Male Circumcision and Penis

Enhancement in Southeast Asia:

Matters of Pain and Pleasure
TerenceH Hull, Meiwita Budiharsana
This paper reviews some uniquely male sexual health concerns in Southeast Asia, with particular
attention to Indonesia. These include various forms of male circumcision, different types of penis
enhancementcarried
out across the region and the use of dry sex by women. These practices appear
to be motivated by specific notions ofsexual pleasure, based on indigenous gender constructs.
Although they may or may not pose a serious public health problem, as markers of misguided or
exploitative gender relations they do reveal important aspects of social psychology related to
sexuality and sexual health. Male circumcision provides an ideal opportunity to consider male
reproductive health needs and risks in Indonesia, Malaysia and the Philippines. Practices that involve
cutting the male genitals need to be addressed in ways that stress the importance ofsexual
relationships based on mutual respect and open communication.
Penis implants and inserts and other
penis augmentation
devices, as well as dry sex practices, are potentially dangerous to both men and
women, and of questionable value in bringing pleasure to either, and should be discouraged.

Keywords: sexual health, male circumcision,

HE 1994 International Conference on Population and Development in Cairo produced a

Programme of Action aimed primarily at the
improvement of womens reproductive health.
To the extent that men are mentioned in the
document, it is in terms of their responsibilities
to support sexual and reproductive health and
quality reproductive health services for their
spouses, and to avoid violent and sexually risky
behaviour. The focus on womens needs and
mens responsibilities, however, does not help to
identify or alleviate mens reproductive health
problems, including those arising from indigenous concepts of male sexuality, which have
implications for women too.
This paper reviews some uniquely male
sexual health concerns in Southeast Asia, with
particular attention to Indonesia, and speculates
on the forms of service delivery and priorities
that might be effective in addressing these concerns. These include various forms of male cir60

penis enhancement,

Indonesia,

Southeast

Asia

cumcision (including those carried out in

religious rites) and different types of penis enhancement carried out across the region. Information is also included on Indonesian and Thai
womens use of herbs and astringents to dry and
tighten the vagina, whose purpose seems to be
to increase friction during intercourse, with a
motivation that may be similar to mens use of
implants. Overall, these practices appear to be
motivated by specific notions of the enhancement of sexual pleasure, based on indigenous
gender constructs. Although these practices may
or may not pose a serious public health problem
as such, as markers of misguided or exploitative
gender relations they do reveal important
aspects of social psychology related to sexuality
and sexual health.
This paper reports information on penis implants, male circumcision and dry sex, gathered
during formal and informal interviews in the
course of research projects in Jakarta, Mataram,

Reproductive

Kupang, Bandung and Indramayu in Indonesia,

and in Manila in the Philippines, Bangkok in
Thailand and Hanoi in Vietnam. The research to
date has been exploratory, in order to gauge the
dimensions and nature of the practices. Experience has shown that the use of implants is concentrated in certain social groups, and is not
likely to be adequately revealed in large sample
surveys. Further, although circumcision is very
common, people know very little about the exact nature of the procedure or the variety of
outcomes produced. Our approach has been to
open the discussion and let respondents take us
to the limits of their knowledge - be it personal
experience, memories of circumcision, or their
understanding of practices followed by others.
Respondents have included labourers, medical
staff, taxi drivers, sex workers, community organisers, researchers, servants and retail workers. This is not a random sample across society,
but it does reflect a broad slice of experience. To
the degree that there is selection bias, it is in
favour of the working class and the young. We
have also reviewed some of the literature on
circumcision and genital implants to confirm
the impressions gained.
We are currently engaged in a four-country
study (Indonesia, Philippines, Thailand and
Vietnam) on the use of various penile inserts, implants and drying agents, to determine the motivations behind these practices and the reactions of women to the experience of sexual
relations using them.
The terminology for the practices explored
in this paper is potentially fraught. The use of
the term male genital mutilation would encounter the same political and cultural sensitivities as the use of female genital mutilation,
while the term genital cutting may be a form
of understatement since the severity of the
practices varies greatly across the region. We
use both cutting and circumcision to refer to
the range of practices described below.

