I was always very adamant that infant male circumcision was not something I wanted for my sons. I’m not Jewish or Muslim and I’m pretty sure my family would support whichever decision my husband and I made.
But then I did some research into the benefits of infant male circumcision and I had to re-think my position…
Is infant male circumcision an abuse of basic human rights, or an important preventative health measure?
The World Health Organisation (WHO) release a report in 2007 titled “Neonatal and child male circumcision: a global review“. The report states (pp53-55) that circumcision is beneficial for the prevention of urinary tract infections, AIDS and other sexually transmitted infections such as human papilloma virus (which causes penile cancer in men and cervical cancer in women), chlamydia and possibly herpes simplex virus type-2.
Should all parents consider circumcising their sons?
Urinary tract infections (UTIs) affect 1-4% of uncircumcised males, but only 0.1% of uncircumcised males, predominantly in the first year of life. One in 5 uncircumcised males will get a UTI in their lifetime, circumcised males are at a significantly lower risk. Lastly, there is an association between chronic kidney disease and UTIs.
With our knowledge of AIDS reaching the 3 decade-mark we have learnt a lot about the disease. We know it is not going away quickly, and will continue for decades to come. Studies by UNAIDS (the United Nations program on HIV/AIDS) indicate that countries with the highest rates of male circumcision have the lowest rates of HIV, and countries with lower rates of male circumcision have higher rates of HIV. It is also known that circumcised males acquire HIV at a lower rate than uncircumcised males.
We are currently experiencing an epidemic of Human Papillomavirus, which can cause cervical and penile cancer. Circumcised males have a lower risk of penile cancer. Recent studies suggest the protective benefits of male circumcision extend to women too, with female partners of circumcised males being at a lower risk of cervical cancer.
Lastly, phimosis, or swelling of the foreskin causing painful erections and urination, is a condition entirely unique to uncircumcised males.
Uncircumcised penises are harder to keep clean. My brother-in-law just told me that two of his adult male colleagues were spotted hobbling around work following elective circumcisions. Their decision to get a circumcision was based on the fact that spending long stints in the bush without showers meant it took them longer to clean themselves and put them at increased risk of infection.
One in three uncircumcised males will get a condition in their lifetime that requires medical intervention.
Male circumcision is one of the oldest known surgeries, is simple and safe when performed in medical conditions, and provides a lifetime of benefits.
Circumcision is an irreversible procedure, is it really necessary?
The foreskin is a specialised tissue with a unique nerve supply, structure and muscle. The inside of the foreskin is similar to the inside of the mouth and is very good at protecting the penis from physical and microbial damage.
The number of uncircumcised boys contracting UTIs in the first year of life is up to ten times higher than circumcised boys. But even ten times more is not very many at all, with up to 99% of uncircumcised boys NOT contracting a UTI in the first year of life.
UTIs are generally caused by some underlying problem, which is not generally readily identifiable. To protect those at-risk boys would require the circumcision of many more boys, who could generally be helped by less invasive medical means (such as antibiotics.)
There is good evidence for the benefits of male circumcision in resource-poor countries, and especially countries with a high incidence of HIV such as many African nations. But in low-prevalence societies such as Australia and New Zealand, male circumcision does not protect against AIDs in the same way. In fact, a recent statement on infant male circumcision by the Royal Australian College of Physicians (RACP) states that male circumcision has no profound affect on the prevention of HIV. Dr David Forbes, who chaired the review into infant male circumcision calculates that you need to circumcise 1,500 – 2,000 males to prevent one case of HIV in Australia. In this country, safe sex behaviours go a lot further in preventing HIV than circumcision.
Human Papillomavirus (HPV) infections are only significantly preventable by circumcision where there are 5 or more partners or where the partner is a prostitute. Also, we now have a highly effective vaccine for HPV and the RACP anticipates a significant drop in the rates of cervical cancer. All women aged 18-26 had the option to receive the HPV vaccine. Discussions are still needed on vaccinating boys against HPV.
The surface of the foreskin is fused to the shaft of the penis in newborn males, becoming partially retractable by 5-7 years of age and fully retractable by puberty. During infancy the foreskin requires no special care and should be left alone, retracting the foreskin can be very painful, can often injure the foreskin and can lead to scarring or phimosis. Once the foreskin is easily retractible (your son will know!) it is necessary to clean underneath the foreskin during bathing. Good hygiene and proper care of the foreskin is not difficult.
Not only is the foreskin designed to protect the penis, it also a primary sensory part of the penis, containing some of the most sensitive parts of the penis. Circumcision removes these sensitive parts, possibly reducing sexual sensation.
Most conditions that affect the uncircumcised male can be treated with antibiotics, salves, or good personal hygiene. Furthermore, the frequency of diseases for which circumcision provides protection is so low in Australia and New Zealand as to not warrant routine circumcision in those countries.
Is circumcision a violation of a child’s right to bodily integrity?
In Australia, parents aren’t having their sons circumcised because of some weird desire to mutilate their sons but following a carefully reflected decision based on what they feel to be in the best interests of their son. In this case, infant male circumcision is not a violation of basic human rights.
As an irreversible procedure, perhaps the decision to circumcise is best left to the child? What about all the other decisions parents must make for their children such as vaccinations, blood transfusions, diet, etc?
How many men regret the decision made by their parents? The circumcised man has no choice but to live with his parents’ decision. The uncircumcised man can not go back in time to be circumcised as a baby.
A basic ethical requirement for performing a medical procedure on a child is that it can reasonably be expected to produce more benefits than burdens (in the long term) for the child. Is this the case for infant male circumcision?
Complication rates of male circumcision
The WHO report from above indicates that if a male is to be circumcised, the best time to do it is within the first month of life and the sooner the better.
Clinical circumcision of infant males carries a complication rate of 1-3%, but increases to 2-4% in adult males.
Also, the variety of suitable circumcision techniques changes with age. When men reach maturity the likelihood of an erection means the “bell” technique where a plastic ring stays on the foreskin until it drops off is not suitable.
Watch a video of a baby boy being circumcised: WARNING! This is pretty graphic.
WHO Male circumcision information package, insert 3: “Health benefits and associated risks”: http://www.who.int/entity/hiv/pub/malecircumcision/infopack_en_3.pdf
RACP report “Circumcision of infant males” (PDF): http://www.racp.edu.au/index.cfm?objectid=65118B16-F145-8B74-236C86100E4E3E8E
After looking at the medical data I feel very strongly that the diseases preventable by circumcision are also preventable by good personal hygiene and less invasive, less permanent medical treatments.
I figure boys are born the way they are for a reason. They have a foreskin with an important function (or two) and a brain to know the importance of personal hygiene and safe sex practises.
I won’t be getting my son circumcised but I am glad that the Australian Government allows all parents the right to chose what they feel is best for their sons.
As a parent, what is the best decision you can make for your son regarding circumcision? Please share your thoughts in the comments section below.