Excerpted from his book Make me understand parenting, family and health.
UNDERSTANDING HIV/AIDS
What is HIV/AIDS?
It has been observed here in uganda and worldwide parents these days fear to talk with their children about HIV/AIDs leaving huge task to teachers, social workers, health workers like doctors etc and activist. lets explore, give us your ears
HIV stands for Human Immune deficiency Virus. • The “H” is for “Human” because it survives only in human beings. • The “I” is for “Immune deficiency”because it attacks the immune system. • The “V” is for “Virus.” A virus needs a host cell to reproduce. • HIV attacks a specific type of human white blood cell, the T-cell. • A person can be infected with HIV and
not know it. People who are infected with HIV often have no symptoms and feel healthy.
TALKING WITH CHILDREN ABOUT HIV/AIDS
How parents and caregivers talk with their children about HIV/AIDS
HIV/AIDS is a worldwide epidemic. Countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East are some places where the numbers of young people infected with HIV are rising. Ask apparent or caregiver to spend some time with you researching how HIV/AIDS impacts the rest of the world, and then compare the information to the UGANDA.
You can visit your local public library or use the Internet to gather information. Perhaps you’ll be able to find out:
How poverty contributes to the spread of HIV/AIDS
Any laws that protect people who are HIV positive
If people who are HIV positive have access to necessary treatments and medications
What life is like for someone who is HIV positive Pick a country and talk about what you would do to help with the HIV/AIDS epidemic? How could you help make a difference in that country even though you live in UGANDA?
Then, find ways to make a difference in your community. Perhaps you can volunteer by donating your time to an organization that helps people that are HIV positive, raising money by participating in a fundraiser like AIDS Walk, or working with your school or public library to organize an event for World AIDS Day (December 1).
Then let’s go to the point, how you can share information about HIV/AIDS in your home.You may think that children are too young to learn about HIV/ AIDS, but young people hear many messages about it from the media, friends, or other family members. Perhaps they even know someone who is HIV positive.The truth of the matter is that the only way to help prevent HIV/AIDS among young people is to share accurate,age-appropriate information so that they can protect themselves.ThisissueofFamilies Are Talking includes basic facts about HIV/AIDS, information and messages to share with your children and teens,activities to raise HIV/AIDS awareness, as well as organizations and Web sites for more information.
Tips to help parents and caregivers talk with their children about HIV/AIDS?
Do not wait until your children ask questions
Know and practice the messages that you want to share
Seek “teachable moments” —daily opportunities that occur when you are with your children — that make it easy to share your messages and values
Let your children know that you are open to talking with them about sexuality issues
Listen
Provide pamphlets, books, and other age-appropriate, medically accurate materials
If you don’t know how to answer your children’s questions, offer to find the answers or look them up together
Find out what your children’s schools are teaching about HIV/AIDS
How does someone get HIV? Someone who is HIV positive can pass the virus to another person through certain body fluids. The sources are:
Blood
Semen
Vaginal Secretions
Breast Milk
Other Body Fluids containing blood
Certain behaviors can put people at risk for HIV infection. The most common means of transmission are:
Having sexual intercourse (oral, vaginal, or anal) with someone who is HIV positive.
Sharing needles with someone who is HIV positive — for drug or steroid use, to pierce the ears and body, and to tattoo the body rom an HIV-positive mother to her baby before or during birth, or after birth through breastfeeding
PARENT’S GUIDE TO PREVENT HIV/AIDS
Talking with infants and toddlers (0-2years), talking with preschool children (3-4years), talking with young children (5-8 years), talking with preteens (9-12years) talking with teens (13-19 years)
TALKING WITH INFANTS AND TODDLERS (birth to two years)
Of course, infants and toddlers are too young to comprehend HIV/AIDS. But, as their main teachers, it’s important for parents and caregivers to help them develop a healthy attitude toward sexuality. You can begin by naming all the parts of their bodies, teaching them that their entire body is natural and healthy. (“This is your arm. This is your elbow.This is your vulva/penis.This is your knee.”) Byreacting calmly when they touch their genitals, you are teaching them that sexual feelings are normal and healthy. By holding them, hugging them, talking with them, and responding to their needs, you are laying the groundwork for trust and open discussions as they grow up.
