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All about circumcision
CIRCUMCISION - An Overview
by Geoffrey Francis
CIRCUMCISION - the surgical removal of the prepuce, or
foreskin, from the penis - is one of the oldest operations
known to man and, worldwide, is the most commonly performed
operation. It has been practiced through all ages by both
primitive tribes and great civilisations and is widespread
across most of the globe.
Nobody is able to give conclusive reasons for the origins
and the widespread nature of this custom. Many theories have
been propounded, of which at least parts must be correct, but
as yet there is no real explanation for the desire by so many
peoples to modify the natural appearance of the male genital
organ.
The one thing on which all serious anthropologists are
agreed is that the practice of Circumcision grew up totally
independently in many different places. Some tribes are known
to have adopted it from others, but there is no one common
source of the practice.
In the modern world Circumcision is the norm amongst all
Jewish and Moslem religious groups; most African tribes; the
Australian Aborigines; Polynesians; and all English speaking
peoples except the United Kingdom. It has gained no stronghold
amongst Germanic; Hispanic and Nordic peoples; nor in Asia
except amongst Moslems and Jews.
Circumcision has been used variously as a mark of a slave
(or captured people); as a royal badge; as a tribal or
religious initiation; as a medical prophylactic; and as a
punishment for various wrongdoing.
It is well known that the ancient Egyptians performed
Circumcision initially as a mark of Royal status. Pictures in
the Pyramids clearly show Royal teenagers submitting to the
operation. Over a period of time the upper classes and then
eventually the common people adopted the Royal custom and had
their sons Circumcised. Informed scholars now accept that the
Jewish prescription of universal infant Circumcision is based
on having learnt the practice from their Egyptian neighbours.
It is interesting to note that both Jews and Moslems hold
two common tenets in their religions, both of which actually
are based on sound medical reasoning. Both practice
Circumcision and both prohibit the eating of Pork meat. In the
desert conditions where these great religions started, both
practices are desirable. Pork deteriorates fastest of all
meats in desert conditions and so a ban on eating it prevents
much unnecessary food poisoning. Water is scarce in the desert
and cannot be wasted on frequent washing of the genitals. A
foreskin tends to harbour not only smegma, but also sand which
gives rise to irritation and inflammation of the penis. Thus
Circumcision is a desirable action to prevent problems. Many
British troops found this out the hard way during the North
African desert campaigns in World War 2.
Circumcision is performed at widely varying ages in
different parts of the world. Naturally, those operations
which are performed as a result of serious medical necessity
will be done at whatever age the problem shows itself - from a
few months to old age. The Jews, in accordance with the
Covenant, perform the operation on the eighth day of a boy's
life. The strictest Moslem groups wait until a boy's
thirteenth birthday before Circumcising him; whilst other
Moslems perform the operation variously during the first;
sixth; eighth and eleventh years of a boy's life, or at any
other convenient time in between.
In general the age for 'tribal' Circumcision is at or
around puberty. In most cases it acts as a test of courage as
a lad passes from being a mere boy to being a man with the
obligations of hunting and fighting to feed and protect the
tribe.
There are numerous methods used to perform Circumcision -
most of them developed in Western nations within the last
hundred years. The ancient Egyptians tied a cord around the
outstretched foreskin and then sliced it off with a knife. The
traditional Jewish method involves pulling the foreskin through
a slit in a lyre shaped metal shield and then slicing off the
protruding skin using the shield as a cutting guide. A
relatively late addition to the Jewish rite makes it necessary
to then tear the inner lining along its dorsal (upper) surface
so as to make any form of foreskin restoration virtually
impossible.
A modern device, much favoured by American pediatricians
for neo-natal Circumcision, is the Plastibell. This is a clear
plastic bell with a groove around its rim and a large hole at
the top. A snap-off handle initially protrudes from the top of
the bell. In use, the foreskin is first slit along its dorsal
surface and folded back to expose the glans. The bell is
placed over the glans, which is positioned so that the meatus
(piss slit) protrudes through the hole in the top of the bell.
