Medical reasons for and against
Social reasons for and against
The issue of routine male circumcision remains controversial, with strong proponents and opponents to the practice. The present medical stance tends to be that there is:
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No strong medical evidence to support routine circumcision of newborn boys, but there can be some health circumstances where there is a medical reason to perform it. |
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Some recognition that there could be some health benefits from routinely circumcising boys, but that they do not outweigh the risks attached to the circumcision procedure. |
The latest policy statement from the Royal Australasian College of Physicians, RACP (2002) states:
"After extensive review of the literature the RACP reaffirms that there is NO medical indication for routine male circumcision.
Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years. It remains an important ritual in some religious and cultural groups. In Australia and New Zealand, the circumcision rate has fallen considerably in recent years and it is estimated that currently only 10 percent of male infants are routinely circumcised. It is now generally performed with some form of local or general anaesthesia, and usually outside the neonatal period. The best recognised indication for circumcision is phimosis.
There have been increasing claims over recent years of health benefits from routine male circumcision. The most important other conditions where some benefit may result from circumcision are urinary tract infections, HIV and later cancer of the penis.
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Urinary tract infections in boys are uncommon, affecting at most 1-2%, and may be about five times less frequent in circumcised boys, while circumcision has a complication rate of 1% to 5%. Routine neonatal circumcision can not be supported as a public health measure on this basis. |
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While there is some evidence, particularly from sub-Saharan Africa, that male circumcision reduces the risk of acquisition of HIV, evidence is conflicting and clearly this can not be seen as an argument in favour of universal neonatal circumcision in countries with a low prevalence of HIV. |
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Penile cancer is a rare disease with an incidence of around 1 per 100,000 in developed countries. Even though the evidence suggests neonatal circumcision may reduce the risk ten-fold, the rarity of the condition is such that universal circumcision is clearly not justified on these grounds. |
The complication rate of neonatal circumcision is reported to be around 1% to 5% and includes local infection, bleeding and damage to the penis. Serious complications such as bleeding, septicaemia and meningitis may occasionally cause death.
The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit. Whether these legal concerns are valid will be known only if the matter is determined in a court of law.
If the operation is to be performed, the medical attendant should ensure this is done by a competent operator, using appropriate anaesthesia and in a safe child-friendly environment.
In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents.
Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure."
For more information about the RACP statement, you can visit their website:
www.racp.edu.au