Male circumcision

in Southeast

Asia

Justifications for male circumcision revolve

around attempts to deal with problems of penile
hygiene and malformations of the genital foreskin, and to enhance sexual pleasure. The origins of such practices have for the most part
been forgotten. Various religious explanations

Health Matters, Vol. 9, No. 18, November 2001

link the practice to individual identity with a

group, a rite of passage to adulthood, or an interpretation of appropriate gender relations.
In Vietnam, Laos, Cambodia, Thailand,
Burma, among many groups in Melanesia and
the Chinese diaspora throughout the region,
there is an almost total absence of the practice
of male circumcision. Across the rest of Southeast Asia and parts of Melanesia, there are,
broadly speaking, two general patterns for male
circumcision:
l

widespread pre-colonial practices of male

circumcision among peoples of the Philippines and many groups in Eastern Indonesia
(including Timor, Rote, Savu, and Maluku)
and Melanesia, for a variety of spiritual,
identity, hygiene or sexuality reasons, and
male circumcision among Muslims throughout the region as a primary expression and
dominant norm of Muslim identity, thought
to have some peripheral sexual and hygiene
benefits.

Though Islam is the only religion with formal

injunctions supporting circumcision for men
(and women), the practice in Islamic Southeast
Asia varies greatly, depending on the cultural
foundations of the particular ethnic area and
the teachings of influential religious leaders.
Some religious teachers in Java argue that in a
natural state, women are highly sensitive to
sexual stimulation, and men are less so. Cutting
away bits of the genitals is meant to remove
some of the sources of pleasure for women and
expose the sensitive glans of the penis - thus
balancing up the pleasure potential of the
couple. While this is not a widespread belief in
Indonesian society, there are many variations
on the theme that circumcision is a way of
increasing the power of a man to give pleasure
to a woman, and enjoy a more exciting sex life
himself. l
Circumcision is usually the first serious
sexual health issue to be faced by boys or men.
In Indonesia virtually all Muslim men are
circumcised, a procedure called sunatun. However, in Maluku in 1996 many Muslim men had
undergone sunatan without any foreskin being
cut. It was said that when Islam had come to the
islands centuries ago, adult men had died of
circumcision, so the Islamic leaders had changed
61

Hull, Bundiharsana

the nature of the ceremony to overcome the

communitys fears. This anecdote, plus the wide
variation in the age at which circumcision takes
place, is indicative of the lack of specificity in
religious teaching concerning sunatan.
About a quarter to half of Christian men in
Indonesia are circumcised as neonates for reasons of hygiene, or later in life as part of traditional ethnic practices. Most often male circumcision is carried out on boys between the ages of
5 and 18, but in urban settings some neonatal
procedures are performed, and among some
ethnic groups of eastern Indonesia adult males
undergo traditional circumcision procedures.
The safety of the most common types of male
circumcision in Indonesia is uncertain. This reflects the lack of any monitoring or systematic
management of infection. While there is obviously great concern among both patients and
practitioners for safety, no institution has formulated safety standards or required there to be
supervision. Traditional Muslim practitioners
(such as the famous circumciser Bong Supit in
Central Java, whose clients include the children
of the Jakarta elite) are skilled but not medically
trained or professionally qualified to respond to
complications. Muslim community groups often
arrange for mass circumcisions for the children
of poor families. The practitioners in these
events tend to be medical students (second to
final year students have been found to take
part), male nurses and young general practitioners attached to local government clinics.
Observation in hospitals in Jakarta indicates
that the techniques used by these different
practitioners
vary greatly, and sometimes
include practices of dubious clinical value,
such as the retention of parts of the prepuce at
the request of parents. Doctors working in
Sumatra have reported similar practices. The
retained skin may be tied in a bundle or left as
a flap with a hole through which horsehair or
other stimulants can occasionally be attached
prior to intercourse; the motive appears to be to
prepare the young boy for a more pleasurable
marital sex life. Circumcisers do not question
such requests.
Circumcision is not covered in most Indonesian medicai textbooks, and by and large surgeons and urologists would regard the operation as too simple to be offered in their practice.
A detailed handbook on the procedure2 was
62

