Ringing the changes for circumcision

Doctors at work in the urology department of the Air Force General Hospital in Beijing. In China, the male circumcision rate is lower than 5 percent. Han Meng / China Daily

AIDS prevention strategy

The World Health Organization estimates that about 30 percent of all males aged 15 and older worldwide are circumcised, and about 70 percent of them are Muslim or Jewish. Although the practice is most prevalent in Judaism and Islam, and is carried out during childhood or around puberty as part of a rite of passage, it's also common among Christians in Egypt, Syria and a small number of other countries. In China, the male circumcision rate is lower than 5 percent.

In 2007, WHO and UNAIDS, the Joint United Nations Program on HIV/AIDS, issued guidelines on using medical male circumcision as an additional strategy to prevent HIV infection. According to the US Centers for Disease Control and Prevention, clinical trials have demonstrated that circumcision reduces the risk of contracting HIV/AIDS by 50 to 60 percent. The procedure also reduces the chances of contracting herpes and human papilloma virus, two pathogens believed to cause cancer of the penis, by 30 percent.

However, circumcision is still almost unknown in China, according to Zhou Xiao-zheng, a professor of sociology at Renmin University of China. "Few Chinese men have a religious background that promotes circumcision. In addition, surgery on the male genitals remains unthinkable. In the minds of the Chinese people, the only equivalent widely known surgery is the castration of eunuchs, which can be traced back to the Qin Dynasty (221-206 BC)," he said.

According to Zhu Jichuan, director of the Andrology Center at Peking University Hospital, the traditional notion that "only a patient needs surgery" is deeply rooted. "Most men choose to be circumcised because of a skin inflammation that results from having an overlong foreskin, rather than to prevent disease. However, surgery is an option that must be open to them," he said.

That reluctance is also a result of the defects of conventional surgery, because scars and the risks related to bleeding are inevitable, Zhu said. "More important, the amount of foreskin removed can't be targeted by the millimeter, so some men may be concerned that their erections will be shorter after surgery," he said.

Whatever their concerns, the patients have high expectations. The urology department at Chaoyang Hospital in Beijing performs about 1,000 circumcisions every year, and most patients opt for the Shang Ring, even though it costs 1,200 yuan ($192) to 1,300 yuan, double that of conventional surgery, according to Tian Long, director of the department.

"People expect more nowadays. Not just in terms of safe removal of the foreskin, but also in terms of good appearance and perfect function," Tian said. "To a surgeon, circumcision is actually a challenging operation, not because it's complicated, but because it requires an exquisite technique."

Although some private hospitals advertise "painless laser-scalpel surgery" to encourage people to have the traditional operation, the differences are minimal. "They just revolve around the type of anesthesia and surgical instruments; the procedure is fundamentally the same," he said.

Philip S. Li, associate research professor of urology at the Weill Cornell Medical College of Cornell University, said that in the past three years, the male circumcision rate in the US has been around 70 percent.

Li said the surgery is usually performed within a day or two of a baby's birth. However, doctors may also suggest circumcision for older patients who are experiencing problems, such as inflammation of the foreskin, or phimosis, difficulty in retracting the foreskin.