Male Circumcision: Taboo or Permissive
The
prevalence of circumcision is the percentage of males in a given population who
have been circumcised. In 2010, the World Health Organization (WHO) estimated 30%
of adult males worldwide aged (15+) are circumcised. It is estimated that 20.7%
of males in the United States of America are circumcised; virtually 0% of males
in Honduras; 45% of males in South Africa, to over 90% of males in Israel. Male
circumcision (MC) is not among the cultural practices of Afro Caribbean
males. In a study edited by Susan Marie Graham examined male prevalence of
circumcision among men in Western Jamaica. The research revealed that fourteen percent
(14%) of the respondents reported that they were circumcised. The research entitled
“Factors Associated with the
Acceptability of Male Circumcision Among Men in Jamaica” discovered that
among the reasons given for men not being circumcised are; not changing the way
God made the penis, the fear that the surgery may damage the penis and inability
to have sex until the penis heals. The cross-sectional,
interviewer-administered questionnaire surveyed 549 men aged 19-54 years. The
parishes include St. James, Westmoreland, Trelawny and Hanover. Jamaican has
fourteen parishes. The Mayo Clinic states that circumcision is a religious or
cultural ritual for many Jewish and Islamic families, as well as certain
aboriginal tribes in Africa and Australia. Circumcision can also be a matter of
family tradition, personal hygiene or preventive health care. Sometimes there is
a medical need for circumcision, such as when the foreskin is too tight to be
pulled back (retracted) over the glans. In other cases, particularly in parts
of Africa, circumcision is recommended for older boys or men to reduce the risk
of certain sexually transmitted infections. The American Academy of Pediatrics
(AAP) says the benefits of circumcision outweigh the risks. However, the AAP
does not recommend routine circumcision for all male newborns. The AAP leaves
the circumcision decision up to parents and supports use of anesthetics for
infants who have the procedure. George, who is in his early 60’s revealed that
he got circumcised at age 25. “It was too much to be pulling back to wash.” A significant number of men suffer from
Phimosis. According to the online source, Prime Health Channel, Phimosis is a
medical condition that is characterized by limited exposure of the glans
clitoridis, the red mass of tissue that stands at the tip of the penis. This
happens when the foreskin of the penis tightly sits over the aperture of the
penis and cannot be retracted. In uncircumcised male infants, the foreskin is
normally tight in the initial years and become retractable as the boy begins to
grow. But in case of Phimosis in infants, the foreskin is not easily
retractable and neither does it loosen with time. This causes problems during
urination and if not corrected in time, can hinder sexual activity. WedMD mention
in uncircumcised men, the glans is covered with pink moist tissue called
mucosa. In circumcised men, the foreskin is surgically removed and the mucosa
on the glans transforms into dry skin.
Up Front and Personal
George
(not his real name), is a Jamaican who now lives in the United States of America. He
migrated to the USA while he was a teenager. However, he has strong roots in
Jamaica and as such visits frequently. He mentioned that he was in his second
year at medical school when he decided to have this procedure done due to phimosis. George, now
in his early 60’s and married with one child stated the procedure was done
under general anesthesia. “The suture around it was uncomfortable. I could only
wear boxers; no sexual activity for about 6 weeks, not even masturbation.” He
shared his experience of visiting South Africa and having the chance to visit the place were the Rite of Passage was done. “Boys have to leave home for a period of time to be
prepared by the elders for the ritual.” He added, “there is a big celebration
when they return; returning as men, not boys.” Women are not part of these male
circumcision ritual ceremonies. Another colleague, Jason (not his real name),
said he was circumcised as an infant. Jason was born in the United States of
America but has lived in Jamaica for most of his adult life. He added that all
three of his brothers also had the procedure done. He said the circumcision was
done for penile hygiene. Sheldon who is now 68 said, “it does not have the same
hygienic importance today as it did when I was a child.” Some males because of underlying health
conditions chose to have a circumcision done. As with most medical procedures every person
has a different experience. Brandon 44, my colleague, had circumcision as an
adult. He is married and suffers from diabetes; type 2. “I had some skin
complications where the foreskin became hardened. Because of this, it became
difficult to pull the foreskin back and whenever the skin was pulled back it
became painful and sex would be painful as well.” Brandon added, “I would get cuts on the
foreskin after sex. Intercourse was seldom.” Interestingly, Brandon, who currently lives in
the United States of America returned to his land of birth Jamaica in order to
have this medical procedure done in 2014. “The cost was a total of US$1,200 including
airfare, cost of the surgery, medication and one follow up care visit.” Brandon
had his circumcision done under local anesthesia. “I was awake during the
process.” When asked how long before he resumed sexual activity, he replied, “I
resumed sex six weeks after.” “I was instructed by the care nurse to wash the
penis with salt water, then use cotton swabs with Dettol antiseptic before
wrapping the penis with gauze. I couldn’t get the area wet for three days after
surgery. I was told no sexual intercourse for at least 6 weeks.” When asked to
compare sex before circumcision to sex after, Brandon said, “The sexual
experience after the surgery was phenomenal. The head of the penis became much
more sensitive so that increased the pleasure.”
