Adolescent Experience in Performing Sifon Tradition (Post- Circumcision Sex) in the Village of Fatumonas-Middle Amfoang, East Nusa Tenggara

Introduction

Adolescence is a transition period from childhood to adulthood, with many physical and psychiatric changes. Primary sex signs characterize physical changes in adolescents, and emotional changes and changes in intelligence characterize secondary sex signs and psychiatric modifications. As the turmoil of sexuality increases, teens will meet these natural needs in ways they know are obtained from friends, the media, and other sources that are not necessarily true. Teenagers sometimes get caught up in misinformation and environments, leading to risky premarital sex. The research results Govender D, [1] in South Africa show that adolescent knowledge about pregnancy, sexuality and reproductive health is still very lacking, even about repeated pregnancies. Teens are also not better informed about pregnancy and reproductive health. This shows that social determinants, as well as efforts/methods of delivering information about adolescent sexuality and reproductive health education, are critical.

Reproductive health is a state of complete physical, mental and social well-being, not solely free from disease or disability in all matters related to the reproductive system, as well as its functions and processes. Some infectious diseases that can attack the reproductive organs of adolescents, both men and women, are caused by a lack of attention to these organs. Several factors can cause infection in the reproductive organs, such as laziness to change underwear, free sex, etc. Building a secure sexual identity is an individual’s primary developmental goal from childhood to adolescence and the years that follow. During puberty, not only do physiological and anatomical changes occur, but adolescents also become aware of sexual arousal, desire, and function, and adolescents begin to develop self-orientation and interpersonal sexual behavior. Several internal and external factors, biological and environmental factors, including mental disorders, can influence emerging sexuality. Developmental disorders that appear very early in life can affect the socialisation of adolescents and, as such, are essential for the development of sexuality [2].

Sexuality in human beings is not only a basic need but also a significant right to enrich interpersonal relationships, providing mutual satisfaction and pleasure. Improving self- esteem contributes to quality of life and overall physical and mental health. However, if it is not controlled, it can be a problem [3]. Not infrequently, teenagers think that premarital sex behavior is commonplace, even though premarital sex behavior causes more adverse effects on the lives and dignity of adolescents. Adverse effects can occur, namely unwanted pregnancy, increasing maternal and infant mortality, Risk of contracting sexually transmitted diseases, psychiatric trauma, and character development. Reproductive health and the development of reproductive organs need to be discussed with parents, including circumcision. The most commonly cited reasons for not discussing topics on reproductive health are lack of awareness, discomfort, and shame from adolescents and between doctors and patients [4]. Teenagers are sometimes shy and do not discuss circumcision with their parents.

Male circumcision is an important thing to do [5]. The efficacy of male medical circumcision against HIV incidence from randomised controlled trials is supported by the effectiveness of observational studies in populations at diverse HIV risk and the changing context of the epidemic. Medical circumcision of men remains an essential evidence- based intervention for controlling the HIV epidemic. Strong and consistent research results from diverse designs and research methods have proven that circumcision reduces the risk of HIV infection in heterosexual men. Circumcision is also one of the most cost-effective and critical interventions to maintain progress towards the end of the HIV/AIDS epidemic [6][7][8][9].

Similarly, traditional circumcision can reduce the risk of HIV/AIDS infection in men [10]. HIV/AIDS prevention needs to achieve and maintain high circumcision coverage. Interventions for HIV prevention should focus on uncircumcised adolescent boys, who are found to be mostly younger, rural populations, low socioeconomic status, and traditionally uncircumcised communities [11][12].

The results showed that traditional circumcision is often associated with increased morbidity and mortality among people in South Africa. The investigation found that 743 people had to be hospitalised for injuries, and 12 had penile damage, including circumcision performed on children under five. The search also found that 9% of the 45 youths who required hospitalisation after traditional circumcision eventually died. Data shows that 63% of people prefer traditional circumcision, and 13% prefer medical circumcision. Traditional circumcision is becoming common in South Africa, and its impact is considerable. In addition, there have been reports of serious injuries resulting from ritual circumcision, so the circumcision procedure should at least be performed by a qualified and experienced medical practitioner [13].

In East Nusa Tenggara, especially on the island of Timor, there is a tradition of Sifon circumcision. Sifon is a traditional sudat tradition passed down from generation to generation by the Timorese tribe, Atoin Meto in East Nusa Tenggara using bamboo or razor blades. This siphoning process will be closed with sexual intercourse which aims to heal the wound after circumcision and get rid of bad luck. Sifon is a part of the culture of the Atoin Meto people in several regions in the middle to the west of the island of Timor, namely circumcision activities (circumcision), but what is unique is that after circumcision, the man is required to have sex, which is believed to be able to heal the wounds after circumcision. So Sifon is post-circumcision sex that a patient must have when his circumcision wound has not healed. The goal is to dissipate heat so that the male sexual organs return to function correctly. Once Sifon has been performed, the patient should no longer have sex with the woman for the rest of his life [14].

