Circumcision in Australia: Further evidence on its effects on sexual health and wellbeing
Jason A. Ferris, Juliet Richters, Marian K. Pitts, Julia M. Shelley, Judy M. Simpson, Richard Ryall, and Anthony M. A. Smith
Australian and New Zealand Journal of Public Health, Vol. 34 (2), April 2010, 160-64

OBJECTIVE: To report on the prevalence and demographic variation in circumcision in Australia and examine sexual health outcomes in comparison with earlier research.

METHODS: A representative household sample of 4,290 Australian men aged 16–64 years completed a computer-assisted telephone interview including questions on circumcision status, demographic variables, reported lifetime experience of selected sexually transmissible infections (STIs), experience of sexual difficulties in the previous 12 months, masturbation, and sexual practices at last heterosexual encounter.

RESULTS: More than half the men (58%) were circumcised. Circumcision was less common (33%) among men under 30 and more common (66%) among those born in Australia. After adjustment for age and number of partners, circumcision was unrelated to STI history except for non-specific urethritis (higher among circumcised men, OR=2.11, p<0.001) and penile candidiasis (lower among circumcised men, OR=0.49, p<0.001).

Circumcision was unrelated to any of the sexual difficulties we asked about (after adjusting for age) except that circumcised men were somewhat less likely to have worried during sex about whether their bodies looked unattractive (OR=0.77, p=0.04). No association between lack of circumcision and erection difficulties was detected. After correction for age, circumcised men were somewhat more likely to have masturbated alone in the previous 12 months (OR=1.20, p=0.02).

CONCLUSIONS: Circumcision appears to have minimal protective effects on sexual health in Australia.

Comment

One of the most interesting findings of the study is that circumcision nearly doubles a male’s risk of non-specific urethritis (NSU). This result is consistent with Jonathan Hutchinson’s notorious syphilis study of 1854, which showed (though this point was never mentioned by circumcision enthusiasts) that circumcised men had a higher risk of gonorrhoea. Since NSU is a urinary tract infection, the finding must also cast serious doubt on the claim that circumcision significantly reduces the risk of UTIs in male infants. A study published in the USA in 1987 also found that "lack of circumcision" did not increase the risk of gonoccocal urethritis, but that the foreskin had a protective effect against non-gonoccocal urethritis: Smith GL, Greenup R, Takafuji ET. Circumcision as a risk factor for urethritis in racial groups. Am J Public Health 1987;77:452-4.

What is striking is how differently the media report these sorts of studies, depending on whether the foreskin has been found pathogenic, neutral or beneficial. There has been no coverage of this article in the Australian media, nor of the recent study by Adelaide researchers in Annals of Family Medicine, both of which conclude that circumcision is either useless for health or even harmful. But recall the numerous screaming headlines over the past decade every time some study or other showed that "lack of circumcision” was somehow associated with vastly increased risk of STDs, cancer, AIDS and tutti quanti. Actually, the reports rarely put it as cooly as that: usually they leave the impression, if they do not explicitly allege, that the mere presence of the foreskin is enough in itself to generate all these terrible diseases. Even a report on the Ferris/Richters study in 6Minutes does not escape the anti-foreskin prejudice: its headline is “Circumcision benefits not seen in Australia”, but why not write "Circumcision can double risk of urethritis"? And don’t forget to check out the responses to Prof. Morris’s comment.

It's interesting to compare the Canadian media, where newspapers reported the Adelaide study at length, and regularly carry opinion pieces critical of circumcision. In Australia, however, it seems to be impossible for anybody to utter a word against circumcision without being "balanced" - i.e. running through an exhaustive list of the "benefits" before muttering half-heartedly about a few remote risks or trivial disadvantages. Is everybody here too intimidated by Professor Voldemort and his “scientific” death eaters? If nothing else, they certainly seem to have mastered the Imperius and Confundus curses.