TALKING WITH PRE-SCHOOL CHILDREN (three to four years) Children at this age are learning about their bodies.They learn about their world through play.They begin to ask questions about where babies come from. They can understand simple answers.They do not understand abstract
ideas or adult sexual behaviors.They can learn simple things about health, such as bathing, washing their hands, brushing their teeth, eating nutritiously, and napping.They can begin to accept the need for privacy. The best thing a parent can do at this stage is to create an environment where children will feel comfortable asking questions about their bodies, health, and sexuality. Children will then learn that sexuality is something that you are comfortable discussing in your home.
TALKING WITH YOUNG CHILDREN (five to eight years) Children at this age understand more complex issues about health, disease, and sexuality.They are interested in birth, families, and death.They have probably heard about HIV/AIDS from television, friends, or adults. They may have questions or fears about HIV/AIDS.They may have heard that people get HIV/AIDS because they are bad.They understand answers to questions based upon concrete examples from their lives. For example, if your children cut their fingers and blood appears, you have an excellent opportunity to explain how germs (things that make you sick) can get into the blood system from cuts in the body. If they are in a school with a child who is infected with HIV, they need to know that they cannot get HIV/ AIDS from playing, studying,eating with, or talking with that child.
SHARING WITH SPECIFIC MESSAGE WITH YOUNG CHILDREN ABOUT HIV/AIDS Today, children grow up in a world where they are surrounded by messages about HIV/AIDS.To be sure that your young children know about HIV/AIDS infection and prevention, share the facts in simple, clear, age-appropriate language.Thefollowing are questions kids ask and messages that you can share with them.
What is HIV? HIV is caused by a small germ in a person’s blood that is so little it can’t be seen with the eyes. Some people with HIV feel and look healthy. Other people feel and look sick.
How do people get HIV? HIV can only live inside the body. There are very specific ways that HIV goes from the inside of one person’s body to the inside of another person’s body. You can mention that during sex, someone who has HIV can pass the germ from their body to the other person’s through certain body fluids.
Can kids get HIV? Very few children get HIV. If a woman who has HIV is pregnant, sometimes her baby is born with HIV. Some kids don’t have enough good cells in their blood and may need more by having a transfusion. That’s when they go to the hospital and receive a treatment that gives them another person’s blood to make their blood stronger. It’s rare, but sometimes the blood that they received at the hospital may have had HIV.
How can kids protect themselves from HIV? •If someone is bleeding, don’t touch their blood. Find an adult to help. •If you find a needle in the playground, street, or anywhere else, don’t touch it. Find an adult to help.
Can kids be friends with people who have HIV? •A person cannot become infected with HIV by being around someone who has HIVor AIDS. •People with HIV or AIDS are just like other people, but their bodies may work harder to keep them healthy.
Talking with young children about hiv/aids Since young children learn best by example, it is helpful to give them the information that they need by sharing stories or reading books together that address HIV/AIDS.
TALKING WITH PRETEENs (nine to 12 years) Because of the strong social pressures that start at this age, it is important that you talk about HIV/AIDS regardless of what you know about your children’s sexual or drug experiences. As a concerned parent or caregiver,you must make certain your children know about prevention now .During the changes of puberty, preteens are very curious about sex and need basic, accurate information. They need to know that sex has consequences, including pregnancy, diseases, and HIV infection. They need to know why sexual intercourse — oral, vaginal, and anal — is an adult behavior and why it is a good idea for young people to wait to have sex. They need to know how HIV is transmitted, how it is not transmitted, and how to prevent transmission, including talking about condoms. This may seem like a difficult task, but it will give you a chance to teach your children the values that you hope they will adopt in their lives. It is also the time to remind your children that they can come to you with questions about HIV/AIDS or sexuality.
TALKING WITH TEENS (13 to 19 years) Social pressure to try sex and drugs are often very strong for teens. In fact, almost 50 percent of young people In grades nine through 12 have had sexual intercourse. Whether your child is among the 50 percent who have had sex or the 50 percent who have not, it’s important to share your values with your children. Let your teenagers and preteens know that the best way to prevent HIV infection is by not engaging in any behavior that puts them at risk for infection, including having any type of sexual intercourse or using any type of drugs. At the same time, explain that if they are going to be sexually active, they must protect themselves against pregnancy and sexually transmitted diseases (STDs), including HIV. This is also a time when you might consider talking with your teens about the full range of sexual behaviors that people find pleasurable but do not involve any exchange of body fluids and therefore lessen the risk of HIV/STD infection and pregnancy.