In East Nusa Tenggara, especially on the island of Timor, there is a tradition of Sifon circumcision. Sifon is a traditional culture of the Atoin Meto people in several regions in the middle to the west of the island of Timor, namely circumcision activities (circumcision), but what is unique is that after circumcision, the man is required to have sex which is believed to be able to heal the wounds after circumcision. So Sifon is post-circumcision sex that a patient must have when his circumcision wound has not healed. The goal is to dissipate heat so that the male sexual organs return to function correctly. Once Sifon has been performed, the patient should no longer have sex with the woman for the rest of his life [14].

Sifon circumcision increases the risk of transmission of venereal diseases. Because the circumcision wound is not sterile, the wound can develop into an infection that results in tissue damage to the penile area. Then, because the young man must have sex immediately after circumcision, this increases the risk of sexually transmitted diseases such as syphilis, gonorrhoea, and even HIV — both for men and women [15]. The results of a qualitative study Tumina MS, et al. [16] On thirteen women through in-depth interviews found that there is still a lack of knowledge about HIV / AIDS transmission and unawareness of being a Sifon woman. The experience of Siphon women in performing Siphon rituals shows that Siphon is a risk factor for HIV / AIDS transmission.

Based on social phenomena that may occur due to women’s involvement in the Implementation of the obligation to perform Sifon circumcision, several essential things need to be observed, namely:

1. Gender Issues. The involvement of women in the Implementation of customary circumcision obligations violates the concept of gender.
2. Health problems. In every traditional circumcision accompanied by a siphon as a complement, the woman’s vagina is used as a trash can to collect faeces from circumcision. Thus, the suffering of women who are obtained/received from sexual intercourse after circumcision has an impact on the health of the body.
3. Human Rights Issues. If women are objectified for male sexual vitality, then in every traditional circumcision series, there will always be harassment and humiliation of women’s dignity and dignity.
4. Religious Issues. The practice of Sifon accompanies every circumcision as a compliment, so according to the religious norms recognised in this country, Sifon is contrary to religious norms
5. Legal Issues.

Performing Sifon as a complement to traditional circumcision is against national criminal law. Legal problems seen and observed in traditional circumcision are the occurrence of adultery and the emergence of abortion and child murder [17].

Based on preliminary data collection, it is known that there have been incidents of severe bleeding experienced by adolescents after performing Sifon circumcision in the central Amfoang area. This is because the methods and tools used do not follow the rules / of medical science. The practice of Sifon circumcision can also increase the risk of contracting sexually transmitted diseases due to the Sifon process or “hot defecation,” required to have marital relations with a woman prepared by a shaman or sought by the Sifon circumcision practitioner himself. Based on preliminary data collection, it is also known that shamans still practice Sifon circumcision now in Oenenas village, central Amfoang and many teenagers practice Sifon circumcision in these shamans.

Based on the problem description above, researchers are interested in conducting a “Qualitative Study: The Experience of Adolescents performing Sifon circumcision in Bonmuti Village, Central Amfoang.”

Method

This research is a qualitative type, using exploratory design and a phenomenological approach. The main informant was a teenager aged 17-24 years who had performed Sifon circumcision. The supporting informant was a Sifon circumcision shaman. Data collection was conducted using in-depth interviews and non-participant observation—questions in the in-depth interview related to adolescents’ judgment, responses and feelings in performing Sifon circumcision. Non-participant observations were also made to see the circumcision process. Shamans carried them out. The method of retrieving informants is carried out using purposive sampling techniques. Researchers approach, introduce themselves and ask for willingness to be informants. The interview was conducted after the informant signed informed consent. The study was conducted from June-August 2023 in Oenenas Village, Central Amfoang, East Nusa Tenggara.

Data analysis was carried out using qualitative analysis with a phenomenological approach. Steps in data analysis: 1) Create a transcript; 2) Coding data; 3) Categorize information, namely grouping the same information from the coding results into a matrix, and each category is analysed based on the research theme (final category); 4) Interpret information, present data and draw conclusions in the form of research reports. The variables explored are the perceptions and experiences of adolescents in performing Sifon circumcision. Data validation/validity in this study uses the data triangulation method, namely by triangulation of sources and methods. Triangulation of sources by the way the author interviews core informants and supporting informants. The authors also compared the observations with the results of in-depth interviews. Triangulation method where the author, in addition to conducting in-depth interviews, also conducts non-participant conservation at the research site.

Result

Based on Table 1, it is known that the number of informants interviewed was six people. Four people were Key informants, namely teenagers aged 17-24 years who had performed Sifon circumcision. 2 were supporting informants, namely traditional circumcision shamans. The highest age is 64 years, and the lowest is 18 years. The highest education is high school (), and the lowest is not finishing elementary school.

