Circumcision in Males.

Warning: The following content deals with sensitive human anatomy & morphology. Some images / graphics might be disturbing, viewer’s discretion is required.

One of the most controversially misunderstood and stigmatised topics among males are the concept of Circumcision.

Circumcision is an elective surgical process (Elective surgery / procedure is surgery that is scheduled in advance because it doesn’t involve a medical emergency) of removal of foreskin from the ‘head of the penis’ / ‘Glans Penis’ in a holistic or partial manner, due to probable or prevailing medical conditions, incurable by other means.


ORIGIN OF CIRCUMCISION :-

Circumcision has ancient roots among several ethnic groups in sub-equatorial Africa, whereas in Judaism, circumcision has traditionally been practised on males on the 8th day after birth (after the 1st Temple era). The Book of Genesis (Important text in Hebrew bible) records circumcision as part of the Abrahamic covenant (an important event in Jewish mythology, where the God reveals himself to Abraham and tells that all his descendents shall inherit the land of Israel) with Yahweh (Jewish God).

Herodotus (an ancient Greek writer / philosopher / historian), writing in the 5th century BCE, lists the Egyptians being the oldest people practicing circumcision, then Colchians (Georgian polity of Egrisi located on the coast of the Black Sea during 323 – 31 B.C.E.), Ethiopians, Syrians, etc, as circumcising cultures.

The writer of 1 Maccabees (Jewish text) wrote that under the Seleucids (Greek state in western Asia), many Jewish men attempted to hide or reverse their circumcision so they could exercise in Greek gymnasia, where nudity was the norm. In the oldest written account, by an Egyptian named Uha, (23 B.C.E.) it is described as mass circumcision and boasts of his ability to stoically endure the pain: “When I was circumcised, together with 120 men, there was none thereof who hit out, there was none thereof who was hit, and there was none thereof who scratched and there was none thereof who was scratched.

CIRCUMCISION & RELIGIONS / CULTURES :-

1. Judaism : - In the Jewish religion, male infants are traditionally circumcised on their 8th day of life, providing there is no medical contraindication (Anything including a symptom / medical condition that is a reason for a person to not receive a particular treatment or procedure because it may be harmful). The justification, in the Jewish holy book the Torah, is that a covenant was made between Abraham and God, the outward sign of which is circumcision for all Jewish males. The Torah states: “This is my covenant, which ye shall keep, between me and you and thy seed after thee: every male among you shall be circumcised”. (Book of Genesis, verse - 17:10). Male circumcision continues to be almost universally practiced among Jewish people.


2. Islam : - Islam is the largest religious group to practice male circumcision. As an Abrahamic faith, Islamic people practice circumcision as a confirmation of their relationship with God, and the practice is also known as ‘tahera’, meaning purification.

With the global invasions of Islam from the 7th century AD, male circumcision was widely enforced upon those who were converted among previously non-circumcising peoples. There is no clearly prescribed age for circumcision in Islam, although the prophet Muhammad recommended it to be carried out at an early age and reportedly circumcised his sons on the 7th day after birth. Many Muslims perform the rite on this day, although a Muslim may be circumcised at any age between birth & puberty.

3. Christianity : - The Coptic Christians in Egypt & the Ethiopian Orthodox Christians — two of the oldest surviving forms of Christianity— retain many of the features of early Christianity, including male circumcision.


Circumcision isn’t prescribed in other forms of Christianity. In the New Testament, St. Paul wrote: “in Christ Jesus neither circumcision nor uncircumcision count for anything” (Galatians 5:6) and a Papal Bull (an official order issued by a pope.) issued in 1442 by the Roman Catholic Church stated that male circumcision was unnecessary: “Therefore it strictly orders all who glory in the name of Christian, not to practise circumcision either before or after baptism, since whether or not they place their hope in it, it cannot possibly be observed without loss of eternal salvation,” it stated.

Focus group discussions on male circumcision in sub-Saharan Africa found no clear consensus on compatibility of male circumcision with Christian beliefs. Some Christian churches in South Africa oppose the practice, viewing it as a pagan ritual (having religious beliefs that do not belong to any of the main world religions), while others, including the Nomiya church in Kenya, require circumcision for membership and participants in focus group discussions in Zambia and Malawi mentioned similar beliefs that Christians should practice circumcision since Jesus was circumcised and the Bible teaches the practice.

