DRHOOK- Cutting and rutting: What's the point of circumcision anyway?

the handsome doctor John Hong

"Penis is a polite word," my high school biology teacher told our class. There are so many words that every Tom, Dick, and Harry can use to substitute for the word penis. I had heard of forehead, foreshadow, and foreclosure, but never heard of foreskin. I imagined it to look like the hood on a bald monk's sweatshirt. 

Should parents be forewarned about the foreskin?

For the record, I don't lean one way or the other in the "to circumcise or not to circumcise" debate. But that is a question for parents of a male infant.

"San Francisco, Open your Golden Gates...." (thank you, Judy Garland). That song might need to include, "Circumcision can put you in jail and net you a fine," if a ban on circumcision hits the ballots there next year.

Circumcision dates back thousands of years to Egypt, where the procedure was done, among other reasons, for hygiene.

Circumcisions became popular in Western cultures in the mid-19th century, supposedly to prevent masturbation. I totally believe that. John Harvey Kellogg, founder of Corn Flakes (emphasis on un-Frosted Flakes) was a huge opponent of masturbation. But you know what you call a man who doesn't masturbate? A liar.

Back to circumcisions. They are done for religious reasons (Jewish, Muslims) and cultural reasons. Circumcision is the #1 operation in the U.S., the only country in the developed world in which circumcision is done for nonreligious reasons.

 But the rate of circumcision in infants has been dropping, especially out West. About 65 percent of American male infants born in a hospital had a circumcision in 1999. 

The rate of complications of circumcision is low: 0.2-0.5 percent. Did you ever see the Seinfeld episode of the mohel with a bad tremor at the bris? Oy vey zmir! 

Hospitals have contraptions to reduce the risk of a bad foreskin removal, though if the penis is pulled or clamped too hard, damage can occur to the urethra (the duct in the penis where urine flows out). If the glans (head of the penis) is caught during the excision, it can even be chopped off. (Could you imagine Lorena Bobbitt doing circumcisions? Poor thing.)

Bleeding and infection are the main complications and almost always are quickly treatable, although if someone has a bleeding disorder, like hemophilia, it can be more difficult.

An abnormal scar can adhere to the glans of the penis, which surprisingly I see fairly often in my practice. If the scar is bad enough, it can cause an erection to curve like an exit ramp. 

Cicatrix is not The Matrix sequel or a female cicada. It is a circumferential scar (meaning all the way around and covering the penis shaft like a stocking) so it can hide the penis from plain view. I saw a picture of it and the surgical repair, and I'll admit (even as a doctor) I thought I was going to faint.

Some nerves are cut in circumcision, so perhaps there is less sexual stimulation, but in fact, only a sexually active, uncircumcised grown man who then gets a circumcision will be able to report if there's truly a difference. 

Men who have been circumcised have less risk of HPV virus. HPV can be a cause of penile (and cervical) cancer. HIV and Herpes Simplex II are less likely to occur in circumcised men. Smegma, a cheesy excretion from the glands in the penis, doesn't accumulate under the foreskin after circumcision. 

The foreskin causes phimosis the first years of childhood, which can make it more difficult for mothers to clean their infant boys. Phimosis can also occur later in life, which means the glans of the penis can't retract underneath the foreskin. 

Like I said, I don't have an opinion about circumcision, so, please, no one yell at me. I don't have kids and never will! I'm definitely not a cut above the rest in the kid department.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.