Sharing specific message with young people
Social pressures to have sex and use drugs are often very real issue all young people must there4 know that;
Not having sexual intercourse (abstinence) is the best method for preventing HIV infection. It is also the best method for preventing other STDs and pregnancy.
Lifelong monogamy with an uninfected and honest partner is as effective in preventing HIV infection as abstinence.
Teenagers who have intercourse must use latex condoms for each and every act of intercourse, including oral,vaginal, and anal sex.
Teenagers should avoid all drugs including alcohol. Drugs and alcohol impair good decision making and may suppress the immune system.
Sharing needles of any kind puts people at risk for HIV and other infections.This includes sharing needles for injecting drugs, injecting steroids, piercing the ears and body, and tattooing.
An activity for young people to communicate with parents and care givers. Hiv/aids is a worldwide epidemic.Countries in Africa, Asia, Eastern Europe, Latin America, and the Middle East are some places where the numbers of young people infected with HIV are rising. Ask aparent or caregiver to spend some time with you researching how HIV/AIDS impacts the rest of the world, and then compare the information to the UGANDA. You can visit your local public libraryor use the Internet to gather information. Perhaps you’ll be able to find out: How poverty contributes to the spread of HIV/AIDS Any laws that protect people who are HIV positive
HIV/AIDS & STDS awareness in Family If people who are HIV positive have access to necessary treatments and medications what life is like for someone who is HIV positive Pick a country and talk about what you would do to help with the HIV/AIDS epidemic. How could you help make a difference in that country even though you live in UGANDA?
Then, find ways to make a difference in your community. Perhaps you can volunteer by donating your time to an organization that helps people that are HIV positive, raising money by participating in a fundraiser like AIDS Walk, or working with your school or public library to organize an event for World AIDS Day (December 1).
SEXUALLY TRANSMITTED DISEASES (STDS)
Questions and answers
What are the different types of STDs?
STDs are often divided into two categories—viral and bacterial—based on the type of microorganism that causes the specific disease.
Those STDs caused by bacteria—such as Gonorrhea, Syphilis, and Chlamydia—are curable with antibiotics. Those STDs caused by viruses are not. These include Human Immunodeficiency Virus (HIV), Human Papillomavirus (HPV), Herpes, and Hepatitis B. Medical treatment can, however, alleviate the symptoms of these STDs.
Some STDs are also caused by protozoa (Trichomoniasis) and other organisms (crabs/pubic lice and scabies). These STDs are curable with antibiotics or topical creams/lotions.
What are the symptoms of STDs?
STDs have a range of symptoms, but it’s often hard for people who are infected to determine if they have an STD. Many STDs have no symptoms, have symptoms that are easily confused with common illnesses, or have latent symptoms that take weeks or years to show up.
Symptoms of STDs like Chlamydia and gonorrhea can include itching or burning during urination. Herpes and HPV symptoms sometimes don’t occur for weeks, months, or years and can include sores or a rash (for Herpes) or whitish, raised growths (for HPV). And HIV-positive individuals usually don’t have any symptoms for years until they begin to experience the opportunistic infections that characterize AIDS.
There is no way to tell if another person has an STD just by looking at them. The only way to know for sure is to visit a healthcare provider and get tested. What is involved in testing for STDs?
There are many different ways health care providers screen for STDs. These can include visually examining sores or lesions, collecting fluid from the urethra or cervix with a cotton swab, testing urine or blood, or conducting a biopsy.
Individuals should seek diagnosis and treatment at the first sign of symptoms to avoid serious complications. Because many STDs have no symptoms, individuals should also talk to their health care providers about having a routine STD screening as part of their annual physical or gynecological. Women need to understand that STD screenings are not necessarily part of their annual gynecological exam and that Pap smears do not screen for STDs other than HPV.
Individuals can find an STD clinic in their area .
