Circumcision and Chinese culture
中国文化与包皮环割
中國文化與包皮環割



UTC



The Chinese word for circumcision, 割礼 (traditional: 割禮, pinyin: gē lǐ), literally means "cut rite". In recent years, there is some evidence that the practice is gaining popularity in mainland China.



Flag of the Peoples Republic of China (669 bytes)
China Considers a Pro-Circumcision Policy   BEIJING, (Reuters, 29.Nov.2007) : The rate of new HIV/AIDS infections in China is slowing and is now mainly being transmitted through sex, which the government could tackle with a circumcision campaign, the health minister said on Thursday.

The country will have an estimated 50,000 new infections in 2007, compared with 70,000 in 2005, though groups like men who have sex with men are increasingly at risk, according to a report by the State Council, or Cabinet, and the United Nations.That will mean there will be about 700,000 people living with HIV/AIDS this year in China, up from an earlier estimate of 650,000. Of the new infections, 44.7% will come from heterosexual transmission, 12.2% from men having sex with men, and 42% from intravenous drug use, the report said.  In the past, most infections were caused by intravenous drug use.  “At present, the AIDS epidemic in China continues to spread, but at a slower rate”, Health Minister Chen Zhu told a news conference. “Sexual transmission is now the main route for the spread of AIDS.”

Chen said more focus needed to be put on traditionally marginalized groups, like the gay community and drug users, though he added condom use by sex workers had risen from 14.7% in 2001 to 41.4% last year. Yet the report found risky behavior by men who have sex with men remained widespread, with just a third using condoms for anal sex.  Chen said that with infections now primarily coming via sexual transmission, a male circumcision campaign could not be ruled out in China.

Studies have shown that circumcision could reduce the risk of HIV infection by up to 60 percent, though it does not offer total protection from the virus.  The World Health Organisation has already recommended it as one of the ways developing countries, especially in Africa, could use to fight the spread of AIDS.  “This is a technical question. I think our experts will evaluate it,”  Chen later told Reuters. “Even before the AIDS era some children in China were already being circumcised.”

Circumcision rates are low in China compared to Asian countries like South Korea or Japan, where the foreskin is often removed at birth for hygiene reasons, or Muslim countries like Indonesia which practice it for religious reasons.  China’s Muslim minority, concentrated in the far western region of Xinjiang, likewise circumcise their male children, normally as they reach puberty.  Chen said that were the government to decide to promote circumcision among the wider population, he did not think it would run into much opposition or cultural problems.   “As long as there is evidence it is effective, I don’t think it would be an issue,” he said.


Pre-adult circumcision rates reported for 2008 (Chongqing Province)

A study of 10421 boys aged 0 to 18 years, conducted in Chongqing between February and November 2008, reports the following observed rates of circumcision:


Age Group Age Sample
size
Percentage
circumcised
Location Map for Chongqing
Map © 2006, US Department of Agriculture
1 Under 1 month 667   0 %     Location map, Chongqing
2 1 to 12 months 1349   0 %    
3 1 to 2 years 1737   0 %    
4 3 to 6 years 2109   10.05 %    
5 7 to 10 years 2342   15.29 %    
6 11 to 18 years 2217   17.28 %    


These figures should not be interpreted as an indication that the Chinese abandoned infant circumcision two years ago. The study from which the data has been extracted primarily concerns phimosis; what is happening here is that boys are being circumcised (mainly in the age range 3 to 10 years) as a cure for phimosis or in connection with other urological issues such as the correction of hypospadias. Data source: Yang C, Liu X, and Wei GH., Foreskin development in 10421 Chinese boys aged 0-18 years. World J Pediatr. 2009 Nov;5(4):312-5.



More information required:

Reports reaching us from the southern province of Hainan in 2009 suggest that a policy of routine infant circumcision has been adopted in hospitals and maternity clinics there. CIRCLIST wishes to know whether this policy is local, regional or national. Can you help by providing more information?

我们得到來自海南省2009的报告,似乎那边的医院和母婴诊所采取了一個广泛跟婴儿逬行包皮環割的政策。 CIRCLIST希望知道这项政策實行的範圍是个別地方,省市,還是全国。 您可以提供更多信息來帮助我们嗎?

