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The Big Korean Flap

By Dr. Robert T. Francoeur


Dr. Robert T. Francoeur and Huso Hyungsug Yi explain why South Koreans circumcise all their boys at age 12 and why this is medically unsound.



In 1945, after World War II, very few South Koreans knew there was such a thing as a "naked penis," a penis with no foreskin. Male circumcision was practiced only within the tiny Jewish and Muslim enclaves. Nationwide, fewer than one in a thousand South Korean boys were circumcised and circumcision was equally unknown in neighboring China, Japan, and other Asian nations. In Asia, only the Filipinos embraced circumcision, or at least the Spanish version which involves cutting a slit in the top of the foreskin rather that removing the foreskin altogether.


Around the world, 50 years ago, only about 15 percent of boys were circumcised at birth or puberty. Circumcised penises were not fashionable in Europe or Canada, except for Jewish and Moslem boys. However, one "developed nation" stood out as champion of circumcision and that was the United States, where 90 percent of newborn sons were circumcised. This American tradition dates back to the 1800s when circumcision was embraced by our sex-phobic ancestors as a way to reduced the temptation to masturbate and so avoid the "terrible consequences of self-pollution" such as loss of memory and premature death.


Then American soldiers arrived in Korea to implement the United Nations trusteeship (1945-48) and returned in even greater numbers to South Korea during the Korean War (1950-1953).


Within a decade, South Koreans came to believe that practicing circumcision was "advanced and modern," just like the American soldiers. If Americans did it, it must be good. Soon only old Korean men thought that circumcision was just an ancient biblical custom practiced by Jews and Muslims.


In the 1960s, South Koreans adopted circumcision with a passion, but also with some fascinating differences. While Americans circumcise their sons soon after birth, South Korean physicians decided it much healthier to circumcise their sons at puberty, when they were 12 years old and could understand the importance of leaving their childhood behind and becoming a man. Unlike most American circumcisers who until recently used no anesthesia as they operated on the newborn boy, South Korean circumcisers use a local anesthesia.


In the 1960s, Korean doctors and advice columnists launched a campaign in newspapers and magazines urging parents to have their adolescent sons circumcised during the long winter break before a boy enters middle school. Infections, the Korean doctors say, are much less likely if circumcision is done in the winter rather than in the summer. Another reason Korean doctors cite in recommending circumcision is their claim that South Korean men have a gene that causes penile phimosis or "abundant foreskin". In their view, at least 90 percent of Korean men have "too much" foreskin. Strangely, there is no evidence of this alleged genotype for phimosis among North Koreans, where a 1971 study of men aged 19 to 31 entering military service found on 5 percent to be circumcised and fewer that 1 percent of uncircumcised men with phimosis. This North Korean incidence of phimosis is similar to that in the rest of the world. At the same time, in a recent survey, Sae Chul Kim, Professor of Urology at Chung-Ang University School of Medicine, Myung-Geol Pang, CEO of GenDix Pharmaceutical, Inc., and DaiSik Kim, Professor at Seoul National University, found that most physicians could not define "phimosis."  


The same survey revealed that 99 percent of South Korean physicians recommend universal circumcision because they believe it eliminates tight foreskins and brings many benefits. Circumcision, they claim, makes for harder penises. It eliminates the bad smell of the penis and reduces susceptibility to various sexually transmitted diseases. It cures premature ejaculation. It prevents penile and cervical cancer. (The claim is commonly made that Jews and Muslims have a much lower rate of penile cancer than Hindus, a belief still found among some Americans who support circumcision.) And finally, there is the irresistible claim that circumcision produces a definite "cure-all-aphrodisiac effect" in the penis!


According to Sae Chung Kim, an andrologist, Myung-Geol Pang and DaiSik Kim, "It is apparent that nearly all textbooks, encyclopedias, and newspaper articles [in South Korea] essentially advocate universal or near-universal circumcision, and the debate is about when to be circumcised or to circumcise, not about whether to or not."


