Over 90% of boys in the United States are circumcised. On the other side of the spectrum, in many countries and cultures, it isn't practiced at all. There are numerous questions surrounding circumcision, including religious, socio/cultural, or primacy ideologies. Should the procedure be done at birth because of the benefits that it may provide? Is it really medically necessary or can it be considered a type of child abuse? Does good personal hygiene offer all the advantages of circumcision, but without surgery? Should it be performed in order to maintain a cultural image and avoid being "different?" Does circumcision impact a boy's/man's self-esteem? Finally, what are the sexual implications of circumcision?

The issue is so hotly debated that lobby groups exist. One anti-circumcision group known as NOCIRC lobbies against male circumcision, and goes so far as to compare the negative impact of male circumcision to female circumcision (removal of the clitoris). Another called UNCIRC, promotes the reversal of circumcision through plastic surgery or by stretching the loose skin on the shaft of the retracted penis. Yet many people consider non-circumcism a cause for embarrassment and anxiety. Not to mention the fact that it is unhealthy, they say.

This much is obvious: circumcision is a personal choice and, depending on a person's perspective and beliefs, can have positive or negative consequences.

What Exactly Is Circumcision?
Circumcision is the removal of a piece of tissue called the foreskin, or prepuce, that covers the head (glans) of the penis. Generally, no anesthesia is used during the procedure, which is usually performed shortly after birth. Some doctors will use local anesthesia, but this is by no means common. Anesthetic injections will make the penis swell, causing pain, and making the surgery more difficult. Both injections and topical anesthetic creams can be dangerous. General anesthesia is never used on young babies because of the risk of breathing problems.

On the flip side, many people are now taking into consideration the amount of trauma the baby undergoes and are in strong support of using local anesthesia to avoid undue pain to the infant during the surgery.

There is no medical indication for circumcision; it traces back to political and religious beliefs. Today, it is generally performed during the first 48 hours after birth

Circumcised men are also less likely to contract certain sexually transmitted diseases (STDs) including HIV. Male circumcision reduces the risk of HIV-infection by at least 50 percent

Smegma? What Motivates Parents?

The choice on the part of parents to have their son circumcised may have to do with hygiene or appearance, or may have to do with "being like dad," than anything else.

Circumcision has been advocated because of physical benefits such as better genital hygiene, the elimination of phimosis (inability to retract the foreskin), and prevention of penile cancer. Circumcision has also been touted as a way to prevent the development of smegma (a secretion that collects under the prepuce), annoying itching under the fold of the foreskin, and potential impotence later in life.

However, from a physiological point of view, the foreskin plays an integral part in protection and sexual function. Here are some of its functions:

1. To cover and bond with the synechia so as to permit the development of the mucosal surface of the glans and inner foreskin

2. To protect the infant's glans from feces and ammonia in diapers

3. To protect the glans from friction and abrasion throughout life

4. To keep the glans moisturized and soft with emollient oils 5. To lubricate the glans

6. To coat the glans with a waxy protective substance

7. To provide sufficient skin to cover an erection by unfolding

8. To provide an aid to masturbation and foreplay

9. To serve as an aid to penetration
10. To reduce friction and chafing during intercourse

11. To serve as erogenous tissue because of its rich supply of erogenous receptors

12. To contact and stimulate the G-spot of the female partner

Increased Infection Risk for Uncircumcised?

There was a trend away from circumcision in the 1970s when it was felt that there were no valid medical reasons for the procedure, but new studies show medical benefits throughout a man's life. These benefits include less penile infection and urological problems, a decrease in the incidence of urinary tract infections and problems with erections (especially at puberty), and a decrease in penile cancer. Circumcised men are also less likely to contract certain sexually transmitted diseases (STDs) such as syphilis, gonorrhea, chancroid, papillomavirus, chlamydia, non-gonoccocal urethritis, herpes, and HIV. Male circumcision reduces the risk of HIV-infection by at least 50 percent. Female partners of uncircumcised men may be at an increased risk for cervical cancer.

It is thought that the skin of the circumcised penis is stronger and more resistant, while the moist skin under the folds of the uncircumcised penis permits bacteria to grow, and the accumulation of body secretion and urine, causing smegma to develop. In addition, the thinness of the skin makes it more accessible to trauma during sexual intercourse, with a higher likelihood to permit the entrance of infectious agents.

Are There Sexual Differences?

Does circumcision affect a man's ability to enjoy sexual sensation? According to men circumcised as adults, the sensitivity during sexual intercourse is the same as before circumcision. Masters & Johnson found no difference in sexual performance. The National Health and Social Life Survey found that uncircumcised men were more likely to experience sexual dysfunction, received more fellatio (oral sex), and masturbated more.

Are There Psychological Consequences?

Many studies have linked post-traumatic stress disorder (PTSD) and a predisposition to violence to men who have been circumcised. Patients have been known, under hypnosis, to remember their birth and the traumatic event associated with circumcision. It has also been reported that traumatic and/or painful procedures in the peri-natal period seem to cause a greater propensity to suicide. The upshot of these studies is that more research is needed in order to fully ascertain the extent of long-term trauma from circumcision.

No psychological consequences have been demonstrated concerning those who are uncircumcised. Due to the high percentage of boys in this country who are circumcised, though, some uncircumcised boys suffer self-esteem issues as they consider themselves "different" rather than part of the "norm." If a child is uncomfortable with being uncircumcised, they can always have it performed at a later date. The operation can be done as an outpatient procedure and recuperation takes about 10 days to two weeks.

Further research is required to determine the effects of circumcision on a boy's emotional well being as well as his socialization within the context of his family dynamic, society, religion, and culture. But one thing's for sure--as a parent, making a decision on the issue of circumcision is not always easy. Personal beliefs and values must be taken into consideration, as well as a number of physiological/health concerns within the parameters of our busy and stress-filled lifestyles.