Editorial Comment to Circumcision related to urinary tract infections, sexually transmitted infections, human immunodeficiency virus infections, and penile and cervical cancer
Article first published online: 21 APR 2013
© 2013 The Japanese Urological Association
International Journal of Urology
Volume 20, Issue 8, pages 775–776, August 2013
How to Cite
Shimada, K. (2013), Editorial Comment to Circumcision related to urinary tract infections, sexually transmitted infections, human immunodeficiency virus infections, and penile and cervical cancer. International Journal of Urology, 20: 775–776. doi: 10.1111/iju.12176
- Issue published online: 1 AUG 2013
- Article first published online: 21 APR 2013
The prepuce is a common structure of the external genitalia of all human and non-human mammals. It has not disappeared or remodeled for at least 60 million years. In the last several thousands years, some cultures or traditions vilified the prepuce, and considered it to be dangerous and unhealthy, whereas other cultures have accepted the complete genitalia as normal. Now approximately one in six men in the world have been circumcised. One of the well-known motives was religious circumcision. In Judaism, circumcision represents the covenant made between God and Abraham. There are no reasons to seek justification based on health or other grounds. In the Islamic faith, on the contrary, circumcision was not introduced by Islam, and is not mentioned in any form in the Holy Quran. It is at most considered as an external symbol of being Muslim, a typical rite of passage in young males. Despite the fact that Jesus was born as a Jew, and was circumcised, Christianity never accepted this practice. Apart from the religious rituals, circumcision was rarely carried out in the West during the Middle Age, and was considered to be a rite of minorities. In 18th century England, the rapid industrialization led to public health problems, which were inherited by Victorians in the 19th century. The Victorians have been famous for their obsession with cleanliness. Victorian physicians were determined to stop excessive sexual activity, particularly masturbation, which they believed could cause tuberculosis, seizures, psychiatric illness or blindness. The description of phimosis and circumcision came to be found from the mid 19th century in medical textbooks. The most permanent treatment offered by doctors in 19th century England for the prevention of excessive sexual activity was circumcision. They believed that foreskin offered the greatest inducement for self abuse.
In the mid 19th century, a doctor in the USA introduced circumcision as an important public health measure. He presented a report on the cure of leg paralysis in 5-year-old boy through circumcision. His success spread through the English-speaking world, and doctors across the USA began to use circumcision as a surgical prophylaxis against all sorts of diseases, from epilepsy to mental disorders. What was once viewed as a public health measure became a symbol of American citizenship. It became a mark of distinction between those who were born in the USA and were clear, from those who were not, and were poor and unhygienic.
The understanding of anatomy and function of the prepuce started only in 1930s. The prepuce is an integral part of external genitalia, protecting the glans, urethral meatus, inner prepucial epithelium and primary erogenous tissue. Although the glans penis is primarily protopathic in sensitivity, a ridged band of the prepuce has a high concentration of “fine-touch” nerve receptors. Interaction between protopathic, receptor-deficient glands and the “fine-touch” receptor-rich prepuce is required for normal sexual behavior. Circumcision ablates the most sensitive parts of the penis. Removal of the prepuce can cause sensory imbalance, and possibly induce aggressive intercourse. If the prepuce is an inappropriate structure, mammals (including humans) that have it would have become extinct based on the Natural Selection Theory. Instead of talking about the negative effect of the prepuce, we have to take lessons from history and reconsider its positive significance.
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