For unknown reasons deeply rooted in their ethos, South Korean doctors misinterpret the recent decrease in American parents circumcising their newborn sons -- down to 59 percent in 1992 -- as recommending universal circumcision at about age 12, even though there is absolutely no evidence that American boys are now being circumcised at puberty. The doctors are also puzzled why such "advanced" countries as Japan and Denmark do not recommend universal circumcision.


One advice columnist recently wrote that "If a child feels different because he is not circumcised and his friends boast of having a superior penis because of circumcision, it is good to have him circumcised for psychological reasons".


Today, at least 95 percent of South Korean boys entering middle school have had been circumcised. For the other five percent, the question is not whether they should give up their foreskin but when they should be circumcised. Korean boys simply take circumcision for granted. It is their right of passage to manhood.


Some of the uncircumcised five percent described themselves as "naturally circumcised" with either a very short foreskin or no foreskin at all (medically known as aposthia). The idea that one can be "naturally circumcised", born with no foreskin, is a fallacy. But even the shortest foreskin contains the same tens of thousands of highly sensitive nerves as the longest foreskin.


What are the facts? Well, for a start, there is the basic fact that the foreskin is not just a flap of skin. It has some important functions.


There are thousands of sensory cells and Meissner's corpuscles in the foreskin that enhance erotic pleasure. The foreskin stores and releases pheromones (sex attractants) during erection. It stores and releases natural lubricants, smegma and pre-ejaculatory fluid. It makes the glans a visual signal for sexual desire. It supplies skin to cover the penile shaft during erection and prevents tightness. It acts as a "roller bearing" during intercourse and masturbation. It prevents painful intercourse (dyspareunia). It keeps the glans soft and moist, protecting the thin-skinned glans and its nerves against injury.  


Moreover, as Sir Randolph Fiennes found on his epic transpolar walk, the foreskin protects the less vascular glans against frostbite. It can also provide skin for grafts for hypospadia, burnt eyelids, and other reconstructive surgery. And, to keep a touch of humor on this sensitive issue, some suggest that the foreskin can be useful to store contact lenses and smuggle jewels.


On a much more serious notes, researchers have been debating several studies that indicate that circumcised men are less likely to become infected with HIV than uncircumcised males. However, because circumcision is linked with both culture and religion, some argue that the apparent protective effect is likely to be due not to removal of the foreskin but to behaviors prevalent in the ethnic or religious groups in which male circumcision is practiced. What needs to be explained is not the high female-to-male HIV transmission rate in uncircumcised Europe, but the high male-to-female rate in circumcised America. Could the reason for the latter be the rougher action of dry, circumcised American penises producing tint tears in the vaginal wall?


Recently, after interviewing over 5,000 South Korean males of all ages, DaiSik Kim, Myung-Geol Pang and Sae Chul Kim published an article in the British Journal of Urology International, describing the history of male circumcision in South Korea and challenging the recent custom of universal circumcision. When this article came to the attention of the National Organization of Circumcision Information Resources Centres, that group decided to give its Human Rights Award to the three South Koreans at its international Symposium held in Sydney Australia the first week of December, 2000


The reasons why circumcision is now universal in South Korea and seldom practiced elsewhere in Asia are a fascinating excursion into modern cultural and medical myths. As DaiSik Kim observed in accepting the Human Rights Award, "Circumcision in South Korea is unique for three reasons, it is a very recent development, it is promoted by peer pressure and we seem to be embracing circumcision at the same time the rest of the world is abandoning the practice." And then there is Dr Margaret A. Sommerville, founder of the McGill Centre for Medicine, Ethics and Law, and professor of the Faculty of Medicine at the McGill Centre for Medicine, Ethics and Law, in Montreal, Quebec, who claims that male genital mutilation is as ethically wrong as female genital mutilation and that non-therapeutic circumcision of baby boys is a criminal assault. "Our duty to protect those who cannot protect themselves."



update 2010-08-29

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