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Circumcision: The Endless Debate

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Male circumcision is a touchy subject. People argue passionately for and against circumcising male babies, presenting evidence to back their arguments up. Not surprisingly, it’s an issue that confuses many new parents.

And the debate has flared up again with the inquest into a UK baby’s death from blood loss after being circumcised in February 2008.

Male circumcision involves surgically removing the foreskin of the penis, or the fold of skin overlapping the end of the penis head (glans penis). This procedure is usually performed within the first few weeks or months of a boy’s life.

Many people choose to circumcise their son because they want him to look like his father, so there is no confusion. The Children, Youth and Women’s Health Service puts the rate of circumcision in Australia at less than 10 per cent, so circumcising a boy would actually put in him in the minority in his peer group.

Circumcision has been performed on male babies for religious and cultural reasons for thousands of years, and is still widely practised in some cultures. However, according to MBF’s Chief Medical Officer Dr Christine Bennett, the current medical policy in Australia, “suggests that there is no medical indication for routine neonatal circumcision”.

The Pros

However, Dr Bennett added that evidence did show uncircumcised males having a higher risk of health problems such as urinary tract and kidney infections and sexually transmitted diseases (STDs).

This evidence was backed up by Dr John Schulze, one of the few Central Coast doctors who still perform circumcisions. Dr Schulze, from Absolute Medical Services at Lisarow, estimates he has performed 10,000 circumcisions. He will circumcise a child up to six months, but prefers to do it before three months of age.

“Circumcising a male child reduces the risk of kidney and bladder infection by 95 per cent, and is also reduces the risk of STDs in adults by 66 per cent,” Dr Schulze said.

“The foreskin presents a risk of infection at the end of the penis and can be treated by antibiotics, but it can be an emotional issue if it’s ongoing,” he said.

Dr Schulze explained that people with a history of bladder and kidney infections and people who work with the elderly often choose to have their children circumcised.

MBF’s fact sheet, The Pros and Cons of Male Circumcision, states that urinary tract infections affect 1-2 per cent of boys, but may be five times less frequent in circumcised boys.

Another benefit is the reduction in risk of developing some cancers. According to the fact sheet, “Compared to uncircumcised men, circumcised men appear to have a lower risk of penile cancer and their female sexual partners may have a lower risk of cervical cancer”. Penile cancer is rare, affecting one in 100,000 men.

Cons

The fact sheet also explains that 1-5 per cent of circumcisions have complications including local infection, bleeding and damage to the penis. And in rare cases, serious complications such as severe bleeding and septicaemia can result in death.

It’s an unavoidable fact that circumcision is a medical procedure that involves pain and blood. “Circumcision is a procedure that involves needles and some discomfort. I use a blocker at the end of the penis,” Dr Schulze said. “Only 50 per cent of parents give Panadol at home [after the procedure] and the majority of those cases are due to the child being unsettled [rather than in pain].”

The main ethical reason against circumcision is a baby cannot choose to have the procedure. “A baby can’t give permission [for circumcision],” Dr Schulze said.

He also said that, like many medical procedures, death was a risk. “There is a risk of dying, but there is a risk of dying if you shave your legs. You have to keep things in perspective. The risks are bleeding, infection and shortening of the foreskin, but that [shortening] has happened in one [case] that I know of and another two [cases] I suspect in 10,000 circumcisions.”

When There is No Alternative

Newborn males are born with the inner surface of the foreskin fused to the glans, and they separate during childhood. By the time uncircumcised boys are five most can retract their foreskin and can learn how to clean the area themselves.

However in some cases the foreskin is too tight and cannot be retracted – or has been retracted too far and can’t be folded back. In these rare cases, a circumcision must be performed for medical reasons.

Umina Beach mother Annalisa Holmes faced this issue with her son Oliver.

When Oliver was three, a GP and a specialist confirmed his foreskin wasn’t growing. And according to the specialist, the only way to alleviate the problem was circumcision.

“He gave us a lot of information and said it’s quite a common thing. It wasn’t something we wanted to do, but given the problems he possibly could have had we booked [Oliver] in to have the surgery,” Mrs Holmes explained.

“If it wasn’t a necessary procedure I just wouldn’t have had gone through it. It was an experience we didn’t anticipate going through. I was pretty shocked at how it looked [afterwards] because I wasn’t prepared. It was very bruised, very swollen.

“I didn’t know anyone who’d had problems who did have it [circumcision] done or anyone who had problems who didn’t. Because it was for a medical reason you tend to put faith in the medical profession. There have been no problems since and it’s been almost four years,” she said.

What About Sexual Performance?

The parentsconnect.com website also has an article on the pros and cons of circumcision, with a note at the end stating:

“Removing the foreskin is a permanent choice that your son may later regret. An intact foreskin may enhance sexual pleasure.”

This note is backed up by Dr Christine Northrup who wrote the article, How Male Circumcision may be Affecting Your Love Life. Dr Northrup has performed hundreds of circumcisions, but wrote the article stating circumcision was not only a “risky, painful and unnecessary procedure”, but also one which affected sexual pleasure.