Eliminates excess body odour and looks clean Factors driving adolescents to perform traditional circumcision Reasons for Performing Circumcision to Look Clean So that the face does not look old, both on the man and his wife People say that if you don’t circumcise, you will be old... Children get ugly Lack of trust in the circumcision of doctors because it is not neat Some circumcision doctors Come back here for re-circumcision It has become a tradition that cannot be lost. It is impossible to ban because this is already a culture.

Fear of dead/dysfunctional/sterile genitals The Sifon is a genie. He said otherwise, the genital siphon could malfunction.

For the body to fat quickly Suppose the body wants to get fat quickly. The rest of the wound should be slightly cooling.

I’m afraid I must disagree and feel obligated, but I am still done, so the wound heals quickly.

Sifon circumcision procedure

No siphon is not a problem. However, otherwise, the siphon means the wound will heal long ago.

Performed in a ll cottage, bathroom or ll pool Entering the pool, the body has begun to tremble, after which it comes out and cuts.

Count stones as a way of confession and prayer. We collect stones according to the number of people in contact. After that, we throw stones at the brilliance to forget the past.

Use a razor blade or knife... can be both.

Discussion

Male circumcision is one of the oldest and most common surgical procedures worldwide and is performed for many reasons: religious, cultural, social and medical. [18]. Male circumcision is medically a good thing for health, especially in the prevention of sexually transmitted diseases. Male circumcision has the opportunity to support their health and well-being in the future [19]. Circumcision is a widely performed procedure with risks that must be considered to reduce the likelihood of its occurrence. The prevalence of circumcision is unlikely to decrease because the practice is associated with cultural and religious rituals. Given the variety of methods, conditions, and ages of patients undergoing circumcision, it should be noted that not all circumcision is the same. Since this ritual is often performed by traditional circumcision herbalists, unwanted long-term complications can occur, complications that can occur, such as narrowing of the urethra, abnormalities in the penis and unwanted appearance of the penis. Previous research has concluded that due to complications and risks, circumcision must be performed by medically trained professionals and in a sterile environment [20].

Based on the results of the study, it is known that adolescents will get ridiculed and pressured if they have not done traditional circumcision. The teenager finally decided to perform traditional circumcision to avoid ridicule and bullying by his circumcised friends. Social pressure or peer pressure is the direct impact peers have on an individual that makes them follow their peers by changing behaviors, values, and attitudes to fit into the group or individual that affects them. Peer pressure can have a direct negative impact on students and their peers. In general, peer pressure in school affects academic achievement among students in terms of diverse content [21]. Adolescent boys appear to be more susceptible to peer influence that encourages risk-taking of certain behaviors than women [22]. Peer pressure has been shown to affect adolescent behavior in the real world and cyberspace [23].

Social norms formed in the group will be something that is maintained. If friends do not follow social norms, they will get pressured, insulted and ridiculed. This also occurs in the practice of Sifon circumcision. Teens who do not perform will get pressure and ridicule from peers who have performed Sifon circumcision. Changes in behavior at the individual level can be influenced by interpersonal communication among family, members, and friends. People’s experiences tend to change other people’s perceptions and attitudes toward health interventions such as circumcision, increasing participation in modern and traditional circumcision. Research conducted Shezi MH, et al. [24] shows that adolescents who have circumcised friends are almost four times more likely to be circumcised than those who have uncircumcised friends. Men who have the social support to perform circumcision from their friends are more likely to be circumcised. Circumcision in males in the area is influenced by complex factors on a multi-social level. Macrosystem factors related to stigma and discrimination in people/ friends who have not performed circumcision have been shown to influence circumcision behavior [25].

Based on the results of the study, it is known that adolescents perform traditional circumcision to look clean and not smell bad. Teenagers believe that by performing traditional circumcision, body odor will be reduced. The attitudes and beliefs within him influence a person’s behavior. If the teenager has a positive attitude towards traditional circumcision, then traditional circumcision will be performed. Fishbein and Ajzen cit. Donovan RJ, et al. [26] says that a person’s willingness to perform an action or behavior is strongly influenced by intention. Subjective attitudes and norms influence intention. Attitude is a function of belief in the impact or consequences of behavior. In contrast, the subjective norm is a function of how significant others see or judge the behavior and is weighed by their motivation to conform to others.

This model explains two essential things: First, a person who uses this theory must clearly distinguish between his attitude towards objects, issues and events and his attitude towards the way of doing it. For example, a person may like luxury cars and have a positive attitude. Still, his attitude will be negative when he wants to buy them because they are costly. Second, this theory must distinguish between one’s belief in objects, issues and events and one’s belief in what others think about objects, issues and what others will do related to these objects and issues [26]. This theory also explains subjective norms that people around them influence.

