One of the first sexual decisions for boys is made for them at birth by their parents. Although it’s much less common these days, most parents still go through the motions of deciding whether to modify their sons’ sexual apparatus by circumcision. Boys are born with a hood of skin called the foreskin, covering the glans (knob) of the penis. Circumcision is a surgical procedure where this foreskin is cut off. Although there is no accepted medical reason to do it, parents have all sorts of motives for deciding to have this done. For followers of the Jewish faith, it is a non-negotiable issue. They see it as a physical mark of dedication to the service of God, and as such it is considered a religious rite rather than a medical procedure. As a family doctor I am occasionally asked for my opinion. Now aside from religious reasons, I tell parents ‘If it’s not broken, it doesn’t need fixing.’ In addition, the foreskin is loaded with sexual sensory nerve endings, so it is impossible to tell what difference that could make to his sex life.
Because the groundswell of medical opinion is now firmly against routine circumcision, some parents like to explain to me why they decided to go ahead with the operation; not that I think anyone needs to justify it after the fact. Some want their sons to look like their fathers, to have a set of matched penises in the family. Unfortunately, it’s going to be a long time before that little thing is going to look the slightest bit like Dad’s, and by then it’s not likely to be an issue. Some parents are worried that if the father is circumcized, he won’t know how to look after his boy’s foreskin, or teach him later how to maintain it himself. Certainly an uncircumcized penis does need a little more attention than a circumcized one, but it’s simple enough. In small boys, the foreskin is actually attached to the glans beneath. It can be tempting to pull the foreskin back before it’s ready, but this is not necessary. As a general rule of thumb, a foreskin is ready to be pulled back when a boy discovers he can do it himself. This usually happens by the time he is three or four years old. After that, he just needs to be taught to pull it right back and clean under it every day, just as you would teach him to wash behind his ears or brush his teeth. Of course there will be some foreskins that need to be removed at some stage because they are too tight or have become infected, but if we accepted that logic as a reason for routine circumcision, we would also take out everyone’s appendix and gall bladder at birth just in case something goes wrong there too.
You may have heard that recent evidence has suggested that the incidence of cancer of the penis, AIDS and urinary tract infection in males is slightly higher in the uncircumcized group. Taking a closer look, these findings are open to question, and the current opinion is that the results don’t justify recommending the operation.
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