Male circumcision is still a controversial topic ? is it vaccination or mutilation?
Male circumcision is a controversial topic. San Francisco will consider a ban on the practice in November, and last year the Dutch Medical Association called it medically unnecessary and against the rights of the child. Meanwhile in Swaziland, the king called last week for all men to be circumcised to fight HIV infection. So is it vaccination or mutilation?
What is circumcision?
The removal of the foreskin covering the end of the penis to leave the tip exposed. It can be carried out on babies for religious reasons (among, for instance, Jewish and Muslim communities) in the first few days after birth, sometimes without anaesthetic. There are fewer complications in newborns.
What are the health benefits?
The WHO says there is "compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%". And that three trials have shown that it is safe when carried out by "well-trained health professionals in properly equipped settings". It recommends it for men in regions with high levels of heterosexually transmitted HIV and HIV epidemics, but says men should also practise safe sex.
A paper in the Australian and New Zealand Journal of Public Health says the role of the foreskin in HIV transmission is now compelling and circumcision removes the problem of a phimosis, when the foreskin can't be pulled back (the given rates of this range from 1% to 14%). Advocates say it can reduce the risk of catching other sexually transmitted diseases, urinary infections in children, cancer of the penis in adults, and cancer of the cervix in women who have sex with circumcised men.
But the American Academy of Pediatrics and others point out the HIV studies were carried out in developing regions where penile hygiene and condom use may be different to western countries ? so results may not be applicable. They say the potential medical benefits are not enough to recommend routine circumcision and parents should be informed of the risks and benefits, and pain relief should be given to babies.
It also says this cancer is rare and 600 men would have to be circumcised for one to be prevented from getting penile cancer. Washing your penis carefully probably reduces the risk substantially. The risk of a uncircumcised boy getting a urinary infection is estimated to be three to 20 times the risk in a circumcised boy. A paper in the Lancet put the increase in risk at 3.7 times, in a study of 30,000 boys.
There is a growing movement of men who feel their sex lives are diminished by reduced sensation, although the American Academy of Pediatrics says research showed circumcision made no difference in touch sensation.
What are the complications?
The American Academy of Family Physicians says the rate ranges from 0.1% to 35% in various studies ? it is likely to be closer to 1%. The main risks are bleeding, failure to remove enough foreskin or scarring. Serious complications are very rare.
Should I circumcise my son?
The British Medical Association says: "The responsibility to demonstrate that non-therapeutic circumcision is in a particular child's best interests falls to his parents . . . evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it." So there you have it.
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