The foreskin is folded back over the bell and temporarily
clamped to the handle whilst surgical thread is placed over the
foreskin above the rim of the bell and tied very tightly into
the groove. The loose flaps of foreskin are roughly cut off
and the handle of the bell snapped off, leaving the bell
clamped to the glans by the constricted foreskin.
The tight thread causes the blood supply to the remaining
foreskin to be stopped, thus the remnant dies and falls off.
The tight thread kills nerve endings immediately below it,
seals the blood vessels and causes the edges of skin to fuse
together. Thus no stitching is needed and the boy feels little
or no pain from having the bell clamped on his penis. The
Plastibell is so easy to use that the operator doesn't have to
acquire much by way of surgical skill - all one needs to be
able to do is tie a secure surgical knot - even a nurse can
perform a Plastibell Circumcision. The major disadvantage is
that the bell must not be pulled to tightly onto the glans and
hence the final Circumcision usually leaves a considerable
amount of untidy loose skin on the penis. Plastibells are
available in several sizes and can be used on most boys up to
the age of 12, but are best used only on infants and toddlers.
For older children and adults the two preferred methods are
totally freehand cutting and the Gomco Clamp. Freehand cutting
can give the most perfect aesthetic and practical results since
the surgeon has total control of the operation at all times.
However, it does presuppose that the surgeon is highly skilled
in performing Circumcisions and that the patient is either
totally unconscious or totally relaxed and cooperative. With a
less than perfect surgeon, the results of freehand cutting can
be the most ugly and awful mess imaginable.
The Gomco clamp is a good compromise solution and can be
used on young boys, teenagers and adults with equal ease.
There are no problems like those posed by a tightly fitted
Plastibell since the clamp is in place for only a few minutes
whilst the actual surgery takes place. The Gomco Clamp
consists of four stainless steel parts, which are deceptively
simple in practice but considerably harder to describe.
Firstly there is a baseplate which has a tapered hole at one
end, a threaded stud at the other and, near the hole, a
transverse groove with a rounded bottom. The second major part
is a bell, available in different internal sizes to suit the
size of the glans, which fits through the hole in the
baseplate. On top of the bell is a 'T' shaped extension under
which the third portion can hook.
The third part of the clamp is a bar with a semi-arch at
one end. This arch has a pair of hooks to fit under the 'T'
piece of the bell. At the base of the arch, the underside of
this part has a half-round protrusion which will fit into the
groove of the baseplate and allow it to rock about that axis.
The far end has a hole which fits over the threaded stud of the
baseplate. The final part is a circular nut which fit over the
'hook' part and screws down on the stud.
In use, the foreskin is slit dorsally and the bell placed
over the glans. The foreskin is pulled forward again and the
bell and foreskin passed through the hole in the baseplate.
The hook part is placed under the 'T' piece of the bell and
clamped gently with the nut. The foreskin is now pulled
forward between the bell and baseplate until the point at which
the cutting is to take place has come in front of the
baseplate. The nut is then tightened to clamp the foreskin
there. The surgeon waits for the clamping action to seal the
blood vessels and then slices the foreskin off with a scalpel,
using the baseplate as a cutting guide. The clamp falls off
and the resulting cut edges are stitched together. Although
the Gomco clamp requires considerable surgical skill for
successful use, most surgeons can produce consistently better
results with it than they would with freehand operations.
This article has necessarily been a brief overview only and
has left many matters untouched. If there is sufficient
interest then further articles may appear in future
newsletters. The author welcomes discussion, facts and
statistics relating to circumcision in all parts of the world.
Feedback can be via the newsletter or in the form of articles
on STUDS or personal mail to the author.
Copyright (C) 1989 Geoffrey Francis and STUDS Newsletter
________________________________________________________________________________
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