The Male Cicumcision debate
Circumcision is the surgical removal of the foreskin form the penis for medical indications, cosmetic appearances, or religious reasons. The foreskin protects and also serves as sensory organ for the penis, yet sexual satisfaction and sensation seems not to be affected by lack or presence of the skin. Rates for the procedure vary world wide, pending on the local medical evidence, ethical and cultural reasons and range from 85 % in the states , where the Center of Disease Control and the American Academy of Pediatics recommend it as a general measure , to countries like Sweden and Finland , where the procedure is banned unless for medical or strong religious reasons. The Australia male infant circumcision rate is estimated to be between 10 – 20 %. Interestingly dutch authorities advise delay of circumcision til an age where the boy is able to make an informed decision himself. There is no doubt that circumcision is indicated for Balanitis (recurrent infection of the foreskin) and in recurrent Urinary Tract Infections especially if there are upper renal abnormalities as this prevents chronic renal damage. To prevent 1 Urine Infection in the healthy child would require 111 circumcisions. The Royal Australian College of Physicians (RACP) have recently published a guideline being neutral on circumcision but Professor Brian Morris from the university of Sydney is a strong advocate of general population wide circumcision and even opposes delay of procedure til puberty as it reduces health benefits by years and might increase trauma surgically and emotionally to boys. It seems clear that the procedure reduces risk of a number of STD’s (HIV , Syphillis , thrush , Chlamydia…) an effect which might be more marked in the developing world where these are more prevalent. IN the developed world like Australia it is in the opinion of the RACP more effective and less harmful to prevent these with safe sex practices in later life. The risk of penile cancer might be reduced but is very low in Australia anyway at 1 case in 250.000 of the population. There are statistical risks in the range of 1-4% if circumcision is performed in infancy like bleeding , loss of penis , infection, complications from surgery and general anaesthetic. These risks are lowest if it is performed in theatre environments by qualified surgical doctors. This is noteworthy as circumcision may be performed by non medical operators or not formally surgically trained doctors in Australia. It seems a wise recommendation from the college to advise doctors to discuss benefits and harms in a balanced manner and offer written information on the procedure. The decision of the parents after informed discussion must be respected and there are no right and wrong answers. Boys might grow up to regret being circumcised as well as regretting not to have undergone the procedures. Decisions by parents are made at the time based on their considerations.
Helko Schenk
Geraldton 22 11 2010
Circumcision is the surgical removal of the foreskin form the penis for medical indications, cosmetic appearances, or religious reasons. The foreskin protects and also serves as sensory organ for the penis, yet sexual satisfaction and sensation seems not to be affected by lack or presence of the skin. Rates for the procedure vary world wide, pending on the local medical evidence, ethical and cultural reasons and range from 85 % in the states , where the Center of Disease Control and the American Academy of Pediatics recommend it as a general measure , to countries like Sweden and Finland , where the procedure is banned unless for medical or strong religious reasons. The Australia male infant circumcision rate is estimated to be between 10 – 20 %. Interestingly dutch authorities advise delay of circumcision til an age where the boy is able to make an informed decision himself. There is no doubt that circumcision is indicated for Balanitis (recurrent infection of the foreskin) and in recurrent Urinary Tract Infections especially if there are upper renal abnormalities as this prevents chronic renal damage. To prevent 1 Urine Infection in the healthy child would require 111 circumcisions. The Royal Australian College of Physicians (RACP) have recently published a guideline being neutral on circumcision but Professor Brian Morris from the university of Sydney is a strong advocate of general population wide circumcision and even opposes delay of procedure til puberty as it reduces health benefits by years and might increase trauma surgically and emotionally to boys. It seems clear that the procedure reduces risk of a number of STD’s (HIV , Syphillis , thrush , Chlamydia…) an effect which might be more marked in the developing world where these are more prevalent. IN the developed world like Australia it is in the opinion of the RACP more effective and less harmful to prevent these with safe sex practices in later life. The risk of penile cancer might be reduced but is very low in Australia anyway at 1 case in 250.000 of the population. There are statistical risks in the range of 1-4% if circumcision is performed in infancy like bleeding , loss of penis , infection, complications from surgery and general anaesthetic. These risks are lowest if it is performed in theatre environments by qualified surgical doctors. This is noteworthy as circumcision may be performed by non medical operators or not formally surgically trained doctors in Australia. It seems a wise recommendation from the college to advise doctors to discuss benefits and harms in a balanced manner and offer written information on the procedure. The decision of the parents after informed discussion must be respected and there are no right and wrong answers. Boys might grow up to regret being circumcised as well as regretting not to have undergone the procedures. Decisions by parents are made at the time based on their considerations.
Helko Schenk
Geraldton 22 11 2010
