Circumcision

Circumcision is the removal of a simple fold of skin (the `foreskin’ or `prepuce’) that covers the head (glans) of the un-erect penis in a male.

Male circumcision

Male Circumcision is the full removal of the penis foreskin, fully exposing the head of the penis.

Medical Male Circumcision  is performed at a hospital or clinic by a qualified medical professional.

Fast facts about circumcision

1. 80% of the world’s males are not circumcised.

2. Though many people associate circumcision with Jews, most circumcised males are Muslims.

3. Circumcision is painful. Only 45% of doctors who do circumcisions use any anaesthesia at all.

4. A circumcision with adequate anaesthesia takes a half-hour – if they brought your baby back sooner, he was in severe pain during the surgery.

5. The pain of circumcision causes a rewiring of the baby’s brain so that he is more sensitive to pain later (Taddio 1997, Anand 2000). Circumcision also can cause post-traumatic stress disorder (PTSD), depression, anger, low self-esteem and problems with intimacy (Boyle 2002, Hammond 1999, Goldman 1999).

6. ”My baby slept right through it.” Not possible without total anaesthesia, which is not available. Even the dorsal penile nerve block leaves the underside of the penis receptive to pain. Babies go into shock, which though it looks like a quiet state, is actually the body’s reaction to profound pain and distress.

7. Circumcised men and boys are 60% more likely to suffer from alexithymia, a psychological trait disorder which causes difficulty in identifying and expressing one’s emotions, which can lead to difficulties in sustaining relationships.

8. Most physicians do not have their sons circumcised.

All men have the right to safe and hygienic medical male circumcision services.

Benefits of Male Circumcision

When the foreskin has been completely removed under medical conditions, from the head of the penis:

•             It is easier to keep clean.

•             It eliminates bruising and tearing during sex, which makes sex more enjoyable for men and women.

•             Cells that attract HIV have been removed.

•             It reduces the risk of HIV infection but there is still a 40% chance that circumcised men can get HIV.

•             Lower risk of STI’s and diseases.

•             It provides health benefits for sexual partners – Medical male circumcision (MMC) is good for a women’s health too as it reduces her risk to cervical cancer by removing the human papilloma virus that is often carried in the foreskin.

What male circumcision doesn’t do

Male circumcision does not prevent pregnancy.  It also does not prevent STD’s. Therefore circumcised men should still use a condom every time you have sex.  Keep to one sexual partner. Test for HIV to know your status so that you can make the best decision for your health.

Male circumcision  does not benefit the partner of an HIV-positive man.

If you are HIV-positive, you may also be circumcised, but this does not protect your partner from HIV. If you test positive for HIV, you should have your CD-4 cell count taken to determine the strength of your immune system, and you will be referred to care and support services. HIV-positive men who choose to be circumcised should continue to use condoms at all times to protect their partners from HIV and themselves and their partner from re-infection if both are HIV-positive.

Male circumcision does not reduce your risk of HIV infection if you have anal sex.

What are the risks of male circumcision

1. Pain and distress. Surgical excision of the foreskin is painful. Safe and effective pain control should be offered to all infants undergoing the procedure. Post-operative pain, swelling and bruising are common
2. Cosmetic concerns. Too much or too little skin removal may present problems or abnormal scar tissue may develop
3. Buried penis. Refers to a penis that is buried under scar tissue that develops at the site of incision. It may occur if too much or too little skin is removed. Treatment is surgical.
4. Sexual dissatisfaction. Some men say the end of the penis becomes less sensitive when the foreskin is removed. However, most circumcised males do not describe psychological trauma or decreased sexual function as a result of being circumcised.
5. Psychological trauma. Some males resent having been circumcised and increasingly, are requesting a procedure be developed to recreate the foreskin.

How is a circumcision done?

Male circumcision culture

Initiation is most commonly practiced in the Eastern Cape, Limpopo and Mpumalanga. One traditional ritual that is still regularly practiced is the manhood ritual, a secret rite that marks the transition from boyhood to manhood (Ulwaluko).

After ritual circumcision, the initiates (abakwetha) live in isolation for up to several weeks, often in the mountains. During the process of healing they smear white clay on their bodies and observe numerous taboos

The Xhosa rite of passage is described either as going “to the bush” or “to the mountains”, and includes seclusion in a hut for up to a month, with very little contact, if any, with women. The cutting, by a traditional surgeon, is performed without anaesthesia – the pain is an important feature of becoming a man. In that province, the death toll for botched circumcisions for the five years from 2008 to 2012 was 323. During that time, a further 126 boys suffered genital amputations.

More than 80 boys died in initiation schools in South Africa during 2013. In this initiation school in Fochville on the West Rand, 7 boys were rescued. They were far away from running water, cold , naked and some had not eaten for 4 days.

The Eastern Cape has a head start on other provinces – in 2001 it became the first province to introduce legislation regulating traditional circumcision in an attempt to curb deaths and genital mutilation taking place in the bush.

Official records cannot shed light on the deaths that occur at illegal initiation schools or at those where the tradition is to manage complications and deaths “in the bush”.

If an initiate dies at initiation schools, the culture is you don’t bring the body home. The body is buried at the initiation school, in the bush wherever they are in the mountain. The death is not reported before the burial.