CIRCUMCISION

DEFINITION

The surgical removal of the foreskin of the penis in a male or the prepuce of a clitoris in a female.


A typical circumcision procedure involves the following steps: Figure A: The surgeon makes an incision around the foreskin.
Figure B: The foreskin is then freed from the skin covering the penile shaft. Figure C: The surgeon cuts the foreskin to the initial
incision, lifting the foreskin from the mucous membrane. Figure D: The surgeon sutures the top edge of the skin that covers the penile
shaft and the mucous membrane.


DESCRIPTION
The foreskin of the penis safeguards the sensitivity of the glans and shields it from irritation by urine, feces, and foreign
materials. It also protects the urinary opening against infection and accidental injury.
Despite a long-standing belief that infants do not experience serious pain from circumcision, most authorities in the early 2000s
believe that some form of local anesthesia is necessary. The physician injects local anesthesia at the base of the penis or under the skin
around the penis (subcutaneous ring block). Both anesthetics block key nerves. EMLA cream, a topical formula of several anesthetics,
can also be used.
In circumcision of infant boys, the foreskin is pulled tightly into a specially designed clamp. Pressure is applied and the
foreskin pulls away from the broadened tip of the penis. Pressure from the clamp stops bleeding from blood vessels that supplied the
foreskin. In older boys or adults, an incision is made around the base of the foreskin, the foreskin is pulled back, and then it is cut
away from the tip of the penis. Stitches are usually used to close the skin edges.
After circumcision, the wound should be washed daily. An antibiotic ointment or petroleum jelly may be applied to the site. If
there is an incision, a wound dressing will be present and should be changed each time the diaper is changed. Sometimes a plastic ring
is used instead of a bandage. The ring usually falls off in five to eight days. The penis heals in seven to 10 days.
Infants who undergo circumcision may be fussy for some hours afterward, so parents should be prepared for crying, feeding
problems, and sleep problems. Generally these go away within a day. In older boys, the penis may be painful, but the pain goes away
gradually. A topical anesthetic ointment or spray may be used to relieve this temporary discomfort. There may also be a bruise on the
penis, which typically goes away with no particular attention.
The clitoral prepuce of infant girls is drawn up and away from the body before being removed. In this procedure, the clitoris is
also frequently removed. The vaginal opening may be partially closed. Healing is slower in girls than for boys. Most female
circumcisions are performed under unhygienic conditions using primitive, homemade implement such as rusty razor blades and
thorns. Infections are common.


PURPOSE
In the United States, circumcision in infant boys is performed for social, medical, cultural, or religious reasons. Once a routine
operation urged by pediatricians and obstetricians for newborns in the middle of the twentieth century, circumcision has become an
elective option that parents make for their sons on an individual basis. Families who practice Judaism or Islam may select to have their
sons circumcised as a religious practice. Others may elect circumcision for medical reasons.
Female circumcision (also known as female genital mutilation) is usually performed for cultural and social reasons by family members
and others who are not members of the medical profession, with no anesthesia. Not only is the prepuce of the clitoris removed but
often the vaginal opening is sewn to make it smaller. This practice is supposed to ensure the virginity of a bride on her wedding day. It
also prevents the woman from achieving sexual pleasure during coitus. Female circumcision is illegal in most countries of the world.
It is considered by most people to be a human rights violation.
Though the incidence of male circumcision has decreased from 90 percent in 1979 to 60 percent in 2002, it is still the most
common surgical procedure in the United States. Circumcision rates are much lower for the rest of the industrialized world. In Britain,
it is only performed for religious practices or to correct a specific medical condition of the penis.
Parents may choose circumcision because they believe the surgery protects against infections of the urinary tract and the foreskin,
prevents cancer , lowers the risk of getting sexually transmitted diseases , and prevents phimosis (a tightening of the foreskin that may
close the opening of the penis). Though studies indicate that uncircumcised boys under the age of five are 20 times more likely than
circumcised boys to have urinary tract infections (UTIs), the rate of incidence of UTIs is quite low. There are also indications that
circumcised men are less likely to suffer from penile cancer, inflammation of the penis, or have many sexually transmitted diseases.
Here again, the rate of incidence is low. Good hygiene usually prevents most infections of the penis. Phimosis and penile cancer are
very rare, even in men who have not been circumcised. Education and good safe-sex practices can prevent sexually transmitted
diseases in ways that a surgical procedure cannot because these are diseases acquired through risky behaviors.
With these factors in mind, the American Academy of Pediatrics issued a policy pronouncement that states although there is existing
scientific evidence that support the medical benefits of circumcision, the benefits are not strong enough to recommended circumcision
as a routine practice.


