The Philippine Online Chronicles

Every Filipino boy goes through a rite of passage that almost every other Filipino male goes through.

Circumcision involved the removal of the foreskin to expose the glans penis. This has been done for millennia and the origins of the practice can be traced to religious reasons. It is estimated that about 30 percent of the world’s male population are circumcised, with almost 70 percent of this figure being Muslims. In the United States, male circumcision is fairly common with almost 57 percent of newborns circumcised before even leaving the hospital. Canada has a male circumcision rate believed to be at 17 percent while Australia is at 12 percent.

Some newborns are circumcised right away under the assumption that the baby either: 1) doesn’t really feel the pain due to his immature nervous system; or 2) even if there was pain felt, it’s unlikely that he will grow up remembering the experience. The first assumption is actually false but for sure many can attest to the veracity of the second statement.

Circumcision is most probably the most common surgical procedure in the world – even medical students do it on a regular basis and this is before they get their licenses to practice! The medical benefits of circumcision continue to be sketchy and short of compelling, but the social cost of being uncircumcised in the Philippines is something that can’t be ignored.

The double standard

It’s notable that while circumcision is a widespread practice all over the world, the female counter part of the procedure is totally abhorred by the West. There are tribes in Africa who still practice the rite of female circumcision by the removal of the clitoris. This side of Africa’s culture was highlighted when Ethiopian-born model wannabe Fatima joined America’s Top Model to share her story.

Most Western journalists don’t even refer to female circumcision as a form of circumcision. It’s commonly termed as “female genital mutilation” and the phrase itself evokes sheer anger and disgust. On the flip side, male circumcision is never referred as “male genital mutilation”.

Health benefits?

Filipinos have varying beliefs regarding the health benefits of circumcision. For one, a lot of people still think that uncircumcised males cannot bear children. This is obviously not the case since the circumcision process is strictly an external anatomy operation without any consequences for what lies within the scrotal sac – the real determinants of fertility for men.

A lot of Filipino fathers also attest their sons only started growing shortly after they got their children circumcised. The link is purely coincidental since most boys would be circumcised around the age of puberty – around 10-12 years of age. This means that the circumcision would most likely fall during the time that a boy experiences his growth spurt.

There are some scientific studies that link male circumcision with some medical benefits. A meta-analysis that took into consideration prior studies on urinary tract infection and circumcision proved that there is some benefit in circumcision in terms of preventing UTI among boys who either have recurrent UTI or some form of anatomical dysfunction that increases one’s risk to develop UTI. Circumcision wasn’t shown to be that beneficial to anatomically-normal boys or those without a history of recurrent UTI.

Even if circumcision were to be proven to be of value in the prevention of UTI, this sort of infection is easily preventable with the proper hygiene and the use of suitable antibiotics.

Penile cancer incidence rates were said to be also markedly lower for circumcised men. But penile cancer isn’t really the most common of cancers. In Denmark for instance, only one man will get penile cancer out of 1,947. Denmark is in Europe where circumcision is not widely practiced. It is estimated that less than one percent of Danish men are circumcised. For the most part, the bigger risk factors for contracting penile cancer would be having multiple sex partners, unprotected sex and cigarette smoking.

The factor implicated for penile cancer in uncircumcised males is the accumulation of smegma under the foreskin. Filipinos have a very unsavoury and vulgar term for this and while it is foul and downright disgusting, researchers have proven that on a carcinogenic stand point, the substance is harmless to one’s health. Again, even if this were to be true and proven under scientific studies, it would still be a feasible alternative to simply keep the penis clean to make sure that there is no build-up of smegma.

There are studies out of the African continent regarding the link of the reduced HIV/AIDS infection rates of circumcised men vis-a-vis men who are not. Sub-Saharan Africa is a hotbed for AIDS research due to its unusually high levels of infection. The World Health Organization reports that the risk of infection is reduced by 60 percent for men who are circumcised. The study was conducted in Africa and was only applicable for men who practice heterosexual intercourse.