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CIRCLIST Member reports from and about mainland China:

I travel to China frequently for work and know a number of men in the major cities in mainland China.  In the major metropolitan areas circumcision is becoming more common.  It is thought of as modern and like many things in China (Walmart, McDonalds, etc.) it is becoming more and more popular to be circumcised.  A few guys in their early 20s told me that several of them had been done when they were around 10-12 by parents because of this modern, wealthy, healthy, view they seem to equate with circumcision.  Several other guys indicated that they had been done at their request when they were 17-24, and you could easily get it done by a doctor upon request, with or without medical necessity, so long as you could pay the nominal fee.  They felt the poor and rural males were not circumcised ever, regardless of need.

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I’ve been dating a guy who was born in mainland China. He is loosely circumcised. He tells me that while the Chinese do not routinely circumcise infants, it is not at all uncommon to be circumcised during your teen and early 20s in China and that male circumcision is the single most commonly performed medical procedure in China. He reports that approximately 25% of all Chinese males are circumcised, usually because of problems with their foreskins, which they discover as they become more sexually active. He also tells me that he believes this has to do with the fact that most families are extremely hesistant to discuss hygiene of the genitals because of cultural reasons. Consequently, he never was told (nor did any member of his family) to peel back the foreskin and wash the bared glans. He believes this leads to a higher incidence of problems with the foreskin, and hence the higher need for circumcision. He was circumcised under local anaesthetic, freehand. They left plenty of inner foreskin, along with the frenulum. It is a loose circumcision by American standards, although the glans is never covered with skin even when completely soft. However, a large cuff of foreskin remains bunched up behind the glans when soft and their is ample loose skin during erection.

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Although circumcision was practically unheard of in China, this practice is becoming quite popular in the past 10 years or so. It is obviously done in the big cities and in the well-off families. A Chinese doctor even devised a special method, as parents were complaining about the residual scar. Apparently the scar tissue is more visible on the Asian type of skin than on whites. Therefore this Chinese doctor thought it was wiser to make the cut around the root of the penis rather than cutting the foreskin itself. After the cut the skin is pulled back to completely uncover the glans and is stitched there. The end result is very much appreciated as it is just like an uncircumcised penis with the foreskin pulled back. No damage is done to the frenum and so on.



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In Taiwan, circumcision used to be routine.  Until 1995 they had a private, insurance-based healthcare system like the USA. At that time they circumcised almost all newborn boys.  Now they have a socialized medical system similar to the UK’s National Health Service.  Like the UK, they too stopped routine circumcision of boys once the state was paying the medical bills.  Only wealthy families consider circumcision today in Taiwan.  The vast majority of males born since the turn of the century are likely to be uncut.

曾经有一段时期,割包皮在台湾是非常普偏的。在1995年前,台湾有跟美国一样的私有和基于保险的卫生保健系统。那时他们几乎替所有新出生的男孩割包皮。现在他们有一个社会提供的医疗系统,跟英国的国家保健服务 (NHS,National Health Service ) 非常相似。跟英国一样,自从国家开始付担医疗费用,他们也停止了广泛地替新出生的男孩割包皮。今天在台湾只有富裕的家庭会考虑替男孩割包皮。 2000年之后出生的男性,绝大多数是未有割包皮的。



Colonial Flag of Hong Kong (24017 bytes) Post-colonial Flag of Hong Kong (724 bytes)
During the time of British colonial rule, Chinese families in Hong Kong did not practice circumcision routinely. The extent to which circumcision rates in Hong Kong reflect changes in the PRC (Peoples Republic of China) under the “One country, two systems” policy is unknown and more information is required.

在英国殖民地统治期间,中国家庭在香港沒有广泛地實踐包皮環割。 在一国兩制底下,這手術在香港實踐的頻率,對估計在中國實踐的頻率有多少帮助也是一个未知數。我们有必要搜集更多資料。

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CIRCLIST Member reports about Chinese communities elsewhere in the world



