DEFINITION : Circumcision in males is the surgical sharp excision of the foreskin (prepuce) covering the head of the penis (glans). This could be done by a sharp metal blade or by using an electric current knife.
THE ADVANTAGES OF CIRCUMCISION
1) Cancer of the penis is extremely rare in Muslims and not known in Jewish populations.
2) Circumcision certainly improves hygiene.
3) In my long private practice in surgery, several non-Muslim parents bring their teenage boys for circumcision. Many non-Muslim wives encourage their middle-aged husbands to have the procedure controversy topics of circumcision! Many non-Muslim adult males especially between the ages of eighteen (18) and forty (40) perform circumcision for esthetic reasons and also for enhancement and improvement of appearance.
4) Circumcision of boys lowers their risk of urinary tract infection (UTI) during infancy by about ten (10) times.
5) Circumcision gives some immunity to Sexually Transmitted Infections (STI).
THE ABSOLUTE INDICATIONS OF CIRCUMCISION ARE THE FOLLOWING:
A) PHIMOSIS The foreskin (prepuce) is too tight in older boys and men and the opening at its tip is too narrow.
1) In Phimosis, the prepuce cannot be retracted (pulled back) over the glans.
2) Phimosis may make it difficult to clean the glans thoroughly and, as a result, infection may occur under the foreskin, inside the prepuce (Balanitis) (see infra).
3) Phimosis causes painful erection.
4) Phimosis sometimes interferes with the normal flow of urine and may be accompanied by a weak urinary stream because of the pinhole size of the orifice and gradual ballooning of the foreskin when passing urine. Because of the raised back pressure, it will affect the urinary bladder, the ureters and the kidneys causing hydro-ureter and hydro-nephrosis with stagnation of the urine and infection especially in more deprived communities. Stagnation of urine encourage the formation of stones in the bladder and kidney.
5) In most cases, Phimosis is present at birth or becomes apparent during childhood, although it can occur at any age. By the time a boy is twelve months old, it is usually possible to retract the foreskin. If it is not possible to pull the boy’s foreskin (prepuce) over the glans by the age of five years, he has pathologic Phimosis which needs correction by surgical operation. Frequently, in adults, there will be pain, scarring, thickening and fissuring of the foreskin.
6) Phimosis will hide some very serious sexually transmitted infections (STI) such as shanker of Primary Syphilis, condyloma lata and condyloma acuminata.
7)Phimosis predisposes to Paraphimosis (see infra).
B) PARAPHIMOSIS a complication of phimosis. In this condition, it is not possible for the foreskin that has been retracted to be rolled forwards again. The condition needs immediate surgical intervention i.e. surgical operation, because it constricts the flow of blood to the glans, causing the area to become swollen and extremely painful.
C) CHRONIC BALANITIS is inflammation of the glans penis and foreskin. The foreskin becomes itchy, sore, inflamed with a foul odour and there may be a discharge and rash. Chronic Balanitis is due to bacterial infection, a fungal infection such as thrush (Candidiasis) or an allergic reaction. It may also be due to a sexually transmitted infection (STI) such as acute or chronic gonorrhoea, chlamydia, and other pus forming (pyogenic) bacterial infection. Furthermore, a tighter than normal foreskin (Phimosis) may increase the risk of infection by preventing effective cleansing of the glans and a foul smell. Men with Diabetes Mellitus are more susceptible to the condition cause and effects essay topics because their urine contains high levels of glucose which can encourage the growth of microorganisms. This leads to infection and inflammation at the opening of the urethra (the tube leading from the bladder to the outside of the body). Excessive use of antibiotics can increase the risk of a fungal infection by temporarily lowering the body’s natural defence mechanism against this type of infection. Children are especially vulnerable to Balanitis. It may also occur as a result of sensitivity of the penis to certain chemicals such as those found in some condoms, contraceptive creams, detergents and soaps.
OTHER REASONS OF CIRCUMCISION Many non-Muslims and non-Jewish families circumcise their boys not on religious grounds but for other purposes. I recall one of the British Christian Consultant Surgeons with whom I worked with in London circumcised his three children and claimed they become better lovers when married.
I also performed hundreds of circumcisions on non-Muslim adult males especially between the ages of eighteen (18) and forty (40) for esthetic reasons and also for enhancement and improvement of appearance. They were Hindus, Christians, Buddhist, Sikhs, etc. Furthermore, I circumcised several Gujaraties and Sindhies who passed middle-age. Some adults and seniors were brought to my surgical clinic by their wives for circumcision! Also, several young adults are referred to me by The Ministry of Labour Dubai for circumcision because they have converted to Islam.