Similarly, the BBC also reported that two studies conducted in Uganda and Kenya on 8,000 men also cut the risk by around half compared to uncircumcised men. The mechanism by which circumcision helps stop the infection is unclear. One hypothesis is that HIV has a special predilection to attack the skin cells of the male foreskin. Since this is absent for uncircumcised males, the virus would not have the benefit of having a susceptible target to cling on to.

The WHO believes that these recent findings would increase the demand for circumcision in the African continent. There are three African countries whose HIV infection rates are over 20 percent – Lesotho, Swaziland and Botswana. Countries like South Africa and Namibia have theirs in the high teens.

It also seems like circumcision reduces the risk of contracting the human papilloma virus; the virus that is seen as the precursor to penile cancer and one of the most common forms of cancer in females – cervical cancer. Oral cancer can also be passed through oral sex and it has also been proven that circumcision reduces the risk of transmission of the virus.

But most importantly, circumcision should not be used as a stop gap mechanism to address the problem of HIV, AIDS and HPV infection. The most important things to do of course is to practice safe sex and simply abstain from having intercourse with people you don’t know. This would be very valuable in a country where one of five is HIV positive.

Aside from the prevention of diseases, circumcised males were also observed to have a lower likelihood of developing penile injuries related to sex. In a study in Kenyan males, it was derived that uncircumcised males had a higher chance of developing soreness, abrasion and bleeding as a result of intercourse.

The social cost

There is a grave pressure on young boys to be circumcised since boys who have not gone through this rite of passage end up getting bullied and ridiculed to no end. It’s somehow seen as a test that one needs to pass – it’s seen as a young man’s chance to prove his bravery and show that he doesn’t fear anything.

It’s an interesting topic whether or not women prefer a circumcised male to those who aren’t. Pages upon pages of internet forums are devoted to this topic just to see what is inside women’s heads.

In most areas of the Philippines, boys are expected to be circumcised by the time they’re in their teens. In some parts of Bontoc in the Cordilleras, children even get teased as having “loyyup” (loosely translated to “long penis”). Since when was that an insult? Clearly, there are differing standards and acceptance levels when it comes to being uncircumcised around the world and the Philippines is probably not the best place for those who have not had the operation.

Filipinos also have a knack for developing therapies when the circumcision or the healing process goes array. This is not for the faint of heart, but during cases of kinamatis (or penile swelling), some Filipinos would actually put coconut shavings or even termites on the wound to drain it. Special contraptions are used and some even believe that Black Saturday is the best time to have a circumcision done. Traditional unlicensed healers and herb doctors perform this for a minimal charge. Boys who undergo this operation typically swim in a river and chew on bayabas leaves after the circumcision.

The ethics

At the end of the day, one question is valid. Is it the right of the parents to make the choice for their newborn son? The right to self-determination and the right to make a free and informed choice is one of the most cherished statutes of many liberal democracies in the world. Suppose that a child would later on want his foreskin back, what happens then? Were the parents in the right position to decide for the baby?

Even if a pre-teen boy was to make a choice to have circumcision, chances are, it was done under great duress, peer pressure and other factors that have something to do with how society perceives the necessity of the operation. No medical organization in the world actually supports the universal circumcision of newborn boys but the social pressures definitely have a strong coercive force in influencing the decision-making process of an impressionable pre-pubertal boy.

The foreskin is still a part of a man’s sexual organ and just like the rest of it, it is very sensitive. There is a lot of pain involved even if there’s a local anesthetic used for the operation. Once the drug wears off, it would be a painful week at the very least before the healing process finishes. The foreskin is loaded with nerve endings that could have a strong impact on how one person appreciates and enjoys sex. If you have more surface area to feel with, you’re more likely to feel bigger sensations.

To cut or not to cut?

In the end, it all boils down to choice and the willingness to stand up for it. There are organizations devoted to stopping male circumcision from being commonplace. To a certain extent, it does make sense. Why call female circumcision something as really bad as “mutilation” while male circumcision is tolerated and even celebrated in other cultures? The practice does have very barbaric elements into it and it does seem very out of place in the 21^st century.

Photos: “Isaac's Circumcision” by , c/o Flickr. Some Rights Reserved / “anti-circumcision_contingent_08970” by Mik Scheper, c/o Flickr. Some Rights Reserved.