Circumcision practice in the Philippines: community based study

Male circumcision is a well studied phenomenon. However, much of the published knowledge on circumcision is derived from highly industrialised Western countries, particularly the United States. The non-Western context of circumcision is not well known despite being a universal practice in various countries. For example, in the Philippines, circumcision was common in the past as it is at present, being an integral aspect of the social organisation of the society. 3 This report offers a Philippine perspective of male circumcision, particularly its adoption and complications. The study employed semistructured face to face interviews with 114 circumcised males conveniently recruited using a snowball technique from two communities. One fourth (22) of the clients were aged 13–18, while the rest were older, working in varied and low income occupations, and were single, married, or separated. The majority of respondents (51.7%) were circumcised between ages 10 and 14. Others had the same experience before age 10 (42.1%) or between 15 and 18 (5.3%). Respondents gave several reasons for their circumcision: not wanting to be called ‘‘supot’’ or uncircumcised (66.7%); being at the right age (41.2%); and wanting to grow tall and physically fit (29.8%). Other reasons included the need to get rid of smegma in the penis (22.8%); to cause pregnancy (20.2%); and to obey parents (18.4%) (table 1). Seven of every 10 clients (68.4%) were circumcised by non-medical providers; the remaining three by medical providers. Respondents paid for their circumcision in cash (51.8%) or in kind (6.1%); more than a third (36%) said that they used the services at no cost but by courtesy of the community and extension services offered by some groups and individuals from or outside their neighbourhood. Six of every 10 respondents (59.6% or 68 of 114) reported having post-circumcision penile complications (inflammation and swelling), while four (40.4%) had none. Almost all (60 of 68) did not consult their circumcisers about their penile complications. The rest (n=60) self medicated. The healing period was from less than 1 week to 2 months. Circumcision among the low income respondents occurred at prepubescent ages. Ever since, the procedure has been regarded, along with corollary health reasons, as a rite of passage towards manhood. Circumcision was pursued with broad community participation: parents, peers, women, and circumcisers assumed various roles in its adoption. Respondents’ circumcisers included medical doctors and lay people in the community. The central role of lay individuals in undertaking circumcision is part of the traditional character of this community based practice. Post-circumcision complications were limited to inflammation and swelling, consistent with Western data wherein risks are regarded as minor and complications were at a rate 0.2 to 0.6%. 6 Respondents did not take these complications nor the risks from circumcision seriously when they opted not to see their circumcisers and when they adopted self medication. The seeming lack of serious concern for these problems was inappropriate given that the healing period of the circumcised penis of many respondents was highly protracted. Much of the foregoing evidence on reasons for adopting circumcision highlights the fact that respondents’ circumcision was predominantly traditional.