RISKS
Complications following newborn circumcision appear in one out of every 500 procedures. Most complications are minor.
Bleeding occurs in half of the complications and is usually easy to control. Infections are rare and present with fever and signs of
inflammation. Uneven healing of skin may lead to laterally curving erections in adulthood.
There may be injuries to the body of the penis that may be difficult to repair. In 2000, there were reports that the surgical
clamps used in circumcision were at fault in over 100 injuries reported between July 1996 and January 2000. In nearly all cases, the
clamps were assumed to be in working order but had been repaired with replacement parts that were not of the manufacturer's
specifications. Physicians were urged to inspect the clamps before use and ensure that their dimensions fit the infant's body parts.
Circumcised girls have a high incidence of infertility and sexual dysfunction as adults. Most experience infections immediately after
the procedure.


NORMAL RESULTS
Among boys who are circumcised, most have no penile, urologic, or sexual dysfunction as adults. A majority of girls who are
circumcised experience urologic, reproductive, and sexual dysfunction as adults.


KEY TERMS
Foreskin A covering fold of skin over the tip of the penis.
Glans penis The cone-shaped tip of the penis.
Hernia A rupture in the wall of a body cavity, through which an organ may protrude.
Hydrocele A collection of fluid between two layers of tissue surrounding the testicle; the most common cause of painless
scrotal swelling.
Hypospadias A congenital abnormality of the penis in which the urethral opening is located on the underside of the penis
rather than at its tip.
Phimosis A tightening of the foreskin that may close the opening of the penis.
Prepuce A fold of skin, such as the foreskin of the penis or the skin that surrounds the clitoris.


PARENTERAL CONCERN
The only medical justification for male circumcision is to correct a health problem or condition. There are no medical
justifications for female circumcision. The only other justification for male or female circumcision is religious or cultural. Leaders of
the vast majority of religions throughout the world condemn any form of female circumcision.


Read more: Circumcision - Definition, Purpose, Description, Risks, Normal
results http://www.healthofchildren.com/C/Circumcision.html#ixzz1L7TfvJUC


ADVANTAGES OF CIRCUMCISION

1. Full penis length and circumference. The "prepuce" (foreskin) constitutes 50% or more of the skin system of the penis. If
unfolded and spread flat, the average adult foreskin measures 60-90 square cm (10-14 square inches) or about the size of an index
card.

2. Protection. The sleeve of tissue known as the foreskin normally covers the glans and protects it from abrasion, drying, callusing
(keratinization), and environmental contaminants. The glans is intended by nature to be a protected internal organ, like the female
clitoris. The effect of an exposed glans and resulting keratinization on human sexual response has never been studied. Increasing
reports by circumcised men indicate that keratinization causes a loss of sexual sensation, pleasure and fulfillment.

3. Ridged bands. The inner foreskin contains bands of densely innervated, sexually responsive tissue. They constitute a primary
erogenous zone of the human penis and are important for realizing the fullness and intensity of sexual response.

4. Gliding action. The foreskin is the only moving part of the penis. During any sexual activity, the foreskin and glans work in
unison; their mutual interaction creates a complete sexual response. In heterosexual intercourse, the non-abrasive gliding of the penis
in and out of itself within the vagina facilitates smooth and pleasurable intercourse for both partners. Without this gliding action, the
corona of the circumcised penis can function as a one-way valve, dragging vaginal lubricants out into the drying air and making
artificial lubricants essential for non-painful intercourse.

