Kids on the coast

Circumcision was first practiced by tribes in Africa, as a rite of adolescence. The Egyptians got into the act, as they were obsessed with cleanliness, believing that hygiene and bad ‘vapours’ were responsible for disease. Over the centuries circumcision became practised by many religions, particularly Judaism and Islam, and became an infant procedure. It was not a part of Catholic or Anglican religion, but it became popular in 19th century England due to a belief it cured or prevented illnesses such as epilepsy or blindness. So our Anglophile ancestors are to blame for circumcision rates hitting up to 90% in Australia during the 1950s and ’60s. But during the 1970s, circumcision rates plummeted as the practice became questionable. Rates have now dropped to around 10%-15%. 

Doctors are usually not consulted when parents decide on the procedure. I can remember being asked by parents on only half a dozen occasions whether I thought it was a good idea. For most, the decision is non medical. 

So what are the latest medical arguments supporting circumcision? It is thought that the foreskin increases the chances of infection. So the circumcised male has a lower chance of urinary tract infection as an infant, and appears to have less chance of catching and passing on sexually transmitted diseases. Those supporters of circumcision cite evidence showing higher rates of HIV and HPV (Human Papilloma Virus) in uncircumcised males, particularly in parts of the world where heterosexual HIV is common (such as Africa). HPV is the main cause of cervical cancer and penile cancer (rare). 

Many Asian cultures, including Japanese, do not circumcise. Many European countries have also never considered it. The Italians and Greeks, for instance, have never had circumcision as a part of their culture and are probably horrified at the thought. The opinion of the Royal Australasian College of Physicians (and the equivalent in the USA and England) does not support routine circumcision from a medical point of view. The risks of complications of the procedure, trauma to the infant and anesthetic concerns do not justify the perceived benefits. 

In September 2010, the college re-stated its position:
“Circumcision provides some benefit in preventing UTI in boys, particularly in those with underlying anatomical anomalies of the urogenital tract. In low prevalence populations such as Australia and New Zealand circumcision does not provide significant protection against STIs and HIV, and is less effective than safe sex practices. Circumcision decreases the risk of penile cancer probably by preventing phimosis. Male circumcision may offer protection against the development of cervical cancer in high risk populations, but is overshadowed as a protective measure by HPV vaccines. Circumcision has not been demonstrated to decrease the risks of prostate cancer...” 
(Source: http://www.racp.edu.au/page/policy-and-advocacy/paediatrics-and-child-health) 

Looking at this from another point of view, the most common operations in Australia performed on children are a tonsillectomy or adenoidectomy (5-10% of children). If we use the circumcision argument does this mean that all toddlers should have their tonsils and adenoids removed in the interest of population health? I don’t think this campaign would get off the ground. The idea of surgery to remove something healthy, such as a foreskin, to lessen risks is not what Hippocrates had in mind when he gave doctors his oath of “first do no harm”. 

In 99% of cases, the foreskin is fine if left alone. There is no need for retraction or special care. It sorts itself out through middle childhood. If there is phimosis (a condition where the foreskin has become stuck) and there are urinary problems (such as a poor stream) then this can be treated non-surgically as a first option.