compiled by a specialist urologist in the early

1990s intended as a guide for general practitioners. It describes two approaches to circumcision (dorsal slit and the guillotine or classical
cut) and recommends the use of local anaesthesia and careful suturing to prevent bleeding.
lt has no national standing as a statement of
Standard Operating Procedure (SOP), however,
though this would be relevant for the medical
personnel who carry out most procedures in the
cities. Most practitioners we have interviewed
about the procedure say they had never studied
the techniques prior to joining a mass circumcision event and learning by observation and
assisting. Learning by doing (magang) is widespread in medical training facilities, including
for nursing and some paramedical positions in
Indonesia. In any case, it is unclear which professional organization or government agency
would be responsible to issue and enforce a SOP
for genital cutting, since practitioners, whether
medical or traditional are not associated with
the major specialist medical associations and
tend to work outside the influence of the Ministry of Health.
While European nations have low rates of
circumcision and campaigns are being waged
in the Americas, the UK and Australia to reduce
the practice of routine neonatal circumcision,
circumcision has been promoted as a secular
orthodoxy for reasons of hygiene in Indonesia,
due to religious pressures. In Java, Sumatra and
eastern Indonesia procedures are often carried
out without costly anaesthesia. Infections are
said to be rare due to the prophylactic use of
antibiotics, but there are no studies to indicate
the incidence of infection or the prevalence of
serious complications. It may be that most procedures carried out by medical professionals
are safe, but there are no studies to verify this,
nor are there standard procedures for recording
any problems that might occur. The same is
true of the majority Roman Catholic Philippines, where circumcision is virtually universal.
For a significant minority of Indonesian
men, genital cutting takes on far more dangerous and socially problematic forms. Very
dangerous procedures are used for circumcision
of young (and sometimes older) men in Timor,
lrian and other areas of Eastern Indonesia. In
January 1997, in Kupang, West Timor, the
deaths of three men who had undergone tradi-

