circumcision and its danger to life

Traditional male circumcision using traditional methods is a dangerous, even life-threatening, rite of passage.

Traditional male circumcision using traditional methods is a dangerous, even life-threatening, rite of passage.

In a study to test the feasibility of an intervention for safe traditional circumcision among Xhosas in the Eastern Cape, Karl Peltzer found weak support for encouraging this practice.

Circumcisions carried out under non-clinical conditions have significant risks of serious adverse events, including death. Among the Xhosas in South Africa, an unsterilised, unwashed blade may be used on a dozen or more initiates in a single session.

Initiates are also significantly dehydrated during their two-week period of seclusion in the belief that this reduces weeping of the wound. And after-care may be done by an attendant with no basic medical training.

The combination of dehydration and septicaemia can result in acute renal failure, gangrene, tetanus or even death. The Eastern Cape provincial department of health recorded 2262 hospital admissions, 115 deaths and 208 genital amputations for circumcisions between 2001 and 2006.

To address this, the Eastern Cape Legislature promulgated a law which regulates traditional male circumcision.

In this intervention study, traditional surgeons and nurses registered with the health department were trained over five days on 10 modules, including safe circumcision, infection control, anatomy, post-operative care, detection, early management of complications and sexual health education. Initiates from initiation schools of the trained surgeons and nurses were examined and interviewed on the second, fourth, seventh and 14th day after circumcision.

Traditional surgeons were provided with a tool box containing scalpels, scalpel handles, latex hand gloves, sterilisation instruments and paper towel rolls.

The research protocol was reviewed and approved by the ethics committee of the Human Sciences Research Council (HSRC), provincial health department, district health office and traditional authorities.


Of the 192 initiates examined on the 14th day after circumcision by a trained clinical nurse, the rates of complications were high: 40 (20,8 percent) had mild delayed wound healing, 31 (16,2 percent) had mild wound infections, 22 (10,5 percent) had mild pain and 20 (10,4 percent) had insufficient skin removed.

Seven days after the circumcision, initiates were asked about the circumcision procedures. Most (85 percent) indicated that the traditional surgeon had been wearing gloves when performing the procedure, and two-thirds (69 percent) of the traditional nurses wore gloves when caring. Further, 53 percent of the initiates reported that they had been circumcised with an assegai (spear) and 47 percent indicated that they had been circumcised with a surgical blade or knife.


A total of 126 respondents (70 percent) felt they expected some complication following male circumcision and 57,8 percent expected to stay in the bush for a month, 40 percent less than a month and 11,1 percent for more than a month.

The level of satisfaction among all participants was high; 72,9 percent reported that they were extremely satisfied, 18,8 percent reported that they were quite satisfied, and 5,6 percent reported their dissatisfaction with the appearance of their sex organs.


Most initiates (88 percent) had sexual intercourse before circumcision. The mean age of first sex was 14,8 percent ranging from 10 to 25 years; 55 percent had been sexually active in the past 12 months; 29 percent reported that they had sexual intercourse with two partners; and 24 (15 percent) had sexual intercourse with three and more sex partners in their lifetime.

Only 38 percent indicated that they had used a condom with their last sexual partner, nine percent were diagnosed with a sexually transmitted disease in the past 12 months, 15 percent used alcohol in the past week and 10 percent indicated that they had sex under the influence of alcohol. Almost all had received Aids training.

Delayed wound healing was found among 21 percent of initiates 14 days after-operation. Most young men (88 percent) were found to be sexually active prior to circumcision and the long period for healing could expose them to elevated risk for HIV infection through an open wound.


More training is needed in the surgical procedure, the control of sepsis, post-operative wound care, recognition of complications, and when to refer patients to hospital. - Health eNews