Male infant circumcision: ‘safe, convenient, cheap and fast’

The benefits of circumcision outweigh the risks by 100 to one. Jeff Dickerson

Medical circumcision of baby boys has plummeted in Australia, with only 20% of male infants now undergoing the procedure, down from 90% in the 1970s.

Meanwhile, HIV infections continue to rise in the broader community, with heterosexual contact now accounting for 23% of new HIV diagnoses.

To protect Australians against the spread of HIV and other sexually transmissible infections, we need to increase male circumcision rates. And the safest, most convenient and cost-effective time to do this is shortly after birth.

But in recent years, short-sighted measures by state health departments (except Queensland) have restricted access to publicly-funded circumcision, meaning parents need to go beyond the public hospital system to procure a circumcision for their baby. And they’re left with the bill.

If they can’t afford it, their son misses out.

Parents love their children and strive to do the best for them in all aspects of life – and this should include the ability to have their baby boys circumcised in the public hospital system.

Adverse outcomes of circumcision are extremely rare but opponents of circumcision ensure they make the headlines. It’s important to keep it all in perspective: the benefits of circumcision outweigh the risks by around 100 to one.

Minimal risks

The circumcision of boys in infancy is safe, convenient and performed under local anaesthetic. Pain can be zero and healing is quick.

The risks of serious complications are extremely low, affecting only one in a million boys.

Inflated statistics of harm are sometimes used by opponents to intimidate parents but these are based on “kitchen table” circumcision outcomes or the use, against advice, of general anaesthetics.

There’s no credible evidence of any adverse effects later in life on sexual function, sensitivity or satisfaction.

The widely-cited adult penis “sensitivity study” – which claimed the foreskin was the most sensitive part of the penis – has been outed in medical literature as being statistically flawed.

I was the reviewer for a recent Danish study by circumcision opponents that, despite their best efforts, failed to find any major effect on sexual function.

I recommended the paper be rejected because of statistical flaws in their finding – that a small number of men (10) circumcised after experiencing penile problems were slightly less likely to reach orgasm during intercourse.

In fact, data from large, high quality randomised controlled trials show circumcision enhances the sexual experience of men and their female partners.

Benefits

Studies show both men and women believe circumcision improves the appearance of the penis.

But beyond the cosmetic, parents who make this choice for their baby boy can be reassured that he now has a lifetime of protection against certain diseases and could have improved penile function later in life.

Their infant son will be 10-times less likely to get a urinary tract infection, which affects one in four males over their lifetime. (UTIs also damage the kidneys of half of all infants who contract them).

The circumcised boy will be immediately protected against phimosis, which affects one in ten teenage boys and men. This is when the orifice of the foreskin is too small for urine to pass, resulting in ballooning of the foreskin. Phimosis also means painful and difficult erections, and frenulum tearing.

Steroid treatment can’t cure phimosis; only circumcision can. But circumcision later is inconvenient, expensive, higher risk, and can involve a general anaesthetic. It’s better to remove the foreskin in infancy rather than risk complications later in life.

Phimosis is the biggest risk factor for penile cancer, which affects around one in 1,000 males over their lifetime, virtually all of whom are uncircumcised.

Other foreskin-related complaints include inflammation, malodorous smegma and itching.

Sexually-transmitted infections (STIs)

STIs are more common in uncircumcised men but it’s circumcision’s ability to protect against HIV that gets the headlines.

The epidemic of cancer-causing types of human papillomavirus (HPV) in Australia also has authorities worried.

Not only are HPVs responsible for some penile cancers, when passed on to women during sex they cause more than 99% of cervical cancers.

Circumcision reduces the likelihood of contracting syphilis and other ulcerative STIs such as genital herpes. Thrush is also less common in circumcised men.

Not only will a circumcised boy’s future sexual partner(s) be less likely to get cervical cancer, they will be at lower risk of developing Chlamydia, a bacterial infection that can cause pelvic inflammatory disease, ectopic pregnancy and infertility.

Herpes, trichomonas, genital ulcer disease and bacterial vaginosis (gardneralla) are also more common in women who have sex with uncircumcised men.

The evidence that infant male circumcision protects against the spread of disease is so compelling the procedure is now regarded by academic and clinical experts as a “surgical vaccine”.

Just as conventional vaccinations are recommended for populations of children, circumcision should be universally available for all boys.

Condoms should, of course, be used to reduce the risk of infection, but their effectiveness against different STIs is variable and falls well short of 100%. And despite public health campaigns, condom use has failed to increase.

Circumcision is a sensible precaution to reduce the spread of infection, but condoms must be worn each time a person has sex outside a stable, zero-risk relationship.

The anti-circ movement

Up to half of all uncircumcised men are likely to suffer from a condition caused by their foreskin over their lifetime. But despite the protective benefits of circumcision, anti-circ campaigners continue to overlook the evidence and perpetuate a raft of myths.

More than one in ten men have problems with impotence or other sexual dysfunction. Many will go to the internet, type in a few keywords and, hey presto, they come across an anti-circ website that tells them their infant circumcision is to blame.

Et voila … a new convert is signed up! This poor gullible chap then perpetuates the anti-circ myths.

Some even use devices purchased over the Internet to stretch the skin on the shaft in an attempt to grow a (pseudo) foreskin. But this doesn’t improve their erection problems and can instead cause tragic complications, as for a case at the Royal North Shore Hospital in Sydney.

Greater availability

Given the enormous amount of medical information supporting infant male circumcision, governments have a responsibility to promote the benefits of this “surgical vaccine”, just as it did the HPV vaccine.

Elective circumcision should be subsidised and offered in public hospitals.


Should circumcision be subsidised and offered in public hospitals? Have your say below.

Read Ryan McAllister & John W.Travis’ article ‘Unethical and harmful’: the case against circumcising baby boys


For more of Brian Morris’ research on the health benefits of circumcision, visit his website Male circumcision guide for doctors, parents, adults and teens.