The prepuce and the what now? What is that foreskin for anyhow?
We understand this is a very hot topic, it is my intention to share accurate (evidence based) information concerning routine infant circumcision. There is a ton of misinformation out there. As parents and people it is important to understand the actual purpose and function of the foreskin, and the risks and benefits of a circumcision procedure. Without that, you have no way in making an informed choice as to whether your baby boy should, or should not, have theirs.
What do we mean by Circumcision? This page is concerned with non-therapeutic circumcision, which is the amputation of the foreskin (prepuce) without medical indication. Almost all circumcisions preformed in Canada, and globally, are non-therapeutic. As a result non-therapeutic circumcision is commonly referred to as just “circumcision”.
An elephant in the hospital you say? This is one of the most enlightening University lectures on Routine Infant Circumcision to date. It provides a fantastic opportunity for learning. Have a gander.
What is the foreskin? The foreskin is a highly innervated and erogenous double layer of skin that surrounds the glans (tip) of the penis. The inner layer contains a mucosa membrane. The foreskin has numerous functions.
During infancy, the foreskin is attached (like a finger nail) to the glans and protects it from urine, feces, and abrasion from diapers/environment. Just like an eyelid protects the eye.
Throughout life, the foreskin keeps the glans soft and moist and protects it from trauma, infection, and injury.
The foreskin is self-cleaning as urine flushes out the area. There is no extra cleaning required until the foreskin retracts. Normal retraction takes place around age 2-6. Then you clean it like your armpits.
The foreskin has built in antibacterial properties.
Without this protection, the glans can become dry, calloused, and desensitized from exposure and chafing.
The foreskin is highly erogenous and provides sexual stimulation for both male/female partners. 20, 000 specialized nerve endings in the foreskin, the gliding mechanism of the foreskin, and its lubrication functions enhances sexual pleasure for both males and females. During circumcision up to 50% of the skin on the penis is removed. On average this equates to a loss of 100 cm2 on the adult male penis.
How is infant circumcision preformed? The baby is placed spread out on his back upon a board called a circumstraint. His arms and legs are strapped down to this board so that he can’t move. His genitals are scrubbed and covered with antiseptic. The foreskin is then either crushed, cut off or torn from the glans using a circumcision device. The main devices used in Canada are: plastibell, and gomco clamp (the Gomco is the most common here in Windsor.)
In Canada and the United States anesthetic is generally not used (according to the Family Birthing Centre Manager at Windsor Met "It is rarely used and at the discretion of the Dr." Sometimes a numbing cream is used, however even if it is, the amputation is still felt and painful.
What are the benefits? Surprisingly most people tend to believe it is cleaner to be circumcised, causes less infection long term (this is a hygiene issue, not a foreskin one,) looks nicer, and spreads less disease etc. None of this is true, and has all been debunked with evidence based research, which is all available below. This is also one of the reasons why OHIP does not cover the cost of the surgery. In developed Countries where circumcision is uncommon they do not have higher infection, disease, cancer rates or a penile health crisis at hand.
Benefit and Risk from the Canadian Pediatric Standpoint Remember these are the only medical and current evidence based differences between the two. This is copied and pasted right from the CPS webpage availablehere.
Of every 1,000 boys who are circumcised:
20 to 30 will have a surgical complication, such as too much bleeding or infection in the area.
2 to 3 will have a more serious complication that needs more treatment. Examples include having too much skin removed or more serious bleeding.
2 will be admitted to hospital for a urinary tract infection (UTI) before they are one year old.
About 10 babies may need to have the circumcision done again because of a poor result.
The immediate risk of complications is between 2% to 10%.
This includes excessive bleeding, infection, complications from anesthetic (if used), heart failure, surgical mistakes such as loss of glan or entire penis, and even death. The last reported death occurred in 2007 in Ottawa. The baby was circumcised using the plastibell device. Though it is estimate that as many as four deaths occur each year in Canada.
Long-term risks include extensive scarring, skin bridges, meatal stenosis (10% of circumcised boys), painful erections, loss of sensation, difficulty ejaculating, tearing/bleeding at the scar, and psychological issues. Overall the long-term complications are not well studied.
Of every 1,000 boys who are not circumcised:
7 will be admitted to hospital for a UTI before they are one year old.
