Is "Pagtutuli" Really Necessary?

Summer is that time of the year when multitudes of Filipino boys “shed blood” to become men. No, it’s not in war that their blood is spilled, but in the surgical procedure called circumcision. 

For some reason, blood plays an important part in the coming-of-age of both girls and boys. Just as a girl’s first menstruation signifies her crossover from childhood to womanhood, Filipino boys undergo the bloody ritual of “pagtutuli” to enter manhood.

To appreciate what circumcision is, people first need to know what foreskin is: It is the loose fold of penile skin that slides over the penile head to cover it. Contrary to popular belief, the foreskin is not just extra and useless skin. It serves the special purpose of protecting the head of the penis from infections and injury, and it is a highly-erogenous area which is as sensitive as the finger tips and lips. Interestingly, the human foreskin is also used in the manufacture of facial skin creams, skin grafts, and porous bandages.

The goal of circumcision is permanent exposure of the head of the penis so that it ceases to be hidden by the foreskin. The two styles of circumcision done in the Philippines include the “dorsal cut” and the “German cut.” 

• The dorsal cut is one short snip of the foreskin, with the snip being as long as the penile head. In the dorsal cut, there is no foreskin removed. Once the cut heals, the foreskin just droops to the sides and underside of the penis as loose skin. Because the dorsal slit is simple and quick to do, this is the style of circumcision commonly done in “operation tuli” or “mass circumcision” events. 
• In the German cut, much or all of the foreskin is surgically removed. Without the foreskin, the penis attains a neater and sleeker look. The German cut however is a more bloody, time-consuming, and complicated procedure since it involves cutting off the foreskin all around the circumference of the penis. 

Medically speaking, there is no reason to do routine circumcision on males. Circumcision is necessary only when the foreskin is too tight, thereby resulting in the following problems:

• Strangulation of the penis head
• Obstruction of urination and ejaculation
• Ballooning of the foreskin with urine
• Recurrent urinary tract infections
• Skin lesions
• Painful erections and painful sex. 

When done correctly, circumcision poses no physical harm on the patient except of course for the wound it creates. Barring infection, the wound generally heals within 2 weeks. 

Culturally speaking, Filipino tradition dictates that all males must be circumcised at birth or around pubertal age. This Filipino tradition of circumcision is primarily based on the myth that circumcision will make boys grow taller, bigger, and more fertile. Filipinos also insist on circumcision because uncircumcised penises are considered disgusting and smelly due to smegma which accumulates underneath the foreskin. Smegma is an accumulation of dead skin, oils, sweat, and grime. “Kupal” in fact, which is the Tagalog word for smegma, is taboo in conversations and is spewed out as a cuss word.

Psychologically speaking, Filipino males need to be circumcised, otherwise they become the butt of ridicule and insults. It is a source of confidence and pride for Filipino boys to courageously suffer the “ordeal” of circumcision. To shirk away from this rite-of-passage is a sign of cowardice and inferiority. For Filipino males, it is not the surgical procedure of circumcision which causes long-term psychological trauma but rather, the shameful state of being uncircumcised. 

Philippine culture is not yet ready to accept uncircumcision as a norm for Filipino males. Since the circumcision experience is here to stay, here are some insights to make “pagtutuli” less nerve-wracking for the boys:

• Children who are excessively fearful of pain, needles, and blood should be given more emotional support to allay their anxieties. They should never be forced into circumcision.
• Circumcision should never be a public spectacle like what happens in “operation tuli” events. Because the procedure involves the reproductive organs, the children’s privacy must be respected.
• Boys waiting in line should not be allowed to hear the hysterical bawling of those undergoing the knife, otherwise, they too lose their nerves. On the other hand, when boys are in the company of other “brave” boys who show that they’ll tough the circumcision out, they become braver themselves. 
• Parents should be aware that not all the people doing circumcisions in “operation tuli” events are doctors. Some are nurses, health workers, and medical students who are merely developing their skills. Parents are better off consulting a private doctor who has much experience and skill in circumcisions. 
• And lastly, circumcision is better done on older boys since they are more capable of giving fuller informed consent to the surgical procedure.