Circumcision

Circumcision has been performed for cultural and religious reasons for thousands of years. In the nineteenth century it was seen as a sign that your baby was delivered by a doctor (a reflection of social status) an over the years it has been performed as a means of preventing and even curing such ails as tuberculosis, epilepsy and insanity! The procedure was common from the 1920’s to 1960’s, but from the 70’s medical authorities began advising against it and in the 1980’s medically unnecessary circumcision was largely abandoned. Today, the percentage of circumcised males in Australia ranges in estimates from 10-20%, with approximately 60% in America and 6% in the UK (Royal Australasian College of Physicians).

The medical procedure for circumcision

Circumcision, which means ‘to cut around’, is an operation that involves removing the foreskin from the head (‘glans’) of the penis. Once the area has been numbed with anaesthetic creams or an injection (for older children a general anaesthetic is often used), a bell-shaped instrument is inserted underneath the foreskin to separate it from the penis. It is then removed using scissors, a scalpel or a special clamp. This process usually takes around 10 minutes.

The medical indications

According to the Royal Australasian College of Physicians (RACP) “there is no medical need for routine neonatal circumcision”. Some conditions are, however, recognised as medical indications for circumcision, the most recognised of which are phimosis and recurrent balanoposthistis.

Phimosis is a condition in which the foreskin cannot be fully retracted over the glans (head of the penis). It is rare under the age of five and affects approximately 1% of boys. The application of steroid ointment or cream helps to resolve the condition for the majority of boys.

Balanoposthistis is an inflammation of the glans. It affects between 3-4% of boys, but is only recurrent in approximately 1%.

In recent years there has been some evidence of possible health benefits of circumcision, and it is often these that are cited as reasons for parents choosing to circumcise their sons.

Urinary tract infections (UTIs), which affect only 1-2% of boys, can be about five times less frequent in circumcised males. It is important to be aware, however, that circumcision itself has a complication rate of 1-5%. For every one thousand babies circumcised, about eight will develop fewer UTIs, but twenty will develop a complication.

HIV – Circumcision has also been reported to reduce the risk of HIV. The evidence, however, is conflicting and, according to RACP, does not justify routine circumcision in countries where HIV is of low prevalence.

There is some evidence that circumcision can reduce the risk of penile cancer by ten fold, but the rarity of the condition (approximately 1 in 100,000 in developed countries) and other predispositions means that routine circumcision for this reason alone is not supported.

The risks associated with circumcision

Complications associated with circumcision are reported in 2-10% of cases. These include:

• Haemorrhage (uncontrolled bleeding)
• Infection
• Ulceration
• Meatal stenosis (an narrowing/obstruction at the end of the urinary opening)
• Injury to the urethra (the tube through which urine leaves the body from the bladder)
• Too much skin removed
• Loss of penis (1 in 1,000,000)
• Anaesthetic complications
• Psychological trauma
• Secondary phimosis
• Secondary chordee (a condition in which the head of the penis curves downwards)

Psychological trauma from circumcision

Until fairly recently, many infant circumcisions were performed without anaesthetic. One of the reasons cited was that newborns have no memory of pain. The Royal Australasian College of Physicians reports on emerging evidence that painful experiences in early life can have long term consequences, even if not in the conscious memory. Recent statements on the topic suggest that newborns may even have a higher sensitivity to pain, and that the lack of a behavioural response (such as crying) does not indicate a lack of pain.

Religion and circumcision

According to Judaism, circumcision (known as ‘bris or brit milah’) is commanded in Genesis 17:10-14 as an outward sign of a man’s participation in Israel’s covenant with God, and a sign that the Jewish people will perpetuate through him. The ‘rite’ of circumcision occurs on the eighth day of a boy’s life in a ceremony attended by family and guests. The procedure is performed by a ‘mohel’, an observant Jew who has been trained in the relevant Jewish law and surgical techniques of circumcision. According to Jewish law, a circumcision is deemed invalid if it is not performed in this way, and those Jews who are not circumcised will suffer kareit, a punishment for sins in which the person loses his spiritual connection with his divine source.

The Jewish Circumcision Resource Centre represents Jews who question circumcision. It advocates that circumcision is in fact a choice and believes that many Jewish parents feel bound by social expectations to have their sons circumcised.

This article has been provided by Penni Drysdale a freelance writer and mother of two boys.