While it is the most common surgical procedure in the world, there is virtually no demonstrable health benefit derived from circumcision of either newborns or adults, a new study concludes.
The sole exception seems to be using circumcision to reduce the risk of transmission of HIV-AIDS in adult males in sub-Saharan Africa, though it is unlikely that benefit carries over to other parts of the world where rates of HIV-AIDS are much lower.
The research, published in Tuesday’s edition of the Annals of Family Medicine, shows that, despite claims, there is little evidence that circumcision can prevent sexually transmitted infections, urinary tract infections and penile cancer.
There are also risks to the surgery that, while rare, range from sexual dissatisfaction through to penile loss.
“Patients who request circumcision in the belief that it bestows clinical benefits must be made aware of the lack of consensus and robust evidence, as well as the potential medical and psychosocial harms of the procedure,” said Guy Maddern, of the department of surgery at The Queen Elizabeth Hospital in Adelaide, Australia, and lead author of the study.
In newborns, he said, the surgery is “inappropriate” because it offers no therapeutic benefit.
About one-third of males worldwide undergo circumcision, the surgical removal of the prepuce (or foreskin).
The procedure is done principally for religious, cultural and social reasons.
Religious male circumcision is practised under both Jewish and Islamic law, and it is an integral part of some aboriginal and African cultural practices.
The main social reasons the practice has continued is a widespread desire that boys resemble their fathers, and a belief that boys who undergo circumcision have fewer health problems.
The new study, a systematic review (a compilation and analysis of previously published research), looked only at the latter point.
Dr. Maddern and his research team found no evidence that uncircumcised men have higher rates of penile cancer. In fact, they noted penile cancer is extremely rare and seemingly unrelated to the presence of a prepuce.
The belief that urinary tract infections are more common in uncircumcised males is not backed up by research. Dr. Maddern noted the fewer than 2 per cent of boys suffer urinary tract infections which “makes it unlikely that preventive circumcision of normal boys would outweigh the adverse events associated with the procedure.”
Finally, there was no evidence at all that there are fewer sexually-transmitted infections among circumcised males. The exception was a study in sub-Saharan Africa that showed doing the surgery on adult males reduced their risk of contracting HIV-AIDS. (However, rates of HIV-AIDS were not reduced in their female partners.)
Rather, Dr. Maddern said, the prepuce seems to act as a barrier against contamination and, by helping maintain a moist environment, enhance sexual pleasure.
According to the study, the only medical justification for circumcision is to treat boys or men with penile abnormalities.
and good news from the U.S.A
San Diego, CA (PRWEB) January 12, 2010 -- Lawmakers toiling over a final health care reform bill this week now have another medical issue to contend with: circumcision. Yesterday the San Diego based health and human rights organization MGMbill.org submitted a proposed bill to every member of Congress that would prohibit the controversial practice of forced circumcision. Fourteen state legislatures across the country received similar bill proposals for their respective states.
"Health care reform will not be complete until patients are given full autonomy over their own bodies," said Matthew Hess, president of MGMbill.org. "If a person doesn't want a healthy, functional body part taken from him by force, shouldn't the government step in to provide that protection? Last year in this country more than one million foreskins were amputated from children who had no say in the matter. An important part of their manhood was taken from them whether they liked it or not, and that has to stop."
One pregnant mother in Lexington, South Carolina, agrees.
"Cosmetic genital surgery is not a choice we get to make for another human being," said Brandy Walters, whose young son is intact. "My husband and I researched this issue before our first son was born and we easily came to the decision that circumcising a child who cannot consent is just wrong. If our son ever decides he wants to be circumcised, that option will always be there for him."
Another intactivist mother said that Congress should roll the proposed MGM Bill into the current health care reform bill as an amendment before the final version is passed.
"With all the talk about rising health care costs, it only makes sense to stop spending money on surgeries that are unnecessary," said Erica Fuchs of Ames, Iowa. "Even the more conservative estimates figure the savings to be in the neighborhood of $200 million per year, and that's not counting all of the additional dollars spent on follow-up care to deal with complications. Newborns and older boys should be allowed to grow up intact so that as adults they can decide for themselves whether or not they want elective surgery of their most private of body parts. There is no legitimate reason to force it onto them."
Brandy and Erica are not alone in their opinions. Forced circumcision has come under intense criticism over the past year, both in the U.S. and abroad. In March, a group of intactivists marched outside Congress and the White House demanding that boys be given the same legal protection from forced genital cutting as girls. Over the summer, the chairman of the Swedish Pediatric Surgeons Association compared male circumcision to female genital mutilation and regarded it as "an assault". That was followed in September by a North Carolina court conviction of a father who circumcised his two infant sons for religious reasons. A High Court judge in South Africa ruled on a similar case the following month, broadly declaring that circumcision without consent was illegal and went against an individual's constitutional rights.
At least one state is not waiting for Congress to act. Massachusetts will be the first U.S. state to provide boys and girls with equal protection from circumcision if Senate Bill No. 1777 passes before the current session ends. Similar state bill proposals were submitted by MGMbill.org yesterday to more than 2,800 lawmakers in California, Florida, Georgia, Illinois, Iowa, Maryland, Minnesota, New York, Oregon, Pennsylvania, South Carolina, Texas, Virginia, and Washington.