Tilted Forum Project Discussion Community - View Single Post - Is the circumcision of a boy sexual abuse?

Jinn · 01-10-2006, 11:42 AM

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As a prelude to this, one needs to first understand the anatomy. The foreskin is composed of an outer layer that is keratinized, i.e., as is skin generally, and an inner layer that is a mucosal surface. The inner lining thus resembles other mucosal epithelia such as line the cervix, nasal passages and rectum. It had been suggested that the foreskin protected the glans from drying out and becoming keratinized. However, histological examination has shown the same amount of keratin in the skin of the head of the penis irrespective of circumcision status [279]. The inner layer lines a 'preputial sac', which becomes a repository for shed cells, secretions and urinary residue that accumulates [54, 212]. It is also a hospitable environment for the growth of bacteria and other microorganisms. During an erection the head and shaft of the penis extend so that the inner layer becomes exteriorized along the distal half of the shaft. This exposes it to infectious agents during sexual intercourse. It has been speculated that the prepuce is a source of secretions, pheromones, etc, but given the dubious authorship of these reports and the absence of any research support, such suggestions should be regarded as fanciful.

It has been suggested [43] that the increased risk of infection in the uncircumcised may be a consequence of the following:

# The foreskin presents the penis with a larger surface area.
# The moist inner lining of the foreskin represents a thinner epidermal barrier than the more cornified outer surface of the foreskin and the rest of the penis, including the glans of both circumcised and uncircumcised penis, which have been found to have the same amount of keratin (i.e., similar skin thickness and protection from invasion of microorganisms) [279]. This means that the inner lining is a potential entry point into the body for viruses and bacteria. (A photograph of a histological section illustrates this later, in the section on the AIDS virus.)
# The presence of a prepuce is likely to result in greater microtrauma during sexual intercourse, thereby permitting an entry point into the bloodstream for infectious agents.
# The warm, moist mucosal environment under the foreskin favours growth of micro-organisms (discussed in detail later). The preputial sac has even been referred to by Dr Gerald Weiss, an American surgeon, as a 'cesspool for infection' [302], as its unfortunate anatomy wrapped around the end of the penis results in the accumulation of secretions, excretions (urine), dead cells and growths of bacteria as referred to above. Parents are told not to retract the foreskin of male infants, which makes cleaning difficult. Even if optimal cleansing is performed there is no evidence that it confers protection [317, 318].

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Dr Edgar Schoen, Chairman of the 1989 Task Force on Circumcision of the American Academy of Pediatrics, has stated that the benefits of routine circumcision of newborns as a preventative health measure far exceed the risks of the procedure [256]. He has continued to this day to campaign for public education of the benefits of circumcision. During the period 1985-92 there was an increase in the frequency of post-newborn circumcision (to over 80% in one study [322]) and during that same time Schoen points out that the association of lack of circumcision and urinary tract infection (UTI) has moved from "suggestive" to "conclusive" [256]. Moreover, this period heralded the finding of associations with other infectious agents, including HIV. In fact he goes on to say that "Current newborn circumcision may be considered a preventative health measure analogous to immunization in that side effects and complications are immediate and usually minor, but benefits accrue for a lifetime" [256].

Some of the health benefits are:
# Decrease in physical problems involving a tight foreskin [201].
# Lower incidence of inflammation of the head of the penis [79, 82,85].
# Reduced urinary tract infections.
# Fewer problems with erections, especially at puberty.
# Decrease in certain sexually transmitted diseases (STDs) such as HIV.
# Almost complete elimination of invasive penile cancer.
# Decrease in urological problems generally [reviewed in 6, 8, 17, 87, 162, 246, 254] to cite just a few. More details appear in specific sections to follow)

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Problems involving the penis are encountered relatively frequently in pediatric practice [167]. A retrospective study of boys aged 4 months to 12 years found uncircumcised boys exhibited significantly greater frequency of penile problems (14% vs 6%; P less than 0.001) and medical visits for penile problems (10% vs 5%; P less than 0.05) compared with those who were circumcised. In infants born in Washington State from 1987-96, 0.2% had a complication arising from their circumcision, i.e., 1 in every 476 circumcisions [50]. It was concluded that 6 urinary tract infections could be prevented for every circumcision complication, and 2 complications can be expected for every penile cancer prevented [50].

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The proponents of not circumcising nevertheless stress that lifelong penile hygiene is required. This acknowledges that something harmful or unpleasant is happening under the prepuce. Studies of middle class British [140] and Scandanavian [207] schoolboys concluded that penile hygiene, as such, is at best poor and at worst non-existent. Furthermore, Dr Terry Russell, an Australian medical practitioner and circumcision expert states "What man after a night of passion is going to perform penile hygiene before rolling over and snoring the night away (with pathogenic organisms multiplying in the warm moist environment under the prepuce)" [246]. The bacteria start multiplying again immediately after washing and contribute, along with skin secretions, to the whitish film, termed 'smegma', that is found under the foreskin. Bacteria give off an offensive odour. Men differ in their sensitivity to this smell and some shower several times a day as a result (See section 'What men say'). Some uncircumcised men, and/or their partners, find the stench so unpleasant that the smell has caused these men to seek a circumcision on this basis alone. Penile hygiene is often difficult to achieve and attempting a very high degree of hygiene in uncircumcised men can result in new dermatological problems. For mothers and fathers, it is far easier to maintain cleanliness of their son's penis if it is circumcised. If their son is not circumcised the messages are confusing: should they clean under the foreskin or leave it alone?

Some additional research, for the skeptics (like me) among us.