The masculine Circumcision

Surgical removal of the foreskin or redundant skin of the penis is called circumcision and is one of the most controversial issues in the initial management of the male newborn. The contradictory information and the most varied positions in this regard, medical or religious health, make the decision on its use something terrifically difficult, or paradoxically, extremely simple.

Circumcision

It is necessary? What are the benefits? What are the risks?

These are the questions asked of pediatricians when the option of circumcision has no religious character. We will see if we can help you in the decision

Female circumcision

This mutilating procedure of the genitals has no place in medicine and represents a kind of pseudo-religious procedure that has no other purpose than to deform the female genitalia and limit the sexual pleasure of women, exposing her, in addition, to great risks during vaginal delivery – if the girl does not die earlier due to hemorrhage or infection -. It seems to us that the one who invented this was an impotent man and/or premature ejaculator with a tiny penis unable to satisfy a woman. It is the most grotesque form of machism that can exist.

Opinions of groups and organizations

Everyone has a different opinion about it and absolutely everyone is “specialist” in the area. Some small groups say, without much evidence, that all circumcised men may have been emotionally affected and unable to identify their feelings about it; others suggest that it is a violation of the human rights of the baby who is unable to decide for himself, who alters sexual pleasure and finally constitutes a mutilation.

The truth is that collegial organizations generate a body of knowledge based on the available evidence and issue recommendations to their study groups.

• Canadian Pediatric Society: the evidence on risks and benefits is so balanced that it is not enough to recommend its routine use in newborns.

• American Society of Pediatrics: available scientific evidence demonstrates potential benefits of circumcision in the newborn; however, its use is not essential for the infant’s health. Religious, ethnic and cultural traditions should also be considered in the decision of the parents and are so important

as medical considerations. They are currently reviewing their findings considering recent evidence that circumcision has a protective effect

on the transmission of HIV and other sexually transmitted diseases

• American College of Obstetrics & Gynecology: assumes the position of the American Society of Pediatrics described above

• World Health Organization: considers circumcision as part of a preventive package for Africa and other regions highly prevalent in HIV and low in circumcision. These measures must guarantee a safe, consensual procedure without any discrimination or coercion.

Benefits

Reduction of cases of urinary infection

Urinary infection is more common in infants than in adults, although the risk is less than 1%. Clinical studies have reported a significant decrease in cases of urinary infection in circumcised children (3 to 12 times lower), but since these infections are infrequent, 100-200 circumcisions are needed to prevent a single case of urinary tract infection.

In the adult circumcision decreases the frequency of urinary tract infections especially in the presence of diabetes and other chronic diseases

Reduction of cancer cases

When you compare circumcised men with non-circumcised seemingly the first ones have

Lower risk of penile cancer and your women lower risk of cervical cancer

Penis cancer – this cancer is very rare and apparently the circumscription decreases its frequency. This type of neoplasms could be associated with HPV, cigarette, HIV and prolonged male hygienic negligence

Cervical cancer – the frequency is lower in women whose partners are circumcised, without pregnancy, controlled the presence of HPV and an adequate gynecological control would seem that the problem is persistent infection by HPV, sexual promiscuity and other factors such as smoking and prolonged gynecological neglect

Prostate cancer – there are many factors that cause confusion and it can not be said with certainty that circumcision reduces cases

Reduction of inflammatory pathologies of the penis

Inflammatory conditions of the penis (dermatitis, balanitis, meatitis …) are seen less frequently in the circumcised man but its frequency is equally rare in both groups when there is good local hygiene. The education in genital hygiene from early ages is fundamental

Reduction in cases of Sexually Transmitted Infections

For logical reasons it would be assumed that a micro-climate drier and exposed to the environment would prevent the risk of suffering from sexually transmitted diseases, but the truth is that circumcised or not the promiscuous man is the one who is exposed to a high frequency of transmission infections sexual. It is likely that in the circumcised there is some protection against the acquisition, prevalence and transmission of HPV, HIV and genital herpes 2 but not against gonorrhea or syphilis. Of course, this is statistical and under no circumstances would allow my son to do his own without protection right and left thinking that circumcision will prevent these infections, especially HIV

Easier genital hygiene

In general lines penile hygiene is easier and more effective in the circumcised male, but this is debatable in the face of good instruction.