Are condoms effective in preventing STDs?
Condoms provide different levels of risk reduction for different STDs because infections are spread differently—some STDs are spread by contact with bodily fluids while others are spread by skin to skin contact. In general, research shows that condoms are most effective in preventing those STDs that are spread by bodily fluids, such as HIV. Condoms can reduce the risk of contracting diseases spread by skin-to-skin contact, such as Herpes, as well. However, they may be less effective because contagious sores and lesions can occur outside of the area covered by the condom.
These are prevention messages recently developed by the CDC:
Latex condoms, when used consistently and correctly, are highly effective in preventing the transmission of HIV, the virus that causes AIDS. In addition, correct and consistent use of latexcondoms can reduce the risk of other STDs. Latex condoms, when used consistently and correctly, can reduce the risk of transmission of Gonorrhea, Chlamydia, and Trichomoniasis. Latex condoms, when used consistently
and correctly, can reduce the risk of Genital Herpes, Syphilis, and HPV only when the infected areas are covered or protected by the condom.
What is Chlamydia?
Chlamydia, which is caused by the bacteria chlamydia trachomatis, targets the cells of mucous membranes including the surfaces of the urethra (male and female), vagina, cervix, and endometrium (the lining of the uterus) as well as the anus and rectum. Although possible, it rarely targets the mouth or throat. If left untreated in women, it can spread to the fallopian tubes and lead to Pelvic Inflammatory Disease (PID), a serious medical condition that can cause infertility.
Chlamydia is transmitted through vaginal or cervical secretions and semen during unprotected anal, oral, or vaginal sex with an infected person. It can also be transmitted from mother to newborn during childbirth.
Chlamydia is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, sitting on public toilets, or touching door knobs.
Chlamydia is curable with oral antibiotics prescribed by a health care provider. All partners should undergo treatment at the same time to avoid passing the infection back and forth. They should also be sure to finish the full course of antibiotics even if symptoms subside. How common is Chlmydia?
Over 1,030,911 Chlamydia infections were reported to the CDC. The reported rate of Chlamydia among women (515.8 cases per 100,000 females) was almost three times as high as the reported rate among men (173.0 per 100,000 males). Young women ages 15–19 had the highest reported rates of Chlamydia (2,862.7 per 100,000). Chlamydia infections increased from 50.8 to 347.8 per 100,000 between 1987 and 2006.
What is Gonorrhea?
Gonorrhea, once known as “the clap,” is caused by bacteria called Neisseria gonorrhoea that grow in the warm, moist areas of the reproductive tract, including the cervix, uterus, and fallopian tubes in women and the urethra in both women and men. The bacteria can also grow in the mouth, throat, and anus.
Gonorrhea is transmitted through vaginal or cervical secretions and semen during unprotected anal, oral, or vaginal sex with an infected person. It can also be transmitted from mother to newborn during childbirth.
Gonorrhea is not transmitted through such casual contact as hugging, shaking
hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.
Gonorrhea is curable with oral antibiotics prescribed by a health care provider. All partners should undergo treatment at the same time to prevent passing the infection back and forth. They should also be sure to finish the full course of antibiotics even if symptoms subside. How common is Gonorrhea?
Over 358,366 cases of Gonorrhea were reported in the United States. For the sixth consecutive year, gonorrhea rates among women (124.3 per 100,000) were slightly higher than among men (116.8 per 100,000). Among women, those ages 15–19 had the highest reported rate of Gonorrhea (647.9 per 100,000). Among men, those ages 20–24 years of age had the highest reported rate of Gonorrhea (454.1 per 100,000).
What is Hepatitis B?
Hepatitis B is a virus that causes chronic infection, cirrhosis (scarring), and cancer of the liver. The virus is present in blood, semen, vaginal secretions, and breast milk.
Hepatitis B is transmitted through unprotected anal, vaginal, and oral sex with an infected person; through contaminated needles or syringes; or from an infected mother to her newborn during childbirth or breast-feeding.
Hepatitis B is one of the only STDs for which a vaccine is available. Individuals must take all three doses of the vaccine to protect themselves against infection. They can obtain the vaccine from their health care provider.
Hepatitis B is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.
