Docs on circumcision: Think before you “cut”

Visibly edgy while chomping on guava leaves, a Filipino boy takes off his shorts and mounts one end of a bench fronting a man holding a razor-sharp knife and a wooden club.

With confidence, the man positions the knife above the stretched foreskin of the boy’s genitals. He then raises the wooden club and, with a snap, delivers a quick blow.

Foreskin severed and fresh blood now dripping, the boy spits the masticated guava leaves on the wound.

Smiling yet visibly shaken, he quickly jumps into a nearby stream amid the anxious stares of peers waiting for their turn before the manunuli, the expert circumciser.

Such scene is common during summer in many rural villages in the Philippines as boys, mostly nine to 12-years-old, go through this sort of traditional “rite of passage” to manhood.

Practically considered as obligation and a tradition, male circumcision or “tuli” remain widely practiced in the Philippines, making it among the few countries that still adhere what to others is penile mutilation.

It is usually during hot summer days – when school is off – that rural boys gather near a river or a stream to take on the tradition of entering manhood.

A “manunuli” usually executes the manhood rite, using an extremely sharp knife, locally known as a labaja and a “pukpok” (club).

A boy being circumcised is asked to chew guava leaves which extract he will spit on the cut as an antiseptic. Some boys were known to have swallowed the leaves instead out of anxiety.

In more urbanized places, however, the situation is different. The procedure is done the modern way in hospitals or clinics, almost painless with an anesthetic and the proper surgical tools by a licensed professional.

Of late, midwives found a way to augment income by including circumcision as among services in their birthing clinics. Circumcision costs from a hundred to P2,000 depending on the facility and the person who performs it.

During summer, various groups, including civic, business, professionals and religious organizations, embark on mass circumcision (Operation Tuli) as outreach projects, giving circumcision free of charge among children in mostly depressed communities.

To many Filipinos, males and females alike, going through the “cutting” process means mainstreaming into the vast majority of circumcised males 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.

A social stigma that developed against the uncircumcised boost with some Filipino folk beliefs on the benefits of circumcision contributed much in cementing the practice into the Filipino psyche.

Among these folk belief is that circumcision helps make a person taller. But, medical practitioners point out that a person’s height is a function of genetics and nutrition. A person will grow tall with or without circumcision, they said.

Many Filipino mothers, who are usually the most insistent – even shoving their boys to be circumcised, believe that circumcision increases the size of their boy’s penis.

Again, its genetics and not removal of foreskin, the physicians said.

No matter how many circumcisions a boy has to go through, if his ancestors just do not have that log his mother wishes him to have, it would all be in vain, they explained.

They also debunk another belief that circumcision makes a man more fertile and would allow him many children. The quantity and quality of a sperm has nothing to do with circumcision, they pointed out.

The practice of circumcision seemingly started during the stone age as suggested by tools and artifacts that were recovered in Egypt, where the procedure is known to have started.

In the Philippines, however, nothing is definitely known as to how and when it began; although there is that common belief that the practice was introduced by western colonizers centuries ago.

 

Historical accounts also reveal that it was first introduced by Arab missionaries and later by the Spaniards. It was said that colonizers used circumcision as a way to identify who supports them.

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

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, among 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.

Clinical studies also 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.

Other findings blame the infections on the accumulation of smegma (tiktik in the vernacular), a white emollient under the foreskin.

But, in his article “The Case Against Circumcision,” Dr. Paul M. Fleiss, a professor of pediatrics at the University of Southern California Medical Center, said smegma 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, on the other hand, 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 also wrote that the foreskin is necessary and should not be removed. He discussed in his article 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.

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, an avid campaigner against genital mutilation in the Philippines.

Physician in the Philippines could not just stop performing circumcision however, as it could give rise to problems. Boys would now have no choice other than resorting to the painful traditional method – crude tools and masticated guava leaves.

Aware of the uphill battle he faces, Joson said there is a need to give complete information and counseling to parents prior to and after making the decision of whether to have their sons circumcised or not.

The physician said people should be aware that on the issue of circumcision there are two options–to cut or not to cut. (Reported by Rommel Rebollido for PECOJONPH/knr)

  • Carla

    Many thanks to all the midwives and nurses for giving the boys this procedure! Without them, boys would resort back to unsanitary conditions and many infections. These women are heros!