Circumcision - What Parents Need to Know
Labioplasty is the latest woman's beauty fad, and women are flocking to the surgeon's knife for petite wings like the airbrushed centre fold models. But if you do this to your daughters, you'll be thrown in jail for type one female genital mutilation (FGM). This is because Australian law recognises a woman's right to choose in matters concerning her own body.
This is not so in Turkey, Egypt, Somalia, Sudan, Mali and other African and Middle Eastern countries, where female infants and children are subjected to anything from trimming, piercing or stretching of the labia or clitoris (type 4 FGM). To excision of the prepuce and part or all of the clitoris (type 1 FGM), ;excision of the prepuce, clitoris and part or all of the labia minora (type 2 FGM), and excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation) (type 3 FGM). Many doctors in these societies defend such practices with claims of health and social benefits, yet many young girls suffer horrific injuries leading to reduced sexual pleasure, pain during intercourse, complications during childbirth, and even death.
Australia has been wise to outlaw FGM in several states, and we can only hope that all states will outlaw FGM in the near future. So what does all this mean for male circumcision? The reader would be hard pressed to find a society practicing FGM that does not also circumcise males, as both rituals have similar cultural origins and social roles. Both male and female circumcision remove erogenous nerve tissue to diminish sexual pleasure, control sexual behaviour, and initiate an individual into the community.
So how did Australia come to have a double stand where girls are protected but boys remain vulnerable to the surgeon's knife? The answer lies in the incredibly prudish Victorian era, when Britain and other English speaking countries adopted circumcision and other genital mutilations to control sexual behaviour and disease. Circumcision, clitoridectomy and hysterectomy were prescribed to cure masturbation, tuberculosis and mental illness in both men and women.
Not all British doctors held male or female circumcision in good esteem, and female circumcision gained ill repute in 1867 when a woman's right to choose the fate of her own body was recognised. In contrast, male circumcision was spurned into the 20th century by physicians with prudish or religious interests, who claimed it could protect men and women from sexually transmitted diseases (STD) and cancer.
Male circumcision gained ill repute in Britain in 1949, when the lack of necessity and dangers of the operation, including bleeding, damage to the penile head (glans), excessive skin removal, and deaths, were discussed in detail for the first time in the British Medical Journal. Australian paediatricians have discouraged the practice since the 1960s, and the incidence of circumcision steadily fell from over 70% of boys during the mid 1960's to 49% in 1973 and 39% in 1980.
In 2002 approximately 12% of young boys were circumcised Australia wide, but there is a wide variation between states. Western Australia and Victoria have the lowest incidence of around 5%, yet Queensland has the highest of 20%, and New South Wales the second highest at 15%. This large variation exists due to a difference in public education on circumcision between states. Few doctors in WA or Victoria will perform a circumcision without definite medical need, and will instead give parents information on how to care for the normal intact penis.
More doctors in NSW and Queensland are willing to do circumcisions without good medical reason, particularly those older physicians who remain undeterred by medical policy against circumcision, or have strong financial or religious motives. A number of these doctors still loudly voice their opinions in favour of circumcision, and claim it can prevent urinary tract infections in young boys, STD and penile cancer in adult men, and cervical cancer in their female partners.
Parents can sometimes be easily impressed by these claims, and not all of our state governments are equally forthcoming with information for parents on the risks of circumcision and care of the intact penis. So what should the expectant mother or father do?
Expectant parents should read the Policy Statement on Circumcision by the Royal Australasian College of Physicians (RACP), and the excellent parents' brochure on circumcision by the Health Department of Western Australia. The RACP has also published a parents' brochure on circumcision, but this document is not as informative as the one by the Health Department of WA. All of these documents are easily available online or can be obtained in print form by contacting the RACP, Health Department of WA, or Circumcision Information Australia.
Parents are often concerned about making a good decision for the health of their children, and should not hesitate to take these documents along to their family doctor for discussion. During the decision making process, the most important point to remember is that it is a woman's right to choose in matters concerning her own body. ; It should be a man's right to choose also. Circumcision Information Australia (CircInfo Australia) receives complaints from adult men who are unhappy about being circumcised as infants or children, and wish they had been given the choice that was rightfully theirs. We also assist adult men and parents of children who seek information on conservative treatments of penile problems to avoid circumcision.
Circumcision Questions and Answers
Does any medical organization recommend circumcision of boys?
No medical organisation anywhere in the world recommends routine circumcision of boys. Many organisations state that there is no medical indication for routine circumcision of boys, including the Royal Australiasian College of Physicians, the British Medical Association, and the American Academy of Paediatrics.
Is circumcision less painful for a baby than an adult?
Infants experience excruciating pain during circumcision and also for 1-2 weeks postoperatively, and can show behavioural changes such as frequent crying, avoidance of physical contact, reduced feeding, and sleep disturbance. Anaesthetic creams, such as EMLA, are not adequate and a general anaesthetic poses a significant risk of brain damage for infants under the age of six months. Adult men can undergo general anesthesia and request pain relief during the postoperative period.
