Circumcision is not appropriate for 21st Century Aussie boys. A definitive article in Australia’s leading child health journal confirms the judgement of Australian paediatricians since 1971 that boys should not be routinely circumcised as a health precaution. In a rebuff to the American Academy of Pediatrics (and by extension the Centers for Disease Control, which repeats its errors) the article endorses the conclusion of the circumcision policy statement issued by the Royal Australasian College of Physicians in 2010, namely, that there is no medical warrant for routine circumcision in the Australian and New Zealand context.

The paper, by leading Australian child health authorities, runs through the reasons traditionally cited for non-therapeutic circumcision of infants and finds none of them convincing or sufficient. They particularly reject the common argument that circumcision should be performed in order to reduce the risk of HIV infection. Although there is evidence that circumcision can reduce the risk of disease transmission during unprotected intercourse with an infected female partner, all of it comes from studies of adult circumcision in under-developed African countries with both very high HIV prevalence and social and epidemiological conditions quite different from those in Australia. As the authors point out “Although most of the research on circumcision have sound scientific basis, its findings are usually only applicable to the specific socio-cultural context in which the study was conducted”, and they warn that too many authors “tend to prematurely extrapolate the data in an attempt to set national and international standards.” (Brian Morris: are you listening?)

The authors also raise important questions of bioethics and human rights, pointing out that while adult males can give autonomous consent to circumcision for any reason, “it is difficult to argue the same ethical principles for infants.” While parents have “legal rights to consent for a medical procedure if it is in the child’s best interest,” it is difficult to justify circumcision “as being in the best interest of the infant when most uncircumcised Australian adult males themselves … are reluctant to undergo adult circumcision?” In other words, circumcision fails the imputed judgement test and violates the child’s right to a open future.

The upshot is that paediatricians should seek to discourage parents from having their boys circumcised, as was the case back in the 1980s. Very few boys are circumcised these days, and the incidence is declining, meaning that the old, silly argument about “looking like his father” is no longer relevant. Quite the contrary: “as fewer children are being circumcised, parents’ priorities might have changed from making the boy to look like his father to allowing the boy to look more like the other uncircumcised boys at school.”

The authors conclude that “although there is a benefit of circumcision in those with urogenital tract anomalies, in a healthy newborn, the disease in the foreskin is non-existent.” Taking into account the lack of significant medical benefits, risk of complications, the harms of foreskin loss, and the financial cost, routine circumcision in Australia “cannot be justified. From medical point of view, the ‘price’ is still too high.”

Source: Angelika F. Na, Sharman P.T. Tanny and John M. Hutson. Circumcision: Is it worth it for 21st-century Australian boys? Journal of Paediatrics and Child Health. Advance access, 12 February 2015.