There is no cure for Hepatitis B. Treatment varies depending on whether the infection is acute (newly acquired) or chronic (persistent). How Common is Hepatitis B?
The number of new Hepatitis B infections per year has declined from an average of 260,000 in the 1980s to approximately 60,000 in 2004. Of an estimated 1.25 million Americans chronically infected with Hepatitis B, 20 to 30 percent were infected during childhood.
What is Herpes?
Herpes is a recurrent skin condition characterized by sores on the mouth or genitals. It is caused by the herpes simplex viruses called HSV-1 and HSV-2. Although HSV-1 most commonly causes “cold sores” or “fever blisters” on the mouth or face and HSV-2 most commonly causes sores on the penis or vulva, the viruses are identical under a microscope and either type can infect the mouth or genitals.
Herpes is transmitted through skin-to-skin contact during unprotected anal, oral, or vaginal sex with an infected person or through kissing. This is possible even when no sores are present.
Herpes is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.
There is no cure for Herpes. Antiviral medications can reduce the frequency of outbreaks and speed the healing of the outbreaks
How Common is Herpes?
Nationwide, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had a genital Herpes infection. Infection with HSV-2 is more common in women (approximately one out of four) than in men (almost one out of five). This may be due to the fact that male-to-female transmission is more efficient than female-to-male transmission.
What Is Human Immunodeficiency Virus (HIV)?
The Human Immunodeficiency Virus (HIV) causes an individual’s immune system to weaken and lose its ability to fight off infections and cancers. After developing a number of these infections or reaching a certain blood count level, an HIV-positive person is diagnosed with Acquired Immunodeficiency Syndrome (AIDS).
HIV is present in blood, semen, vaginal secretions, and breast milk. It is transmitted through unprotected anal, vaginal, and oral sex with an infected person; through contaminated needles or syringes used to inject drugs; or from an infected mother to her newborn during childbirth or breast-feeding.
HIV is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.
There is no cure or vaccine for HIV or AIDS. There are, however, a number of drugs and combinations of drugs that allow people with HIV or AIDS to stay healthy for longer periods oftime.
How common is HIV?
At the end of 2003, an estimated 1,039,000 to 1,185,000 persons in the United States were living with HIV/AIDS. CDC has estimated that approximately 40,000 persons in the United States
become infected with HIV each year. In 2005, almost three quarters (74%) of HIV/AIDS diagnoses were for male adolescents and adults. In 2005, blacks (including African Americans), who make up approximately 13% of the US population, accounted for almost half (49%) of the estimated number of HIV/AIDS cases diagnosed. An estimated 4,883 young people received a diagnosis of HIV infection or AIDS in 2004, representing about 13% of the persons given a diagnosis during that year.
What is Human Papillomavirus (HPV)?
There are over 100 strains of the Human Papillomavirus (HPV). Approximately a third of these strains are sexually transmitted and cause genital HPV. Some types of genital HPV may cause warts that can grow on the cervix, vagina, vulva, penis, scrotum, urethra, and anus. Other strains of genital HPV can cause abnormal cells to grow on the cervix and can lead to cervical cancer.
Researchers at the pharmaceutical companies Merck and GlaxoSmithKline have developed vaccines that target particular strains of HPV. Merck’s vaccine, Gardasil, targets HPV types 16 and 18, which are associated with 70% of all cervical cancer and types 6 and 11 which are associated with 90% of all genital warts. GlaxoSmithKline’s vaccine only targets HPV types 16 and 18. Both vaccines have been shown to be nearly 100% effective in preventing infection with the HPV strains they target. Merck’s vaccine, Gardasil, was approved by the Food and Drug Administration (FDA) for females ages 9–26 and was recommended for routine use with females ages 11–12. Individuals can obtain the vaccine from their health care provider. GlaxoSmithKline’s has not yet been approved by the FDA.
HPV is transmitted by direct skin-to-skin contact with an infected individual. It can also be transmitted when warts are not present. It is sometimes transmitted from mother to infant during childbirth.
There is no cure for HPV. Many HPV infections will resolve on their own without causing any long-term harm. Others may require treatments to remove warts or abnormal cells.
How common is HPV?
