Circumcision - to cut or not to cut

 

Glenn de Swardt

Circumcision has been around throughout the ages: it was practiced by the Ancient Egyptians 4000 years BC, and it formed part of the Mayan and Aztec cultures. Historically, circumcision has also occurred among tribes native to Australia, parts of Africa, Asia and the Americas. In some areas the practice was seen as a cure for homosexuality and impotence. The Book of Genesis requires Jewish male infants to be circumcised by the eighth day of life. Many male Muslim infants are circumcised, traditionally by the seventh day, because Muhammad was reportedly circumcised.

It is clear that circumcision has fulfilled various social functions, particularly religious and cultural. Such ritualised practices include a symbolic rite of passage from childhood to adulthood, a marker of ethnic identification and the imposition of social norms on an adolescent at an age when youthful rebellion might be anticipated.

A 2008 article by Peter Lavelle suggests that the foreskin fulfilled an evolutionary function which has now become redundant: before early man wore clothes, the “…foreskin protected the tip of the penis from dust, sand, insects and infections”. However, when men started wearing clothing, the foreskin became a liability: “Trapped inside clothes, themselves often dirty and sweaty, it became unhygienic.” Some sources state that circumcision is currently the most frequently performed surgical procedure in the world, in spite of falling rates of circumcision in many Western countries. Approximately 60% of boys in the USA are circumcised.

Circumcision has also taken on a socio-political tone, with advocates opposed to the practice insisting that it is nothing less than body mutilation and an infringement on human rights if it is conducted for non-therapeutic reasons. An Australian report, published in August 2009, questions the legality of non-consensual circumcision. Quoting a Children’s Commissioner, it states: “Laws protect girls from genital surgery but parents wanting to circumcise boys can go around willy-nilly chopping up bits of their sons.” The report also raises the question of doctors being liable for performing non-therapeutic circumcisions if a boy’s “genital autonomy is thought to have been infringed.” Anti-circumcision lobbyists also argue that removal of the foreskin reduces sexual pleasure.

Let’s not forget that a significant number of circumcisions are carried out under non-sterile, often even unhygienic conditions, by people not trained in medical procedures. And without anesthesia - ouch! Such circumcisions pose a significant health risk and we have all heard of young men dying to infections following traditional, non-medical circumcision. 

Over the past few years there has been an increasing focus on circumcision as a means to address the spread of HIV. Significantly, there is no data suggesting that circumcision protects gay men against HIV infection. Condoms must remain on top of our responsible-sex agenda.   

So let’s take a quick peek at dynamics related to circumcision in the queer community and also revert to easier terminology. This is about cut versus uncut, and immediately we notice a far more complex playing field. Many guys have preferences, even fetishes, related to cut or uncut penises. Significantly, Gaydar caters for this by allowing us to stipulate our preference. There are also websites and porn movies specifically featuring and showcasing ample foreskins. Docking – placing your foreskin over the head of your partner’s penis – is a popular practice in some circles. Significantly, a foreskin can also make a flaccid dick look larger.

Among gay men, the cut versus uncut issue is often about nothing less than aesthetics. Evidence yet again that gay men are fashion junkies and it seems that uncut penises are currently en vogue. Indeed, many men who have been cut have taken to what some call “foreskin reconstruction”, by stretching whatever skin remains on their penis using weights, straps or manual stretching.  

 

Dr Kevin Rebe

Circumcision is the surgical removal of the skin covering the head of the penis. It is a practice handed down through the ages and is performed for many reasons including, cultural, religious and sometimes medical conditions. Male circumcision has become a hot topic, based on reports that being circumcised lowers a man’s risk of becoming HIV positive. Before suggesting that you rush off to your nearest chop shop and put your cock on the (chopping) block, we need to consider the evidence.

Male circumcision is a sensitive (sorry) topic as it essentially involves amputating a body part and is considered by some as mutilating surgery. In context though, we live in a culture where the practice is common among Jews, Muslims and Xhosas and where other body “mutilating” activities such as piercing and tattooing are considered fashionable and desirable by many. 

No matter what your fetish, cutting some skin off the end of the penis sounds like a pretty bizarre way of reducing HIV risk. There is however a good explanation, what scientists like to call “biological plausibility”. The inner foreskin lacks a thick layer of keratin as is found on the rest of the penis, making it a more delicate surface. Also this surface has a high concentration of cells that are vulnerable to infection with HIV. Removing this surface lowers the number of cells around that are vulnerable to HIV infection, as well as toughening the barrier effect provided by keratinised skin. So in theory, circumcision really could lower the risk of becoming HIV positive.

The question of a protective effect of circumcision was addressed by three, good- quality medical trials conducted in Africa. These trials enrolled more than 10 000 straight men and clearly showed that the risk of acquiring HIV was reduced in men who were circumcised by about 50% over the projected two years of the studies. These studies and other evidence have lead to a pretty convincing medical conclusion that HIV risk can be lowered by circumcising men.

But what about men who have sex with men (MSM)? Here the evidence is unfortunately disappointing. A large collection of studies looking at this issue failed to show any protective effect from circumcision. One could suggest that many MSM may acquire HIV from receptive anal sex, a situation where circumcision would obviously have no influence. However, even when the authors looked at results among men who were exclusive tops, there was no protective effect. So for now, circumcised or not, if you enjoy sex with men, it still seems as if condom use remains one of the easiest ways of lowering HIV risk. 

So whatever your cultural and personal views about circumcision are, circumcision does lower the risk of HIV among straight men but seemingly not among MSM. The World Health Organisation recommends that male circumcision be rolled out by local governments as an add-on to their existing heterosexual HIV programmes. Contextualising this intervention is likely to be difficult and many factors such as human rights, ethics, safety and cultural appropriateness will all need to be carefully considered. Nevertheless, look out for the line of straight men queuing up at the local circumcision clinic near you.

 

Gary de Klerk

My busty friend Angela once had as her screensaver that infamous photograph of Brad Pitt – the naked poolside shot. Everyone who walked past her desk would comment and the most popular comment was “Oh, he’s cut!”

It was never “Brad’s quite a big boy” or “Jen’s a lucky gal” and this just highlights the fascination that everyone has with a very small piece of skin, or lack thereof.

As nothing is sacred in Hollywood or in cyberspace, many celebs have had their bits ’n bobs exposed to the world. A quick Google search comes up with 114 000 sites using the words circumcised celebrities and 118 000 using uncircumcised celebrities. That’s a lot of celebrity and either a lot of chopping or a lot of skin!

A quick peak at some of these sites revealed that Woody Allen, Princes Charles and Andrew, Christopher Atkins, Sam Neil, JFK, Woody Harrelson, Richard Nixon, Tom Cruise, Brad Pitt, Bruce Willis, Kevin Bacon, Justin Timberlake, Eminem and Jake Gyllenhaal are (or were) cut while Daniel Craig, Ewan McGregor, Ralph and Joseph Fiennes, Hugh Grant, Hugh Jackman, Daniel Radcliffe, Colin Farrell, Christian Bale, Gael Garcia Bernal, Wentworth Miller, Jude Law, Guy Ritchie, Dominic Purcell, Mick Jagger, James Blunt, Sting, Robbie Williams, Ronan Keating, Gareth Gates, Mika, Will Young, Elvis Presley, Ricky Martin, Michael Jackson, Princes William and Harry, Leonardo DiCaprio, Keanu Reeves and Will Smith are uncut.