Dear Dr G,

I recently stumbled across your column and really need your help.

I am a mother of two boys, aged 12 and 15. I am currently having a big dilemma regarding the management of the foreskin of my younger boy.

My husband is 45 years old, and was circumcised when he was 12. He said he recalled having a tough time with the operation and recovery.

Sometimes, I wonder whether the psychological effect of my husband’s ordeal had affected his performance in the bedroom.

The only reason why my husband underwent the circumcision was simply a family tradition that is carried down for generations.

On the basis of that “family tradition”, he imposed the same ritual to my older son when he was 12 years old.

Sad to say, he also had a hard time following the operation with pain and infection of the wound.

Now, facing the possibility of putting my younger boy through the same ritual, as a mother, I am seriously contemplating breaking away from this family tradition.

I know non-religious elective circumcision is often a contentious issue in the previous articles of your column.

Despite such divided opinion on the foreskin, I still insist on putting Dr G on the spot about circumcision.

Can you tell me the risks and benefits of elective circumcision?

Do the risks outweigh the benefits?

Finally, is there any evidence on long-term psychological effect in boys who had complications following circumcision?

Your opinion is greatly appreciated and the fate of my younger son’s foreskin lies in your answer.

Regards

Hazel

The word “circumcision” is derived from Latin “circumcidere” meaning “to cut around”.

This is a surgical intervention for the removal of the foreskin, which is a practice that has been documented since the ancient Egyptian civilisation.

It is estimated that around one-third of the world’s male population had undergone the snip, making it the most performed surgical procedure in the world.

The practice of circumcision is most common among Muslims and Jews for religious reasons, most likely symbolising a rite of passage marking a boy’s entrance into adulthood.

For non-religious removal of the foreskin, the practice is more prevalent in countries like North America and certain parts of Africa.

However, such elective procedure is less established in Europe, Latin America and most of Asia.

The position of law for elective circumcision is hotly debated and polarised.

Laws restricting, regulating or even banning circumcision dates back to ancient times. Ancient Greeks prized the foreskin and disapprove the custom of circumcision, outlawed circumcision with the death penalty.

In modern times, the proponents of laws in favour of non-therapeutic circumcision often point to the rights of parents and religion.

However, judges in several high-profile court cases in various countries have pointed the act as grievous bodily harm, and affects the right to self-determination and bodily integrity of the boy.

The views of doctors are equally divided with regards to circumcision – ranging from having no benefits to having modest health benefits that outweigh the risks.

No world’s major medical organisations recommend either universal circumcision or banning it.

Medical literature has highlighted the evidence of reduced urinary tract infections, sexually transmitted infections, inflammation of the glans and even protection against penile and cervical cancers in partners.

At the same time, studies also revealed the risks of post-operative pain, bleeding, infection and even unintended injury to the penis.

The psychological impact of circumcision on boys has also been well studied.

Short-term behavioural effects have been observed in infants including changes in sleep pattern, irritability and parental bonding.

Although the experience of childhood circumcision may seem traumatic at the time, long-term psychological adversity is not common.

Multiple studies have been done to highlight the impact of circumcision on sex. A 2013 systemic review of all the medical literatures showed that circumcision did not appear to adversely affect sexual desire, pain during intercourse, premature ejaculation, ejaculation, penile rigidity or difficulty with orgasm.

Whether circumcised or non-circumcised men make better lovers, both parties continue to “fight their corners” with or without their foreskins.

American TV personality, Judy Sheindlin, better known as Judge Judy once said: “I want first time offenders to think of their appearance in my courtroom as the second worst experience of their lives; circumcision being the first.”

Although this may seem a bit extreme, we cannot deny even the word “circumcision” will make any teenage boy break up in cold sweat.

When Dr G is put on the spot, with the big question whether to cut or not to cut, it is often important to assess the medical necessity as the first priority.

The famous novelist and broadcaster, CS Lewis, once said: “The task of the modern educator is not to cut down jungles, but to irrigate desserts.”

When it comes to the preservation or removal of the perceived “insignificant” foreskin, Dr G’s view is: “The task of a modern doctor is not to just cut off the skin, but to nurture the minds of the child and parents, helping them to make the right decision for them.”

As the country is venturing into the historic era over the last few days after the polls, I also think as a society, we are mature enough to question many things we do as a ritual or tradition, including circumcision.

As today is Mother’s Day, despite the parental dilemma Hazel faces with the issue of circumcision for her boys, I wish her and all the mothers in the world, “Happy Mother’s Day!”

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