Making the Cut

Cut or uncut? It’s a very personal question yet most men have no say in the matter unless we’re making the decision on behalf of someone else: our children. While popular news sources are once again discussing supposed merits of circumcision, the verdict should be obvious: non-medical surgery without consent violates children’s bodily integrity.

Circumcision is a bizarre concept. Cutting off a bit of skin that naturally covers the tip of the penis. Whoever thought up the idea must have been having a bad day.

The history of male circumcision stretches back thousands of years to the dawn of the Jewish faith, where the removal of the foreskin was a sign of God’s covenant with his people. Thankfully, St Paul declared circumcision unnecessary for Christians (Galatians 6:12-15). It nonetheless became popular throughout the Christian world in the late 1800s. Puritans advocated it as a means of discouraging masturbation and reducing men’s sexual pleasure. These days the motivations for circumcision are complex and emotional, based on the personal bias of parents, perceptions of sex and sexuality, religious and cultural traditions and obscure health claims. The harsh reality remains: male circumcision causes significant pain, damages the “genital integrity” of the child and is practically irreversible.

In recent years, circumcision has become increasingly rare in Australia. In the early 20th century the majority of men were circumcised. Since the late 1980s, medical opinion has generally opposed the procedure unless medically necessary, and cosmetic circumcision stopped being carried out in public hospitals. Circumcision is thus much more common among men aged over 30. There is also significant regional variation. Prominent pro-circumcision advocates in NSW and Queensland (usually doctors benefiting financially from conducting the operations) have resulted in much higher circumcision rates in those states. In Tasmania on the other hand, circumcision is more or less unheard of outside small Jewish and Muslim communities, with just 1.6% of boys being circumcised.

Yet there are indications secular circumcision is increasing. In 1993 the national neonatal circumcision rate was 10.6% and falling, but today rates in NSW are approaching 20%.

While most of us remain blissfully ignorant, debate on the ethics and health benefits of circumcision quietly rages. Just last year the American Academy of Pediatrics released data showing that circumcision may reduce the risk of transmitting HIV, herpes and HPV.

SomeHowever some important caveats, however, must be acknowledged. As Australian medical bodies have consistently stated, it is dangerous to think circumcision could remedy ongoing sexual health issues. Circumcision is not and never will be an effective means of preventing sexually transmitted infections. Worryingly, a recent US study showed that as a result of perceived protection circumcised men are less likely to use condoms. An Australian study has also found condoms are more likely to slip off or break for circumcised men. Circumcision to reduce the likelihood of HIV infection might be beneficial where HIV rates are high and condom usage rare. However in countries like Australia, circumcision is not justified as a preventative measure and cannot replace condom use as an appropriate precaution against Sexually Transmitted Infections.

Circumcision advocates like Brian Morris have claimed circumcision reduces the risk of penile cancers. However rates of these rare cancers are not significantly different between Israel, where close to 100% of men are circumcised, and Scandinavia, where next to none are. Similarly, claims that circumcision helps prevent urinary tract infections have been rejected: infections are much more strongly linked to hygiene practices. With good basic hygiene, circumcision has no significant impact on infection risk.

While it is generally thought that circumcision reduces sexual pleasure, this is supremely difficult to prove. However we do know that the risks of circumcision can be severe. Complications arise in roughly 3% of cases, and in the United States over 100 babies die every year as a result of botched circumcisions. The process is impossible to completely reverse and is always painful. According to the Italian Journal of Paediatrics, circumcision is “one of the most painful procedures a baby can undergo”.

Circumcision is also legally contentious. According to the Queensland Law Reform Commission, non-consensual circumcision technically falls under the definition of assault, however no charges have ever been laid against doctors or parents. In 2012, the Tasmanian Law Reform Institute recommended that non-religious non-therapeutic circumcision be explicitly banned, as has already occurred in Germany and Sweden. Other European countries are currently querying whether non-consensual circumcision breaches human rights. In 2013 a Council of Europe resolution called the circumcision of young boys, even for religious reasons, a “violation of the physical integrity of children”.

The real question here concerns consent and personal autonomy. A baby cannot consent to a body altering procedure. While parents have an obligation to protect the health of their child, a minor reduction in future susceptibility to HIV is not grounds to irreversibly alter a baby’s body, and deny him the opportunity to make his own decision when he is old enough to do so.

In contemporary Australia, there is no longer any acceptable reason for mutilating the genitalia of infants. Leading medical bodies continually warn that the risks of circumcision clearly outweigh any negligible benefits. American fearmongering based on outdated cultural traditions and sexual prudishness, coupled with statistics from countries rife with HIV, should have no bearing on medical practices in this country.