The first cut

Circumcision for baby boys is popular in this country but, whether it’s for cultural reasons or just to be like dad, it’s never an easy choice

I know whether most of my male friends are circumcised. Not, of course, because I’ve seen their private parts but because whenever someone I know is pregnant with a son the debate over whether or not to circumcise the baby ensues.
"So are you?" all the men in the room are asked. About 50 per cent of the time the answer is "yes". Culturally, we are rather fond of male circumcision. In Jewish and Muslim communities, boys are circumcised soon after birth for religious and cultural reasons and, in most black African cultures, circumcision is a rite of passage in the teenage years.

There are no general statistics in this country but worldwide the rate of circumcision varies enormously. In the US, the figure, regardless of religious custom, is believed in some states to be as high as 85 per cent but about 55 per cent on average. The figure has been steadily dropping across the country as what was once a routine procedure is now being questioned. In Europe, where circumcision has never been routine, it is only 10 per cent.

Here, even in families where there is no religious or cultural reason to circumcise, it’s popular, though no-one is able to tell me why and when it started as a common surgical procedure. What is a fact is that even among those families where it is performed for religious reasons, more and more expectant parents are grappling with the decision, a decision that some opponents describe as "genital mutilation".

So what happens during a circumcision? During the five- to 10-minute procedure, which is usually done in hospital before the newborn goes home, a paediatrician or surgeon (or sometimes a gynae) surgically removes the foreskin covering the end of the penis. A numbing cream or a local injection is used to minimise pain.

So why do we do it? When you ask around, as I have done for this article, you commonly hear from men and women, “Well, it’s cleaner and healthier, isn’t it?” And, from women, in particular, “It looks nicer.” They are talking, of course, about the adult penis. Among my friends, the common thread seems to be that they decide to circumcise if dad is: like father, like son, so to speak.

It is perceived, particularly by those men who don’t have a foreskin, that a circumcised penis is easier to keep clean. Of course, men with foreskin argue vehemently against this. The medical point of view, according to Cape Town paediatrician Dr Carl Wicht, is that cleanliness is not an issue as long as a boy is taught good hygiene.

Of course, the motivation to circumcise is more complex than soap and water. As well as religious reasons, proponents of circumcision cite more specific health, aesthetic and sexual reasons for supporting the decision.
In South Africa, the very real threat of HIV is one of the most compelling arguments. Studies worldwide, including trials here in SA, have shown that male circumcision can reduce the risk of heterosexually-acquired HIV infection in men by as much as 60 per cent. In March, the World Health Organisation went so far as recommending that male circumcision should be recognised as an "additional important intervention to reduce the risk of heterosexually-acquired HIV infection in men".

But, explains Dr Wicht, there are real concerns over that as a preventative guideline. "The concern is that this may give out the wrong message, that you are ‘safe’ from HIV infection if you are circumcised. You are not," he says.
According to Dr Wicht, the general medical guideline is that circumcision is not recommended as a routine procedure and the decision should be made on personal and/or religious reasons.

Sometimes there are medical indications for circumcision, which may present in older boys. These include phimosis (tight foreskin) or recurrent balanitis (infection) or, especially, recurrent renal tract infections with a tight foreskin. As with so much in this world, sex plays its role in the decision whether or not to circumcise. Men who have had their prepuce (foreskin) removed say that they are better lovers. Over time, a circumcised penis loses sensitivity because the glans is not protected by the foreskin and it rubs against the owner’s underwear. Circumcised males argue that can therefore perform for longer and are, aesthetically, more pleasing to women. That, of course, is personal preference.

In contrast, those men with their foreskin intact argue that their penis is more sensitive and, therefore, the sexual experience is heightened for both them and their partner. One of the biggest objections to circumcision is that it’s a surgical procedure performed without any real medical interventions on a non-consenting human. It carries risks, though they are rare when performed in a clinical situation, such as bleeding, infection and the chance that a botched surgery will leave the foreskin too short or long.

Dr Mark Reiss, executive president of the US-based Doctors Opposing Circumcision, says, "We don’t cut off eyelids because they attract gunk in the morning or cut off girls’ breasts so that they someday don’t get breast cancer. The bottom line is that circumcision is being done for conformity and custom."

The decision remains a personal one.