Risks

Risks and immediate complications

The risk and complications of circumcision are estimated between 2-5%, most of which are mild immediate complications without sequelae: local bleeding and infection

Bleeding is treated with local pressure for a few minutes. It can be problematic and require minor surgery in cases of familial coagulopathies

The local infection is managed preventively with the administration of topical antibiotics and the use of local antiseptics at home

The established infection, depending on the severity, can be managed with topical antibiotics or

systemic, usually oral

The most severe complications reported, although rare are: severe infection and sepsis with potential death, hidden penis due to excess skin removal, fistulas, meatitis (inflammation of the urethral meatus), stenosis and necrosis / amputation of the glans.

Inadequate cosmetic results due to excess or defect in the extension of removed skin

Sexual insensitivity

It occurs in a minority of susceptible individuals, since removing the foreskin removes specialized sensory terminals that are located on the mucosa. Some studies indicate that the penis becomes less sensitive and therefore there is less pleasure during sexual activity: however, most of the men studied deny psychological traumas, lack of desire or effects on sexual sensitivity even in circumcised men in adult life and sexually active

Pain

The procedure is painful, even for the newborn, so some type of local anesthesia is recommended during the procedure. In the infant and even the adult, the use of a surgical room and regional or general anesthetic methods is recommended

Interesting: In a serious English publication of 1860 it was established that pain during circumcision was desirable because it was assumed that the habit of masturbation decreased. remember that it was the Victorian era where there was a marked “moralistic” trend

Summary, advice and recommendations

The United States is the only developed country where the majority of males are circumcised for non-religious reasons. The prevalence varies by region, religion, race, ethnic group, insurance coverage and type of hospital; it is estimated that 80-85% of males are circumcised

In other nations the prevalence varies from 20-80%

The advice on circumcision must be made by the pediatrician and later the urologist, the obstetricians are not part of the decision

The potential medical elements of risk and benefit, religious and social relatives, of the procedure must be considered.

Many of the benefits depend on the age of the male at the time of the procedure, it is assumed that by advancing the younger age will be the same

It is possible that in most of the world parents do not have adequate information or advice to make the best decision regarding the circumcision of their sons.

In one study, the parents of uncircumcised children were more likely to feel sad about their decision than the parents of circumcised children: 27% vs. 14% and in some surveys almost 50% of the mothers of uncircumcised men said they would circumcise their children. next sons if they had them (due to stress on the care of the penis without proper instruction – something easy to do if the pediatrician is involved in this aspect)

• Circumcision performed for religious reasons does not represent a problem for decision-making

• Parents should receive the best available information adjusted according to their particular needs and socioeconomic elements

• The benefits include: fewer urinary tract infections, cancer of the penis, statistical reduction of some sexually transmitted diseases and genital dermatoses, potential reduction of cancers and sexual diseases in their sexual partners. these benefits that are statistical for populations at risk should be adjusted for the risks of the procedure

• Circumcision as a procedure in the individual can not supplant a good education in personal hygiene and sexual behaviors

• Virtually no scientific organization recommends circumcision as a routine procedure

• Circumcision, whether performed or not, is not related to the final size of the adult penis or future sexual dysfunction (except for a very rare case of severe complication due to the procedure)

• In the light of current knowledge, doing it or doing it, it is a good decision if you have had enough prior information. Having decided in one way or another is well done and in both cases the fundamental pillar of the health of the male child is in their education, especially in regard to hygiene and safe sexual habits. In very poor and deprived populations of water and preventive and curative medical care, and with a high prevalence of HIV infection, it is possible that universal and involuntary circumcision is beneficial for that particular population.