Dr. Sam Christian

Dr. Sam Christian

We overcame a little distraction this past week. I am pleased to return the focus on health topics that affect our daily lives.

Last Friday morning, I did a continuing medical education presentation to a large group of doctors at the Princess Margaret Hospital. Despite the sensitive nature of the subject, I found their responses to be eager and engaging. To wit: Are there health benefits to circumcision? What are the social considerations for us as citizens of the world?

Circumcision began in Old Testament times, proverbially as sign of the covenant between Abraham and God. Islam subsequently adopted the ritual after Muhammad introduced the whole Ishmael/Isaac theology in the 6th century. No surprise then, Middle Eastern countries have the highest circumcision rate in the world today. The procedure was introduced in Europe and the United States in the 19th century beginning in the middle and upper classes. The thought at the time was that it would control masturbation and prevent blindness. (People have believed some strange things in history eh boy!) The rate rose as high as 85% in some Commonwealth countries, but subsequently dropped to under 20% in most parts of the world, including Dominica. In the United States and Canada it remains about 65 and 35% respectively.

In Ohio, a white lawyer about my age, who was converting to Judaism, asked me to perform his circumcision. The surgeon was required to don a shawl and recite ritual prayers associated with the procedure in the office. I asked him if I had to believe in the ceremony to do the operation. He said no. So he had his circumcision, and I got a sharper cultural understanding of what it means to certain people.

Circumcision is on the rise again as medical research clearly shows it lowers the spread of HIV and other sexual transmitted infections. It is therefore strongly championed by the World Health Organization (UNAIDS) and the Pan American Health Organization (PAHO). Circumcision also not only lowers the rate of cancer of the penis (which is low) but also of cervical cancer, which is high – and rising steadily in Dominica. (A subsequent article will deal cancer care in Dominica. I am in the process of getting maximum input from all the stakeholders).

Mothers often want to know at what age should they be able to retract their son’s foreskin. Do not try too hard because it hurts. It happens naturally usually by high school age. An ‘uncut’ man who is doing just fine up to this point, should not feel under any obligation to consider circumcision. However, if the foreskin is too tight (phimosis), it causes troublesome bruising of the male during intercourse. This was not something the average male has been comfortable talking about with their doctor. Rarely, the tight foreskin gets caught in the grove behind the head of the penis (paraphimosis). And that how trouble starts.

Such a patient presented to me while serving as chief extern at Howard University in Washington DC. As the student doctor running the infirmary in the dormitory, he was embarrassed to tell me his problem. The head of his penis was being strangled by the minute. It had swelled to the size of a grapefruit! The definition of a medical emergency is a reluctant young man who feels his manhood is about to explode in front of his very eyes at any moment. It was one of my proudest moments in my budding medical career. Even the hospital urologists (specialists in kidney, bladder and the male equipment) had never seen such a case before. They praised me for doing the right thing – which was simply getting the patient into the operating room in record time for emergency dorsal slit and circumcision.

Even when blessed with the best nursing care, very old or incapacitated men may be neglected in this one area of cleaning. Parental guidance is advised here: According to conventional wisdom, North American women tend not to free up themselves with men who are uncircumcised. I don’t know how else to say it. They are concerned about hygiene. Has that ever been a realistic issue for the Dominican man in his global experience?

And in this corner, there are those who argue that circumcision is a barbaric, painful ritual inflicted on innocent baby boys. They compare it with female genital mutilation. Not even close. For anyone with a conscience, if you want to see something to really make your blood boil, try looking at the trailer of the instant classic movie, Desert Flower:http://www.youtube.com/watch?v=iKgaXGMPJDs

Is the small risk of complication worth the benefits? Does the toughened skin decrease sensation just enough to minimize premature ejaculation? Does a woman’s personal preference matter? Circumcision clearly modifies and even eliminates the chance of several real medical problems. It was not just an intellectual debate for my family. How about yours?