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Circumcision – is it necessary or beneficial for boys in Malaysia?

Dr. Nada Sudhakaran
Paediatric Surgeon & Urologist

Circumcision – is it necessary or beneficial for boys in Malaysia?

IMPORTANT: This article only discusses the MEDICAL reasons to circumcise or otherwise. It expresses no opinion on religious/cultural reasons for circumcision which are common in Malaysia.

Male Circumcision involves surgical removal of part or all of the foreskin of the penis. For the majority of boys in Malaysia, this is done for religious or cultural reasons, traditionally conducted just before puberty as a passage to manhood.

Your son’s penis & foreskin – possible complications

At birth most baby boys’ foreskin cannot be retracted over his glans penis (head of penis). This is normal and called physiological (natural) phimosis.

At about 5 years of age about 10 % of boys are unable to do so and at age 10 around 5% of boys cannot do this. However after puberty only about 1% are unable to retract their foreskin fully.

This inability may cause pain with erections and problems with sexual function.

This is the 1% of all boys who could benefit from a circumcision once assessed just prior to puberty at about age 10-12 years old.

The other medically indicated reason for circumcision is if the foreskin has pathological phimosis or otherwise an abnormal skin. This is usually in the form of scarring or thickening, secondary to infections or trauma. The incidence of this to occur is 0.1% of all boys.

With a normal foreskin, there is oily secretions and some dead cells which may collect under the foreskin and appears as white cheesy substance called smegma, especially if the foreskin cannot be retracted and the inside washed. This may get infected and the treatment for this is to sit your boy in a tub of warm salty water and some topical antibiotics cream from your doctor. Usually the foreskin will heal back to normal after a few days.

Boys should be taught to retract their foreskin in the shower to wash and when passing urine. With this daily practice and washing under the foreskin, infections can be avoided.

To circumcise or not has created much debate in the medical community worldwide. The timing of circumcision and risks and benefits of not being circumcised will be presented here, based on current available medical evidence and trends throughout the medical world.

Reasons NOT to circumcise without urgent medical reasons (excludes religious reasons)

  1. The foreskin has purpose. It keeps the head (glans) of the penis soft supple whilst a circumcised glans becomes keratinized (dry, skin like thickening)
  2. The foreskin is a complex, specialized tissue – a mobile, double-layered fold of skin, mucous membrane, and muscle, containing dense concentrations of erogenous nerve endings. It is an integral part of the penile skin system, not something “extra.”
  3. Circumcision is excruciatingly painful. When conducted on a newborn, the local anaesthesia is inadequate to fully anaesthetise the penis. Babies have continuing pain during the healing period, when the wound is exposed to faeces, urine, and irritation from the diaper. The diaper irritation also risks meatal stenosis (an abnormal narrowing of the urethral opening).
  4. Circumcision destroys the protective and sexual functions of the foreskin. Surgical complications are rare but includes: bleeding, infection, meatal stenosis, adhesions, death and loss of some parts of the penis, although rare, do occur. Some boys may have an excessive amount of skin left behind or some too little.
  5. Breastfeeding and the relationship of the mother and child after circumcision as a newborn may be impacted.
  6. Overall risk of any form of infections or any complications with a normal foreskin is about 0.1%. Whereas risks of any complications form circumcision is about 1%. With daily routine hygiene of the foreskin, risks are reduced and practicing safe sex as an adult will avoid of sexually transmitted diseases as an adult. It’s all about education, awareness and self-care.
  7. Most developed countries are going away from circumcising the normal penis, even in the US where previously most boys are circumcised at birth.

Benefits of Circumcision (excludes religious reasons)

  1. A decreased risk of urinary tract infections.
  2. A reduced risk of some sexually transmitted diseases in men. The world health organization recommends circumcision to reduce this risk.
  3. Prevention of balanitis (inflammation of the glans) and balanoposthitis (inflammation of the glans and foreskin).
  4. Prevention of phimosis (the inability to retract the foreskin) and paraphimosis (the inability to return the foreskin to its original location).
  5. Circumcision also makes it easier to keep the end of the penis clean.

In conclusion…

The debate goes on however, the bottom line is that it’s a personal choice to keep the foreskin or otherwise.

My personal view is that we should avoid circumcision for babies and offer the choice of circumcision to your boy at an age he could make his own mind up about his own body, closer to puberty. This is in keeping with the traditional age of cultural circumcision practiced in Malaysia.

Female circumcision is regarded as Genital Mutilation and it should not be practiced. There are no benefits whatsoever to this practice. Even the prick technique where a needle is used to pierce the skin, causes bleeding, pain and unnecessary trauma for the poor child and at the end of this there is scarring to where the skin was damaged.

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Dr Nada Sudhakaran

Paediatric Surgeon & Urologist

Paediatric Surgeon

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