Circumcision (ser-kum-SI-zhun), the surgical removal of the foreskin (I Figure 4.9), is widely practiced throughout the world for religious, ritual, or health reasons. About 80% of men in the United States are circumcised (Rabin, 2010). The prevalence of circumcision in the United States, the only nation where nonreligious circumcisions occur in large numbers, has declined steadily over the last four decades (Ahmed & Ellsworth, 2012; Rabin, 2010). However, it is still a relatively common procedure experienced by a slight majority of U. S. newborn males. A recent nationwide survey of American hospitals revealed that 54.7% of male newborns were circumcised (Zhang et al., 2011).
Male circumcision is legal in the vast majority of the world’s nations, although mutilation of female genitals is banned in most Western countries. One noteworthy exception is Finland, which bans male circumcision but does allow exceptions for religious reasons (Evans et al., 2011). A recent vote on a Massachusetts ballot measure to outlaw circumcision in this state failed (Evans et al., 2011). However, efforts to outlaw male circumcision within areas of the United States continue. A recent example of this legal
‘Intactivists" Attempt to Criminalize Infant Circumcision in San Francisco
push occurred in San Francisco as discussed in the Sex and Politics feature entitled "‘Intactivists’ Attempt to Criminalize Infant Circumcision in San Francisco."
Proponents of routine circumcision have maintained that the procedure has significant health benefits. The area under the foreskin, if not routinely cleaned, can harbor a variety of infection-causing organisms. Numerous studies indicate that circumcision decreases the incidence of childhood urinary tract infections, adult penile cancer, and genital wart infections (Klausner & Morris, 2012; Tobian & Gray, 2012). There is also strong evidence that circumcision provides increased protection against HIV, the virus that causes AIDS. (See Chapter 15 for a discussion of the relationship between circumcision status and vulnerability to HIV infection.)
Opponents of routine circumcision have, with increasing frequency, leveled several arguments against it. First, the foreskin could serve some important function yet to be determined. Second, some investigators have expressed concern that sexual function may be altered by excising the foreskin; we consider this question shortly. Finally, some health professionals think that performing this procedure on a newborn is unnecessarily traumatic and invites possible surgical complications.
Despite recommendations for the use of pain relief analgesia for circumcision issued by the American Academy of Pediatrics and the American Society of Anesthesiologists, less than half the number of infant boys undergoing this procedure receive any analgesia at all (Boschert, 2004; Horton, 2005). However, infants undergoing circumcision without analgesia feel and respond to pain (Boschert, 2004; Van Howe & Svoboda, 2008). Some health risks of circumcision include hemorrhage, infections, mutilation, shock, and psychological trauma (Ahmed & Ellsworth, 2012; Meldrum & Rink, 2005).
Because the circumcision issue has so many pros and cons, it is not surprising that the medical profession in the United States has been somewhat indecisive in its position regarding circumcision. In 1989 the American Academy of Pediatrics (AAP) assumed a neutral stance by suggesting that circumcision has both medical advantages and some risks (Schoen et al., 1989). In 1999 the AAP modified its position on circumcision by shifting from neutrality to a position of moderate opposition to this medical procedure (Task Force on Circumcision, 1999), a stance it reaffirmed in 2000 and 2005. In its most recent statement, the AAP concluded that while there are potential medical benefits associated with circumcision, the clinical data are not sufficient to recommend routine circumcision of newborns (Ahmed & Ellsworth, 2012; Dickerman, 2007).
Clearly, the debate about the potential health benefits of infant circumcision will continue, and future editions of this textbook may present still other modifications of
Male Sexual Anatomy and Physiology
protection against the transmission of sexually transmitted infections for both partners. Other strategies for preventing transmission of infections are described in Chapter 15.
Some sexual gadgets can also be hazardous to penile health. For example, a "cock ring" (a tight-fitting ring that encircles the base of the penis) may accomplish its intended purpose of sustaining erections, but it can also destroy penile tissue by cutting off the blood supply. In the past, sexually oriented magazines published testimonials attesting to the pleasure of masturbating with a vacuum cleaner. This is not a good idea! Research suggests that severe penile injuries (including decapitation of the glans) resulting from masturbating with vacuum cleaners and electric brooms are much more common than reported (Benson, 1985; Grisell, 1988).
On rare occasions, the penis can be fractured (Morey, 2012). This injury involves a rupture of the cavernous bodies when the penis is erect. This injury most commonly occurs during coitus. A student reported his encounter with this painful injury:
I was having intercourse with my girlfriend in a sitting position. She was straddling my legs using the arms of the chair and her legs to move her body up and down on my penis. In the heat of passion, she raised up a little too far, and I slipped out. She sat back down hard, expecting me to repenetrate her. Unfortunately, I was off target and all of her weight came down on my penis. I heard a cracking sound and experienced excruciating pain. I bled quite a bit inside my penis, and I was real sore for quite a long time. (Authors’ files)
This account suggests that taking precautions during coitus is wise. This injury usually happens in the heat of passion and often involves putting too much weight on the penis when attempting to gain or regain vaginal penetration. When the woman is on top, the risk increases. Communicating the need to go slow at these times can avert a painful injury. Treatment of penile fractures varies from splinting and ice packs to surgery. Most men injured in this fashion regain normal sexual function.