Another
colleague, Ynona, said he had the medical procedure done in infancy. “I have no
idea why it was done. There was a period of my life when I felt ashamed of my
circumcised penis.” Yvona, who is 64 years, attended an all male high school.
“I felt different in the presence of other boys who were not circumcised…guilty
that maybe there was something weird about me?
Yvona went on to say that he had problems after his circumcision. I asked
Yvona why at the time he did not speak to his mom or dad regarding the
discomfort he was experiencing. “I suffered silently. I felt discomfort even
from soap.” He went on to say, “The
slightest change in the water cold or hot… I would wince.” As far as I can
remember my penis was too sensitive, it was only during bath time or different
cloth texture; I welcomed wearing briefs. At ten years the tenderness
disappeared.”
A former student, Mr. T, age 39 said he had his circumcision when he was 32 years old. "I read up on it and saw that there were hygienic and health benefits to it. Also, medically I got bruised sometimes after intercourse." He added, "since surgery, all is corrected and I am feeling 100 percent better. ". Mr. T stated, "I was awake throughout and closer to the end of the procedure I slightly felt the knife." When asked was he afraid of the knife. "I was afraid somehow of the knife but I think the anesthesia worn out a bit so she applied some more to finish up." He concluded that the cost to have the circumcision done was approximately $40,000 and this was conducted at the University Hospital of the West Indies. This cost was offset by his health insurance.
In
Australia there has been an increase in circumcision of young boys and men. According
to the Australian Institute of Health and Welfare, the number of circumcisions
using local anesthesia grew almost 60 percent from 6518 in June 2017 to 10,
352 in June 2019. The number of circumcisions with a regional nerve block more
than doubled from 5425 in 2017 to 11, 526 in 2019. Circumcision for medical
reasons is free in a public hospital but the median waiting time for the
procedure is 60 days. A circumcision in a private hospital can cost between
$700 and $3000. The rate of newborn circumcision, once routine for social
reasons, has plummeted to between 10 and 20 per cent of babies, the Paediatrics
& Child Health Division of the Royal Australasian College of Physicians
said. The rise in older age circumcision is due to a condition called phimosis,
a narrowing of the foreskin, which may make retraction over the shaft of the
penis impossible. Phimosis can cause multiple infections and even rupturing of
the foreskin, but its onset happens well after birth. The only permanent fix is
circumcision.
Rite of Passage
The
Xhosa tribe of South Africa is known for their male circumcision rite of
passage. According to Moore and Habel a Rite of Passage is a ritual action
through which the initiate is ‘separated’ from one ‘world’ and taken into
another. Rites of passage are performed on special occasions and mainly deal
with entering a new stage of life. The
Eastern Cape Province of South Africa is home to the Xhosa people, one of the
nation’s largest tribes. The National
Geographic states, this tribe lives in the modern world, but they maintain
ancient customs including one by which boys become men. South Africa male
circumcision ritual is revered and guarded by the Xhosa people but the
unhygienic conditions and abuse by some initiation schools comes at a high
price. These initiation schools are part of the Xhosa tribe customs and
traditions. It is at these schools that bush doctors preside over male
circumcision of these boys. Disturbingly, without formal training a number of
boys die yearly. This tradition is not only dangerous but painful since
anesthesia is not used during the removal of the foreskin. Xhosa tradition
states the removed foreskin must be buried to keep sorcerers from using them in
witchcraft. This journey to manhood is a community effort. The men build the
boys huts some distance away from the village. The boys are forbidden to drink water during the time of healing. Some Xhosa boys die from infection
in this rite of passage to become men. If the boy seeks medical intervention he
will not be accepted back in his tribe. Once these boys successfully complete
this initiation they return to the village and are eligible for marriage.
