Circumcision - Misinformation from uninformed Korean doctors

November, 2005

As far as we are aware, there has been no article on circumcision written by a Korean doctor and published in an international journal. Thus, we must rely largely on articles published by doctors in the lay press to determine their views on circumcision. The attitude apparent of Korean doctors, i.e. to classify both the very small percentage of males with phimosis and most of those with normal, uncircumcised prepuces as abnormali, seems to have changed little over recent years. Therefore, most sources are very much in favour of universal circumcision and the question is not whether a male should be circumcised but when the operation should be performed. For instance, a popular textbook states that

"Phimosis or redundant (long) prepuces may cause; (i) penile or cervical cancer; (ii) increased susceptibility to various sexually transmitted diseases; (iii) bad smells in the penis; (iv) premature ejaculation."

While offering no references for the origin of these statements, this text mentions the supposedly lower penile cancer rates in Jews and Moslems compared with Hindus. Most of these beliefs were, or still are, held by some Americans. Most are controversial, e.g. the association with cervical cancer. In America, premature ejaculation is seldom, if ever, mentioned as a justification for circumcision, whereas in Korea, the belief in the enhancement of sexuality through circumcision is very popular, not only among the general public but also apparently in the medical community.

A popular Korean medical website advises, with no reference, that "nearly all Korean males need circumcision".

The same website also states, "there is no specific age at which circumcision should be performed."  Another popular website providing sexual education for teenagers states that "..the best age for circumcision is known to be between 12 and 14 years", again with no reference cited.

Yet another site advises parents that ".. if a child feels different because he is not circumcised and his friends boasts of having superior penis because of circumcision, it is good to have him circumcised for psychological reasons." In one widely read Korean encyclopaedia it is stated that "if prematurely ejaculating, circumcision must be performed" and "cervical cancer should be prevented through circumcision"

For comparison, a recent edition of the Encyclopaedia Britannica mentions nothing about premature ejaculation or cervical cancer in relation to circumcision, and states that the practice is in decline even in America.

It is also instructive to consider some of the leading newspaper articles on circumcision. Although these articles might not best reflect the general attitude of the Korean medical community, most are written by popular urologists, or refer to them. These articles no doubt influence popular beliefs about circumcision and therefore warrant consideration, especially because they help to understand why most males choose to be circumcised.

Some of these titles are listed in Appendix 1. A relatively liberal position taken by Korean doctors on circumcision can be found in a recent textbook in which the authors state that "not every male needs to be circumcised". It is apparent that nearly all textbooks, encyclopaedias and newspaper articles 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.

It is clear that the beliefs held by the Korean public and medical community were directly influenced by the beliefs of some Americans in the past and, to a lesser degree, at present. It is interesting as to why Koreans are circumcised at much later ages, after popular medical advice. At the start of Korean circumcision, nearly all procedures were performed on adults. Therefore, it is possible that simply by habit, the operation is generally performed mostly on older males and not on infants. Currently, many  Korean doctors tend to recommend circumcision mostly at the onset of puberty. It appears that the recently changing American attitudes toward circumcision may have exerted some indirect influence. There are numerous American studies on the pain felt by infants when circumcised and this is a cause for debate. When recommending circumcision at specific ages, Korean doctors routinely cite recent American studies showing that even infants feel the pain. It seems that Korean doctors recommend circumcision at the onset of puberty because at that age, boys tend to accept the procedure as a "right of passage". One recent newspaper article by a urologist states that "these days, even in America, the neonatal circumcision rate is declining and only about 60% are neonatally circumcised because infants also feel pain". This urologist goes on to recommend near universal circumcision at the onset of puberty. However, it is possible that this doctor assumed that most of the uncircumcised American infants would later be circumcised. This assumption goes against the present American situation where the decision about circumcision is primarily made at birth and not later.

Appendix 1

Titles of articles about circumcision, published recently in leading Korean newspapers.

Circumcision should be performed at around 12 years of age - (HanKyeoRae Shinmun, June 16, 1997)

Correction of false teeth, circumcision, removal of warts and acne are best performed at the winter breaks - (Dong A Ilbo, Dec. 21, 1996)

My 70-year-old patient who was circumcised
(Kukmin Ilbo, Sep. 24, 1996); in this article the urologist mentions that this man wished to be circumcised so that his children would not be embarrassed when they performed the ritual bath upon his death!

Danger!: Self-Operating Circumcision Machine -(SeGye Ilbo, August 15, 1996)

"The time to be circumcised: Is it when a baby is born, or is it around 10 years of age? Medical Community sharply divided." -(SeGye Ilbo, Aug. 12, 1995).

"Premature Ejaculation (states that "phimosis or long prepuce causes premature ejaculation)
Cervical Cancer: A cancer of environment - (KyungHyang Shinmun, Oct. 9, 1995); states "the probability of getting cervical cancer is enhanced when having sex with uncircumcised males".

In the same article, it is stated that to prevent cervical cancer, the male partner must be circumcised.