Benefits of male circumcision

When I received a phone call from a consultant obstetrician and gynaecologist who is in private practice, I thought it was a call for assistance to resuscitate an asphyxiated baby; but I was wrong. It was meant to inform me of a dying male neonate bleeding from complications of circumcision.

After all the interventions to stop the bleeding proved abortive, the doctor decided to refer the patient via a phone call due to the urgency involved. The baby and the parents were well received, as I had prepared for them, based on all the information from the telephone conversation between me and the obstetrician.

Immediately they arrived, I placed the baby on admission in the paediatric centre where I was working. We nursed him by placing him head down in order to maintain blood flow to the brain. We also placed him on fluid and a drug to control the bleeding.

We obtained his blood sample, which we took to the laboratory for urgent blood level, group and cross-matching in order to enable us give him a fresh blood.

We discovered that the patient’s packed cell volume (blood level) was 21 per cent, whereas the normal level for that age group is 45-54. We counselled the parents on the need for urgent blood transfusion, but their religion forbade it. They refused blood transfusion and rather asked for treatment based on blood substitute. I was left helpless because it was night time.

The baby survived without the blood, while the blood substitute did not come till the following day. After this incidence, I made it a point of duty to tell every parent whose son is going for circumcision the risk of bleeding as a complication of circumcision and the need to be prepared.

Why circumcise?

The event also made me to ponder the benefits of male circumcision: Is it really worth the pain and the stress on the nursing mother?

Circumcision is a religious or cultural ritual for many Jewish and Islamic families, as well as certain tribes in Africa. It can also be a matter of family tradition, personal hygiene or preventive health care. It is probably the world’s most widely performed procedure.

Medical specialists in western world believe that there is no medical reason for routine circumcision of newborn male infants as it is done in this part of the world. However, the World Health Organisation recommends circumcision as part of a comprehensive HIV-prevention programme in areas with endemic rates of HIV transmission.

Male circumcision is the surgical removal of the foreskin; the foreskin is opened and then separated from the glans after inspection. The circumcision device, called Plastibel (a plastic ring) is worn on the penis, starving the foreskin of blood. This makes the foreskin to slowly eat away until the ring falls off in a healthy circumcision exercise.

Sometimes, there is a medical need for circumcision, such as when the foreskin is too tight to be pulled back (retracted) over the glans. This is not a problem in this part of the world, as routine circumcision is done for over 90 per cent of the male population.

Pain management

The circumcision procedure causes pain; and for newborns, this pain may interfere with mother-infant interaction or cause other behavioural changes. Consequently, physicians advocate the use of analgesics.

In practice, localised or regional pain-blocking injections and topical analgesic creams are effective for pain. For adults, anaesthesia is required, and the procedure is often performed without a specialised circumcision device.

Health benefits

• Circumcision aids personal hygiene, as it makes it simpler to wash the penis.

• Though the risk of urinary tract infection in males is low, it is more common in uncircumcised males. Circumcision therefore prevents urinary tract infection.

• Prevention of sexually transmitted infections: Circumcised men might have a lower risk of certain sexually transmitted infections, including HIV. In some instances, circumcision is recommended for older boys or men in order to reduce the risk of certain sexually transmitted infections.

• Prevention of penile problems: Occasionally, the foreskin on an uncircumcised penis can be difficult or impossible to retract (phimosis). This can lead to inflammation of the foreskin or the head of the penis. Although cancer of the penis is rare, it is less common in circumcised men.

Contraindications

Circumcision is contraindicated in premature infants, those who are not clinically stable and those who are not in good health. The same goes for those with certain genital structural abnormalities, such as a misplaced urethral opening, curvature of the head of the penis, ambiguous genitalia, and those with family history of serious bleeding disorders (hemophilia).

Complications

The most common complications associated with circumcision are bleeding and infection. Circumcision may also result in foreskin problems, as the foreskin might be cut too short or too long.

The foreskin might also fail to heal properly. When this happens, the remaining foreskin might reattach to the end of the penis, requiring minor surgical repair.

To save the day, circumcision must be performed in a sterile, hygienic environment, with sterile instruments, in order to avoid risk of tetanus, hepatitis and sepsis.

In conclusion, biblically, Leviticus 12:3 says, “On the eighth day, the flesh of (a male child’s) foreskin shall be circumcised.”

This is also supported by medical science, which notes that there is more vitamin K and prothrombin present in the blood on the eighth day, which means less pain, less bleeding, and a better healing process. Prothrombin deficiency usually leads to the slowing down of the blood clotting process.

Routine newborn circumcision should, therefore, not be done before the baby is eight days old.

Author: Rotimi Adesanya

Culled from Punch