The Age (Melbourne) 1996

There is no medical reason why baby boys are circumcised. Why then do we put newborn children through such pain?

PAMELA BONE reports.

ONE had to feel sorry for baby Kane, with a blood-stained bandage sticking to his poor little penis in an episode of the ABC's recent documentary-soap, 'Sylvania Waters'.

However, as Paul, his father, lovingly explained to the baby, "It has to be done because when Daddy was a little boy and he went to the toilet with the other kids, the ones that weren't circumcised were laughed at. They weren't normal because they weren't circumcised." Even so, Paul said, he had to cry himself when he saw the tears running down the baby's face after the cut. But was little Kane's pain necessary? Because, contrary to what Paul believes, by the time Kane goes to school he is more likely to be different because he is circumcised. A generation ago parents who didn't want their baby boy circumcised had to take a firm stand. Today it is parents who do want their child circumcised who have to take a stand.

Nearly everyone, in this country at least, finds the idea of female circumcision abhorrent. Bring up the subject of male circumcision, however, and you are likely to get reactions ranging from amusement to defensiveness and hostility; because the majority of Australian adult males, whether Christian, Jew, Muslim or atheist, have been circumcised.

About 24 per cent of newly born boys in Australia are being circumcised today, but during the 1960s the proportion was about 70 per cent. Earlier, it was a routine procedure in Australian hospitals, almost as common as cutting the umbilical cord, and it was often done without the parents even having been consulted.

Today most doctors agree that there is no medical reason why baby boys should be routinely circumcised. For Jews and Muslims, circumcision is a religious requirement. But Jews and Muslims together make up just over one per cent of the Australian population, which suggests that a lot of baby boys are undergoing a painful surgical procedure for no good reason.

It is true that there is little comparison between the horrific practice of female circumcision, which is more properly described as genital mutilation, and male circumcision. Female circumcision, according to in which country the procedure is carried out, can range from what is described as a "ritual scratch" of the clitoris, to the removal of the clitoris and labia and even the sewing up of the area with catgut or thorns. It often leads to lifelong gynaecological problems. And it is done for an extremely nasty reason - to ensure a woman's sexual fidelity by denying her sexual pleasure. Male circumcision is the removal of the foreskin, the skin which usually covers and protects the head of the penis. The most common reason given for non-religious male circumcision is that it is more hygienic. But some men are now saying that male circumcision is genital mutilation, too, and that, like female circumcision, it represents a cruel denial of the human rights of a helpless child.

In the United States, groups such as "Nocirc" have been campaigning strongly against the practice. They are facing a battle, because with 60 per cent of baby boys in the US still being circumcised, it is more common there than in any other Western country. (In Canada the rate is 40 per cent, in New Zealand two per cent, and in the countries of Europe less than one per cent, though that proportion is probably increasing with the growth of migration from Muslim countries).

Male circumcision was carried out in Egypt 6000 years ago. It is also known to have been practised by Australian Aborigines about 300 years ago. In Judaism and Islam, circumcision is taken from the prophet Abraham, who, it was said, was directed by God to circumcise his sons. The earliest Christians had been Jews and so would have been circumcised in infancy. But St Paul, who had been an orthodox Jew, denounced circumcision as a heathen mutilation, and said Christian circumcision should be metaphorical, a control over oneself.

So why did circumcision become so prevalent in Christian countries in the 19th and 20th centuries? It seems we have to thank for it the sexual repression of Victorian England. During the reign of Queen Victoria, circumcision was very widely practised, and the main reason for it was to "cure" masturbation. Masturbation, or the "secret vice" was an enormous worry in both England and America at that time. According to the experts of the day, it was responsible for sleeplessness, night terrors, frequent urination, bed-wetting, epilepsy, St Vitus's Dance, kidney disease and insanity. Dr Kellogg, of Cornflakes fame, listed 38 suspicious signs by which habitual masturbators could be detected, and recommended the eating of his breakfast products to effect a cure.

While today it is known that the foreskin is naturally adherent in the newborn male and grows free later in childhood, in Victorian times "a tight foreskin" was seen as something that needed to be corrected.

According to the "Ladies' Handbook of Home Treatment", published in 1907, "many a nervous, irritable, restless baby has been transformed into a most contented bit of humanity by the simple operation of circumcision". The same handbook noted that "A fact almost unknown among the laity is that girls sometimes require a slight operation which resembles circumcision in the boy ... Any girl who does not yield to the ordinary measures employed in the treatment of self-abuse should be examined with a view to having this operation performed ...". The mere fact "of undergoing an operation and of having the genital organs carefully covered with protective dressings and bandages for some time, tends in itself to lessen the force of the habit", the book said.

A medical text book published in the US in 1912 noted that "circumcision for the girl or woman of any age is as necessary as for the boy or man ... but the girls have been neglected ... I do feel an irresistible urge to cry out against the shameful neglect of the clitoris and its hood". Despite such pleas, the practice of female circumcision never became as popular in Anglo-Saxon countries as did male circumcision.

The Australian Medical Association has no official policy on male circumcision,* though a spokesman said it is becoming increasingly difficult to find a doctor who is comfortable with the procedure. The AMA "strongly disapproves of female circumcision".

