Tule or not Tule…is that a Question?

Oft heard in boy’s locker rooms are heckles and jeers usually targeted at individuals who have not yet gone through a circumcision (pagtutule in Filipino). In fact in our culture, there is even a derogatory term in the vernacular for it. What is a cultural norm for Filipinos is not generally practiced across the world, except for those of Jewish or Islamic descent.  In Europe, a great majority of parents choose not to circumcise their children, some to avoid lingering anti-Semetic or Islamic sentiments in certain parts, while in some parts of Africa, it is done as a religious rite.  

According to the Circumcision Reference Library (cirp.org), in 2009, 32.5% of North Americans had the procedure. Circinfo.net shares that UK has an average of25%,  Australia 69%, and eight out of 27 countries in South East Asia have high rates of circumcision, with the Philippines  leading at 93%. In Mexico, 10-30%, and Brazil and Columbia at 7% and 13%, respectively, of males are circumcised. Europe is behind in most surveys generally, with the UK at 12%, Slovenia at 4.5%, Denmark at 1.6%, and Finland at 7%.

One might think that circumcision is a colonial influence, but the numbers above indicate otherwise, with Spain itself at a low 2% only. The website Circlist.com theorizes that circumcision has become an integral part of our culture due most likely to our Islamic origins, even going as far as to cite our aboriginal heritage.

The general belief in the Philippines is that the procedure is a rite of passage, as well as something many medical practitioners deem necessary for hygiene and for the prevention of future diseases, as evidenced by summer’s prevalent “OPLAN TULE” in rural and marginalized areas. Complications, however, are common in those who have had improper procedures.

[previous|page|next]

Dr. Bill Sears of the American Academy of Pediatrics (AAP) and Britain’s Royal College of Pediatricians is a world-renowned pediatrician who authored over 30 books and has appeared in various US television programs including CNN, CBS and Oprah, claims on his website (askdrsears.com) that circumcision has absolutely no medical benefits, and states that the area that collects waste in the foreskin is just an “area to wash in the shower”.  The AAP supports these statements. Dr. Sears says regarding opting for the procedure, “If your answer is for religious reasons, then follow your faith. If not, and you can't think of any other significant reason other than ‘just because‘, then consider the above information as you make your decision,” referring to the helpful data posted on this page: http://www.askdrsears.com/topics/pregnancy-childbirth/whether-or-not-circumcise

What does a Filipino pediatrician think? We spoke with Michelle Vergara-Dela Cruz, Diplomate of the Philippine Pediatric society, and an active consultant with clinics at St. Luke’s Medical Center Quezon City and Global City. She goes on to advise our readers that “Circumcision for me is a choice rather than a health issue in the newborn. However, in the puberty age, it is recommended because of risks for UTI.” 

With regards to the debate on whether to circumcise early or at birth, Dr. Vergara-Dela Cruz  says  “I would recommend it be done when they are older or during the pre-teen years so that the patient already understands why this is done and more or less they know already how to deal with it post-circumcision (wound care).  Like any other surgery (major and minor), there is always the risk for infection pre- and post-procedure. Circumcision, which is considered a minor surgical procedure, is done at our Out -Patient Department Operating Room (OPD OR) and  is performed by either a General Surgeon or a Urologist. With this setting you are assured of high quality service and stress free experience. Always take into consideration having your child circumcised by a doctor.”

[previous|page|next]

In high-tier hospitals, the fees for elective circumcision would cost anywhere from P5,000 to P12,000. Public hospitals such as the Ospital ng Makati informed us that they do not perform the procedure unless it is medically necessary.  This procedure is free for “yellow card” holders, or certified city residents, and one may avail of this card at the city hall. In a survey among lying-in clinics and smaller medical facilities in Marikina city, the fee is at an average of P1,500 for either newborns or pre-teens.

Note that there are no truths to sudden growth spurts, or penile shrinkage if done at puberty. Young men really tend to shoot up in height during this phase, and go through all kinds of changes. The decision to circumcise is entirely up to the parents, but in reality, it ought to be the child’s choice because it’s his body after all. In the Philippines, we see that this is more of a cultural habit, as a rite of passage to “becoming a man” and nothing more.

Now armed with this knowledge, will you make the cut?