A guide for parents on the vexed question of circumcision has been released by the Paediatrics and Child Health Division of the Royal Australasian College of physicians – Australia’s premier medical authority. The leaflet points out that only a small minority of Australian boys are circumcised these days, nearly all for cultural and religious reasons, not for reasons of health. In simple language, the leaflet outlines the functions of the foreskin, the risks and harms of the operation, the possible (slight) benefits in later life, and some of the bioethical and human rights issues relevant to making an irreversible decision about an important part of another person’s body – a decision that he will have to live with for the rest of his life. The doctors responsible for the advice state clearly that “newborn baby boys do not need to be circumcised unless there is a medical reason” – that is, unless there is a genuine, diagnosed medical problem that must be treated surgically. Even in these cases, it is good medical practice to give conservative treatments a fair trial before resorting to surgery.

The leaflet warns that the risks and harms of circumcision include pain, bleeding, infections, permanent additional damage to the penis, later psychological problems and “violation of individual rights” because infants and children are not able to give informed consent to an operation they may not want and may later resent. There is certainly evidence that circumcision may reduce the functionality of the penis and lessen sexual responsiveness and pleasure in maturity. The leaflet also points out that “routine” (i.e. medically unnecessary or non-therapeutic) circumcision has been the focus of increasingly critical attention from experts in medical ethics, human rights and law, who warn that the foreskin has functions, belongs to the individual as much as any other body part, is removed without informed consent (usually without medical need) and that circumcision of a minor therefore denies a person control over his own body. An increasing number of men appear to be unhappy at having been circumcised in infancy, and many are either seeking to restore their foreskins or turning to the law to seek damages.

The leaflet provides basic tips on penis care in infancy, and points out that the foreskin needs no special attention and should be left alone. The foreskin is nearly always fused to the rest of the penis in early infancy, but gradually loosens and becomes possible to pull back as the boy grows. This process should not be hurried, and the foreskin should never be forcibly pulled back. Persistent tightness that becomes a problem (phimosis) can usually be successfully treated by appropriate medications, such as steroid ointment.

The RACP experts also point out that while there is some evidence from underdeveloped countries, especially in Africa, that circumcision may reduce the risk of sexually transmitted infections, such as HIV and syphilis, there is no evidence that circumcision has any such protective effect in a developed country such as Australia. In any case, circumcision is no substitute for safe sex.

The leaflet points out that many uncircumcised boys these days have circumcised fathers, and that neither the fathers nor the sons seem to be upset by this small difference. It concludes by pointing out that circumcision can safely be put off until the boy is old enough to understand the risks, consequences and possible benefits of circumcision, and make an informed decision for himself.

The full guide may be downloaded from the RACP website as a PDF: use search function