Reproductive

Health Matters, Vol. 9, No. 18, November 2001

tional circumcision ceremonies with the en- 1 and cool the wound. The women involved in
couragement of their wives or lovers were
providing this sexual service could be commerwidely reported. Traditional healers carried out
cial sex workers, but most often in rural areas
the ceremonies in the mountains at the site of
they are simply recruited to the practice. Recold mountain springs. They used bamboo
ferred to as women of the road the women
clamps to fix the four sides of the prepuce, in
who participate in sifon are often widows who
turn, then sliced off the skin with a sharp razor
provide sexual services for a variety of tradior knife. In all three cases, the men bled protional rituals. In the town of Kupang at least
fusely despite following the healers instruction
one circumciser has set up his practice in a
to sit in the cold water, and they died before
house close to an established brothel, and he
obtaining medical attention.3
relies on the prostitutes to service his clients.
Health professionals have also observed
The attraction is that of participating in a tradiserious morbidity and mortality among prisontional ritual that promises health and spiritual
ers who attempted to become men by carrying
benefits to both the woman and the man. Durout circumcision on themselves, following ening the time of the circumcision and the sifon,
couragement by their peers. This is so common
the man absents himself from his home. At the
that non-governmental
organisations in Melaend of the process, he is ritually welcomed back
nesia (Timor, Papua New Guinea and Vanuatu)
by his wife through an exchange of betel nut.
have offered the services of doctors to visit
Traditional methods of circumcision vary;
prisons monthly to carry out circumcisions on
some are less drastic than the Timorese procemen who might otherwise carry out the procedures. On the island of Roti to the west of
dure alone or with the help of other inmates.
Timor young boys form circumcision groups of
The practice of adult circumcision was resix to eight boys and go together to an older
corded many centuries ago in Timor as a stage
man to receive advice and guidance of this rite
of maturation leading to the recognition of a
of passage.6 They make a small bamboo clamp
male as a headhunting warrior. The practice in
(kakabik) named after a similar instrument used
Timor and some other Eastern Indonesian islands
in tapping lontar palms7 which is fixed to the
has undergone great changes over the last cenprepuce to cut off the flow of blood to the
tury; the ceremonial foundations have been
superfluous skin. The clamp is released when
modified through the suppression of headhunttheboy needs to urinate and is then replaced.
ing and the promotion of certain traditional
After a few weeks the prepuce has shrivelled
activities as indicators of a broader ethnic idenand can be cut away without any bleeding. It is
tity rather than a narrow village identity. There
important in Rotinese ritual that this is a
is some indication that the motivation
for
bloodless process, but it is unknown whether
Timorese circumcision today is being reinterthe procedure poses any serious threats to the
preted as a requirement for sexual hygiene,
boys immediate or long-term reproductive
which may explain why some women encourhealth.
age their partners to be circumcised.4
What is strange, at least to the foreign eye,
are some of the other traditional practices that
Traditional and modern forms of penis
have been maintained in Timor, documented by
enhancement
Primus Lake, a sociologist in Kupang. Called
Men in some areas of Indonesia, the Philipsi@bn,these practices are widespread throughpines, Thailand and Malaysia have a long hisout the western part of Timor in the cultural
tory of inserting or implanting various objects
area of the Atoin A4eh5 A few days after cirin their penises. The origin of these practices is
cumcision, when the man has developed a scab
unclear, but some writers say that they were
on the wound, he is enjoined to have sexual
copied from Chinese traders who visited Southrelations with a woman (not his wife) who has
east Asia, while others argue it is an indigenous
had a number of children. After another period
innovation related to the use of amulets and
of recovery he has sex again, this time with a
practices for medicinal and spiritual purposes.
woman who has never had a child. Each time
The implanted objects range from the very
the purpose of the activity is to break the scab
simple, e.g. ball bearings sewn under the skin,
63

Hull, Bundiharsana

to the elaborate, e.g. specially selected semiprecious stones, gold bars (palang) or rings
inserted through the glans. Recent research has
found that the use of such inserts is spreading
among working class men in Southeast Asia
and Melanesia.a
In February 2000 we examined the records
of a random sample of over 700 men undergoing pre-employment medical examinations
for work in the shipping, hotel and banking
industries in Jakarta9 to determine the likelihood of obtaining information on male reproductive health from conventional clinic records.
Anecdotal evidence indicated that the practice
is found in clusters and increases with age. We
found that one per cent of the applicants for
shipping industry jobs were wearing some form
of penis implant, which might be taken as a
minimum prevalence, given that most of the
men in this group were young and inexperienced.
Interviews with social workers and commercial sex workers suggest that upwards of 10 to
20 per cent of regular clients of lower class
brothels have either penis implants or holes in
the glans or foreskins of their penises to insert
various objects. The holes may be normally for
rings or studs, which are replaced during intercourse with a piece of horsehair or the strand
of a stiff-leaved plant, which is tied and clipped
off to a length of 3-4 cm as a tickler. One
well-known circumciser in Magelang, Central
Java reported that his practice had recently
diversified with increasing numbers of adult
men coming to have their penises pierced and
adorned with stones to bring luck. His customers include well-known
politicians. He
charges Rp 20,000 for each stone (about US
$2), compared with a charge of Rp 200,000300,000 (about US $20-30) for circumcision.
The putative reason for these practices is to
please the woman, and men using such inserts
argue quite strongly that women love it.
However, in the absence of systematic evidence
from the partners of men using these devices,
the testimony of commercial sex workers may
be regarded as useful commentary. Generally,
women who earn a living from sex say that the
use of inserts and ticklers is both strange and
uncomfortable.
One woman recalled how a
man using horsehair had caused her to bleed,
while another man caused her great discomfort.
64

