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Male Circumcision - Purely for looks?

8 Mar 2004 8:18 AM - Dr Roger Morris

What is male circumcision?

Circumcision in boys is an operation in which the foreskin or prepuce (the fold of skin that covers the tip of the penis) is removed. Few boys were circumcised before 1900, and most of these were done for religious or cultural reasons. In Western countries, circumcision rates gradually increased during the last century, reaching a peak in the 1950s when most boys were routinely circumcised. More recently, routine circumcision has fallen out of favour in the community and in medical circles, and now less than 10% of baby boys in Australia are circumcised.

What is the foreskin & what is its function?

The foreskin covers the tip of the penis. Beneath the foreskin, the skin of the glans is thin and moist. At birth the foreskin is attached to the underlying head of the penis (glans) and is fixed. However by age three or four, the foreskin will be retractable in many boys. It is normal for creamy material to come from underneath the foreskin (called smegma) and this represents normal lubricating skin oils and dead skin cells. This does not indicate infection. The foreskin has many roles, but the most important is to protect the sensitive tip of the penis from injury and trauma.

Is circumcision necessary?

The Australian Association of Paediatric Surgeons (AAPS) and the Royal Australasian College of Physicians (RACP) advise against routine circumcision of male infants. These bodies have concluded that the only valid medical reasons for circumcision are:

  • recurrent urinary tract infections.
  • recurrent balanitis (penis infections).
  • phimosis (tight foreskin) resistant to other treatments.

For more information, log on to:
www.racp.edu.au/hpu/paed/circumcision/index.htm
www.surgeons.org/about/publications/pol_rprn03_21b.htm

Risks and benefits – how do the numbers stack up?

Although medical reasons for circumcision are debated passionately, in most cases the decision by parents to circumcise has little to do with medical evidence. More common, the decision is based on family or religious reasons.

It has been suggested that circumcision substantially reduces the risk of cancer or the penis, sexually transmitted infections and urinary tract infections (UTIs). Unfortunately, there is no reliable data from randomised controlled trials to prove this.

Infant circumcision is said to reduce the risk of UTIs from 10 per 1000 to 2 per 100. Therefore one would need to circumcise 125 boys to prevent one UTI during the first year of life.

The main complications from circumcision are bleeding and infection, and an average complication rate is about 2% (20 per 1000 circumcisions). This means that one boy is harmed for every 50 circumcisions performed.

Overall then, for every 1000 boys circumcised, 8 UTIs will be prevented, but 20 boys will develop a significant complication. This would imply that the risks of circumcision outweigh the benefits.

Source: ‘Circumcision in Males’, Dr Jonathan Craig, Australian Paediatric Review, Vol 9 No4 Nov 1999.

Who then should be circumcised?

Boys with the following medical problems may benefit from circumcision:

  • those who suffer from recurrent balanitis (penis infections)
  • those with true phimosis (tight, non-retractile foreskins)
  • recurrent urinary infections

In these children the statistics are more favourable, needing only to circumcise four boys to prevent one UTI.

My personal views on circumcision

The decision to circumcise male babies is ultimately a decision for parents to make themselves. Parents should, however, make sure their decision is based on accurate information. I believe there is no compelling medical justification for routine circumcision of male infants. As such, I believe circumcision is purely cosmetic.

Subjecting a non-consenting child to a painful procedure without proven medical benefits is inappropriate. I do not believe cosmetic aesthetics is a valid reason to circumcise. At a stretch, religious or cultural motivations for circumcision are understandable (e.g. Jews or Muslims).

Making a child look like his circumcised father is not a valid reason for circumcision. A circumcised boy will be different to 90% of his peers. The foreskin is a normal part of the male anatomy and should preferentially be left intact. It serves an important protective function and its removal can sometimes render the penis more vulnerable to injury (such as burns).

Circumcision performed for the valid medical reasons discussed previously should be delayed until the baby’s blood clotting and immune systems are fully functional at six months old. It should be performed under general anaesthetic to minimise trauma to the child.

Simple techniques for proper cleaning of the foreskin should be taught to all boys and, in most cases, this prevents the majority of infection related problems.

Dr Roger Morris is a General Practitioner in Maroochydore, who has a special interest in Child & Adolescent Health.