Isn't circumcision just a "tiny snip" with no risks?
The risks of circumcision include bleeding, infection, damage to the glans (head) and frenulum (male G spot), excessive skin removal, scarring, loss of penis and even death. Infant circumcision has more risk than adult circumcision, as a baby's penis is very small and difficult to operate on, and a greater percentage of a baby's penile skin is removed. Excessive skin removal is a very common problem, and can restrict growth of the penis during puberty.
Will a boy will feel upset if he looks different to dad?
All penises are different, just like noses. Boys don't have rhinoplasty so their noses look like their fathers, so why should the penis be any different? Different doctors perform circumcision differently, and some remove more skin while others remove less. This means the chance of a circumcised boy looking exactly like his father is very slight.
Can circumcision prevent urinary tract infection in young boys?
Research suggests that circumcised infants may have a lower incidence of UTI (0.188%) than intact infants (0.702%). However, this difference is slight and female infants have a higher incidence of UTI than circumcised or normal boys (~5%). Mothers will be happy to know that breastfeeding does protect male and female infants from infection. If a UTI does occur, the most conservative treatment is with antibiotics and more rigorous follow-up for the rare case of recurrent infections.
Should a boy's foreskin be retracted everyday for cleaning and washed with soap?
The prepuce of most newborn boys is still adhered to the glans (head) and can not be retracted. Forcible retraction can result in tearing, scarring and infection, so that circumcision becomes a self-fulfilling prophecy. A boy will retract his foreskin when he is ready, and it is normal for this to happen during teenage years. Boys should be taught to gently retract and wash under the foreskin with water. Soap is an irritant and should not be used.
Are most men in the world circumcised?
Over 80% of the world's men are not circumcised, including most of Europe, Asia, and South America. Circumcised men are a minority confined to the Middle East, some parts of Africa and Asia, and English speaking countries.
Do women prefer circumcised partners?
Most women in the world have intact partners and prefer their men this way. Women in circumcising countries often state a preference for circumcised partners, because this is what they are accustomed to.
Does circumcision affect a man's sexual enjoyment?
Circumcision removes complex tissue containing thousands of highly specialised fine touch receptors and nerve fibres. The loss of sexual sensitivity is proportional to the amount of foreskin removed. Men circumcised as infants may be unaware of this, but many men circumcised as adults report a definite loss.
Can circumcision prevent penile and cervical cancer?
The risk factors for penile and cervical cancer are cigarette smoking and exposure to multiple strains of the human papilloma or wart virus (HPV) through unprotected sex with multiple partners. Penile cancer is an extremely rare disease at less than 1 case per 100,000 men and a median age of diagnosis of 64 years. Circumcised men do develop penile cancer, which often develops on the circumcision scar.
Can circumcision prevent HIV and other STDs?
Circumcision does not prevent STD transmission, but many studies claim that circumcision can reduce a man's risk of aquiring an STD. These studies are often done in less developed countries and do not take into account complex social customs, traditional sexual practices, and genetic factors in susceptibility to disease. Similar studies in industrialised nations, such as Australia, find that circumcision does not reduce the risk of STD transmission.
Does a boy or man with phimosis (unretractable foreskin) or balantitis (swollen foreskin or foreskin stuck behind the glans) need circumcision?
A small percentage of boys and men have foreskins with an unusually small opening, which can be difficult to retract or become stuck behind the glans and cause swelling. In this case, a doctor can compress the glans so that the foreskin can return to its normal position. The opening of the foreskin can then be increased by twice daily application of cortisone cream for 4-6 weeks, hence avoiding the need for circumcision.
For further information contact Circumcision Information Australia. ;
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This article was co-authored by the following two writers
Author - George Williams
George Williams is a consulting paediatrician at his private rooms in
Menai NSW, and also the Westmead Children's Hospital. While completing
postgraduate medical training in Canada, George witnessed a young baby
die after an unnecessary circumcision became infected with gangrene,
which then spread over the child's body. With this horrific experience
and reports of other deaths and serious injuries following infant
circumcision, George was spurned on a journey to abolish this barbaric
and unnecessary practice. George established Circumcision Information
Australia (then NOCIRC of Australia) in 1992, and has since consulted
with the media and written a number of articles for parenting magazines.
Author - Shane Peterson
Shane Peterson underwent reconstructive surgery at the age of 18 to
repair an over-generous circumcision that took place a week after his
birth in West Australia during the 1970's. Shane studied science in
Perth then moved to Canberra for postgraduate studies in medical
science. During his university career, Shane has extensively researched
the available literature on circumcision. Through his surgical
experience as an adult, Shane is aware of the loss of sexual enjoyment
that results when specialised nervous tissue is removed by circumcision.
Shane is appalled at the widespread practice of this unnecessary and
sexually damaging surgery. In conjunction with George Williams, Shane
assists other men who have been traumatised by circumcision, and works
to increase public awareness of the value of the foreskin as a sensory
organ for male sexual function.
My Son: The Little Jew with a Foreskin
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