**Merits and Arguments Related to Circumcision**

Hosni Khairy Salem *Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt* 

### **1. Introduction**

42 Complementary Pediatrics

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Christians and no believers perform Circumcision for health and hygienic reasons especially in U.S.A. and some countries of the Middle East. It is uncommon in Northern Europe, Central and South America and Asia (Leitch, 1970). It is one of the" oldest operations but it has not received enough consideration or progress in the Middle East. It is always regarded as a minor outpatient procedure often performed by primitive clamps by barbers, Mohels, medical students and house officers (Kaplan, 1977).In hospitals, male circumcision is performed by junior gynecologists, urologists, or surgeons. The objective of this article is to perform a review of the literature regarding the different aspects of male circumcision and discussing the following points; history of circumcision, urgent indications of circumcision, merits and arguments related to circumcision, religious factors, contraindications of circumcision, timing of circumcision, different techniques of circumcision , complications after circumcision and relation to STDs or UTI.

#### **2. History of circumcision**

Circumcision is one of the oldest operation in the history and the first unequivocal description of circumcision is found in the forth dynasty Egyptian toombs (3000 BC). According to Herodotus, it was practiced at puberty. It is carved on portraits in the Karnak temple of Mount Saini Statues of Pharaohs. Its technique is seen in a bas brief on Mastaba of Sakkarah in the fifty dynasty (Bistschai& Brodnay, 1956; Arnaout et al., 1962 and Badr, 1963). Whether it had a religious or hygienic in purpose in Ancient Egypt, it is unknown. According to Herodotus, the Egyptians taught the procedure to Jews, Syrians and Phoenicians. Later, the custom spread to Ethiopians but Herodotus did not know that Columbus would find the natives of the West Indias circumcised. Captain Cook found the practice used by natives of Australia, Fijt, New Caledonia, New Hebrides and Madagascar (Blandy, 1968).It is a religious ritual practiced by Jews and Muslims. Jews practice it on the eighth day after birth. From Jews, it passes to the Christians who performed it for hygienic purposes then passed to Muslims as an important ritual of cleanliness for males. It was introduced to the western cultures by Biblical injunctions (Arnaout et al., 1962).Circumcision has also been practiced in other locations and for various reasons throughout the world e.g.,

Merits and Arguments Related to Circumcision 45

glans making the condition worse. As the condition progresses, arterial occlusion and necrosis of the glans may occur. Treatment can be done by firm squeezing of the glans for five minutes to reduce tissue oedema and to decrease the glans size then the skin can be drawn forwards over the glans. If this is unsuccessful, general anaesthesia must be given and the constricting band is incised and circumcision is done to trim the redundant skin

Inflammation of the glans penis is known as balanitis while the inflammation of the prepuce is known as posthitis. Frequently, the opposing surfaces of the prepuce and glans are

The immediate cause of acute balanoposthitis is the multiplication within the preputial sac of pyogenic organisms as Streptococcal pneumococci and coliform bacilli. A contributing

Circumcision is done as prophylactic reasons to reduce the incidence of: urinary tract infection, penile carcinoma and carcinoma of the cervix "and sexually transmitted diseases.

Donovan et al. in 1994,stated that the uncircumcised penis is hypothetically at increased risk of STDs especially-genital herpes, gonorrhea, syphilis, immunodeficiency virus type 1 (HIV-1) infection, candidiasis and chancroid due to larger surface area, thinner epidermal barrier, more liability for epithelial microtrauma and the moist warm neck under the foreskin favoring the persistence of fastidious microorganisms. However, none of these hypotheses has been proven. Moses et al. in 1994, in eighteen cross sectional studies from six countries reported a statistically significant association between male circumcision and the risk for HIV infection. Male circumcision should be considered as an essential strategy for AIDscontrol (Tyndall et al., 1996). Caldwell in 1996 reported that in parts of subsaharan Africa, nearly 25% of the population is HIV positive as a result of heterosexual transmission of the virus. Lack of circumcision makes men in this region particularly susceptible. Taylor and Rodin in 1975, reported that there was a positive relationship between lack of circumcision and genital herpes simplex virus infection (HSV). Simonsen et al. in 1988, reported that in a controlled study of Human Immunodeficiency Disease (HIV), they found that men who

Circumcision is a religious rite among Muslims and Jews (Arnaout et al., 1962).

**5. Circumcision/sexually transmitted diseases (STDs) &HIV** 

were uncircumcised were 2.5 times more likely to have HIV infection.

later on and antibiotics should be given (Bailey & Love's, 1992).

It is a rare indication for circumcision (Blandy et al., 1968).

implicated in the inflammation process (Balanoposthitis).

**4.5 Prophylactic neonatal circumcision** 

cause of balanoposthitis is diabetes (Manson, 1966 and Ross, 1941).

**4.3 Trauma** 

**4.4 Balanoposthitis** 

**4.6 Religious reasons** 

in the-one continent of Africa, only certain tribes circumcise e.g., Zulo, Xahsa, Bechuana and Falasha while among its many Christian communities; circumcision has a religious significance only in Ethiopia (Blandy et al., 1968).
