This procedure is most often associated with ancient Jewish rituals, but few of us realised that the Jewish community were not the first to practice it. Carvings on the walls in the Temple of Karnak depict Egyptian priests over 6000 years ago performing circumcision, making it probably the oldest surgical operation known. In modern times, baby circumcision became extremely popular between the two world wars, particularly in Australia and the US – but times have changed.
Starting in the seventies, there was a trend to keep the foreskin and up to 70 per cent of babies went home intact.
Circumcision is an ancient practice, so it’s not surprising that numerous myths have sprung up about it, including ideas that the procedure ‘weakens the penis’ and therefore, limits intercourse; increases (others say decreases) sexual pleasure; decreases sexual desire; prolongs the ability to have intercourse (in the act and in life); makes men better warriors and better husbands; reduces masturbation; and cures bed-wetting.
These claims are difficult to research, as you can imagine, but all are unreasonable and defy common sense.
We like to think we are more reasonable in our beliefs now. However, the procedure continues to have vocal advocates and critics both within the medical industry and out.
The essence of the discussion remains simple – does the latest information on the subject justify routine circumcision on babies? For other invasive baby routines, such as immunisation or the administration of vitamin K, the benefits are so overwhelming (and the risk so small) that there’s no need for discussion, circumcision however remains another matter.
Microscopic examination of the cells on the inside of the foreskin shows that it contains many sensory nerve endings relating to sexual excitement. In addition, the nerves on the outside of the foreskin are numerous and similar to normal skin – hence they can discriminate fine touch, texture and warmth, and they can stretch.
There is a small advantage for a newborn to keep his foreskin. It protects the penile tip or glans from the effects of nappy rash and will prevent the formation of a meatal ulcer, a small painful ulcer that develops at the opening of the urethra only in the circumcised.
A popular reason given for circumcision of the newborn is that the foreskin causes urinary obstruction. This is almost never the case – if it occurs at all it must be incredibly rare. Certainly, there is often ballooning of the foreskin on passing urine, but this is certainly not an indication for its need for removal either.
Narrowing of the foreskin (Phimosis)
Another common reason given for circumcision in a baby is phimosis, or narrowing of the foreskin. Many people – including many medical and nursing professionals, are not aware that in the majority of baby boys the foreskin is not retractable. Only in 4 per cent of newborns can the foreskin be fully retracted.
As time passes the foreskin gradually separates from the underlying tissue, but even at 3 years of age there are 10 per cent of boys whose foreskin cannot be retracted. In these boys, as there is no space between the foreskin and the glans, no secretions collect, so there is no need for this area to be washed.
After the foreskin becomes retractable, such secretions do tend to accumulate and regular hygiene is necessary each bath time. Many misguided people forcibly retract the foreskin of the infant before it is ready – this causes tearing of the tissues, which leads to scarring and the possibility of narrowing (phimosis). All this then makes retraction and normal hygiene extremely difficult.
In fact, to correct this situation, circumcision may subsequently be required, leading some to incorrectly believe that the baby should have been circumcised as a newborn.
Far and away the most common reason for circumcision in the newborn period is parental preference. A father often wishes his penis and his son’s penis look the same.
Only a few years ago, baby circumcision occurred in the early weeks without any anaesthetic or even painkillers. It used to be said that the advantage of circumcision in the newborn period was that as the baby is so small he can’t feel pain (which has been shown to be completely wrong), it’s just he can’t fight back. If it is to be done, good pain relief is essential and there are now a few techniques which give the baby adequate local anaesthesia.
The least effective is the use of EMLA cream. This is a local anaesthetic cream which is wrapped around the penis in an occlusive dressing. More effective is either A Dorsal Penile Nerve Block, in which an ultrasound guided needle injects local anaesthetic around the nerves that come from the end of the penis, or a Subcutaneous Ring block where the local anaesthetic is injected around the glans (or head) of the penis.
The actual operation is not technically difficult, but it is a good idea to get a doctor with experience. The conventional technique using various surgical clamps are favoured by surgeons whereas the Plastibell (a plastic constriction device which is safe, easy and produces a neat result) is preferred by most others.
Immediately after circumcision you can expect discomfort and swelling, a small patch of blood in the baby’s nappy and the wound area looking unsightly for about ten days.
Complications to the procedure are now extremely rare, but haemorrhage requiring suturing, and infection requiring antibiotics remain a possibility.
Information abridged from Baby on Board 3rd Edition by Dr Howard Chilton. Obtain from www.babydoc.com.au/shop $24.00