404 Where There Is No Doctor 2011
CIRCUMCISION AND EXCISION (CUTTING AWAY SKIN
FROM THE SEX PARTS)
In many communities, boy children are circumcised—as are girls in some parts
of the world—as a traditional ‘practice’ or ‘custom’. Circumcision is not necessary for
health, although male circumcision may provide some protection against HIV. For boys
it is usually not dangerous. But for girls, this practice—sometimes called ‘excision’,
‘infibulation’, or ‘female genital cutting’—is very dangerous and should be strongly
discouraged. For both boys and girls, unclean cutting tools risk spreading HIV.
BOYS
A baby boy is born with a tube of skin (foreskin) covering the ‘head’ of his penis. As
long as urine comes out of the hole at the tip, there should be no problem. The foreskin
will usually not pull back completely over the head of the penis until the boy is about
4 years old. This is normal and circumcision is not necessary. Do not try to pull the
foreskin back by force.
However, if the foreskin becomes red, swollen, and so tight that the baby
cannot pass urine without pain, this is not normal. Take him to a health worker for a
circumcision as soon as possible.
As a family ritual, simple circumcision of a healthy baby boy may be done by a
midwife or person with experience. Using a new razor, she cuts off a little of the foreskin
beyond the head of the penis. After the cut, there is some bleeding. Hold the penis
firmly with a clean cloth, or gauze, for 5 minutes, until the bleeding stops. Some healers
use the juice of a plant to help stop the bleeding (see p. 13).
baby’s
penis
pull upward on
the foreskin
head of penis
(be sure not
to cut it)
line of cut
tip of penis
can now be
seen
If the bleeding does not stop, wash away the clots of blood with clean water, and
pinch the end of the foreskin between the fingers with a piece of clean cloth for as long
as it takes the bleeding to stop. No medicine is needed.
GIRLS
In circumcision of girls, or ‘excision’, the soft knob of flesh (clitoris) at the front end
of the vagina is cut out. Sometimes, part of the vaginal lips is also cut away. Removing
the clitoris is as bad as cutting off the head of a boy’s penis. Excision should not be
done. Girls who have been excised may have frequent urinary and vaginal infections,
and difficulty during childbirth.
There is also danger of severe bleeding during excision. The child can die in a few
minutes. Act quickly. Wash away the clots to find the exact point where the blood is
coming from and press on it firmly for 5 minutes. If bleeding continues, keep pressing
the bleeding spot while you carry the child to a health worker or doctor for help. Watch
for signs of shock (see page 77) and infection.