The motivation to obey or obey the input or encouragement of others around will also affect intentions, and eventually, a behavior can arise. Two essential components in this theory are subjective attitudes and norms that can give rise to the intention to behave.

Based on the study’s results, it is known that informants carry out the Sifon process because they judge that if they do not do Sifon, the genitals die or do not function. This causes teenagers to continue to do Sifon even though there are teenagers who feel it is not mandatory. This misunderstanding keeps teenagers from sex (traditional post-circumcision sexual intercourse) by hiring commercial sex workers. Teenagers assume that by doing Sifon, it will not be barren. Fear of dysfunctional or barren genitals keeps teenagers from choosing traditional post-circumcision Sifons.

In many ways, people’s daily lives during this pandemic reflect misinformation experiments. Even with technological advances trying to stem the flow of misinformation, it abounds on social media and everyday life. This problem may grow with sophisticated misinformation, including engineered photos and videos. Detecting this engineered information is very difficult and may be very impactful. Decades of research have shown that misinformation, mainly health-related information, can affect people’s lives in many ways. Misinformation can affect beliefs about the impact of a disease, effective preventive behaviors a person can take, and even people’s memories of their own past experiences. Thus, combating the infodemic, now and in the future, maybe best done with an interdisciplinary approach that brings together research and expertise from fields such as technology, journalism, public policy, and cognitive science [27].

Adolescents who do not experience barriers have a higher tendency to access reproductive health information than those who experience barriers to access information. There is a significant relationship between barriers to psychosocial access and access to reproductive health information. Psychosocial barriers indicate barriers to the receipt of health services. Culture also makes it difficult for teens to learn about sex and reproduction. Social stigma in the form of taboos in discussing sexuality and reproductive health limits education and social space to provide knowledge to adolescents about sexual and reproductive health. Studies show that adolescents do not approach information services because they feel ashamed and insecure and do not trust health workers to tell stories about their reproductive health problems [28].

Such behavior in culture is certainly not recognized or justified regarding gender and human rights. However, this issue remains a work that is not easily eradicated because this tradition has long been accepted and justified in people’s lives. Not only health problems, the placement of women as a medium to put “heat” and limiting the essence of women as commodities where Sifon women in processions clearly show the phallocentrism that develops in the beliefs of the Atoni Meto tribe. Phallucentrism is an assumption that puts the penis at the center of sexual development. Directly, Sifon places women as objects [17].

Providing excellent and correct information allows for informed choices and appropriate decision-making related to the prevention of sexual behavior and adolescent reproductive health, likewise, in efforts to prevent Sifon in adolescents after performing traditional circumcision. Adolescents’ limited access to information about reproductive health and the dangers of sex before marriage are also obstacles. Efforts must be made to limit barriers to accessing health services and facilitate more adolescent-friendly reproductive health information and services, including reconsidering health training strategies [29].

Circumcision services should be provided with respect and consideration for the cultural beliefs and practices that exist in the community. Coordination and collaboration between local leaders, community leaders and health workers should be encouraged so that circumcision services can be provided in traditional settings but allow for safe outcomes, minimize health-related harm and increase the number of circumcision offenders in rural communities [30]. Likewise, in the practice of Sifon circumcision, collaboration between community leaders and health workers can be carried out. It is necessary to conduct training to familiarise with surgical techniques and hygiene procedures standard to traditional circumcision and the cross-referral system between traditional circumcision and health workers [31] [32][33][34]. Education and assistance must continue so that traditional circumcision can be carried out correctly and healthily and the Sifon tradition can be prevented or even eliminated.

Health education is essential so adolescents understand reproductive health and the dangers of doing siphon tradition (post-circumcision sexual intercourse). The risk of disease transmission becomes excellent. The study results were conducted [35] on two groups of students where the experimental group received two 40-minute sessions of the Health Education program. In contrast, the control group received the usual mode of sexual and reproductive health education. Compared to the control group, students in the experimental group gained more knowledge about sexual health (p<0.01). They developed more positive sexual attitudes (p<0.05) and stronger sexual self-efficacy (p<0.05) during the study period. The proposed sexual and reproductive health education program incorporating various interactive activities proved effective and can be used for school-based Implementation.

Conclusion

Teenagers continue to practice traditional circumcision to avoid being bullied and ridiculed by their peers. The Siphon stage is also carried out because there is a fear that the genitals will not function, so teenagers continue to do siphon (post-circumcision sex) by hiring Commercial Sex Workers in Kupang City. Communication, Information, and Education (KIE) about reproductive health and free sex language must be carried out continuously so that adolescents can be aware and do not misunderstand Sifon circumcision. The role of all parties, such as health workers, community leaders and parents, is significant to prevent the act of Sifon after traditional circumcision. Further researchers can also examine the social pressure of adolescents that encourages adolescents to perform Sifon circumcision.