articles showed that a circumcised man is at greater risk of acquiring and transmitting HIV than a non-circumcised man.

Other findings blame the infections on the accumulation of smegma, a white emollient under the foreskin.

But, in his article "The Case Against Circumcision," Dr. Paul M. Fleiss, an assistant clinical professor of pediatrics at the University of Southern California Medical Center, said smegma (tiktik in the vernacular) is the most misunderstood, most unjustifiably maligned substance in nature.

"Smegma is clean, not dirty," he said, as it is beneficial and necessary for it moisturizes the glans (penile head) and keeps it smooth and supple. It has antibacterial and antiviral properties that keep the penis clean and healthy.

An American doctor once said the animal kingdom would probably cease to exist without smegma.

Circumcision critics said historical data suggests that circumcision was never associated with medical benefits.

It was done for reasons of religion, social control and punishment, they said.

Fleiss said the foreskin is necessary and should not be removed. In his article, he discussed the numerous functions of the foreskin, which include protective, sensory and sexual.

He said the foreskin protects the glans and keeps its surface soft, moist and sensitive. It maintains optimal warmth, pH balance and cleanliness.

Among others, he said the foreskin has erogenous sensitivity as it is sensitive as the lips of the mouth and fingertips. It has specialized nerve receptors, which can discern motion, subtle changes in temperature and fine gradations of texture.

As coverage during erection, Fleiss said when the penis becomes erect, the shaft becomes thicker and longer. The double-layered foreskin accommodates the expanded organ and allows the penile skin to glide freely, smoothly and pleasurably over the shaft and glans.

The foreskin has self-stimulating sexual functions as its double-layered sheath enables the penile shaft skin to glide back and forth over the penile shaft, he explained.

It can normally be slipped all the way or almost all the way back to the base of the penis, and also slipped forward beyond the glands. This wide range of motion is the mechanism that triggers the stimulation of the foreskin, frenulum and glans.

During intercourse, one of the foreskin's functions is to stimulate smooth, gentle movement between the mucosal surfaces of the two partners during intercourse, Fleiss said.

The foreskin enables the penis to slip in and out of the vagina non-abrasively inside its own slick sheath of self-lubricating, movable skin. Thus, the female is stimulated by moving pressure rather than by friction only, as when the male's foreskin is missing.

Fleiss said the foreskin also fosters intimacy between the two sexual partners by enveloping the glands and maintaining it as an internal organ. The sexual experience is enhanced when the foreskin slips back to allow the male's internal organ, the glands, to meet the female's internal organ.

Most of the circumcised males, may have not thought of all these as statistics show that over 90 percent of circumcision in the Philippines are done because of tradition and peer pressure.

Less than nine percent are done for religious reasons and only one percent for medical reasons, said Dr. Reynaldo Joson, head of the Ospital ng Maynila Department of Surgery, in an article posted in the Internet.

Joson is an avid campaigner of "Tule! Masakit, Di Kailangan", an advocacy drive against genital mutiliation in the Philippines.

He said there is a need to give complete information and counseling to parents prior to and after making a decision on whether to have their sons circumcised or not.

In short, people should be aware that on the issue of circumcision there are two options--to cut or not to cut.

That, of course is not a decision that solely rest on the parents, but would need the consent of their son.

A decision must be made soon as summer is just around the bend.

Do I hear the kids...or is it the wives grumbling?

(March 21, 2005 issue)

(File created 21 March 2005)