Approximately 6.2 million new cases of HPV infection are reported every year, and, at least 20 million Americans are already infected.Among those individuals ages 15–49, only one in four Americans has not had a genital HPV infection. Approximately 14,000 women are diagnosed with cervical cancer in the United States each year; over 5,000 die from this disease each year.
What is Syphilis?
Syphilis, which is caused by bacteria called spirochetes, causes sores (chancres) to appear mainly on the external genitals, vagina, anus, or in the rectum. They can also appear on the lips and in the mouth.
There are three stages of syphilis. During the primary stage, which usually occurs within 10 to 90 days after exposure, a sore may appear. During the secondary phase, which usually occurs within 17 days to six-and-a-half months after exposure, a rash may appear on various parts of the body. If left untreated, Syphilis can proceed to the latent stage during which it may have no visible symptoms but can cause irreversible damage to internal organs.
Syphilis is transmitted through direct contact with sores during unprotected anal, oral, or vaginal sex with an infected person. Syphilis can also be transmitted from mother to newborn during childbirth.
Syphilis is not transmitted through such casual contact as hugging, shaking hands, sharing food, using the same eating utensils, drinking from the same glass, sitting on public toilets, or touching door knobs.
Syphilis is curable with antibiotics prescribed by a health care provider. Damage to internal organs during the latent stage is irreversible. All partners should undergo treatment at the same time to prevent passing the infection back and forth. They should also be sure to finish the full course of antibiotics even if symptoms subside.
How common is syphilis?
Over 9,756 cases of primary and secondary Syphilis cases were reported to the CDC in 2006. The reported rate of primary and secondary Syphilis increased 11.8 percent among men (from 5.1 cases to 5.7 cases per 100,000) between 2005 and 2006. During this time, the rate also increased 11.1 percent among women (from 0.9 to 1.0 cases per 100,000).
What is Trichomoniasis?
Trichomoniasis, or “trich,” is a genital inflammation caused by the protozoa trichomonasvaginalis.
Trichomoniasis is transmitted through skin-to-skin contact during unprotected anal, oral, or vaginal sex with an infected person.
Trichomoniasis is curable with antibiotics prescribed by a health care provider. Both partners must undergo treatment at the same time to prevent passing the infection back and forth. They should also be sure to finish the full course of antibiotics even if symptoms subside. How common is Trichomoniasis ?
Trichomoniasis is the most common curable STD in young, sexually active women.
An estimated 7.4 million new cases occur each year in women and men.
CIRCUMCISION QUESTIONS ANSWERS
Circumcision is the surgical removal of the sleeve of skin and mucosal tissue that normally covers the glans (head) of the penis. This double layer, sometimes called the prepuce, is more commonly known as the foreskin.
Parents are encouraged to read as much as possible about circumcision. They should make themselves aware of the complexities of the circumcision procedure itself. Speak to your doctor about the step-by-step procedure. If possible, ask to observe a circumcision at your hospital, so that you will know fully what is involved.
The International Coalition for Genital Integrity has classified circumcision as a type I genital mutilation. Pictures and video of a circumcision are available on the Circumcision Information and Resource Pages (CIRP) website.
What is the foreskin there for?
The foreskin serves three functions: protective, sensory, and sexual.
In most cases, the foreskin is still fused to the glans at birth and will separate over a variable period of time over the first few years. During the diaper period, the foreskin protects against abrasion from diapers and feces. Throughout life, the foreskin keeps the glans soft and moist and protects it from trauma and injury.
Parts of the foreskin, such as the mucosa (inner foreskin) and frenulum, are particularly sensitive and contribute to sexual pleasure. Specialized nerve endings enhance sexual pleasure and control The inner foreskin (mucosa) is the skin directly against the glans. Like the lining of the mouth, this tissue is thinner and of a different texture and color than the remainder of the skin covering the penis (shaft skin). The frenulum is a particularly sensitive narrow membrane that runs down the ventral groove of the glans and attaches to the inner foreskin. The ridged band is the interface between the inner foreskin (mucosa) and the shaft skin. It often “puckers” past the tip of the glans. The band contains whorled smooth muscle fibers, giving it pronounced elastic properties that allow the foreskin to be retracted. The ridged band has a tactile sensitivity equivalent to that of the lips.