She laughed at the idea that the devices were to

please the woman:
That is what they shy, but actually they only
want the woman to reach orgasm before they
ejaculate. It is a sign of their manliness to have
such control.
The difficulty of determining the prevalence and
spread of penis enhancement practices lies in
the fact that they are inspired and implemented
in a highly informal way. Respondents in
informal interviews in the past five years have
reported that they make their own implants
from plastic or semi-precious stones. Prisoners,
seafarers, male sex workers and bored teenagers
have reported experimenting with other forms
of implant or insert, among which the more
extreme are the use of discarded syringes to
inject tree sap into their penises in Papua, and
workers from Java using illegally obtained
drugs to stimulate erections. Such cases are
quite rare, but can cause serious complications.
It appears that groups of working class men
living in isolated circumstances are quite likely
to discuss and attempt these practices.
Interviews in Jakarta, Kupang, Mataram, and
Manila indicate that it is not uncommon for the
men to carry out such procedures on themselves or their friends, with no reference to
medical facilities. Under these conditions the
healing time (from the date of cutting to the
time when sex can be resumed) can take perhaps two weeks. In the Philippines, a variety of
private medical clinics advertise services to
insert bolitas (small balls) and humps (silicon
tubes or rings). These procedures involve the
use of dissolvable sutures: clinic staff estimate
that the average time for the wound to heal is
only 4-5 days. We have recorded a wide variety
of objects used for insertion:
Ball bearings - workers in forestry and mining industries take ball-bearings from machinery, boil them and soak them in antiseptic,
and then insert them under the skin of the
penis, about a centimetre back from the glans.
Some informants report using three or four
hall-bearings simultaneously.
* Silicon - certain sub-populations in Southeast Asia have taken up sub-dermal injection of silicon with enthusiasm, Both men
and women engaged in commercial sex

Reproductive

activities use silicon to accentuate features

such as lips, cheeks or breasts. The technology to do this is available in many urban
beauty parlours. As this practice has spread,
some men have used the same techniques to
inject silicon under the skin of their penises
to produce humps that they think will enhance the sexual pleasure of their partners.
Semi-precious stones and gold - historical
records and some contemporary practitioners report that some men regard the inserts
as symbols of power and wealth. Some men
choose particular kinds of semi-precious
stones - pearls or precious metals - as implants in the expectation that they will be
invested with special sexual powers.
Plastics - men in prison in Indonesia and
Papua New Guinea have faced problems obtaining the preferred materials for penis
inserts, and resort instead to some unusual
alternatives. Some melt down the plastic
from the tops of toothpaste tubes and form
it into small balls. They then scrape the
handles of toothbrushes to sharpen the ends,
and use this tool to effect an incision in the
skin of the penis. It is unclear whether those
undertaking
these incisions
have the
resources to hand to prevent infections or
properly dress the wounds.

According to ad hoc information obtained in

Jakarta since 1998, most men use such devices
before marriage and have them removed when
they settle down with one woman. Why, if the
purpose is to please a woman? One explained:
You cant really be sure about these things what if something went wrong? You wouldnt
want to take a risk with your wife.
And indeed, doctors and sex workers in Jakarta
have told us of the occasional accident in
which a ring or stud or other sharp object is left
in a womans vagina or where women have
suffered cuts or severe pain from mens experiments.

Use of vaginal

drying agents by women

A practice as yet little explored in Southeast

Asia, which is quite common in many parts of
sub-Saharan Africa,r2 is the use of dry sex
among some Indonesian, Malay and Thai popu-

Health Matters, Vol. 9, No. 18, November 2001

lations in the region. This practice appears to

stem from the notion that intercourse will be
more pleasurable for the man if friction is
maximised. To dry and tighten their vaginas,
women in many Indonesian cities consume
traditional herbs, or insert astringent rods called
tongkat putih in the vagina before intercourse.
These rods, and the variety of herbal medications for the same purpose, are readily available throughout Java in traditional markets
and from specialist herbalists and small kiosks
on street comers. We have collected samples
from both small rural markets and large urban
department stores. Wassana Im-Em of Mahidol
University has also identified the use of alum to
dry the vagina in Thailand.i3

