Prevention or violence: Who needs male circumcision
Some consider this procedure a religious relic, others - necessary preventive measure. Disputes about how circumcision affects sexual sensations do not stop, and yet it can be attributed to rare interventions that men decide to "be like everyone else" or even like women. Together with Vigen Malkhasyan, Candidate of Medical Sciences, Associate Professor of the Department of Urology, Moscow State Medical University named after Evdokimova, we understand why science is on the side of circumcision, what are the arguments against, and what does religion have to do with it.
History, culture and religion
Although most people think that circumcision came along with Islam or Judaism, this or similar procedures were performed and much earlier — probably fifty or even seventy thousand years ago. Scientists continue to argue about the reasons for these long-term interventions. It is not excluded that in hot and dry climates (in countries like Egypt, Mexico, central Australia) circumcision served as a prevention of diseases associated with the ingestion of sand grains. For 2000 years BC, the rite, which the followers of the Abrahamic religions will hold in the future, has already appeared. It is believed that Abraham described in the sacred texts then lived: his wife Sarah could not get pregnant, and a voice from above ordered the man to be circumcised. Pregnancy came soon after that - and now historians claim that the problem of Abraham was phimosis, the excessive narrowing of the foreskin, which does not allow the head of the penis to be exposed.
Among Muslims, circumcision has also become a universal practice, although there are no prescriptions in its Qur'an - the main reason for the procedure (besides the tradition itself) is to improve hygiene: “cleanliness” in all its manifestations is a fundamental aspect of Islam. In America, circumcision (a synonym for "circumcision") was practiced before Columbus, then in South America, the procedure became rare, but in the USA it entered into routine medical practice. Now the majority of circumcised men are people born either in the United States or in Muslim families.
It is believed that up to 38% of men in the world have gone through the procedure of circumcision, in Islamic countries this figure reaches almost 100% - but it is nearing such and, for example, in Nigeria, where half the population professes Christianity. In the US, 71% of men are circumcised, in the UK, Australia and Belgium - more than 20%, in Russia - about 11%. Detailed information on different countries can be seen on a recently published map, where the prevalence of circumcision is displayed in different colors. According to Vigen Malkhasyan, in Russia the procedure is performed most often according to indications that include phimosis, genital warts, sclerosing lichen, recurrent balanoposthitis.
Europe vs America
In 2010, nearly 60% of newborn boys were circumcised in the United States, and three-quarters of adults were circumcised. Now the prevalence of the procedure has slightly decreased: before it was done by default and was perceived as something like a vaccination, but in 1999 new recommendations came out, which said that the arguments “for” did not finally outweigh the arguments “against” - and parents were given the opportunity to decide. In 2012, the American Academy of Pediatrics issued another set of recommendations, which states that “although the medical benefits are not so great as to recommend routine circumcision to all newborn boys, the benefit of circumcision is sufficient to justify access to the procedure for families who want to perform it, and payment of this procedure by a third party. "
Given the high prevalence of circumcision, many parents agree to it not even for medical reasons, but in order for the child not to differ from others and not to be laughed at. Malkhasyan adds that even in the event of any diseases, American doctors act more resolutely and perform circumcision more often and earlier than their European colleagues. The type of the penis without foreskin became so familiar to Americans that the ideas about normal anatomy were distorted: according to one study, in less than a third of 90 American medical textbooks the penis is depicted as intact.
In Europe, circumcision is much less common - perhaps one of the most prominent differences in the medical practice of the two regions, adhering to the principles of evidence-based medicine. It is not excluded that this happened due to different financing systems: if in the USA private insurance companies pay for a lot, then in Europe health care is often on the shoulders of the state, and budgets are lower.
Ethical
In 2012, a ban on circumcision without the informed consent of the child was imposed in Germany - this led to protests from followers of Islam and Judaism (in Germany there are about four million Muslims and 120 thousand Jews). Both sides argue their position with questions of ethics: it is not good to perform irreversible body modifications of the child (if they are not aimed at saving lives immediately), but it is not good to interfere with religious freedom, not allowing people to practice safe interventions in general. Three months after the ban, he was removed and the doctors were allowed to perform ritual circumcision.
Now the possibility of a complete ban on circcism is being discussed in Denmark: the corresponding petition gathered 50,000 votes and the country's parliament should hold a discussion on the issue and vote. The arguments are the same: on the one hand, the inability to obtain informed consent from a young child, on the other - interference in the religious practice of the inhabitants of the country.
Opponents of circumcision call themselves intactists (from intact - "intact, unharmed, perfectly safe"). On their side, the arguments that both hygiene and the possibility of preventing infections are now much better than thousands of years ago, that is, the medical or hygienic aspects of the intervention cannot be justified. Some equate circumcision with genital mutilation. Among the celebrity, the intactista are also: Cameron Diaz, Russell Crowe and Alicia Silverstone.