The foreskin provides ample loose skin for the penis to occupy when erect. It is a movable skin sheath for the penis during intercourse, reducing chafing and the need for artificial lubricants, and allowing the glans and foreskin to naturally stimulate each other. Warren and Bigelow described some of the physiological functions of the foreskin in
sexual activity. What are some reasons that circumcision is performed?
Circumcision is primarily performed for cultural or religious reasons.
Because a large number of men in English-speaking Western countries are circumcised, many think of the foreskin as an unnecessary part of the penis. Many circumcisions are performed because a circumcised father often does not want to feel that he is different from his son.
It is often said that a circumcised penis is cleaner, or easier to keep clean, than an intact penis. Smegma (a natural substance composed of dead skin cells, normal flora, and secretions containing the natural antibacterial agent lysozyme) is more likely to accumulate when the foreskin is present.
Medical grounds for circumcision that are most commonly cited are: Reduced risk of urinary tract infections (UTI); reduced risk of penile cancer; reduced risk of cervical cancer in partners; reduced risk of sexually transmitted disease (STD).
There is contradictory evidence in the research literature as to whether circumcision reduces UTI but this seems to be the strongest of all medical claims in favour of circumcision, because UTI can have serious consequences. These infections can, however, in most cases be treated by antibiotics. The frequency of UTI in US male infants is approximately 1%, but is higher for females. There is evidence that babies who are breastfed have a lower incidence of UTI.
Penile cancer is an extremely rare form of cancer. It occurs mostly in older men, and most doctors will not recommend infant circumcision as a preventative measure. Penile cancer can occur in both circumcised and intact men: The Maden study (an ongoing study of penile cancer at Fred Hutchinson Cancer Research Center in Seattle) observed that 37% of penile cancer cases occurred in circumcised men.
The theory that wives of men with intact foreskins are more prone to cervical cancer has been disproven [12]. The theory that the presence of a foreskin may cause an increased risk of sexually transmitted diseases was disproved by a new study [22]. The question of HIV warrants further study [20], [7]. Although there is an apparent geographical correlation between male non-circumcision and HIV infection on the African continent, this is not true globally, and the pattern seen in Africa could easily be due to other factors.
The only known effective means of preventing HIV infection are fidelity, condom use and abstinence. Hygiene
The foreskin is easy to care for and the intact penis is easy to keep clean. The foreskin usually does not fully retract for several years and should never be forced. When the foreskin is fully retractable, boys should be taught the importance of washing underneath the foreskin every day.
Gently rinsing the genital area while bathing is sufficient. Harsh soap and excessive washing can irritate the penis, which can lead to inflammation of the glans (balanitis).
Smegma is a white waxy substance, consisting of natural secretions and shed skin cells, that may occur around the folds of the genitalia in both males and females. In the past it was feared that smegma might be carcinogenic (and this fear was used as a justification for circumcision), but this fear has been disproven. Good general hygiene and common sense are key to preventing infection. If my son isn’t circumcised, won’t it have to be done later?
Abnormalities or diseases of the foreskin can be treated conservatively, if and when they occur, on a case-by-case basis.
Probably the most common abnormality of the penis is “phimosis”, or tight foreskin. (This is not the same as the natural attachment of the foreskin to the glans in very young children, which is completely normal.) The foreskin can normally be retracted by adolescence.
If retraction is not possible, a number of newer treatments are available which do not involve circumcision: Steroid creams, stretching, and preputioplasty. [18] Some of these treatments have only been published recently, and not all doctors are aware of them.
If your son has a serious problem with his foreskin, such as a severe infection (balanitisxeroticaobliterans) or gangrene, perhaps related to diabetes, removal of the affected area may be a medically advisable option. If my son isn’t circumcised, won’t he be teased?
Children can be cruel, and will find things to pick on another child about, whether it be his chubbiness, glasses, or freckles. Some parents think that their son should be circumcised so that he will “match” his father, brothers, or friends. As parents, we can help our children to feel good about their bodies and to respect individual differences.
Parents often express a fear that their son will “feel different in the locker room” if he is intact. There is good evidence that proper education is the answer. Boys who are taught from an early age that they are normal, whole and healthy will have a lesser chance of suffering embarrassment in the locker room, especially if some of the other boys are also intact.
