Male circumcision is the removal of some or all of the foreskin (prepuce) from the penis. Male infants may be circumcised routinely, or for religious or cultural reasons. Most circumcisions are performed during adolescence, although in some countries they are more commonly performed during infancy. Certain medical conditions may require circumcision although these are rare.
The foreskin is the forward continuation of the skin of the penile shaft, which covers the head of the penis (glans penis). The inner lining of this skin is highly specialised erogenous tissue. The foreskin has several known functions: it protects the glans penis throughout life; it covers the penis during erection, when the shaft enlarges and elongates; and it provides great pleasure both to its owner and his partner.
Religious male circumcision is considered a commandment from God in Judaism. In Islam, though not discussed in the Qur’an, male circumcision is widely practised and most often considered to be a sunnah. It is also customary in some Christian churches in Africa, including some Oriental Orthodox Churches. According to the World Health Organisation (WHO), global estimates suggest that 30% of males are circumcised, of whom 68% are Muslim.
Infant circumcision was taken up in the United States, Australia and the English-speaking parts of Canada, South Africa, New Zealand and to a lesser extent in the United Kingdom around the beginning of the 20th Century. A report by the Agency for Healthcare Research and Quality placed the 2005 national circumcision rate in America at 56%. In 1949, the United Kingdom’s newly formed National Health Service removed infant circumcision from its list of covered services, and circumcision has since been an out-of-pocket cost to parents. The proportion of newborns circumcised in England and Wales has now fallen to less than one percent. The circumcision rate has also declined sharply in Australia since the 1970s, leading to an age-graded fall in prevalence, with a 2000-01 survey finding 32% of those aged 16–19 years circumcised, 50% for 20–29 years and 64% for those aged 30–39 years. In Canada, Ontario health services delisted circumcision in 1994.
If anesthesia is to be used there are several options: local anesthetic cream (EMLA cream) can be applied to the end of the penis 60–90 minutes prior to the procedure; local anesthetic can be injected at the base of the penis to block the dorsal penile nerve; local anesthetic can be injected in a ring around the middle of the penis in what is called a subcutaneous ring block. For infant circumcision, devices such as the Gomco clamp, Plastibell, and Mogen clamp are commonly used, together with a restraining device. Adult circumcisions are often performed without clamps and require 4 to 6 weeks of abstinence from masturbation or intercourse after the operation to allow the wound to heal.
According to the American Medical Association (AMA), blood loss and infection are the most common complications, but most bleeding is minor and can be stopped by applying pressure. A 1999 study of 48 boys who had complications from traditional male circumcision in Nigeria found that haemorrhage occurred in 52% of the boys, infection in 21% and one child had his penis amputated. Other complications can include concealed penis, urinary fistulas, chordee, cysts, lymphedema, ulceration of the glans, necrosis of all or part of the penis, hypospadias, epispadias and impotence. In 2010, Bollinger estimated a death rate of 9.01 per 100,000, or 117 per year in the United States.
In some African countries, male circumcision is often performed by non-medical personnel under unsterile conditions. After hospital circumcision, the foreskin may be used in biomedical research, consumer skin-care products, skin grafts or β-interferon-based drugs. In parts of Africa, the foreskin may be dipped in brandy and eaten by the patient, eaten by the circumciser, or fed to animals. According to Jewish law, after a Brit milah, the foreskin should be buried.
It has been claimed that the procedure offers unspecified “health benefits”. However, these benefits have not been convincingly proven and it is now widely accepted, including by the British Medical Association, that this surgical procedure has medical and psychological risks. It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child.
The American Medical Association report of 1999, which was “…confined to circumcisions that are not performed for ritualistic or religious purposes,” states that “Virtually all current policy statements from specialty societies and medical organisations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice.”
In 2001, Sweden passed a law allowing only persons certified by the National Board of Health to circumcise infants, requiring a medical doctor or an anesthesia nurse to accompany the circumciser and for anaesthetic to be applied beforehand. In 2005, the Swedish National Board of Health and Welfare reviewed the law and recommended that it be maintained. By 2007, the Australian states of Victoria, New South Wales, Western Australia and Tasmania had stopped the practice of non-therapeutic male circumcision in all public hospitals.
As a society, we presently allow parents to inflict this surgery upon their children where there is no medical need, if they choose to do so. Consent for any procedure is valid only if the person or people giving consent understand the nature and implications of the procedure. To promote such an understanding of circumcision, parents and children should be provided with up-to-date written information about the risks.
The Department of Health has stated that “It is a matter of concern that it appears that a considerable number of surgical interventions are being performed on children and young people unnecessarily. This is not only costly but is bound to be the cause of unjustified distress to some of those who are the most vulnerable. [From: “Hospital Services for Children and Young People” (128-I)]
Ultimately many do not believe that parents should have the right to make this choice. There is every reason to believe that amputation of part of a sexual organ has an irrevocable effect on the future sexual experience of the individual, and without compelling evidence to prove that this is not the case it seems irresponsible to perform it. Furthermore, if the child is left alone he will be free to exercise his own choice as an adult, whereas surgery will take that choice away.