So clearly you can see how varied interpretations of existence of circumcision are found in Christianity, not to mention that Christian Bible has no mention of it.

4. Nature Centric Religions : - Nature Centric Religions like ‘The Sanatan Dharma’ (Hinduism), ‘The Jainism’, ‘The Buddhism’ and ‘The Sikhism’ neither have any on record obligation for male circumcision, nor any disciplinary action if not getting circumcised. Males belonging to these religions exclusively undergo this process due to specific medical obligations (Zoroastrianism as well).


MEDICAL OBLIGATIONS LEADING TO CIRCUMCISION : -

Normally, the foreskin should cover & retract back in case of flaccid (as far as the frenulum is allowing) & erected penis respectively. The problem arises when this doesn’t happen and pain & infection takes over, ruining sexual experience of an individual.

Obviously this doesn’t obstruct conceiving of the women as medical studies even show that ejaculation (Expulsion of sperms containing semen) anywhere near the vaginal orifice can lead to fertilization.
Circumcision is a treatment option for problematic cases of phimosis & balanitis that don’t resolve with other treatments, and for chronic urinary tract infections (UTIs). Let’s know them each systematically: -

1. Phimosis : - It is basically the condition of tight foreskin which can’t be pulled over the glans penis / head of the penis.


Reasons : - Phimosis can happen due to : - 

- Any kind of underlying infections, i.e., infection of the foreskin – Posthitis or the infection of glans penis – Balanitis.

- Diabetes

- Chronic (repeated / prolonged) Urinary Infections

- Sexually Transmitted Diseases

Symptoms : - Phimosis can be detected via (apart from tight foreskin) : -

- Pain due to restricted movement of the foreskin

- Itching & Soreness in related area

- Thin stream of urine (in younger kids)

- Ballooning of the foreskin due to urine accumulation

- Occasional bleeding

Diagnosis : - There’s no test to diagnose Phimosis, interpretation by the doctor is solely based on patient’s inputs & clinical examination (observation).

Treatment : - Circumcision exclusively.

2. Balanitis : - Balanitis is the infection / inflammation of the glans penis.


Reasons : - Balanitis can happen due to : -

- Irritation by environmental substances

- Physical trauma

- Infections (bacterial, viral or fungal)

- Sexually Transmitted Diseases

Symptoms : - Balanitis can be detected via : -

- Redness of the penis & the foreskin

- Small red erosions on the glans penis (first sign)

- Foul-smelling discharge

Diagnosis : - Balanitis can be diagnosed via pathological tests, patient history and swab cultures.

Treatment : - Topical antibiotic & fungal ointments may be used for treatment for mild cases, whereas, hydrocortisone & other steroidal creams are used for severe cases.

TYPES OF CIRCUMCISIONS : -

The two types of circumcisions possible are: - Complete & Partial. In Complete Circumcision, entire skin covering the penis is removed, whereas, in case of Partial Circumcision, just the foreskin is removed.

WAYS OF DOING CIRCUMCISIONS
: -

There are 3 possible ways of performing circumcision currently, which are: -

1. Traditional Method: In this old school technique, foreskin is cut via knives and tied via stitches (suture), sterilised in case of medical obligation & unhygienic in case of religious / cultural practice.


The blood loss & pain suffered are maximum in this technique because the knife damages the blood vessels along with the tissue folds meant to be cut. The patient also has to take care of the stitches incurred as well, which slows down recovery time.

2. Laser Circumcision Method: In this new technique, the cutting is done via laser, thus negligible to feeble blood loss & pain is experienced by the patient. Minimum amount of stitches ensure fast recovery time of the patient. This is a painless process.


3. Stapler Circumcision Method: It is a very short procedure of performing circumcision, in which single-time use stapler is used. The entire surgery requires no stitches and recovery time is faster. Within 2-3 days, the patient is eligible to carry on with his daily life routine.


SHOULD YOU GET CIRCUMCISED ?

If you’re bound under religious / cultural obligations, then unfortunately be ready to say farewell to your foreskin, else, first seek a doctor and then decide accordingly.


The overwhelming response to our blog – Sex Education in India – “Together we change It !”, published on August 16, 2021 was an ardent evident of people not only opening up towards biological & psychological issues, but also leaving behind prevailing social stereotypes related to them. De-stigmatising Circumcision from prevailing social taboos is therefore also our onus among mass populations.

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