The male circumcision debate

Some years ago, I presented a Triple J program about male circumcision.  It was all relatively light-hearted; a young doctor fielded calls about ‘hoodies verses helmets’ and a producer dared me to say ‘d--k cheese’ on air.  But the mood abruptly shifted when a listener rang in sobbing.  The young man was so upset about being circumcised that he described it as ‘violation and mutilation’ and revealed he was attempting to stretch back his foreskin using special bands. All the men in the studio crossed their legs and winced while the doctor advised him to seek medical guidance as such a procedure was unusual and could be dangerous.

This young man’s pain, heartache and fury came back to me a few years later when I had a baby boy. I was thankful that circumcision wasn’t even discussed at the hospital, baby health care centre or in any of the literature I’d read; let alone offered as an option.  It hurt to even have to consider someone cutting this beautiful, perfect body that had grown inside me. A man in the next room inquired about his son being made to look like him but was told their faces won’t match either.  He let it go. I’d had Jewish friends who had circumcised their babies as a religious and cultural obligation, but I was glad we secular parents were not given the option as the practice was considered unnecessary and out of date.

On a world scale, medically rationalized circumcision is a minority practice that’s illegal in some countries.  It became common in the late Victorian period in Britain and its colonies, initially as a control for masturbation. One advocate Dr John Harvey Kellog (of breakfast cereal fame) was so obsessed by self-pleasuring that he also advocated application of carbolic acid to girls’ clitorises, cold baths, cool enemas, electric shocks and even covering genitals with patented cages.  Worth thinking about next time you are snacking on your Nutri-Grain.

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In the 1970s, medical authorities began to recommend against routine medically unnecessary circumcision of baby boys. They pointed out that the foreskin protects, is a primary sensory part of the penis and that circumcision involved pain, bleeding, infections, damage to the penis and a violation of an infant’s rights.  Parents responded to the advice and, within a generation, Australia changed from a country where nearly 90 percent of newborn boys were circumcised to one where circumcision is about 20 percent. The change happened so quickly that there are many families where one son is done and one isn’t.

But following a recent policy statement from the American Academy of Pediatrics, the debate is back on the agenda. It said the “preventative health benefits of elective circumcision of male newborns outweigh the risks”. The Academy stopped short of recommending circumcision but said parents should consider the literature and advice.  A vocal minority of medical experts go a lot further, saying foreskin removal could act as a “surgical vaccine” to stop the spread of HIV, particularly in Africa. United Nations agencies in the subcontinent agree it should be considered.

Tonight on the SBS programme Insight, medical experts, religious scholars, parents and men will give their views on male circumcision. Some see it as a non-issue, a few as a health concern, others as a religious covenant and a couple as an unnecessary cruelty.

For those who are unsure, I’m sensing another new parental minefield that’s becoming increasingly vexing.  Insight participant Desleigh had Elwyn 29 years ago and was soon told he had restricted urine flow that could only be fixed by circumcision. Elwyn is now an ‘intactivist’, who feels a part of him is missing while his mother feels guilty and still wishes there was another way.  I understand Desleigh when she says ‘I kind of feel you can’t win. You’re damned if you do and damned if you don’t.

Tracey had her son Nathan in 1992.  A single mother, she was worried she wouldn’t be able to teach him to clean his penis properly.  Her grandfather had told her terrible stories of men during war time, stuck in trenches and unable to wash. “One of his air force buddies had to be circumcised in the field without anaesthetic and that horrified me”.  Tracey was so confused that her decision to circumcise was motivated by the fact she didn’t want to do the wrong thing.  She had initial regrets as the doctor nicked the shaft of Nathan’s penis and it needed a stitch.  “He was distressed, I was beside myself – what have I done?”

Nathan’s scar has healed and he’s now happy with his mother’s decision, saying ‘You can’t miss what you’ve never had’.  Tracey also has no regrets; especially in terms of hygiene as Nathan went off to boarding school and ‘God knows how often they washed’.  She also feels girls prefer a circumcised penis, saying it’s cleaner and looks better.  “If I had penis I would rather circumcised and would hope my mother make that decision before I was old enough.”

It’s a decision most parents would rather not have to make.  But by putting it back towards parental choice, the American Pediatrics Organisation is setting us up for more confusion and angst.  Taking out religion, the practice lies at the crossroad of human rights, health and ethics.

Advocates of circumcision talk of a significantly lower risk of becoming infected with HIV and other sexually transmitted diseases in high-risk populations.  They also point to a slightly decreased risk of (extremely rare) penile cancer in men with foreskin retraction problems. These are points acknowledged by our experts at The Royal Australasian College of Physicians Pediatrics and Child Health Division.  But after reviewing the currently available evidence, the RACP still comes down against the practice here. It advocates safe sex rather than an operation on a baby. 

Sometimes being a parent is a Sophie’s choice of difficulties.  There are decisions to be made that you know could be vitally important to your child’s future; decisions that once implemented cannot be reversed. In an age of option and information overload, where we are bombarded with many choices and an infinite amount of information from all over the world, such decisions become even harder. Witness the vaccination debate that meant parents fretted about a link to autism. The concerns turned out to be disproved.

In terms of circumcision, there are potential harms and potential benefits; but religious and cultural reasons aside, I believe there is not a strong enough case for bringing back medical circumcision.  Yet I watch the debate with that common parental fear – of being proved wrong.

Watch 'The First Cut' on Insight, at 8.30pm tonight on SBS one.  

35 comments

  • Very well written and balanced. But sooo much fuss over a bit of limp, useless skin. I'm circumcised. Actually, maybe that explains the stutter I had as a boy.

