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Circumcision

circumcision; male; penis; foreskin; fore; skin; boy; law; legal; issues; ethical; ethics;

Circumcision is the removal of the flap of skin which naturally covers the tip of the penis. Many people, including some doctors, have very strong feelings about circumcision. Circumcision is generally a safe procedure, but there are risks of minor complications and some rare but serious complications.

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Circumcision is the removal of the flap of skin which naturally covers the tip of the penis. Many people, including some doctors, have very strong feelings about circumcision. There are conflicting points of view about the risks and possible benefits of circumcision. Legal and ethical issues about circumcision are also being widely discussed.

Circumcision is generally a safe procedure, but there are risks of minor complications and some rare but serious complications.

Medical specialists in Australia and New Zealand do not recommend routine circumcisions of newborn male infants, and say that parents need to be fully informed about possible risks and benefits to be able to make a decision about having their male infant circumcised.

Some of the information in this topic comes from the leaflet prepared by the Royal Australasian College of Physicians called 'Circumcision - a parents' guide to routine circumcision of male infants and boys'.

Why has circumcision been done?

  • Circumcision has been done for several thousand years. It may have started as a hygiene measure in communities living in hot, dry, dusty climates, and then became a cultural and religious ritual.
  • In the last 100 years, circumcision rates increased until most boys were circumcised in the 1950s in English speaking countries. More recently, the number of boys circumcised has decreased, and now 10% to 20% of boys are circumcised in Australia and New Zealand. In many European countries even fewer boys are circumcised.
  • Now most circumcisions are done for family, cultural or religious reasons.
  • Sometimes circumcision needs to be done for medical reasons, such as when the foreskin is too tight.

Why parents choose not to have their baby circumcised

  • It is natural to have a foreskin, and it plays an important role in protecting the delicate end of the penis, especially while nappies are being worn.
  • They want to avoid an operation, because any operation has some risks. Complications are rare, but there can be bleeding, infection and damage to the tip of the penis.
  • Circumcision is painful for the child, both at the time of the operation and for some days after.
  • Removing the foreskin may lead to the tip of the penis being less sensitive, perhaps leading to less sexual pleasure later in life. The foreskin itself also contains very sensitive nerves.
  • As most boys are not being circumcised, parents want their son to look like other boys of his age.

Why parents choose to have their baby circumcised

  • Many parents who choose circumcision want it for cultural reasons, or so that their son will look like his father or other family members (perhaps older brothers).
  • Recent research has found that boys who have been circumcised are less likely to have a urinary infection in the first year of their life than boys who have not been circumcised. Circumcised infants have a risk of about 1 in 500 of getting a urinary tract infection, while uncircumcised infants have a risk of about 1 in 100. It is not possible to tell which boys would benefit from having a circumcision, so many boys would be needlessly circumcised.
  • Circumcision prevents some infections under the foreskin which may happen in infancy and later childhood. However if they occur, they can be treated without the need for circumcision. Boys who have been circumcised can get infections of the tip of the penis (also uncommon).
  • Circumcision prevents a very rare cancer of the penis. This cancer occurs in only about 1 in 100,000 uncircumcised men, and regular washing of the penis under the foreskin by men probably prevents it. 
  • Circumcised men may have a lower risk of getting some sexually transmitted infections, including HIV in countries where many people have HIV and spread is mainly via heterosexual sex. (In countries like Australia and New Zealand where few people have HIV and spread is mainly male to male, the protection is not significant.) Circumcision is not an appropriate substitute for other better forms of protection against HIV and other sexually transmitted infections (such as condom use).

The opinion of child health specialists

A specialist group of doctors in Australia and New Zealand (RACP, see reference below) have said that the level of protection offered by circumcision and the compiication rates of circumcision do not warrant routine male circumcision in Australia and New Zealand. In other words, they are saying that circumcision should only be done:

  • when a boy or a man has developed problems, and it is the opinion of the boy's or man's doctors that a circumcision may be helpful.
  • when there are cultural reasons which are important to the parents.

Having circumcision done safely

Some parents will decide to have their child circumcised.

  • They need to be sure that their doctor refers them to a surgeon (who will do the operation) who is skilful and who has had a lot of experience in doing circumcisions, and an appropriate anaesthetic should be used so that the boy does not have a lot of pain.
  • The place where the operation is done needs to be able to provide good care for the child (usually in a hospital).

Looking after the penis and foreskin

Care of the foreskin and penis is simple.

  • For most male babies and young boys, the foreskin is still attached to the glans (tip of the penis). Do not try to push the foreskin of a young boy back until it can move freely by itself. Pushing it away from the glans may cause damage to the tip of the penis or the foreskin.
  • With time, the foreskin moves back more easily, and boys should be encouraged to wash under the foreskin when they bath or shower. The age when this happens is variable - different for different boys. Make sure that they know to push the foreskin down over the tip of the penis after they have washed it. If it stays up, the foreskin may swell (drainage of blood away from the foreskin may be affected), and the foreskin can become tight and painful.
  • The white substance (smegma) under the foreskin is natural and does not cause health problems.

Medical, ethical and legal issues

  • Circumcision has become a human rights issue, as many people consider it an unnecessary medical procedure done to children without their consent, removing a healthy part of their body, causing them pain and exposing them to unnecessary risks.
  • Female circumcision has been almost universally seen as child abuse, and is forbidden in almost all parts of the world. Why, they ask, is male circumcision not seen the same way?
  • The legal right of parents to decide to have their son circumcised is being challenged. They have rights in law to make decisions about treatment of their child for illnesses, but do they have the right to request an operation on a healthy child?
    • It is lawful for a doctor to circumcise an infant, so long as the circumcision is performed expertly and reflects current 'best practice', it is believed to be in the child's best interest, and parents who request circumcision are fully informed, and formally consent to the operation.
  • It seems possible that a man may be able to take legal action against his parent(s) for requesting and consenting to circumcision, but it is our understanding that this has not been tested in law yet.
  • Whether circumcision can be shown to be in the best interest of the child is explored in some depth in reference papers below. The paper from the British Medical Association was found to be particularly useful in understanding issues for writing this topic.

References

There is a huge amount of information and opinion on the internet about circumcision, benefits and risks, and the legal and ethical issues. It is important to be very careful about the source of the information.

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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