Circumcision season

It’s summer again, the season of beaches, flip-flops, vacations and circumcisions. We’ve written about the debatable ethics of child-age circumcision in a previous column, particularly in a country like the Philippines where “tuli” is the norm, and “supót” is a pejorative, as illogically offensive as “bakla.” Societal expectations aside, parents ought to have access to at least a bare minimum of health facts. On the one hand, the benefits of circumcision may be blown out of proportion, with some saying it prevents infections (partly true) or cancer (partly true), or gives one a longer penis (not true). On the other hand, some exaggerate the complications of circumcision, a relatively minor and safe procedure. Recently, the BBC covered a story of a British man who committed suicide after complications he attributed to his circumcision, like oversensitivity and erectile dysfunction. While perhaps not entirely factual, this report I hope would only underline that circumcision is not to be taken lightly by all, and is not a universal necessity.

In a nutshell: Male circumcision is the removal of some or all of the penile foreskin. Its benefits vary between those who have the procedure done in the newborn period, and those who have it later in life; some studies suggest that there are benefits to newborn circumcision that are not present when done later. According to the task force on male circumcision convened by the American Academy of Pediatrics (AAP), health benefits of newborn circumcision outweigh the risks. Male circumcision is associated with decreased infection with HIV (human

immunodeficiency virus), HPV (human papillomavirus) and HSV (herpes simplex virus); the evidence for a protective effect for other sexually transmitted infections is less strong. It used to be thought that the benefit applied to heterosexual males only, but there is growing evidence to show that circumcision is similarly protective for MSM(men having sex with men). Circumcision is also protective against bacterial vaginosis in female partners.

Perhaps the most striking benefit of male circumcision is in preventing penile cancer, a rare but devastating disease. It’s suggested that this is because it resolves phimosis, which is a condition of a too-small foreskin opening, a risk factor for penile cancer that is easily corrected by circumcision.

The risks themselves are minimal, as emphasized by the AAP, when performed on stable individuals by competent practitioners with sterile techniques and equipment and adequate anesthesia. Complications are rare, ranging from bleeding in the acute period, to adhesions, narrowing of the urethral opening, or excess foreskin later on. In general, it also does not appear to significantly affect sexual function or sensitivity thereafter. Severe or catastrophic complications are rare, and often related to bizarre circumstances like penile amputation by poorly trained practitioners.

In the end circumcision is not usually done with health issues as the foremost consideration; religious and cultural traditions have an unavoidably larger role. The culture is spurred on by familial pressure and by politicians who would use it as a campaign vehicle. Male children are subjected to the same scare tactics across all social strata, and the distress is the same for the kid being circumcised and yelled at in a room with 40 other prepubescents, and the child tearfully holding his mother’s hand in a private, air-conditioned operating room.

The scenes hold a certain parallel with vaccination drives, but the vital difference is that no physician would say that circumcision is universally necessary, in any age group. We make a lot of noise about toxic masculinity in adults and imposed patriarchal standards on women, and not enough noise about protecting vulnerable, school-age children who come to adopt and project this attitude, as though the circumcised phallus were the source of some deep mysterious power rather than some desirable health benefits. In that sense I think the risks of circumcision are far less than the risks of the culture we’ve attached to it.