The benefits of medical versus traditional circumcision

Regardless of whether they’re performed in a traditional or medical setting, all male circumcisions involve surgical removal of the foreskin. But with botched or unhygienic procedures leading to serious complications or death, traditional circumcisions often make headlines for the wrong reasons.

What sets traditional circumcision apart is that it’s part of initiation – the cultural tradition during which young men are initiated into manhood, explains Dr Mulalo Radzuma, a urologist at Mediclinic Legae.

The age at which boys undergo traditional circumcision differs according to their cultures. For example, in the Xhosa culture, initiation is usually done when boys turn 18. However, in the Venda and Pedi cultures in Limpopo, it takes place when children are much younger – between the ages of 8-10 years old.

Tradition circumcision controversies

A past study, commissioned by Health Minister Dr Aaron Motsoaledi after several initiation school deaths, found hypothermia and lack of food were the leading causes of initiation deaths, and not necessarily botched circumcisions. While there are always “chancers”, most traditional leaders at the circumcision schools were found to be competent at performing circumcisions, says Dr Radzuma.

“Nonetheless, the biggest challenge we face is in the Eastern Cape,” he says. “Here you get people who have not received adequate training for performing traditional circumcisions or who do not have government approval to open initiation schools.”

This lack of training and protocol can lead to botched procedures where the penis is essentially amputated or badly mutilated, he continues, which doctors battle to rectify. “If the circumcision results in sepsis, boys must spend weeks and sometimes months in the hospital being treated for the infection.

“Initially, we also used to face the challenge of the schools using one blade on all of the boys until it was blunt.” As a result, the government intervened and began supplying schools with one blade for each initiate – also vital in preventing the spread of HIV.

How to choose a safe ingcibi (traditional surgeon)

An ingcibi, who performs traditional circumcisions, is not a trained medical doctor. “Their preparation works on a ‘see one, do one’ principle – handed down from one generation to another,” says Dr Radzuma. “The problem is that most ingcibis have no basic understanding of human anatomy and physiology, or of the penis.”

They are frequently encouraged to come to medical institutions and learn from medical specialists, he continues. “In some provinces, the chief of that region will also allow a medical doctor to come in and facilitate the circumcision, provided the doctor himself has been initiated – a prerequisite for entering the initiation camps.”

Initiates can also choose to have their circumcisions done at a medical institution. However, this needs to happen before they go to initiation school, the Dr Radzuma cautions, otherwise they will be circumcised there. Parents must check that the doctors they use are registered with the HPCSA, he advises.

Similarly, parents must check that they pick a government-registered initiation school to ensure their child’s safety. But not all parents have this luxury. In some rural villages, if villagers find that a boy who has come of age is uninitiated, they have the right to take him to an initiation school, even by force.

“Then the parents are forced to pay a certain amount for the initiation to be carried out, and cannot fetch him [before this],” Dr Radzuma explains. “Fortunately, in the suburbs and townships, we don't see that.”

Understanding medical circumcision

A day clinic or hospital offers a sterile and safe environment in which trained medical personnel, who are equipped to deal with complications like blood loss, perform circumcisions. “At Mediclinic Legae, we’ve done more than 350 circumcisions this year and not one became infected,” says Dr Radzuma.

Medical institutions also offer pain management in the form of local or general anaesthesia. In the mountains where traditional circumcisions are performed, anaesthesia is not available – often causing excruciating pain.

“In a medical setting, the procedure is fully explained to the patient and the circumcision itself takes 5-10 minutes,” Dr Radzuma explains. “The wound is closed with glue – for smaller kids – or dissolvable stitches for older kids or adults.” It is then bandaged; patients go home the same day, and they remove the bandages two to three days later. Sexual intercourse is not permitted for six weeks following the operation.

The younger you are, the less complicated circumcision is, adds Dr Radzuma, but traditional circumcision practices mean many African parents prefer to wait longer to adhere to cultural norms.

Why circumcise?

Medically speaking, there are multiple benefits of circumcision, which is why doctors encourage men to circumcise. “Data shows that those circumcised at a young age have zero chance of developing penile cancer,” says Dr Radzuma. “In South Africa, due to the lack of circumcision and our high HIV rate, we get a lot of penile cancer, which is often advanced when patients finally seek help. This leaves us with no option but to do a penectomy – to surgically remove the penis.”

There’s also indisputable data that being circumcised decreases men’s chances of contracting HIV and other sexually transmitted infections (STIs). This also limits their chances of giving their female sexual partners cervical cancer – highly associated with STIs.