If you were born in the United States in the 1960s, circumcision was almost mandatory! My family emigrated from Hong Kong to the US in 1961; the same year that I was born, and which the circumcision rate in the US for that year was 95%. My parents never explained to me about my circumcision. However, I remember several incidents, at a very young age, that made me aware that I was different and that something was done to my penis. My earliest recollection was about 4 year-old and seeing my father’s penis. He was born in the countryside of China and is uncircumcised. I remember seeing this dark hairy root, much like an old rotten carrot. Another incident was when my aunt’s family first arrived in the US, also from Hong Kong, six years after us. My mother was so proud to be the first to come to America and she had just become a citizen. She was showing her sister all she knew about the American way of life and explained that American boys are different - they are all circumcised. She made me pull off my pants to show her my penis. I remember my aunt’s expression! Her son, my cousin Stan, who is 6 months younger than me, was born in Hong Kong and was not circumcised. Growing up together, Stan and I were constantly being compared by the two families and my competitive nature added to the friendly rivalry that ranged from physical differences to academics. I attended Columbia University and he attended Stanford. Because of my father and Stan, I felt very self conscious in my early childhood. This quickly changed when my brother and Stan’s brother were born. Both of them were born in 1967. My brother was routinely circumcised, and I guess my mother talked my aunt into circumcising their “American” son. I remember my brother having to stay an extra day in the hospital to be circumcised, and my mother complaining about having boys and the need to paid $10 more for the circumcision. Times have changed, but circumcisions in America have not. When my son was born in 1994, in Mount Sinai Hospital New York, the price for circumcision was $600 and even then we had to take him home only a few hours after he was circumcised. My mother had it easy. The biggest breakthrough was in junior high school where, after gym class, showers were mandatory. I got to see all my friends that I knew from elementary school naked. Then, I realized that they are all circumcised like me! With only a few Asians in my school, being picked on was quite common. I remember the few who were uncircumcised and were teased. For the first time, I understood my mother, and appreciated being circumcised. It was my only proof that I was not just Chinese, but an American-Chinese. Circumcision is not a daily topic for discussion. All of my previous partners, including my wife, during the first time, were surprised that I was circumcised. They all claimed that they would not have given me oral sex had I been uncircumcised. My cousin Stan, after seeing how everyone was circumcised, eventually chose circumcision just prior to his marriage.

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As a son of Chinese immigrant parents and being a father myself, I can verify that the practice of circumcision in America among Asians is alive and growing. I was born in the US in the 60s and was routinely circumcised. I grew-up in a community that was racially diverse with approximately 30% White, 25% Black, 25% Hispanic and 20% Asian. Most of the Asian-Americans were of Japanese descent. A third of them were second generation immigrants of parents who lived through the concentration camps of WW2. The majority of them were born to parents who were gardeners and nursery owners. Since showers were mandatory after gym classes, I know the status of all my classmates, and have probably observed over 200 boys during the 6 years of junior and senior high school. 99% of Whites and 80% of Blacks were circumcised but only 50% of the Hispanics were cut. On the other hand, I can remember only 4 Asian boys who were uncut. Two of them were Koreans and one Vietnamese. They were foreign-born in their respective countries. The fourth is a good friend of mine, whose parents were also Chinese immigrants. His father was an engineer for the US Air Force, and his mother was a nurse. I suspect it was his mother’s decision. He is now a medical doctor and has a son, similar in age to mine. I believe his son is circumcised. All of my Asian-American friends, except for a few foreign-born (who may be uncircumcised), have all choose circumcision for their sons. There may be some truth that Asian immigrants, in my parent’s generation, choose circumcision to improve their social status in America; however, I believe that it was simply their lack of knowledge of the subject and their tendency not to question authorities, namely the doctors. Subsequent generations are different and are more assured. We are well educated (Harvard and Berkeley are 50% matriculated by Asians), and our income level is perhaps in the top 20%. We have earned the respect of fellow Americans. My wife and I made a conscious decision to circumcise our son based on the same information available to the average American. For this reason, I believe the rate of circumcision among Asian-Americans will follow the national average.

Gene

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I am Asian and circumcised, with exception that I was born in the States. Circumcision is generally less practiced in China, although it recently became very popular. To my surprise, my cousin who just recently immigrated to America has a circed penis. I was amazed at all the advertisements for circumcision from my recent trip to Guangzhou. I don’t know when this trend started but it seem to be very welcomed and accepted by the people.

Aric
October 2009.



Acknowledgements

The following resources were used in the preparation of this web page:
USA flag (316 bytes) Reuters logo (2328 bytes) Reuters News Agency report, 29th November 2007.
Globe (2409 bytes) Circlist Website logo (6480 bytes) Circlist Group logo (8847 bytes) Personal testimony of members of the CIRCLIST discussion group.




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