The unkindest cut: Circumcision

Circumcision is a violation of a boy's right to an intact body, and without medical or moral justification says John Shanahan.

Male circumcision, the removal of the foreskin from the penis, is one of the oldest surgical procedures known.

During normal circumcision, approximately 33 percent of the super tactile genital tissue is forcibly excised. As the foreskin is firmly attached to the underlying glans in 96 percent of newborn boys, it is impossible to retract the foreskin without causing pain and discomfort to the infant. When circumcision is performed in the first few years of life, the foreskin has to be literally torn from the glans - much like the way the skin on your arm would be separated from the underlying tissue. Circumcision performed without an anaesthetic is extremely painful and distressing.

Many new surgical techniques for performing circumcision have been developed in the twentieth century, including Clamps and Bells. Today the most commonly used instrument for circumcision is the Plastibell. This device is reported to be responsible for most post-circumcision complications. With the Bell firmly attached to the penis for up to 10 days, the baby or child suffers undeniable pain. Dr Fred Leditschke, Associate Professor of Paediatric Surgery at the University of Queensland, states that "the application of a bell is equivalent to putting an elastrator on a lamb's scrotum in order to sterilise it and the [cutting off of blood flow] it produces is certainly not pain free." Regardless of what method is employed for circumcision, there is always some degree of pain and trauma for the patient.

Since Adam was a boy

The earliest record of circumcision dates back to ancient Egypt in 2800 BC. The first written documentation of circumcision appears in the Old Testament. Both Jews and Moslems continue to circumcise in accordance with Abraham's covenant with God. The circumcision which Abraham performed on himself and his sons was the removal of just the tip of the foreskin. The Apostle Paul abolished circumcision as a means of salvation. Most of the major religions in Australia do not promote routine circumcision or consider it to be a mandated religious practice.

In a number of Western countries, such as the United States and Australia, the practice of male circumcision for non-religious reasons became prevalent by the beginning of the twentieth century. Within the miasma of myth and ignorance when the causes of most diseases were unknown, a theory emerged that masturbation caused many and varied ills. It seemed logical to some physicians to perform genital surgery on both sexes to stop masturbation. In 1891 Dr Remondino advocated circumcision to prevent or cure alcoholism, epilepsy, asthma, hernia, gout, rheumatism, headaches and curvature of the spine. So obsessed were the medical profession and some clergy about the "evils of masturbation" during the late 1800s that boys and girls were subjected to many methods for the treatment of what became known as "masturbation insanity".

In addition to circumcision, boys were forced to wear inverted spiked penile rings to deter erections and in some extreme cases were castrated. Girls were forced to undergo clitoridectomy, wear chastity belts or have caustic mercury paste applied to their genitals, resulting in severe blistering. Boys also did not escape this method for treating masturbation. Astonishing as it may seem, these ideas on the benefits of circumcision and clitoridectomy were still included in prestige medical journals of the 1930s and 1940s. During the First World War, circumcision was promoted for hygiene reasons and for prevention of venereal diseases. In the 1930s it was considered that circumcision prevented cancer of the penis. In the 1950s it was claimed that cervical cancer occurred in women because their sexual partners were not circumcised. By the 1960s the majority of Australian and virtually all United States and Canadian infants were circumcised. By contrast, in Britain, where non-religious circumcision first became popularised in the late 1800s, the circumcision rate had declined markedly due to the removal of the insurance cover for the surgery by the British Health Department.

Myths versus risks

TODAY, there is no justification for routine removal of the foreskin. As Wallerstein argues in Circumcision: An American health fallacy, all the past benefits of the surgery have been disproved and passed into the realm of medical history.

However, some medicos eager to see the surgery continue have introduced new myths to justify the procedure. Dr Terry Russell, General Practitioner in Brisbane and obviously a keen circumciser, uses the myth that routine infant circumcision will act as a preventative against the AIDS virus and other sexually transmitted diseases in a recent article in The Medical Observer. One only has to look at the situation in the United States where there is an epidemic of STDs, including AIDS, and the vast majority of sexually active men are circumcised to disprove this claim. It is not the foreskin that causes these diseases and circumcision will not prevent them.