    Commenter
    Roger
    Location
    Mona vale
    Date and time
    October 02, 2012, 7:57AM
    • I agree that "limp, useless(sic) skin" seem to occupy the thoughts of many religions. Whether the hymen or the foreskin, superstitious people attribute significance to these membranes which is unbelievable when subjected to a moment's thought.

      But is the foreskin 'useless', as you suggest? As a proud foreskin owner, can I say that in my experience, the sensation of the retraction of the foreskin is an essential part of my sexual pleasure. Indeed, the removal of the foreskin was in part motivated by the desire to reduce the pleasure of masturbation and encourage boys to procreate to sustain the community, rather than "spill their seed".

      That we have no need to sustain our communities, but this preposterous superstition lives on, is testament to the enduring nature of of memes. My opinion? I feel sorry for any boy who is circumcise that he is denied the indescribable pleasure of a foreskin for no good reason. Infant genital mutilation- to give this barbaric practice its correct title- is an anachronism and should be stopped for both girls and boys.

      Commenter
      Nogbad
      Location
      Foreskin City
      Date and time
      October 02, 2012, 9:49AM
    • I also agree that it is actually a very pleasurable piece of skin. The sensation of it rolling over the edge of the helmet is pretty important to me. I think it also keeps the head sensitive as if I retract it then put my undies on the friction can be a turn on.

      Commenter
      Manly man
      Date and time
      October 02, 2012, 10:33AM
    • I've heard of men who were circumcised as adults saying sex after circumcision is like seeing without colour. I still have my hoodie and don't intend to find out whether this is the case.

      When there is a good medical case (like urine flow problems etc) I would not oppose it but there just isn't a convincing enough case for it in otherwise healthy individuals in my opinion. The HIV risk brings up another matter: there is a concept in economics called Moral Hazard (it pops up a lot in regards to insurance as well). Moral hazard is where people start taking more risks if they feel they are somewhat protected from the negative consequences (either by having insurance for example or if they perceive the risk to be reduced). So someone with car insurance might be inclined to drive more recklessly for example. It applies here because if you circumcised a large portion of the population and told them it was to reduce risk of getting STIs, it may misguide them into thinking they are more protected from getting STIs than the reality and consequently you could have must higher levels of unsafe sex. This could perversely result in higher STI infection rates. The exact opposite of the main argument for more widescale circumcisions being performed.

      Oh and getting back to the clean/look debate my wife and I prepare before sex. I shave and wash myself and it's a nice ritual that adds anticipation to the event. So how about we teach our sons to bathe rather than perform surgery on them before they can consent?

      Commenter
      Vayor
      Location
      Melbourne
      Date and time
      October 02, 2012, 10:40AM
    • From my (admittedly limited) experience with circumcised and uncircumcised partners over many years, I would have to say the still intact seemed to be more sensitive and enjoyed sex more. Only a small bit of anecdotal evidence I know, but I wouldn't be circumcising anybody, that's for sure.

      Commenter
      lola
      Date and time
      October 02, 2012, 4:24PM
  • "It's cleaner and it looks better?" Really? I know in a small number of boys, it can be difficult to retract and can affect urination-then it's a reasonable solution. In high STI and HIV risk populations it might have some relevance-although, teaching a boy/man to clean himself properly and use condoms is a better solution-circumcision doesn't eliminate the risk of HIV transmission-lets please remember that.

    It shouldn't be considered unless medically indicated. And I'm sorry, religious male circumcision is no different to religious female circumcision in my eyes, both are unnecessary. No caring/loving God I'd worship would ask me to mutilate my body to prove my worth.
    And by the way....my guy has a hoodie (which looks perfectly adorable to me thanks very much!)...and funnily enough, when it's doing it's job, I don't think about what it looks like at all! :)

    Commenter
    Me
    Location
    Here
    Date and time
    October 02, 2012, 8:41AM
    • I agree, so well written and interrogated Sarah. I didn't watch Insight but will make a point of catching up on the debate.
      We knew we were having a son during our first pregnancy. My husband and I disagree on many issues, and indeed circumcision was a topic of hot debate for those 20 weeks we knew we were having a boy. But when our boy arrived - despite how headstrong my husband had been that his son 'look like him' and 'how much cleaner a circumcised penis was' - neither of us could bare the thought of circumcision. What had been a cause of massive arguments, all of a sudden it vanished from our minds and was a non-issue. When we had sons 2 and 3, the topic never came up.
      I've had partners with and without circumcised penises, and I have to say it's never bothered me either way, so long as the man takes care of his body.

      Commenter
      msjane
      Location
      Melbourne
      Date and time
      October 02, 2012, 8:52AM
      • Insight is on SBS tonight at 8.30 pm.

        Commenter
        Sarah
        Date and time
        October 02, 2012, 9:05AM
      • "But when our boy arrived - despite how headstrong my husband had been that his son 'look like him' "

        Wow. Do people actually think this? That their son must be circumcised so that they 'look like' their dad? The mind boggles.

        Commenter
        Norris
        Date and time
        October 02, 2012, 11:03AM
      • @ Norris - I did go through the same thought process when I had my son earlier this year. My thoughts were along the lines of penis care - how do you take care of the foreskin, when do you get inside and clean it, what is it meant to do as they grow up, etc. Being circumcised myself, I knew none of these from experience.

        At the end, my discomfort with not knowing from personal experience about any of this, and the very minor benefits, was minor compared to the pain I would put him through, the risks of complications (mine was botched).

        So, my son is still "whole".

        Commenter
        ST
        Date and time
        October 02, 2012, 12:37PM

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