The Traditional VS Modern Circumcision

Whenever I see young boys at the health centers with an awkward posture, slightly bent at the waist, I would say to myself, “Yup! It’s summer alright. “This is because in the Philippines, circumcision is the trend amongst boys every summer for a number of reasons.

Reasons for  Circumcision:

1. Part of culture and tradition
2. Rite of passage to manhood
3. For personal hygiene
4. Reduces risk for penile cancer of men and cervical cancer to their female partners
5. Reduces risk for sexually transmitted disease (STD)

Unlike other countries, where circumcision is non-compulsory and other times regarded as taboo, Philippines considers circumcision as part of every boy’s life, except for those contraindicated to it. When these boys are not circumcised, they get teased by their peers. That is why peer and familial pressure usually persuade a boy to go through this painful procedure.

Circumcision may be performed in the rural health centers, while other times “Operation Tuli”, a mass circumcision, is conducted at different venues in the community. This is on the advocacy of Philippine Department of Health (DOH) to help lower sexually transmitted diseases (STD) since HIV/AIDS and HPV cases are increasing in the country. This is also implemented as circumcision is proven to have more benefits than risks.

What is circumcision ?

Circumcision is the removal of the foreskin of the head of the penis to expose the urethra. Incision depends on the length of the head of the penis.  This procedure is usually done on boys 9-12 years old, just before puberty hits them. Yet, according to Dr. Eric Tayag, DOH spokesperson, circumcision can also be done among male infants (9-12 days old) and even male adults.

Steps for traditional circumcision ( “pukpok”) :

1. Icy water is poured over the penis to numb the organ and soften the foreskin. If there is no icy water, the boy can be submerged in a cold creek.
2. The foreskin is placed on the lansadera, a special low table made from wood.
3. The lanzeta (sharp small knife) is placed on top of the stretched foreskin. With one hit/blow of the piece of wood on the lanzeta, the foreskin is then incised.
4. The glans penis is exposed by retracting the foreskin and pulling it down towards the shaft.
5.  “Chewed” banana leaves or guava leaves are placed on the wound before a bandage is wrapped around it.

Steps for modern circumcision: (COMMUNITY SETTING)

1. Provide privacy.
2. Let the patient remove his underpants and underwear.
3. Place the patient comfortably on the bed.
4. Place sterile drapes around the penis. In the absence of a sterile drape, sterile gauze can be used.
5. Sterilize the penis and the surrounding area with cotton balls soaked with Povidone-Iodine solution.
6. Inject intradermally 3cc of Lidocaine at root of the penis to numb the area.
7. Wait for Lidocaine to work. Check after 1 -3 minutes if the boy could still feel pain on his penis (check by introducing pain like a pinch or a prick from a needle). When the boy still feels pain, inject intradermally 2cc -3cc of Lidocaine at the shaft of the penis.
8. When the foreskin has not yet detached completely, manually retract the foreskin by pulling it back to expose the glans.
9.  Put back the foreskin over the head of the penis (glans) and clamp at the left and right lateral of the foreskin.
10.  In between the 2 clamps, put a 3^rd clamp to flatten the skin. After 5-10 seconds, remove the 3^rd clamp.
11.  The flattened skin by the 3^rd clamp is then incised using a surgical scissor.This is called the dorsal slit technique.
12.  Stitch the incised sides with surgical sutures to close the wound and stop the bleeding.
13. When done stitching, retract the foreskin over the glans and pull down towards the shaft to expose the entire head of the penis and the urethra.
14. Bandage the wound with sterile gauze.
15. Ask municipal health officer (doctor in the barrios) to prescribe home medications such antibiotics and pain reliever.
16. Give health education.

It is important that experts perform this procedure. The traditional pukpok method may not be prohibited but Dr. Eric Tayag, DOH spokesperson, still prefers the modern way of circumcision. The reason for the Department of Health’s promotion of this modern procedure is to have boys face a one-time, complication-free circumcision.