A full ban, as is known from experience with the prohibition of abortion, leads to the fact that operations begin to be performed clandestinely, often by non-professionals and in completely inappropriate conditions. Vigen Malkhasyan notes that, in Russia, ritual circumcision, unfortunately, is sometimes done in mosques, synagogues, and even at home. Although this operation cannot be called very complex and usually everything proceeds normally, one cannot compare it with a manicure or ear piercing: the child's body can react pathologically, for example, to anesthesia. In the surgical room of a medical institution there will be access to emergency facilities, and at home the risk is much greater.
Official representatives of religions, of course, do not want associations with criminal circumcision. In the Moscow Jewish Community Center there is a circumcision department, where this ritual (it is called Brit Milah) is conducted by a rabbi with a medical education. After the tragic incident (a three-year-old boy died after circumcision performed at home), the Spiritual Board of the Muslims was also recommended to perform this operation only in medical institutions.
Health
As Malkhasyan notes, most medical data now supports the use of circumcision, and only the risk of complications remains an argument against; they occur rarely and even less often are serious, and in most cases they pass easily and do not require repeated interventions. Now there is evidence that circumcision has a protective effect and reduces the risk of many infections.
For example, a meta-analysis of three randomized studies conducted in Uganda, Kenya and South Africa from 2002 to 2006 showed that circumcision in heterosexual men reduces the risk of HIV infection by 38-66%. The surface layers of the penis mucosa contain many Langerhans cells and T-lymphocytes CD4 / CD8 - these are targets that are attacking HIV. After clipping, the mucous head of the penis becomes coarse, becomes less susceptible to microtraumas and makes it difficult for the virus to penetrate. Therefore, major experts, and organizations such as WHO and UNAIDS (the joint United Nations program on HIV and AIDS), consider circumcision as a promising method for preventing HIV infection and other sexually transmitted diseases.
Another dangerous virus is HPV, and circumcision is associated with a lower prevalence of infection with its oncogenic types. HPV is a major risk factor for cervical cancer and (along with phimosis) for penile cancer, circumcision reduces the risk of these tumors in men and their partners. This is confirmed by extremely low rates of penis cancer in countries such as Israel, where most men are circumcised. In a systematic review of sixty publications made in 2017, it was noted that the partners of circumcised men reduced the risk of dysplasia and cancer of the cervix, chlamydia and syphilis.
Circumcision is also indicated for people with frequent, recurring inflammations of the glans penis (balanitis): it is known that the contents of the space between the head and the foreskin is a breeding ground for microorganisms. This was confirmed in the study of the microflora of the penis head before and after cutting. In a 2006 meta-analysis, circumcision was shown to be associated with a much lower risk of syphilis, soft chancre, and herpes virus infection. In a study in 2010, it was confirmed that circumcision reduces the risk of infection with the herpes virus type 2 by 28%, and the incidence of trichomoniasis and chlamydia was lower in the group of circumcised men. Finally, the procedure reduces the risk not only of sexually transmitted infections, but also of common urinary tract infections (cystitis and urethritis), including in young children.
Sex
Most often, circumcision is done in childhood, and only those who decide to do it as an adult — for medical reasons, aesthetic reasons, or after a transition to another religion can compare sex life before and after. In the Vice publication, four men talk about their experiences - and only one of them says that he is dissatisfied with the result. As an adult, the procedure is more difficult (if it takes no more than a minute for a baby, then for an adult man it is an operation for 30-45 minutes), and the healing process takes more time. In addition, due to spontaneous erections, stitches can cause great pain.
Nevertheless, most men who have undergone circumcision in adulthood say that the quality of sexual pleasure does not suffer, although sensations change: stimulation of the head of the penis becomes more comprehensive, despite a gradual decrease in sensitivity after the initial sharp increase. A psychologist who circumcised only at the age of forty told the Australian edition of MyBodyandSoul that in childhood and adolescence he felt uncomfortable in the locker rooms because of his dissimilarity to others; moreover, he said, maintaining a good level of hygiene without circumcision is much more difficult. He notes that his life has become much simpler, but in terms of sexual pleasure, nothing has changed.
Sexual life before and after circumcision is the subject of much research and scientific analysis. In Kenya, a randomized controlled trial was conducted involving nearly three thousand men, half of whom circumcision was performed at the beginning of the study, and the rest two years later, during which all participants were monitored. It turned out that circumcision not only did not lead to sexual dysfunction, but also increased the sensitivity of the penis and contributed to the achievement of orgasm. In another major study in the same country, the findings were similar: circumcision does not worsen and may even improve sex life.
Men living in the UK also did not show any negative effect of circumcision on sexual function. Finally, in 2013, a large systematic review of publications on this topic was published; the authors selected thirty-six articles describing studies involving more than 40 thousand men. The highest quality data confirmed that circumcision did not adversely affect sexual function, sensitivity, sensation during sex or satisfaction.
Photo: Wikimedia Commons (1, 2, 3, 4)