While female circumcision is not specifically forbidden by any Australian law, the Australian Law Reform Commission says there is little doubt that it would constitute an assault, and it would be no defence that the operation was performed in hospital by a doctor. (It is widely suspected, however, that female circumcision is taking place among some ethnic communities in Australia, and that some girls are sent overseas for the ritual.) Female circumcision is not a requirement of Islamic law. However, a study of female circumcision in Egypt in 1985 found that 81 per cent of a large group of women had been genitally mutilated, and of the sample, 94 per cent were Muslim and six per cent Coptic Christian. The study concluded that "religious beliefs are a strong predisposing factor for female genital mutilation. A large percentage of women whose genitals are mutilated are affiliated with the Islamic religion despite the fact that female genital mutilation is not prescribed by the Islamic religion".

Male circumcision is legal in Australia and the costs of it are recoverable under Medicare. In 1985 the then Health Minister, Dr Blewett, attempted to drop the Medicare rebate for circumcision of babies under six months, but reversed the decision after pressure from Jewish and Muslim communities. Dr Blewett said he was concerned that circumcision may be performed by untrained people if removal from Medicare "proved an economic hardship". The Australian College of Paediatrics discourages the practice of circumcision in newborn males (and of course in females). However, the registrar, Dr Paul Roy, said that the "religious imperative" of Jews and Muslims for male circumcision was respected.

Are there any health benefits from routinely circumcising baby boys?  There are some studies that show that baby boys who have been circumcised have fewer urinary tract infections in the first 12 months. However, Dr Roy said, even if circumcision does helps prevent urinary tract infections in newborn boys, it is not sufficient reason for routine circumcisions. "It means doing 100 circumcisions to prevent one infection. One only has to see a couple of boys get a mutilated penis to realise it is not a good enough reason." Dr Roy said circumcision of newborn boys was not done under anaesthetic and agreed it "must hurt like crazy".

Dr George Williams, a Sydney paediatrician who is writing a book about male circumcision, says on the available evidence there is no medical reason for routine circumcision. He said penile hygiene can be maintained simply by washing with soap** and water without forcible retraction of the foreskin. He also said the foreskin contains tactile sensitive structures for erotogenic function. It used to be believed that the partners of uncircumcised men were more likely to develop cervical cancer. However, Dr Williams said studies that indicated this were "confounded by other variables". A large study in the US in 1973 found there was no difference in the circumcision status of sexual partners of women who had developed cervical cancer from that of other women.

Some men who are campaigning against circumcision say it is most often done because of pressure from the mother, as a kind of Freudian revenge against all men. But Dr Williams says that in his experience it is usually wanted by the father, because the father has himself been circumcised and wants his son to be just like him.

Circumcision may become necessary for some men in later life. But adults are capable of making an informed decision about whether or not to have the operation, whereas babies are not. Circumcision is a surgical procedure with inherent risks of bleeding, trauma and mutilation, pain and infection, and rarely, death. The onus of proof should be to show that it is not harmful, Dr Williams said.

But even if there are no compelling medical reasons for it, most men who were circumcised will stoutly defend the practice. "It didn't affect me", is the common response. How can they know, if they were circumcised as babies? One man, who had been circumcised at the age of 23, said in an article in the US 'Journal of Nurse-Midwifery': "On a scale of 10, the intact penis experiences pleasure that is at least 11 or 12; the circumcised penis is lucky to get to three. If American men who were circumcised at birth could know the deprivation of pleasure they would experience they would storm the hospitals and not permit their sons to undergo this unnecessary loss."

It is true that all kinds of unnecessary surgical procedures are carried out, from ear-piercing and tattooing to hair transplants and breast augmentation. These are done at the behest of adults, who supposedly can make an informed decision. A newborn child certainly can't.

Opposition to male circumcision has been described as "bordering on paranoid". Yet men against circumcision believe it is discriminatory that while female circumcision is condemned, even if for religious reasons, male circumcision is condoned when it is done for religious reasons. John Fleming, a member of an informal group of men who have been campaigning in Australia against circumcision, says the human rights and legal aspects of both male and female circumcision of children need to be clarified. He says: "It is bizarre that while tattooing is illegal for children under 18 it is apparently OK for a doctor, or a religious-authority figure, to painfully mutilate for life a poor child's most sensitive organ."

The United Nations convention on the rights of the child,*** recently ratified by Australia, guarantees the rights of all children to enjoy their own culture. However, the convention also calls upon the signatories to "take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children".

Professor Carl Wood, of the department of obstetrics and gynaecology at the Monash Medical Centre (and well-known IVF pioneer) said the widespread use of circumcision for little or no medical advantage "is an emblem of brutality in society". "I hated performing the operation when I was a young doctor. No anaesthetic was used and the baby most often screamed. It appeared to be a much worse experience than birth and possibly the worst experience for the baby in its early life. What effect does this imprint have?"

The Age (Melbourne), 2 December 1996, p. 6

Notes

*  In 1997 the AMA adopted a policy which stated:

The AMA will discourage circumcision of baby boys in line with the Australian College of Paediatrics "Position Statement on Routine Circumcision of Normal Male Infants and Boys".

The statement, released in June and supported by the AMA's November Federal Council meeting, includes:

• The Australian College of Paediatrics should continue to discourage the practice of circumcision in newborns.
  
  
• Educational material should be available to parents before the birth of their baby and in maternity hospitals.
  
  
• Some parents after considering medical, social, religious and family factors will opt for circumcision. It is then the responsibility of the doctor to recommend this is performed at an age and under circumstances which reduce hazards to a minimum.

Australian Medicine, 6-20 January 1997, p. 5.