Thursday, December 11, 2014

Danish Researcher explains the function of the foreskin and harms of circumcision

HEARING ON CIRCUMCISION in Danish Parliament on October 22, 2014
Arranged by the Danish Parliament's Cross-Party Network for Sexual and Reproductive Health and Rights
Presentation by Morten Frisch, MD, PhD, DSc (Med), Adjunct professor of sexual health epidemiology
Thank you for the invitation. I have placed my ”starters’ kit” on circumcision on every chair and freely accessible on Facebook and Twitter today, such that everyone can get information about the basic health-related and ethical issues related to the circumcision problem. The widespread taboo surrounding the human genitals imply that few people really know what circumcision is all about. Please listen carefully.
During fetal development the male and female genitalia develop from the exact same embryonic structure. Here you see the external genitals of the male (left) and female (right) fetus at around 12 weeks of gestation. At this point in development it is not possible to distinguish between the two sexes. At birth, however, everybody can see the difference.
Please note that all male structures have equivalent female structures. The foreskin covers the penile glans in most boys and men. The foreskin protects the glans. Consequently, the glans of intact men is sensitive, smooth and moist, while the glans of circumcised men is relatively insensitive, uneven and dry. The size of the scar that all circumcised men have depends on the amount of penile skin removed.
The penile glans is exposed during erection, and sexual stimulation occurs when the foreskin moves back and forth over the glans. Only few people know that women also have foreskins known as the clitoral hood. The clitoral hood has the same protective and stimulating functions as the male foreskin. During female sexual arousal the size of the clitoris increases, and the clitoral glans is exposed.
Most women can easily imagine how unpleasant direct stimulation of the clitoral glans will feel in the absence of the clitoral hood. This is the situation for many women after sunna circumcision, and this is the situation for circumcised men. Over time, circumcised men gradually develop a keratinized layer, which results in reduced sensitivity of the glans. The missing foreskin, and the reduced sensitivity of the glans, explain the long-known circumcision-related sexual difficulties, which have been confirmed in recent studies.
The foreskin is not a small, superfluous piece of skin. The foreskin is a complex, double-layered structure rich in sensory nerves. The area of the foreskin is typically between 50 and 90 square centimeters (8-14 square inches), the better part of a dollar note. The foreskin has skin on the external side and an equally large mucous membrane on the interior.
During erection the glans grows in size and pulls with it the mucosal part of the foreskin on its way out. In the picture to the right, you can see that this man’s penile shaft is covered by foreskin from the root of the penis and all the way to the glans. Recalling the slide showing the relatively insensitive, uneven and dry glans, it becomes clear that circumcised men have reduced sensitivity from the root of the penis to the very tip of the glans. This is the future scenario awaiting every circumcised boy.
The Danish National Board of Health’s ”Note on the circumcision of boys” from 2013 is full of errors, inaccuracies, trivializations and serious omissions. From a health professional’s perspective, this “Note” is an embarrassing presentation of the topic, leaving ample room for religious views.
In March 2014, I wrote a harsh commentary in the newspaper Politiken about the National Board of Health’s handling of the circumcision problem. The Board has never proved me wrong in any of the criticisms I have raised. Regrettably, however, the “Note” is often used by ministers and politicians who are too busy to evaluate the matter themselves. From a health professional’s perspective the “Note” is medically substandard and, moreover, entirely unacceptable from a medical ethics perspective.
The “Note” is the central Danish health authority’s recognition that foreskin amputation is acceptable, if the boy is given a little sugar while his body and sexuality is altered for life. European doctors agree that there are no relevant health benefits associated with circumcision of boys. Not one medical association in the whole world recommends circumcision of healthy boys. In contrast, several advocate against circumcision.
Last year, I took the lead in this article together with 37 other professors and consultants in 17 European countries and Canada. We reject the poorly substantiated myths about health benefits gained by circumcision that American pediatricians earn good dollars persuading baby boys’ parents to believe.
Seven minutes do not permit detailed scrutiny of all the complications that may occur. A 2013 study from Rigshospitalet, showed that when the most experienced pediatric surgeons in Denmark perform non-therapeutic circumcision in boys, one in 20 boys will experience a non-trivial complication.
In countries where boys undergo routine circumcision, vast finances are spent on circumcisions and on subsequent operations repairing the consequential damages. In a university hospital in Boston, pediatric surgeons spend 5-7 percent of their operating hours doing circumcision repair operations.
Between 10 and 20 percent of boys circumcised shortly after birth develop narrowing of the urethral opening (meatal stenosis) that requires intervention. Intact boys almost never develop this condition.
All boys experience some level of procedural and postoperative pain. Moreover, they lose sensitivity and are subjected to unnecessary risks. Hemorrhage, infection and meatal stenosis are common, and unpleasant, serious and outright life-threatening conditions may occur – however, fortunately only rarely. Problems can arise with the youngest and older boys – and with adult men and their partners. New studies document that many women can relate to this as well.
According to the Hippocratic oath, doctors are obliged not to cause pain or damage to fellow human beings. This is a good principle that should be extended to everyone, particularly when handling our most vulnerable fellow human beings, our children. However, when it comes to circumcision - whether in boys or girls - this is exactly what the circumciser does. He causes pain and inflicts irreversible, physical damage to the child’s body. An open, painful wound with lifelong consequences that are sometimes serious. This summer, a newborn boy was in a coma in Hvidovre Hospital after a botched circumcision performed by a surgeon in Copenhagen.
Circumcision is not mainly a health issue. Circumcision is first and foremost a human rights issue, a gender equality issue and, lastly, a judicial issue. It is my sincere hope that you politicians will take your responsibility seriously and ensure that future boys will enjoy the same rights to physical, psychological and sexual integrity as those conveyed to Danish girls back in 2003.
Thank you for listening.