“When a male is circumcised, some of the most erotically sensitive areas of the penis are removed: the foreskin that normally covers the head of the penis (the glans) and some or all of the frenulum,” Dr Northrup explained.

“The frenulum contains high concentrations of nerve endings that are sensitive to fine touch. The glans was designed by nature to be covered all the time except during sexual activity… Though the penis contains nerves that are sexually excited by pressure, its tip contains the greatest density of these nerves and is therefore the most sexually responsive part,” she said.

In response to these statements Dr Schulze said most people would laugh.

“Six adults have had elective circumcisions [performed by him] and said it has not affected their sex lives,” Dr Schulze said.

According to Dr Schulze, the biggest factor affecting sexual pleasure was not enough fluid – an issue for both circumcised and uncircumcised men and their partners.

“I believe people should have the right to choose. It’s been done forever,” Dr Schulze said as he showed a picture depicting a disciple performing a circumcision.

There is no doubt circumcision will remain a contentious issue. However, with more medical evidence available than ever before, parents are in a far better position to make the choice that is right for them and their son.

Contacts
www.mbf.com.au
www.parentsconnect.com
www.cyh.com
Absolute Medical Service – www.abmedical.com.au

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15 Comments on “Circumcision: The Endless Debate”

  1. Caroline says:

    There is zero reason, barring a medical emergency, that the boy can not and should not, be allowed to make this choice as an informed and consenting adult. His body, his decision.
    intactamerica.org

  2. Wilfred says:

    The decision to circumcise or not is a personal decision. A decision that only the owner for the foreskin can and should make.
    Parents and doctors must respect the fundamental rights of the child to an intact body (and penis) and refrain from exposing their son’s to this medically unnecessary procedure.
    The only valid medical reasons for circumcision are gangrene or surgically irreparable trauma.
    Treatment of incomplete prepal separation, phimosis, etc can be achieved with great success using conservative treatments. Circumcision should not be employed in the treatment of these minor conditions.

  3. Andy says:

    It’s a human rights isuue, you can’t cut off normal and healthy tissue of any part of the body, genitals or otherwise, boys or girls, without the consent of the owner, and that does not include the parents.
    He can choose when he is an adult, and isn’t it odd, he is more than 99% likely to choose to keep his foreskin.

  4. Thank you Caroline, Wilfred and Andy for adding your thoughts to this debate.

  5. Vanessa says:

    We had our son circumsided by Dr Schulze and he is just fine. We decided to do it for the reasons Dr S pointed out, bladder infections, STDs ect. I belive it is a personal decision, one of many hard decisions we as parents will have to make for our son, and it should not be condemed.

  6. peter brown says:

    Yep. I agree Vanessa.

    In fact, I’m going to have the brain of our newborn removed so he can never get a brain tumour.

    Our children’s bodies are ours in custody only. They’re not ours to indulge our sexual or religious predilections on.

    It’s high time the circumcisors went the way of the lobotomisers.

    (It’s fascinating that female circumcision is banned in law. Anyone that either performs it or asks for it can find themselves in gaol. But little boys are left to protect themselves)

    It’s 2010 everyone.

  7. Thanks Vanessa and Peter

    Yes, circumcision is definitely a personal choice. We all need to weigh up the pros and cons before choosing what to do. And it is choice we have.

    Johanna

  8. Circumcision Day says:

    I went to see a Dr at the same clinic as Dr Schulze and could hear babies absolutely screaming their little heads off. When I asked the nurse what was going on she replied “It’s circumcision day”

    I am sorry to inform you all but those little baby boys sounded like they were in lots of pain.

    I also over hear another lady stating that she had to travel all the way from Sydney to find a doctor to circumsize her son. I don’t know about you but if I couldn’t find any doctor in a big place like Sydney to perform a procedure on my son I probably would think twice about it!

  9. Traumatised... says:

    I also was left traumatised after “circumcision morning” with Dr Schulze. Particularly when the mother’s went off to have their coffee, rather than facing the “music” (agonising screams I kid you not). I ended up in tears myself and I wasn’t even on the torture, i mean operating, table. If this procedure is medically warranted and there is no other option, fair enough. Hopefully then the boys will be old enough to be given anaesthetic at the very least. This is an outdated, barbaric tradition that is done for selfish, aesthetic reasons most of the time. You don’t remove your newborn’s tonsils in case of future infection (particularly without anaesthetic) or give them a nosejob because their nose doesn’t look like Dad’s? So why subject them to the agony of an unnecessary circumcision. I believ we call it genital mutilation if it’s done to girls…

  10. Timothy says:

    I think there seems to be a bit of confusion here as to the pain aspect – I believe it is quite minimal. Those cries of “agony” would actually much more likely be cries of hysteria, very similar to when a baby has blood taken or gets immunised – All is forgotten as soon as they get cuddles and/or fed. If circumcision was not allowed until the child is old enough to make an informed decision, that would mean a significant increase in UTIs etc. in males. This would mean that a certain percentage of males would require circumcision as an adolescent or adult – Knowing someone who needed this, let me tell you it is much preferable to do it as an infant. In any case calling it mutilation is very farfetched (ask any circumcised male whether they think they’ve been “mutilated”). As parents we are legally and morally responsible for the well-being of our children, which includes making decisions on elective procedures. You are quite free to choose not to do this for whatever reason, but I would ask you not to discriminate against the parents who make this choice who have valid reasons to do so.

