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Wednesday 08 April 2009


Foreskins inside out

Posted in: Features, Safe Sex
By Mark Farnworth - 1st August 2008

forskin.jpg
Guys – are you cut or uncut? And does it really matter? Mark Farnworth does some research.

Somewhere in my distant memory I remember watching a documentary in which a Jewish-American doctor likened the foreskin, or prepuce, to the appendix. She claimed that it was simply useless and superfluous to the requirements of human males.

I found myself questioning her lack of justification and instead put her assertions down to "enculturation". Surely if this physical feature is retained, not only in humans but most male mammals, it cannot be as useless as she assumes? Incidentally, as a structure the foreskin is analogous to the fleshy hood of the clitoris, and nobody in their right mind would ever report female circumcision as anything other than brutal, misogynistic and unnecessary.

The foreskin seems to have an obvious function. It's there to protect the head of the penis which, unsurprisingly, contains a very high density of nerve endings. In fact, during male to female gender reassignment surgery, the clitoris is created using part of the glans penis. However the decision is out as to whether the presence or absence of a foreskin effects sensation and sexual satisfaction. Some argue that it doesn't (Bleustein et al. 2008)2 others that it does (Fink et al. 2002)3, it remains a highly contentious and culturally sensitive assertion. Note that the researchers are men, and may have vested interests in the results of their studies.

According to Johnson (2008)1, globally, circumcision is the most commonly practiced surgery. However, it is on the decline as a result of advances in personal hygiene. In the 1950's, 24% of men were circumcised compared to 6% in 2008.

Most infants are circumcised using an implement that looks a little like a tiny eggcup attached to a cigar trimmer. The foreskin is rolled up the device and then sliced off or ligatured, often without any anaesthetic, unless you're an adult. In fact, if you search for images of circumcision devices, there isn't a single one that doesn't look like it could be used by the Spanish Inquisition. Surely, once the circumcision is complete, this is an end to the indignity? Apparently not, complications may include haemorrhage, infection, painful scarring and damage to the penis. Johnson (I just noted the hilarious link between author name and subject) also points out that "tight foreskins", the primary medical reason for intervention, often remedy themselves by the age of three.

Most interestingly, recent research finds that circumcision significantly reduces the chance of contracting HIV (e.g. Reynolds et al. 2004)4, suggesting that it may be an additional method of reducing infection. However, it does not absolutely stop transmission nor does it protect against other sexually-transmitted infections. Education and total barrier methods (if used properly) remain the only sure way of preventing disease transfer.

In light of my sojourn into foreskin literature, if I ever had the fortune to have a son, I would be highly unlikely to have them circumcised, unless, that is, there were significant medical reasons for the surgery.

References:

1. Paul R.V. Johnson (2008) Childhood Circumcision. Surgery(Oxford) 26: 314-316.

2. Clifford Bleustein et al. (2008) Effect of neonatal circumcision on penile neurologic sensation. Urology 65: 773-777.

3. Kenneth Fink et al. (2002) Adult circumcision outcomes study: Effect on erectile function, penile sensitivity, sexual activity and satisfaction. Journal of Urology 167: 2113-2116.

4. Stephen Reynolds et al. (2004) Male circumcision and risk of HIV-1 and other sexually transmitted infections in India. The Lancet 363: 1039-1040.



Mark Farnworth - 1st August 2008