5. Specialized sensory tissue. In addition to the "ridged bands" mentioned above, thousands of coiled fine-touch receptors
(Meissners corpuscles) constitute the most important sensory component of the penis. The foreskin contains branches of the dorsal
nerve and between 10,000 and 20,000 specialized erotogenic nerve endings of several types, which are capable of sensing slight
motion and stretch, subtle changes in temperature, and fine gradations in texture.

6. The frenulum. This is a highly nerve-laden web of tissue that tethers the inner foreskin to the underside of the glans. It is similar to
the frenula found under the tongue, the upper lip and the clitoral hood (female foreskin). For many intact men, the penile frenulum is a
male "G-spot" that is highly pleasurable when repeatedly stretched and relaxed during sexual activity. Depending on the surgical
method used, the frenulum is partially to completely destroyed by circumcision.

7. Proper blood flow. The foreskin contains several feet of blood vessels, including the frenular artery and branches of the dorsal
artery. The loss of this rich vascularization interrupts normal blood flow to the shaft and glans of the penis, damaging the natural
function of the penis and altering its development.

8. Immunological defense. The soft mucosa of the inner foreskin produces plasma cells, which secrete immunoglobulin antibodies,
and antibacterial and antiviral proteins, such as the pathogen-killing enzyme called lysozyme. All of the human mucosa (the linings of
the mouth, eyelids, vagina, foreskin and anus) are the body's first line of defense against disease. This benefit of the foreskin could be
one possible explanation why intact men are at lower risk of chlamydia and other sexually transmitted diseases.

9. Langerhans cells. These specialized epithelial cells are a component of the immune system and may play a role in protecting the
penis from sexually transmitted infections such as HIV (AIDS).

10. Proper lymph flow. The foreskin contains lymphatic vessels, which are necessary for proper lymph flow and immunological
functioning.

11. Estrogen receptors. The foreskin contains estrogen receptors, whose purpose is not yet fully understood and needs further study.

12. Apocrine glands. These glands produce pheromones, natures invisible yet compelling signals to potential sexual partners. The
effect of their absence on human sexual behavior has never been studied.

13. Sebaceous glands. The oils produced by these glands lubricate and moisturize the foreskin and glans, so that the two structures
function together smoothly.

14. Dartos fascia. This is a smooth muscle sheath that underlies the scrotum, the entire penis and the tip of the foreskin. It is necessary
for proper temperature regulation of the genitals (causing these structures to elongate in the heat and shrink in the cold).
Approximately half of the Dartos fascia is destroyed by circumcision.

15. Natural texture and coloration of the glans. In the intact penis, the glans normally appears moist, shiney, and pinkish-red to dark
purple. These visual cues often attract and excite a sexual partner. The glans of a circumcised penis is dry, rough and often light pink
to bluish-gray in color.

16. Zero risk of serious infection or surgical injury. Unfortunate boys who suffer botched circumcisions lose part or their entire
penis from surgical mishap or subsequent infection. They are often "sexually reassigned" by castration and "transgender surgery."
They are relegated to a life of hormone therapy and are compelled to live their lives as pseudo-females, the success of which has never
been fully assessed.

17. Zero risk of death from surgery. Every year boy dies from the complications of circumcision, a fact that the American
circumcision industry ignores, obscures, or downplays.

18. Zero risk of delayed or diminished maternal bonding. Circumcision, even if anesthesia is used, causes unavoidable operative
trauma and post-operative pain that has been shown to disrupt bonding with the mother, which in turn interferes with the first
developmental task of every human, that of trust (trust in human contact, in personal safety, etc).

19. Electromagnetic "cross-communication." Anecdotal reports suggest that, without the mucosa of its foreskin, the penis lacks the
capacity for the subtle electromagentic energy transfer that occurs during contact between two mucous membranes (the vaginal walls
and the exposed inner lining of the foreskin). Such contact contributes to the full experience of sexual pleasure.

