17 August 2006

Male Circumcision, Take 2

Male circumcision is such a controversial topic. Last July, Dr Maurice Bernstein posted about it in an article titled, "Male Circumcision: Should It Now Be A Crime?" and he got inundated with more than 400 reactions. My friend Moof followed it up with "The Male Circumcision Controversy," and she only got 40 strong reactions when she tried to stop it because of rude commenters. Two years ago, I wrote on the same subject, and got the same response, but lost most of the comments because Haloscan disposes comments after some time.

I think there is such controversy because most males fear it. Mutilation is the first word that goes into their heads. The more sound ones quote scientific and medical studies that show that male circumcision is really not that necessary and can be made an optional procedure. Much of the objection and strong response come from Western countries, where most males --- believe it or not --- are uncut, and would prefer to be uncut for the rest of their lives.

In the Philippines, this is not the case. If you are an adult male here and your peers heard you were uncircumcised, you will be the topic of rude jokes --- behind your back, most of the time --- and suffer from too much social embarrassment being called a "supot," or simply, a person who refused to be circumcised. Being a "supot" makes you less of a man here, and in the macho-predominated male Philippine society, that can devastate you. It has also become a tradition here during summertime to have adolescent boys circumcised by an albolaryo (faith healer), if you live in the rural areas, and by top-notch surgeons with proper anesthesia and antibiotic coverage, if you live in the metropolis.

In my previous post two years ago, I asked if male circumcision was still necessary, in the light of the medical studies coming out that shows there is not much benefit doing it, and also to highlight the group of local doctors who are campaigning against the procedure.

Why do men undergo circumcision?

A prospective behavioral study done in Kenya by Kawango Agot of the Impact Research and Development Organisation found that:
  1. the most common reason was an already-existing perception among men and especially among their partners that circumcision was more hygienic

  2. a high proportion of men coming forward for circumcision had erection problems of one sort or another, and circumcision was seen as a last-resort attempt to correct these
In the Philippines, the second reason would be laughed at. The main reasons here, I think, remain to be: rite of passage or initiation to manhood, basic adherence to tradition, and lastly, to maintain good personal hygiene (not necessarily in that order, ok?)

This time around, I will present some scientific studies and results that show male circumcision can reduce the risk of female-to-male transmission of HIV --- as much as 60 percent, according to one study. These studies come from the scientific abstract pool of the ongoing XVI International Aids Conference in Toronto, Canada.

14 reactions:

Moof said...

Dr. Emer ... I'm delighted to see your post! You've also found some very interesting studies to link to ...

I hope you don't mind if I link to your post on my own blog ... ?

Thank you!

rolly said...

Buti na lang pinatuli ako ng magulang ko nung bata pa ko. At least me protection pala ako against AIDS.

ipanema said...

lol Rolly. Here, the government hospital schedule circumcision during school holidays. As far as I can remember it's September. They'll issue a press release stating time and place. It's free.

Since we open school year January, the longer term break is about 2 weeks which I think won't be enough for healing (to my knowledge). So for my children, I had them circumcised December, a month long holiday.

When I was in elementary school, I had this notion that men who are not circumcised can't bear children! :)

Quite interestingly and it is treated hush topic here, girls are subject to FGM (female genital mutilation) too. It is more religiously inclined.

ting-aling said...

Scientific researches and blah,blah,blahs aside, I find men who are cimcumcised happier. I only have two boys-the hubby and the son. Based on my son's experience (son had it when he reached the age of reasoning (???), he thinks that the uncut foreskin hid unwanted bacteria and germs.(in his own words and experience). It could be psychological as well. Yeah, machismo feeling. Son could identify who is and who is not circumcized in his class and it's amazing to find out that there is quite a number of them who have not undergone "alteration".

A few weeks ago, someone in our province won a court case against the provincial government for allowing him to be cut when he was still a baby. He had it reversed. Apparently, he suffered from pain everytime his penis enlarged. His skin was stretched to the extent that he never enjoyed sex. I believe he is 38 y/o.

Kat said...

in most childbirth classes, they do a little lecture of sorts that include the pros and cons of male circumcision. the american academy of pediatrics state that it is not a medical necessity --more of an aesthetic one. most parents here opt for a circumcision if the dad has one (sorta like father and son). we opted for one for our rockstar baby --good to know he has better protection against AIDS in the future!

Dr. Emer said...

MOOF: No problem, go right ahead! Thanks again. :)

TITO R: I never thought for one second there that you were at risk. ;)

IPANEMA: Female genital mutilation deserves is a different story. I don't see any benefits there whatsoever.

TING: Scientific stuff might be boring, but it's the only thing that makes a claim valid and credible. I believe you with your story, but if I present that to peers, your assertions will be anecdotal and will still need some validation. 38 years old? It took that long for him to realize, huh? Kawawa naman. :(

KAT: There are really many pros and cons with male circumcision. The best option, I think, is to let the patients decide for themselves.

bingskee said...

also posted about it here: http://bingskee.wordpress.com/2005/04/13/what-age-do-boys-need-to-be-circumcised/

but your post strengthened more my belief :-) that men SHOULD be circumcised.

Jet said...

Ay naku, you'll never have to hard sell circumcision to me. Personally, hygiene will still be the no. 1 reason why I would only prefer circumcised males. I can never, never imagine doing it with someone who's uncut.

Errr... or doing it with anybody else other than you-know-who for that matter... hehehe.

ate sienna said...

so do you encourage circumcision? personally, mas gusto ko ang lalaking circumcised kasi nga parang ang weird ng may balot. but then again, like you said, culture kasi natin ito.

Dr. Emer said...

BING: I'm happy that the post helped you.

JET: Hello there. Good choice!

ATE SIENNA: If only to prevent HIV infection, yes. But it's always nice to ask the patient first what he wants.

Anonymous said...

"Female genital mutilation deserves is a different story. I don't see any benefits there whatsoever."

Don't some cultures treat it as a similar story (hence using the same term "circumcision" for both rites of passage), though? How could one encourage those parents to keep circumcising their sons and stop circumcising their daughters at the same time? If one can't, would they still have fewer HIV infections, or would the increased risk of infection when a husband rips through more stitches in his wife's labia and she bleeds during sex cancel out that benefit?

"If only to prevent HIV infection, yes. But it's always nice to ask the patient first what he wants."


bing said...

to Ate Sienna: sabi nga, mag-e-enjoy ka ba naman kanin ang kending me balot? he he nagpapatawa lang po..

lcc said...

I just got circumcised as my foreskin was too long, stiches still in. At my age (20, Chinese, Malaysia), it is kind of scary as you worry alot, children go into the operating room clueless!

Anyway, I guess in this region circumcision is very widespread, Malaysia and Indonesia being predominantly Moslems countries. Other races have also started to latch on to it, maybe now parents dont worry too much as modern day equipment is being used. From my friends in Malaysia I conclude:
Malays 100% - as they are Moslems
Chinese/Indian 10% - natural complications, it is very rare that they do it without health reasons.

Anonymous said...

I am not going to be original this time, so all I am going to say that your blog rocks, sad that I don't have suck a writing skills