Cut, uncut - Male circumcision | DW Documentary

Key Concepts

Circumcision, foreskin, fimosis, sexual sensitivity, medical necessity, religious practice, hygiene, HIV prevention, WHO recommendation, mass circumcision campaign, complications, child's right to physical integrity, breach shalom, circumcision trauma, post-traumatic stress syndrome.

Circumcision: Prevalence and Reasons

• Global Prevalence: One in three men worldwide is circumcised.
• Reasons: Religious, cultural, or medical reasons, most commonly performed in childhood.
• Extent of Removal: Up to 50% of the skin of the penis can be lost during circumcision, depending on the radicality of the operation.
• Controversy: Increasing concern among doctors that circumcisions are performed too frequently and are often trivialized as minor interventions.

Florian's Case: Unnecessary Circumcision and its Consequences

• Background: Florian was circumcised at age five due to fimosis (narrowed foreskin), based on a urologist's recommendation.
• Realization: As a teenager, Florian realized he was missing important aspects of sexual sensitivity due to the circumcision.
• Lack of Information: Florian's hospital records lacked information on symptoms and a patient information sheet for the operation.
• Alternative Treatment: Florian later learned that forskin constriction can be treated with an ointment with up to 90% success rate, an alternative not presented to his parents.
• Legal Action: Florian filed a lawsuit to determine if the doctor made the wrong decision, seeking to establish that the procedure was unnecessary and caused damage.
• Prevalence of Unnecessary Circumcisions: Experts estimate around half a million boys in Germany have undergone unnecessary medical circumcisions.

Anatomy and Function of the Foreskin

• Structure: The foreskin covers and protects the glans, consisting of an outer and inner layer. The inner layer is a mucous membrane that keeps the glans moist.
• Function: The foreskin retracts due to the elasticity of the rigid band and frenulum, which are particularly sensitive.
• Common Misconception: The belief that the foreskin must be retractable by preschool age is scientifically outdated.

Historical Context of Circumcision

• Origins: Circumcision is over 5,000 years old, originating as a ritual adopted by various religions.
• 18th-19th Centuries: Non-religious reasons emerged in the fight against masturbation, which was considered a sin and cause of diseases.
• 19th Century Hygiene: Doctors advised circumcision for hygiene, bed wetting, syphilis, and even cancer.
• US Routine: The US adopted circumcision as a routine procedure on newborns, citing advantages like better hygiene and prevention of various diseases.
• European Perspective: European doctors consider the risks of circumcision greater than its benefits, deeming purely preventative procedures on children unjustifiable.

Circumcision in Africa and the HIV Prevention Campaign

• US Funding: Mass circumcision campaigns in Africa are financed primarily by US government funds and recommended by the WHO.
• Campaign Goal: To reduce the risk of contracting HIV through circumcision.
• Criticism: Critics argue that the campaign targets boys and infants and is conducted without adequate parental consent or information about risks.
• WHO Recommendation: The WHO recommends circumcision as an additional preventive measure since 2007, based on studies showing a 60% reduction in HIV infection risk.
• Controversy of Studies: The studies and the explanation (reduction of mucous membrane) are scientifically controversial.
• Alternative Measures: Condoms are a safer alternative but are not emphasized in advertising.
• Expansion of Target Group: The WHO extended the campaign's target group to 10-14 year olds in 2016 and even launched a program for infants.
• Complications and Lack of Follow-Up: Concerns raised about complications and lack of follow-up care in developing countries like Kenya.

Ethical and Human Rights Concerns

• Parental Consent: Cases of children being circumcised without parental consent, lured by incentives like soda and fear of teachers.
• Complications: Kenyan scientists found many children were circumcised without consent and suffered complications.
• WHO Response: In 2020, the WHO recommended circumcision only from age 15, but critics fear this may not be permanent.
• Child's Right to Physical Integrity: Circumcision, when not medically necessary, violates the child's right to physical integrity and self-determination.

Perspectives within Judaism and Islam

• Liberal Islam: Siran Atesh, an Imam, believes a child's right to physical integrity is paramount and that the debate should be conducted civilly.
• Quranic Perspective: Circumcision is not mentioned in the Quran and is considered a tradition, not a religious requirement.
• Breach Shalom: An alternative ritual in Judaism without circumcision, mainly celebrated in progressive Jewish communities.
• Jewish Covenant: Rabbi Nadi Kunun states that the welcoming of the baby does not need or does not have any physical symbols.

Psychological Impact and Trauma

• Circumcision Trauma: Professor Matias France's research indicates that circumcised individuals show more stress when shown images of circumcisions, suggesting traces remain in the subconscious.
• Developmental Stage: Circumcision between ages four and six can be particularly traumatic, disrupting the child's integration of their sexuality.
• Pain Memory: Circumcision can be consciously or unconsciously experienced as traumatic and stored in the pain memory.

Complications and Long-Term Effects

• Common Consequences: Skin bridges and scarring can cause pain and numbness.
• Prevalence of Problems: Around 5% of circumcisions result in later problems, not including long-term effects.
• Reduced Sensitivity: Removal of the foreskin reduces erogenous tissue and can lead to reduced sensitivity of the glans.
• Sexual Dysfunction: Some men experience reduced sensitivity or ejaculatory dysfunction.

Conclusion

The documentary highlights the complex and controversial nature of circumcision, exploring its historical roots, religious and cultural significance, medical justifications, and ethical implications. It presents compelling evidence of unnecessary circumcisions, the potential for physical and psychological harm, and the violation of a child's right to physical integrity. The film questions the WHO's mass circumcision campaign in Africa, raising concerns about informed consent, complications, and the prioritization of circumcision over other HIV prevention methods. Ultimately, the documentary advocates for informed decision-making, respect for bodily autonomy, and the protection of children from medically unnecessary procedures.