20. The foreskin is necessary for optimal health and well-being of the male, as well as contributing to fulfilment
in his sexual relationships.
http://www.noharmm.org/advantage.htm
DISADVANTAGES OF CIRCUMCISION

a. Unnecessary Operation.
If performed in the absence of essential indications, or as a routine procedure, it may be an unnecessary operation. Some men
who were circumcised in infancy feel that they have been mutilated and deprived of an important structure without their consent and
they are just as obsessional about this as those who clamour to be circumcised. On the other hand feelings of regret or resentment are
not engendered in men who are coerced into having the operation when it is not essential (e.g. going to sea or request of fiance) and
they are just as pleased as those who are done for say phimosis.

b. Theoretical Risks.
As with any other operation there are theoretical risks of bleeding, infection, surgical error and death under the anaesthetic.
Out-of-date statistics and 'horror' stories from the past are still quoted even though modern infant circumcision with a 'Plastibell' under
'Ketalar' anaesthesia is devoid of these complications. Adults and adolescents can be circumcised using only local anaesthesia so as to
again eliminate the risks.

c. Psychological Harm.
It has been suggested that the operation may cause psychological harm if it is performed at an unsuitable age. It may well be
that separation from parents and not the operation is the factor because I have never been able to find any evidence of psychological
trauma. Also if circumcision is not explained the child may be disturbed to find he is different from his brothers and friends. Life may
also be made miserable by remarks from his uncircumcised school-fellows in the showers about the shorn state of his organ.
Conversely in a society where infant circumcision is the rule it is the uncircumcised scholar who is made to feel inferior by his class-
mates.

d. Meatitis.
If an uncircumcised infant gets a nappy (diaper) rash his foreskin becomes inflamed but his glans is protected. In the
circumcised infant if the glans becomes involved, a sore (meatitis) develops at the opening of the water pipe (meatus) and passing
water is painful. The meatus soon heals, occasionally there is slight scarring and very rarely the opening may have to be stretched.
Napkin rash is caused by urine in sodden napkins decomposing and releasing ammonia so the condition can be prevented by proper
hygiene. Modern high-absorbancy disposable nappies also make the risk negligible. The risk of meatitis, which is the most common
complication of circumcision in infancy, is advanced as the main argument against routine circumcision but little mention is made of
the fact that balanitis in the uncircumcised male later in life is the most common cause of meatal scarring. Severe inflammation of the
foreskin due to nappy rash can result in phimosis or balanitis and thus in any case lead to a need for circumcision.

e. Loss of Sensitivity.
A number of men complain that a loss of sensitivity or dryness of the glans following circumcision has spoiled their sex lives.
At the other extreme are those who seek the operation to achieve these changes in the glans to enhance their sex lives. These
complaints are similar to the mutilation obsession because men with naturally short foreskins are not troubled by having the glans
exposed.

*ALLEGED DISADVANTAGES
There are also a couple of alleged disadvantages which are just 'old wives tales':-

f. Prevention of Masturbation.
Masturbation is prevented. This is definitely untrue but after circumcision the technique may have to be changed and a little
lubricant may be initially required.

g. Pain.
Patients are in agony for weeks after the operation. There is obviously some discomfort for a few days and the scar is a bit
tender for a couple of weeks but that is about all. If there is active balanitis or the prepuce has been adherent to the glans then there is
more post-operative discomfort. It is also untrue that the exposed glans rubbing against clothing is uncomfortable.

http://www.circinfo.com/guide_to_decision/disadvantages.html

Submitted to:
MRS. CECILIA DACANAY


Submitted by:

GROUP 2
BARROGA, Giliorenz
BAUTISTA, Jerald Angelo
CATANEDA, Mark
MIRANDA, Kimberly
SOLOMON, Kennette Cyril
ZULUETA, Erika