Nonreligious infant circumcision is not an issue in European, Asian or South American countries. In Canada the average rate of infant circumcision for boys is roughly 25%, with large regional variations. The rate in the United States has dropped to less than 60%, and will drop below 50% in a few years if present trends continue. This is already true in the Western US (35% in 1993).
What are some reasons not to have my son circumcised?
Your son’s foreskin is a healthy, natural part of his body. Any part of the body may develop problems. It is possible, though very unlikely, that the foreskin will develop problems. However, most foreskin problems are easily treatable.
When your son becomes an adult, he may choose circumcision for himself. However, there is a good chance he will prefer not to be circumcised. Leaving your baby’s foreskin alone preserves his right to a whole and intact body.
Circumcision will be painful for the baby
The medical evidence in favor of routine circumcision of healthy babies is not persuasive. If your son has a problem with his foreskin, such as a severe infection (balanitisxeroticaobliterans) or gangrene, perhaps related to diabetes, your doctor may recommend partial or complete circumcision or removal of the affected area. Phimosis (nonretractable foreskin, if it persists much longer than normal) can usually be treated by gentle stretching and/or steroid creams. The vast majority of boys will never have any foreskin problems that necessitate surgery.
Is circumcision painful?
The often repeated statement that babies can’t feel pain is not true. It is documented in the medical literature that babies are as sensitive to pain as anyone else, and perhaps more so. [13,14]
Most circumcisions are performed without anaesthetic, because there are risks involved with using anaesthetics on babies. Sometimes local injections are used, but this does not eliminate pain. Most babies will show signs of pain during the procedure and in the week or ten days following circumcision. Recent studies have shown that the pain is remembered long beyond the time of the procedure itself. [23]
While pain may help parents decide against circumcision, parents should look at the long term effects of their decision first, not only during infanthood, but all the way to adulthood. Your decision will affect your son for the duration of his life.
Does infant circumcision have risks?
Circumcision is surgery, and like all surgery it has risks. These include: Excessive bleedingInjury to the glansInfection (raw wound is exposed to feces and urine in diaper) Complications from anaesthesia, if used Surgical error, including removal of too much skin In rare cases, complications can be life-threatening.
Up to 20% of circumcised males will suffer from one or more of the following complications, to some degree: Meatal stenosis (narrowing of the urethral opening due to infection and subsequent scarring, that occurs almost exclusively in circumcised boys) [15] extensive scarring of the penile shaft skin tags and skin bridges bleeding of the circumcision scar curvature of the penis tight, painful erections psychological and psychosexual problems [21]
The surface of the glans becomes dry if not protected by the foreskin. It is believed that dryness and abrasion may cause progressive loss of sensation in the glans, especially in later life. Circumcised men on the whole do enjoy sex and are able to orgasm.
What if we want to have our son circumcised?
Circumcision does not need to be done right away. There is no need to feel pressured by your doctor. Take your time.
If you intend to ask your doctor to have your son circumcised, ensure that the procedure is carried out by an experienced surgeon. Sometimes circumcision is considered “minor surgery” and inexperienced residents are given the task of performing it. This leads to a higher rate of serious errors and complications.
You may desire that your son will retain some inner foreskin, and especially the frenulum, to preserve as much sexual sensitivity and function as possible. Another method is the dorsal slit. This method does not involve the removal of tissue, but allows the glans to be exposed.
Your doctor can help you decide how much skin will be removed and how much of the glans should remain covered if desired. However, in most cases, once your signature is on the consent form, the physician has absolute license to execute the circumcision as he/she sees fit. You must ensure that your intentions are in writing before the operation occurs.
To lessen the pain, speak to your doctor about the use of an anaesthetic for your baby. Note that some doctors who use anesthetic may not allow sufficient time for the anesthetic to take effect: It is important to ensure that this does not happen. When and why was routine neonatal circumcision introduced in English-speaking Western countries?
Doctors in the English-speaking countries started circumcising babies in the mid-1800s to prevent masturbation, which some doctors claimed caused many diseases, including epilepsy, tuberculosis and insanity. Of course, these arguments are not accepted today.
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