Unlike
the uncircumcised male who has to retract the foreskin and clean away the smegma
(cheese like substance); penile hygiene is better for the circumcised male.
Additionally, male circumcision is also used to treat phimosis and the practice
in some societies is viewed and celebrated as a rite of passage. Male
circumcision is also recommended in reducing the risk of heterosexuals
acquiring human immunodeficiency virus (HIV). The World Health Organization
(WHO) says there is compelling evidence that male circumcision reduces the risk
of heterosexually acquired HIV infection in men by approximately 60%. Three
randomized controlled trials have shown that male circumcision provided by well
trained health professionals in properly equipped settings is safe. WHO/UNAIDS
recommendations emphasize that male circumcision should be considered an
efficacious intervention for HIV prevention in countries and regions with
heterosexual epidemics, high HIV and low male circumcision prevalence. Male
circumcision provides only partial protection, and therefore should be only one
element of a comprehensive HIV prevention package which includes: the provision
of HIV testing and counseling services; treatment for sexually transmitted
infections; the promotion of safer sex practices; the provision of male and
female condoms and promotion of their correct and consistent use.
Cut or Uncut
For
some the issue of male circumcision is largely a middle class intervention. This
narrative finds support from a colleague; Ian was circumcised as an infant. Ian
53, is married and is also the father of two boys, both of whom are circumcised.
He stated that all his brothers and his nephews are also circumcised. He
remarked that his dad is 75 years. “He went to boarding school. I think his
exposure there led him to the place not only of circumcision but other things
that his sons had to have.” The idea of boarding school is steeped in a social
class ideology which is pervasive even now. When asked to explain what other
things his father wanted his children to have, Ian commented, “prep school,
middle class upbringing…certainly how I speak.” Interestingly, the manner in
which we speak is often used as an indicator to place us in a social class. Ian
went on to say, “tradition is big deal with us. I have the crib my parents used
when I was a baby, my brothers, my sons and nephews all used the same crib.” There
is also a growing school of thought that male circumcision is a violation of
the rights of boys. The core of human rights is the concept of human dignity. Some
argue that a force medical procedure such as infant male circumcision is a
violation of their human rights. Regrettably,
a significant number of men are not actively involved in the lives of the
children. This abandonment of the father’s role will place the responsibility of
whether to circumcise on the mother. The American Academy of Pediatrics (AAP)
found that the health benefits of male circumcision outweigh the risk, but the
benefits are not great enough to recommend universal circumcision. The AAP states that the procedure may be
recommended in older boys and men to treat phimosis (the inability to retract
the foreskin) or to treat an infection of the penis. Like any other
surgical procedure, there are risks associated with circumcision. However, this
risk is low. Problems associated with circumcision include: pain, risk of
bleeding and infection at the site of the circumcision, irritations of the
glans, increased risk of meatitis (inflammation of the opening of the penis)
and risk of injury to the penis. Circumcision
is final and the foreskin cannot be reattached. Like any other medical intervention parents
should speak to their doctors about the benefits and the risks of this surgery
before arriving at a decision. Brandon
concluded, “Jamaican men are not too quick to discuss penile issues
among peers and would sometimes see the subject as taboo.” He added, “too many
men suffer with penile issues and feel that they are alone. Let’s talk about
the things that affect us and also affect our relationships with spouses.”
Wayne
Campbell is an educator and social commentator with an interest in development
policies as they affect culture and or gender issues.
waykam@yahoo.com
@WayneCamo
©
#malecircumcision
#phimosis #Jamaica #HIV #Jewish #culture #Xhosatribe #manhood #menshealth
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