10 (1%) will have a circumcision later in life for medical reasons, such as a condition called phimosis.
Circumcision slightly lowers the risk of developing cancer of the penis in later life. However, this form of cancer is very rare. One of every one million men who are circumcised will develop cancer of the penis each year. By comparison, 3 of every one million men who are not circumcised will develop penile cancer each year. Please note that according to the Canadian Cancer Society 1 in 9 women will develop breast cancer each year, 1 in 29 will die - and we absolutely do not routinely remove female babies breast tissue for the sake of future risk/benefit.
What About later in life - "I've heard about older children and men needing to have it done? Most infants and small children that require a circumcision are caused from mistreatment or the foreskin. Nothing special needs to be done in order to clean a male penis. In fact, you do not do anything. The number 1 rule is, you ONLY clean what is seen. Meaning you do not pull back or clean under anything. You do not go scrubbing around infant female genitalia, because their bodies too know how to self clean. If older men lose the ability to self clean, we do have a lot of services in place to help our seniors. If an older man is unable to clean his foreskin, he is also likely unable to clean his entire body sufficiently. This is not a foreskin issue, that is a basic hygiene issue.
Things to Think About In 2004 (reaffirmed in 2009) the College of Physicians and Surgeons of British Columbia clearly stated that circumcision has no medical benefits, that it is an extremely risky procedure, and could be a violation of the child’s human rights and a breach medical ethics.
Circumcision in Canada is increasingly becoming a rare procedure. According to Health Canada, roughly 25% of babies are circumcised. Since 1975 the Canadian Pediatric Society (CPS) has not recommend infant circumcision. As a result on April 1st 1994 OHIP ceased funding for infant circumcision.
Originally circumcision was introduced in Canada, as well as other western English speaking countries, during the mid 1800 to prevent masturbation. Masturbation was blamed for causing many diseases, including: epilepsy, tuberculosis, insanity, and loss of skin. Since then numerous other benefits have been claimed, all of which have been largely disproved, are too small to consider (especially considering the risks), or irrelevant to Canadians. Today many doctors no longer practice this procedure, and some countaries have banned it.
Circumcision continues in Canada for four main reasons.
First circumcision has become somewhat of a social tradition for some Canadians. In fact this is the number one reason given by parents choosing circumcision. It continues because that is what happened to the father of the child.
Second it continues for religious reasons 17%.
Third, there is a lot of misinformation and personal bias regarding the subject even among health professionals. For instance doctors that are circumcised (or husbands) are more likely to recommend the procedure, than doctors that are not circumcised.
Finally, it continues because it is also highly profitable. It is a multi-billion dollar industry. Aside from the procedure itself, profit is made from the sale of materials used during the circumcision procedure. The foreskin is sometimes sold for scientific research and to produce cosmetic products. Additionally, because of the loss of sensitivity and natural lubrication, circumcision helps fuel the lubrication and Viagra industry too.
Global Context: Worldwide 15% to 30% of the men are circumcised, meaning that 70% to 85% of men are intact (not circumcised). Annually approximately 13.3 million males are circumcised. The majority of circumcisions occur among males born in Muslim countries, or born to Muslim parents. North America and Israel are the only two places that largely practice infant circumcision. Though rates in America are dropping and it now appears that most infants are not being circumcised. Elsewhere the majority of circumcisions occur after the age of eight. Additionally, no medical society in the entire world recommends the routine circumcision of infants/children.
Circumcision & Religion: Circumcision is practiced in Islam and Judaism. In Islam, circumcision is not required. It is not even mentioned in the Qur’an. Some Muslim parents are now deciding not to have their sons circumcised. In Judaism, circumcision is required on the 8th day after birth. However, some Jews (especially non-‐ practicing and Reform) are no longer having their sons circumcised. In fact most Jews that live in countries that do not practice circumcision (Sweden), do not circumcise their sons. In Christianity, circumcision is not practiced, and is often regarded as being against the religion. Hindus, Buddhists, Sikhs, Confucians, and Taoists also do not practice circumcision. Religious circumcision is increasingly being seen as a violation of the child’s religious and personal freedom.
For more information please check out the resources listed below.
Resources: www.cirp.org A comprehensive website on circumcision that has been around for over three decades. It is well cited, and numerous research article have been posted.