Circumcision+in+the+Philippines

=Circumcision in the Philippines= //by: Bea Daily//

**__Culture:__**
Circumcision in the Philippines is practically a mandatory expectation in the culture, 93% of penis's are circumcised ( Drain et. al, 2006). Cutting the the foreskin off of the penis is very common, and not linked to religion which is [|unique](Gopal, 2009). This may be a result of the Philippines being isolated islands.

media type="custom" key="28505969" [|Tuli]is a long standing historical tradition and is considered a right of passage, as a result circumcision is typically done between the ages of 7-16.( Castellsagues et al. 2005). 42% of circumcisions are done before age 10, 52% between ages 10-14, and 5% are done between ages 15-18 (Lee, 2005). If a penis does have foreskin, it is considered a disgrace to that person's ego and also to social norms. Having foreskin and the genitals [|intact]is considered abnormal, it is culturally perceived as a defect. As a result, boys who have not undergone the ritual are labeled as //supot// which is a Filipino word meaning uncircumcised, but used in an unfavorable, derogatory manner (Ramos & Boyle, 2001). Someone who is labeled //supot// is considered dirty, still a child, and would face ridicule from their peers.

There is a strong pressure and expectation to conform to community norms. If they are violated, the person feels a deep shame that they have not lived up to the cultural expectations. //Hiya// is a universal social shame that creates a deep emotional sanction for failing to live up to the expectations of the society (Ramos & Boyle, 2001). [|Hiya]controls and motivates individual and social behavior. Filipino children's personality structure is oriented toward his relationship with others. //Barkada//'s are tight knit peer groups (Ramos & Boyle, 2001). The group controls the behavior of others by teasing and peer pressure. Teasing is a common and acceptable method of exerting control over Filipino children. As a culture, it is believed that teasing boys will keep them in line and make them sensitive to their own self-esteem— therefore building up his self-love, respect, and //hiya//.

**__Urban vs. Rural Ritual:__**
If the child lives in a city, the circumcision will be done at a hospital. If the child lives in a rural area, it will be done outside a hospital. Most of the //tuli's// are paid for by the government and the Department of Health. Only a third of all //tuli's// are paid for in cash (Ramos & Boyle, 2001).

**__Urban-__**
Urban hospitals schedule mass circumcisions of 100 boys or more in a day. Screening of the boys is done prior to the //tuli////.// The foreskin needs to be retractable before they will schedule the procedure (Ramos & Boyle, 2001). It is usually the first, and only surgery a person will have in their life On the day of the mass circumcision boys are served on a first come, first served basis. Anesthesia is used, and the circumcision is done in a [|dorsal]slit or V-cut manner (Dorsal slit, n.d).

**__Rural-__**
There is not any screening prior to a rural //tuli//. //Tuli's// happen once a year under a big tree or by a lake or river. Information about when and where they occur is done by word of mouth. The // tuli // is done by a native doctor or the towns barber. 7 out of 10 circumcisions take place by non-medical providers (Ramos & Boyle, 2001). If water is nearby, the boys will sit in it for minutes to an hour to soften the foreskin. No anesthesia is used. Instead the boys chew guava leaf as a distraction and to ease the pain. The guava leaf can be applied to the wound to help speed up the healing process, which typically takes two weeks, and can have high rates of post-circumcision complications (Lee, 2005). The boys will line up and one at a time their foreskin is pulled onto a round wooden base where the foreskin can be [|hammered off], usually with a minimum of 2-5 hits before it is successful (Ramos & Boyle, 2001). . .  After the ritual is done, a congratulations of // Binata ka na! // (You are now a man!) is praised to the young person. This ritual can be quite traumatic not only for their genitals, but also in their psyche as the boys hear the cries of their peers and see blood from the previous //tuli's.// Ramos & Boyle (2001) found 70% of the boys subjected to ritual //tuli// and 51% of medical circumcision fulfilled the DSM-IV criteria for a PTSD diagnosis.

__Recommendations for working inter-culturally:__
It is important to recognize how gender is viewed in the Philippines. Being circumcised is a sign of manhood and a cultural rite of passage. It is a sign of manliness that the children are now matcho enough to withstand the pain. There is a high level of pride regarding circumcision and it is a integrated part of Filipino culture and deeply rooted in tradition. There is extreme pressure from both the boys family and his peers to be circumcised. As an educator or clinician it is important to remember that circumcision can help a boy adapt socially and be more accepted by his peers, which in turn is good for his overall mental and social well-being. Some ideas that are held by the Filipino culture can seem outdated to the Western culture, for example the belief that having foreskin helps with hygiene, and pregnancy (Lee, 2005). Doing some education about how pregnancy occurs and attempting to dispel some myths could be beneficial. Doing some research on the best way to deal with PTSD surrounding sexual reproduction and genitals prior to working with this group could also prove beneficial.

__References:__
Dorsal Slit. (n.d). In //wikipedia.// Retrieved from: https://en.wikipedia.org/wiki/Dorsal_slit

Drain, P. K., Halperin, D. T., Hughes, J. P., Klausner, J. D., & Bailey, R. C. (2006). Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries. //BMC infectious diseases//, //6//(1), 1. **DOI:** 10.1186/1471-2334-6-172

Gopal, R. (2009). Religion, culture and the Male cut in Asia. //Exchange on HIV/AIDS, sexuality and gender//, (3), 14-15. Retrieved from: http://www.bibalex.org/Search4Dev/files/315740/146684.pdf

Lee, R. B. (2005). Circumcision practice in the Philippines: community based study. //Sexually transmitted infections//, //81//(1), 91-91. DOI: 10.1136/sti.2004.009993

Madonna T. Virola. Boys' rite of passage best on Black Saturday. // Philippine Daily Inquirer //, Makati City, P.I., Sunday, March 20, 2005 Retrieved from: http://www.cirp.org/news/dailyinquirer03-20-05/

Ramos, S., &, Boyle, G. J. (2001). Ritual and Medical Circumcision among Filipino Boys. In //Understanding Circumcision// (pp. 253-270). Springer US. Retrieved from: http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1120&context=hss_pubs