Dr Thomas Wiswell of the United States army uses the myth that urinary tract infections can be prevented in male babies during the first year of life by practicing routine infant circumcision. In 1989, the American Academy of Paediatrics task force considered the studies of Wiswell and found them to be methodologically flawed, unscientific, retrospective and possibly influenced by selection bias. Subsequent studies on urinary tract infections by Dr Altschul et al refute the Wiswell claims. These infections, which incidentally occur more often in females than males, can be successfully treated using antibiotics, which is evidenced in countries where circumcision is rare.

Circumcision is major surgery with inherent risks, including death. Recently in Queensland a baby boy died as a result of circumcision complications. Rosemary Romberg notes 28 known risks associated with circumcision in Circumcision: The painful dilemma. Among these complications are haemorrhage, ulcerated urethral opening, retention of the Plastibell ring, urethral punctures and full or partial amputation of the penis. Wallerstein claims there could be up to 225 deaths per year in the United States from circumcision complications. Circumcision records in hospitals are very often incomplete or non-existent. I've often wondered how many babies are listed as dying from Sudden Infant Death Syndrome when the real cause of death is circumcision.

Circumcision leaves both physical and mental scars. Many men live with psychological trauma as a result of their circumcision. Some men are now seeking restoration techniques to recover their foreskins.

An emblem of brutality

THE foreskin serves the purpose of protecting the glans and contains sensitive nerve endings for erotogenic function. Recent studies show that following circumcision the glans develops up to 12 times its normal layer of dermal skin. This results in a severe loss of penile sensitivity, which has been documented over the decades in many medical and religious texts as a justification for circumcision. Another question I've often asked is whether circumcision hastens the onset of impotence in later life. A man who was circumcised at the age of 26 says: "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."

The vast majority of male circumcisions being performed today are non-therapeutic. Reasons given for the procedure include "it looks nicer" and "so he will look like his father and brothers". I consider these arguments in favour of the surgery to be totally illogical. Non-therapeutic genital surgery upon unconsenting minors of either sex clearly violates the basic rights of children to maintain an intact body. Adults can always agree to non-medical surgical procedures for themselves as they are able to give their personal consent.

Circumcision is now recognised as an important human rights and legal issue. In December 1993, the Queensland Law Reform Commission tabled a research paper on the subject. Among the many profound statements made by the Commission were the following:

"The circumcision procedure is invasive, irreversible and major. It involves the removal of an otherwise healthy organ part. It has serious attendant risks. On a strict interpretation of the assault provisions of the Queensland Criminal Code, routine circumcision of a male infant could be regarded as a criminal act. Further, consent by parents to the procedure being performed may be invalid in light of the common law's restrictions on the ability of parents to consent to the non-therapeutic treatment of children." One would think this provision of the Criminal Code would also extend to other States and Territories in Australia. There have been suggestions in media circles recently that anyone who had a surgery performed on them as a minor for non-therapeutic reasons, can legally sue for damages, provided they proceed with litigation action from their 18th birthday until they reach the age of 24.

Finally, let me convey to you the feelings about the continuation of non-therapeutic male circumcision of some of our leading medical professionals:

Dr Christopher Green, Paediatrician at Camperdown Children's Hospital in Sydney: "If I was to cut off any other part of a baby for no good cause and without an anaesthetic, I'd be struck off the medical register and the parents would most likely lose custody of the child." Professor Carl Wood, Obstetrician and gynaecologist at Monash Medical Centre in Melbourne: "Circumcision, when performed for non-medical reasons, is an emblem of brutality in society."


First published in the magazine XY: men, sex, politics, 4(1), Autumn 1994. XY, PO Box 4026, AINSLIE, ACT, 2602, AUSTRALIA. Reprinted with permission. © Copyright 1995