Discussion
Male circumcision provides an ideal opportunity to consider male reproductive health needs
and risks in Indonesia, Malaysia and the Philippines. The fact that the vast majority of men in
these countries are circumcised makes the
process of widespread interest. Male circumcision is not usually secret, and may actually be
the focus of social celebration. However, individual and mass circumcision operations are
not well monitored, nor are they subject to
safety precautions; and there are reasons to
think that for many boys and men circumcision
may carry serious consequences.
The prevalence and extent of health risks
from traditional and medically-performed male
circumcision and the penis enhancement practices we found in the region are an important
but unresearched subject in Southeast Asia.
Whatever ways wounds to the penile skin are
made, and for whatever reason, they may carry
a risk of infection, bleeding, dysfunction in
genital development or irritation and inflammation. They may also cause permanent damage to men, particularly when the cutting involved is carried out under unhygienic conditions. Men are also exposing themselves to
pain from genital cutting, and may be exposing
their sexual partners to pain, wounds, inflammation or infection through the use of implants
or inserts. Similarly, practices among women
which involve drying the vagina may create
irritation or inflammation of vaginal tissue and
penile irritation in their partners, as well as the
65

Hull, Bundiharsana

risk of open sores and wounds susceptible to

infection, particularly if dry sex is combined
with the use of inserts or implants.
Circumcision, where indicated for medical or
strong cultural reasons, needs to be governed
by medically approved, standard operating procedures, and care is needed to monitor and
treat complications. Efforts to educate men
about the problems of implants, inserts and
other efforts at penis enhancement should be
undertaken by national Departments of Health,
in cooperation with the many stakeholders in
the medical and religious communities of the
region. Public health campaigns should stress
not only the potential risk of infection and
long-term damage to mens health, but also the
possibility of harm being visited on all sexual
partners, including but not just wives.
Finally, practices that involve cutting the
male genitals need to be addressed in ways that
stress the importance of sexual relationships
based on mutual respect and open communication. Penis implants and inserts and other
penis enhancement devices, as well as dry sex.
practices, are potentially dangerous to both
men and women, and of questionable value in

bringing pleasure to either. Their use should be

discouraged.
Acknowledgments
Much of the information collected here was
generously provided by colleagues in the Australian National University and internationally.
We especially wish to thank Klinik Baruna staff
Dr Tien Irawati and Dr Santi Rahayu Dewi for
access to data and assistance in interpreting
certain results, and Population Council staff
Lila Amaliah, Laily Hanifah and Mayuni for
data collection. Thanks to Dr Firman Lubis of
Yayasan Kusuma Buana for meetings with their
field staff Jeremius Wutun, Deden Wibawa,
Endang Sudarmi and Titin Suprihatin.
Dr
Michael Lim Tan provided useful information
on the situation in the Philippines. This paper
was presented at the 14th IUSSP Congress in
Salvador, Brazil, 18-24 August, 2001, in the
session on Male Reproduction and Sexual Roles.
Correspondence
Terence H Hull, Demography Program, RSSS,
Australian National University, Canberra ACT,
0200, Australia. E-mail: tery.hull@anu.edu.au

Reproductive Health Matters, Vol. 9, No.

18,

November 2001

References and Notes

1. Wibowo A. 1998. Female

Circumcisionin
rural

and urban

some parts
Indonesia.

of

Research Report for UNFPA.

Jakarta: Faculty of Public
Health, University of Indonesia.
2. Karanaka S, Bachsinar B, 1994.

Sirkumsisi(Circumcision).
Jakarta: Hipokrates.
3. These events were reported in
local newspapers and were the
subject of gossip in Kupang
during the time the first author
and colleagues from the Indonesian Academy of Sciences were
investigating reproductive health
issues. See Hull TH, Raharto A,
Handayani T et al, 1999. Family
Planning
and Family Decisionmaking in Nusa Tenggara
Timur.

