The circumcision debate. Discuss

Rick Morton Monday 5 March 2012 12:18pm

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Researchers connected to the Circumcision Foundation of Australia have presented what they claim is the world’s first evidence-based policy for male circumcision saying the benefits vastly outweigh the complications, which they say occur in less than one per cent of cases. Lead author Professor Brian Morris, from the University of Sydney, claimed the evidence was now so clear it was time to act.

“The evidence in favour of infant circumcision is now so strong that advocating this simple, inexpensive procedure for baby boys is about as effective and safe as childhood vaccination,” he said. “In contrast to the comments of opponents, the scientific evidence shows no adverse effects on sexual function, sensitivity, satisfaction or sensation, if anything the opposite. Many common childhood conditions, including kidney damage, will become very rare if baby boys are circumcised in the first weeks of life.”

Big call.

Before we jump into the tug-of-war that is the circumcision debate, let’s be clear that Professor Brian Morris is an advocate for circumcision. But the policy paper is based on studies and research from around the world that he didn’t personally conduct. So even if you doubt Prof Morris, the data still exists and has been used to navigate a difficult health concern around the world.

And it’s not an easy one for many parents. Male circumcision can be both a cultural norm, a religious tradition or something parents choose because, well, they had to choose something and it seemed like a good idea at the time. But there’s always been a bit of debate about that one. Some people aren’t cut and choose to do it as an adult. Guy Ritchie was reportedly circumcised to fall in line with then wife Madonna’s religious beliefs.

Wonder how he feels about that now…

Shall we see what the research shows?

The Study

Infant male circumcision: an evidence-based policy statement examined evidence from around the world to see whether male circumcision was all that necessary. Here’s what it found.

Urinary tract infections

More uncircumcised boys got urinary tract infections than circumcised boys, especially as babies in the first six months of life when UTIs are most common. The prevalence was 1-4% in those without the snip compared to less than 0.2% in those who had been cut.

Hygiene

The study claims hygiene is easier to maintain in circumcised boys who don’t have the added burden of foreskin to navigate when cleaning.

HIV

The paper cites other studies which show male circumcision affords a 60 per cent protection against HIV. Other factors over time increase that protection to around 75 per cent, an effect the authors say makes it nearly as effective as the influenza vaccine. The Centre for Disease Control (CDC) in the United States has touted male circumcision as a cost-saver for the money the country spends on treating HIV.

Other Sexually Transmitted Infections (STIs)

The paper says: “Male circumcision protects against many, but not all, sexually transmitted infections (STIs). In the case of syphilis, genital herpes (HSV-2) and chancroid, a meta- analysis of 26 studies, including 2 from Australia, found lower prevalence in circumcised men.”

Cervical cancer in women

The paper looked at studies which showed the risk of contracting cervical cancer was four times higher if a woman had a high-risk male partner (more than six sexual partners) who was uncircumcised. “An inverse relation exists between Male Circumcision (MC) and cervical cancer prevalence across 118 countries,” the paper stated. Circumcision in male partners also helps reduce rates of STIs in women, such as genital warts and chlamydia.

Sexual function

The study found ‘no adverse effects’ on sexual function, performance or satisfaction of men who were circumcised.

The Conclusion

“The current scientific evidence is more than adequate to support a recommendation of male circumcision in Australia and other developed countries as a low-risk, highly beneficial procedure that is best performed in infancy using a local anesthetic. Infant male circumcision should appear on the check-list of decisions responsible parents need to make for their children.”

Professor Morris said: It is now up to State Governments to ensure than bans on elective infant male circumcision in public hospitals are lifted without delay. And it is essential that the Federal Government revises the Medicare rebate so that this procedure is affordable for low-income families. The costs saved will be enormous, as this policy statement shows that half of uncircumcised males will suffer an adverse medical condition over their lifetime, and many will die as a result of diseases preventable by circumcision. Benefits outweigh minor risks by over 100 to 1.”

Opponents

In the United States particularly, a groundswell of circumcision opponents has been finding a voice. The Intactivists, as they are known, argue male circumcision – like that in females – should be considered genital mutilation and an act of torture.

This from the Miami New Times:

“Foremost, the anti-circumcision crowd believes boys should be able to decide what happens to their bodies — especially in the case of a medically unnecessary amputation. They have likened circumcision to female genital mutilation — the cutting of a girl’s genitals to kill her libido or make her “clean” — which is practiced in parts of Africa and the Middle East but condemned by most developed nations.

Circumcision critics charge that most arguments for the procedure are based on flawed logic. The idea that a child should look like his father? Well, who goes around comparing penises with his dad? The notion that the child will be called an “anteater” in the locker room? They liken it to shame that used to be applied to other once-taboo customs such as interracial marriage. An online “intactivism shop” — where “only the prices are rounded off” — sells T-shirts and bumper stickers declaring “hooded warrior” and “anteater pride.”

Not all intactivists have such a cute sense of humor. Some accuse doctors of having a financial motivation for performing circumcisions. There are websites that “out” celebrities as intact and villainize researchers who have publicly promoted circumcision. Some even go so far as to accuse individuals of circum-fetish — being sexually aroused by circumcision.

Last summer, intactivists in San Francisco scored a win when they collected enough petition signatures to get a measure on the ballot that would ask voters to ban infant circumcision. The victory backfired, however; the ballot measure was stricken by a judge. After a huge outcry — especially by Jews, who found the notion anti-Semitic — the state legislature came down forcefully, passing a law that prevents local municipalities from attempting to ban circumcision.”

Cosmetic circumcision is currently banned in all Australian public hospitals and the Queensland Law Reform Commission found that, strictly speaking, routine male circumcision could be interpreted as a criminal offence under the criminal code. This was one view based on a strict reading of the letter of the law and circumcisions continue to take place there with no prosecutions registered.

The Australian Medical Association neither discourages nor explicitly recommends male circumcision in infants.

So, are circumcisions a cut above the rest or genital mutilation? What experience can you add to the debate?