  11. Peter says:

    Hi Timothy, Al calm and non-hysterical reply.

    I hate to rain on your parade but I DEEPLY resent my circumcision as an infant and the action has caused enormous friction between myself and my parents.

    Without the most demonstrable need, parents, in my view, have no right to do permanent things to their little boys. The important word there is ‘demonstrable’. So far as I’m aware there are NO compelling studies, especially when viewed against an Australasian backdrop, that journalise demonstrable benefits. I’d direct you to the RACP paper on the subject for a real, empirical analysis.

    There being no demonstrable, statistically significant reasons, parents should keep their cotton-picking hands off their beautiful and perfect little boys. The same observation goes to zealous, fringe dwelling doctors.

    Our little boys are in our custody, not our ownership.

    Now, if a consenting ADULT wants to cut some or all of his penis off with a rusty pair of secateurs, I have absolutely no issue.

    Cheers.

  12. Timothy says:

    Hi Peter,

    Good to hear your side of this – I’m sorry to hear that this has been an issue for you. I myself have no issue with being circumcised as an infant, and find no disadvantage in being circumcised.

    Whilst there is not a demonstrable need, I believe that as a precautionary measure it is a valid decision to make. And an adult decision to be circumcised involves a painful experience, wherein as long as the infant is circumcised before 12 weeks of age, this is not the case for them.

    I am actually happy that my parents with whom I have a very loving relationship made this choice for me, so that I would be spared this pain later in life – approximately 15% of Australian males need to be circumcised as an adolescent or an adult due to complications such as a urinary tract infection.

    I guess the only issue I have here is the projection of opinions over others – It is fine and wonderful that you choose not to circumcise your son, that is your right. But it is also my right to circumcise my son, regardless of how you feel about it (please note I am talking generally here, this is not a personal attack). Both sides of this debate deserve respect from the other.

    Again I thank you for your reply, it has certainly stimulated my thoughts on the subject.

  13. Peter says:

    Timothy, I was going to let any other comments on this go through to the keeper.. but I guess I’m weak.

    What would make you think or believe that an infant up the seemingly arbitrary age of 12 weeks doesn’t feel any pain from having some of his most innervated skin cut off?

    There was some research conducted on the subject but apparently the results have been quashed by the (American) university that the students performing the study attended.

    I think their research is referred to indirectly in this piece:

    http://www.psychologytoday.com/blog/moral-landscapes/201109/myths-about-circumcision-you-likely-believe

    If a doctor wields a scalpel on an improperly anesthetized adult, the adult would communicate that fact very clearly, I’m sure.

    Exactly how does an infant male, other than crying his heart out, communicate the fact that he is in agony?

    As to 15% of children eventually requiring circumcision. Frankly, I believe the number is 5% in Aus, although I can’t find confirmation. I DO know that the 15% figure is one often quoted by the doyen of the pro-circumcision movement in Australia, Brian Morris. The Sydney Children’s Hospital, however, makes the subjective statement that ” It is rarely needed for medical reasons”.

    Now, a final word on your ‘rights’. Where, Timothy, do your paramount rights (as you see them) over your son end?

    Would it be OK to have his earlobes excised because you woke up one morning and felt like it?

    (I’m hoping you answered “no” to that rhetorical question).

    Why exactly should adults enjoy the ‘right’ to hack bits and pieces off their little boys without therapeutic imperative?

    Why is interfering with the penis of little boys such a sacrosanct, inalienable parental right?

    An easy answer to THAT rhetorical question too… it isn’t.

  14. Blue says:

    Moi personnellement, comme je n’aime pas trop les odeurs d&8or17;aut#b2onzant (que j’achète dans le commerce à pas cher, style Garnier ou L’Oréal, c’est peut-être ça), et que je ne veux pas de traces et/ou couleurs orange, je mélange l’autobronzant avec un lait hydratant basique, et c’est avec ça que je me tartine. Comme ça je peux en mettre tous les jours, j’ai un hâle progressif d’une couleur naturelle, et je sens bon (et au passage, je suis bien hydratée ).

  15. Anitra Gurnhill says:

    I had my son circumcised when he was 5 days old at a time when it was just not the done thing.
    The doctor even insisted that I sit in on the procedure. I did. I still do not regret the decision nor does my son who is now 37 years old and with 4 children of his own.
    I would still do it today. I have had known too many families whose boys have had to have circumcisions between the ages of 8 and young teens for medical reasons. It is not a good place to be for them.
    I did my son a favour. We live in a very hot, humid climate and germs are breed very easily. So many infections are spread through sex.
    I don’t know how many parents would go in and check their 10 to 12 year old sons have cleaned under their foreskin during showers – when this is a time privacy is very important to them. This is also a time where their cleaniness habits become really important to their overall health.
    I would suggest a study relating to the variety of germs passed on by uncircumcised males might give us some answers – however any one that has conducted studies like that will know you can make a study say anything you want it to.

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