The debate over circumcision is heating up, with new evidence showing it might prevent disease, writes Jordan Baker.
Professor Andrew Li circumcises men. About half his patients seek the procedure for medical reasons (infections, pain) and the rest for “personal” — mostly cosmetic — ones.
Of the latter, many are marched to the surgery by wives and girlfriends with a deep aversion to “ugly”, “unhygienic” foreskins.
“Some men come in with their partner and my whole conversation is with their partner,” says Dr Li.
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On the other side, there’s American Wayne Griffiths, 78. Wayne was so upset about being circumcised that he used weights to stretch his skin and “restore” his foreskin. That was in 1987. Since then, he’s helped more than 10,000 men across the world do the same thing.
“Circumcision cut off anywhere from 20 to 80 thousand nerve endings,” Wayne says. “They are all the pleasure-sensing nerves. And they’re gone forever.”
For such a little operation, circumcision causes big controversy. In the 1950s, 85 per cent of boys were circumcised and the remaining few suffered relentless teasing from their peers.
In recent decades, after doctors decided there was no medical need to cut the foreskin at birth, the opposite has become the case.
Today, just 10 to 15 per cent of boys get the snip, mostly for religious or cultural reasons.
“Cut” boys are now the odd ones out in the locker room, but their time may soon come again. A group of Australian doctors is campaigning for a return to routine circumcision, citing research that shows it protects men from a range of diseases, including two forms of cancer (penile and prostate), urinary tract infections and a range of sexually transmitted diseases, including HIV/AIDS and the human papilloma virus (HPV), which can lead to cervical cancer in their female partners.
“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,” Professor Brian Morris, a professor of medicine at Sydney University, said recently.
In Australia, parents decide whether to circumcise their sons. However, only Queensland allows the procedure in public hospitals and the Medicare rebate is small.
Dr Alex Wodak, a doctor based at St Vincent’s Hospital in Sydney and a member of the Circumcision Foundation of Australia, says parents tend to be discouraged from the procedure by doctors who have not caught up with recent research showing the benefits, including that uncircumcised men are three to eight times more likely to catch HIV/AIDS and syphilis.
With good pain relief, the baby doesn’t have to suffer, so there’s no reason not to circumcise, Dr Wodak says.
“The benefits outweigh the risks by a huge amount,” he says. “The evidence is getting so strong and yet the opposition is so strident, and the situation is unfair for parents. They should be able to get fair and balanced information, but they’re not. It’s a simple procedure when it’s carried out on infants — it’s quick, it’s painless, the benefits are considerable and the risks very small.”
Opponents of circumcision, or “intactivists” as they are known, disagree. They argue that not only is circumcision medically unnecessary and even risky, but it damages the sensitivity of the penis.
Such a permanent operation must not be performed without permission, they say, which a baby can’t give. Should a man eventually wish to be circumcised, he can easily do it as an adult.
With extreme passion on both sides of the argument, parents can struggle to find unbiased information.
The closest comes from The Royal Australasian College of Physicians, which has found that even though circumcision can guard against diseases, those diseases are either easily treatable or extremely rare in Australia (most of the research was done in Africa).
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It advises that the risks outweigh the benefits, but leaves the final decision to parents.
The argument for circumcision:
Reduces risk of syphilis, gonorrhoea and human papilloma virus (HPV) (linked to cervical cancer in women); significantly reduces risk of HIV/AIDS.
Reduces risk of rare penile cancer, but the reduced risk of prostate cancer is still inconclusive.
Reduces risk of urinary tract infection 10-fold.
Effective analgesics make circumcision relatively painless.
The argument against circumcision:
Better treatment for and protection against STDs available, such as vaccine for HPV, condoms, or antibiotics for infections.
Australia has a tiny heterosexual HIV-positive population compared with Africa; local studies show circumcision not relevant here.
Complication rate of 1.5 per cent, most minor, some severe, such as amputation, dangerous infection.
Read more of this story in the May issue of The Australian Women’s Weekly.
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