Jakarta: PPT-LIPL
4. McWilliam A, 1994. Case studies
in dual classification as process:

childbirth, headhunting and

circumcision in West Timor.
Oceania.

65:59-74

9.

5. Lake P, 1999. Sifon:

Antara
Tradisi
dan Risiko Penularan
PMS (Sifon: Between a Tradition
and Transmission
of STDs).

Yogyakarta: Pusat Penelitian

Kependudukan, Gadjah Mada
University.
6. Fox J, 2000, personal
communication.
7. Fox J, 1977. Harvest of the
Palm: Ecological
Eastern
Indonesia.

Change

in

Cambridge:
Harvard University Press.
8. For an accessible overview of
some of these practices see
Hammel EA, Friou DS, 1997.
Anthropology and demography:
marriage, liaison, or encounter?.
In Anthropological
Demography:
Toward a new Synthesis.
Kertzer

R&urn6
Cet article examine quelques prPoccupations
masculines de santC sexuelle en Asie du SudEst, en particulier en Indodsie. I1 sint&esse
aux formes de circoncision, aux differents
types Hdamelioration du penis n pratiques dans
la region et B lutilisation des rapports sexuels
H ti set N (dry sex) par les femmes. Ces pratiques
semblent motivCes par des notions du plaisir
sexuel, fondPes sur des conceptions autochtones de la sexualit
Bien quelles ne posent
pas forcement de grave probleme de santP
publique, elles sont rWlatrices de la psychologie sociale associPe B la sexualit et %la Sante
sexuelle. La circoncision donne loccasion
detudier les besoins et les risques en Sante
gCn&ique des hommes en Indonesie, en
Malaisie et aux Philippines. Face aux pratiques
qui necessitent dinciser les organes genitaux
masculins, il faut souligner limportance de
relations sexuelles fondles sur le respect
mutuel et la communication. Les implants et
autres dispositifs daugmentation de la taille du
penis, ainsi que le dry sen, sont potentiellement
dangereux pour les hommes comme pour les
femmes, dune valeur douteuse quant au plaisir
quils apportent, et devraient etre dCcouragPs.

DI, Fricke T (eds). Chicago:

University of Chicago Press.

Data were from the Klinik

Baruna in Jakarta.
10. Juliastuti N. 2001. The
circumcision business. Latitudes.
8(September]:36-39.
11. Thanks to Dr Dede Oetomo of
Airlangga University for
anecdotal information on this
practice in Surabaya in the late
1990s.
12. Ray S, Gumbo N, Mbizvo M,
1996. Local voices: what some
men say about preparation for
sex. Reproductive
Health
Matters.
4(7):34-45.

13.Personal communication, 200 1.

See also Im-Em, Wassana. 1996.
Partner relations and AIDS in
Chiang Mai villages. PhD Thesis
in Demography, The Australian
National University.

Resumen
Este articulo examina unos aspectos tinicamente masculines de la salud sexual en el
sureste asiitico, especialmente en Indonesia. De
inter&
particular
son varias formas de
circuncisibn masculina, diferentes tipos de
aumentacibn de1 pene que se practican a
travPs de la regibn, y la pr&ztica de sexo seco
por las mujeres. Estas pr&zticas parecen estar
motivadas por nociones especificas de placer
sexual, basadas en construcciones de gPnero
indigenas. Aunque no constituyen necesariamente un grave problema de salud ptiblica, si
revelan aspectos importantes de la psicologia
social relacionada con la sexualidad y la salud
sexual. La circuncisi6n masculina presenta una
oportunidad ideal para tomar en cuenta las
necesidades y riesgos reproductivos de 10s
varones en Indonesia, Malasia y Filipinas. Los
implantes y 10s objetos que se insertan en el
pene, 10s otros artefactos que se usan para
aumentar el tamafio de1 pene, y las practicas de
sex0 seco, son potencialmente peligrosas tanto
para hombres coma para mujeres. Es dudoso el
placer que se les atribuye y habria que desincentivar su uso.

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