I perform circumcisions in my out-patient private surgical clinic in Dubai for all age groups, from new born babies up to seniors. I also repair and amend complications of circumcisions which have been done elsewhere in childhood or later in life. All of the circumcisions that have been performed by myself have been done under local anaesthesia. Circumcision at any age group is a handicraft and it must not be entertained lightly, it needs skill, just as the gem cutter or jade carver and that is why in many countries, it is performed by the highly experienced Barbers and Male Nurses who have mastered the profession over many years.
IN MANY TENS OF YEARS OF MY ACTIVE SURGICAL PRACTICE, I do not recall any complication of a circumcision which has been done by Barbers or Male Nurses. On the other hand, I have encountered numerous cases of post-circumcision in children that have been done by medical establishments such as accidental amputation of the tip of the glans, excessive excision of the skin of the shaft of the penis and/or full excision (de-gloving) of the whole skin of the shaft. I have seen cases of stitching of the “zigzag” edges of the remaining skin of the shaft to the corona of the glans! These very serious malpractices are documented in my records with photographs. In some cases, I was able to rectify and amend the complications, while in the remaining it was not possible to repair the iatrogenic complications of the unfortunate patients.
IN MUSLIM FAMILIES, the procedure of circumcising infants and young boys are semi-public, accompanied with music, special food, and festivities for a few days. It is a usual practice for the wealthy families to invite, welcome and request the pleasure of circumcising the boys of the neighbourhood and nearby communities a few days in advance so that they can organize suitable clothing for the children, preferably loose-fitting, clean and white in colour (dishdasha).
HISTORY OF CIRCUMCISION IN ISLAM, some “fiqh” scholar state that circumcision is “sunnah”, others have considered it obligatory since the time of Prophet Abraham (peace be upon him). In Islam, it should be done before puberty, but generally occurs shortly after birth, during childhood and occasionally around puberty. In tens of years of my surgical practice, I have performed many hundreds of male circumcisions (nearly one thousand) in my out-patient surgical clinic in Dubai. The vast majority were under the age of three (3) year old boys. In the fiqh of Islam as mentioned above and before puberty, it is the sharp excision of the prepuce or part of it in such a way that the external urethral meatus (outside opening of the urethra) and part of the glans is showing. It is not necessary for the whole glans to be visible. The remaining skin should be loose and corrugated and looks like an accordion (a musical instrument) and not flat or tight.
HISTORY OF CIRCUMCISION IN JUDAISM, circumcision is considered a part of the Abrahamic Covenant (Genesis 17) and is performed when the infant is eight days old by a Mohel (a Hebrew scholar trained in the practice of brit milah, the “covenant of circumcision”).
HISTORY OF CIRCUMCISION IN OTHER RELIGIONS Christianity is included in the The Abrahamic Religions. Some Christians also circumcise their boys such as the Egyptian Coptics, the Ethiopian Orthodox Church and the Eritrean Orthodox Church.
In many parts of the world, circumcisions are still performed by the experienced Barbers or Male Nurses. Also, circumcision is common and popular in some predominantly Christian countries such as The United States of America, Canada and some African countries such as Cameroon, Democratic Republic of the Congo, Ethiopia, Eritrea, Ghana, Liberia, Nigeria and Kenya. It is also widely practiced in South Korea.However, it is not popular in Europe but may become commonplace in the future.
CONTRAINDICTIONS OF CIRCUMCISION
1)As mentioned above, Circumcision must not be performed if the surgeon is not familiar with the surgical operation of circumcision in babies, children and adults or if the operator lacks the knowledge of the surgical anatomy in youth, adult and seniors.
2) Circumcision must not be performed if the boy is suffering from a hereditary blood disorder such as Haemophilia because of the real risk of uncontrollable bleeding. In such cases, circumcision could be performed in a tertiary hospital where there are facilities to correct the hereditary blood disorder by the Haemotologist.
3) Circumcision must not be performed if the penis of the boy is abnormal in any way e.g. Chordee, Hypospadias and Epispadias, because the foreskin (prepuce) may be needed for plastic surgical repair.
4) Circumcision must be delayed in infants if, during pregnancy, the mother had been taking drugs that thin the blood and therefore increase the risk of bleeding, such as anticoagulants or anti-platelets such as Acetyl Salicylic acid (Aspirin). The surgeon waits until all such drugs have been eliminated from the new born baby’s circulation.
5) Circumcision must be delayed if the boy is febrile or if there is abnormal or extensive rash.
6) In my opinion, Circumcision of new born, infants and young boys must not be done under General Anaesthesia. Recently, I have seen in the news-paper the death of a two months old male infant because of the complication of General Anaesthesia!