Male Circumcision (first go)

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The medical and cultural practice of male circumcision has long interested me. I think this partly comes from being an uncircumcised boy, youth and man in a peer-group that was otherwise mostly circumcised. It also comes from an interest in how this practice became so widespread in non-religious Western culture, what encouraged it, how it became embedded as a cultural norm, how has been sustained, what has caused, in some parts of the world at least, a reduction in prevalence of the practice, and what causes people to polarise in their opinions when discussing the practice. As a health care professional I am interested in what circumcision does – whether there is evidence to support the assertions of advocates who say it provides health benefits, and I am also interested to understand what harms there are arising from the practice.

At the beginning of what will be a series of articles, a number of things bear stating. I am strongly opposed to infant male circumcision, as I feel that the health benefits ascribed to circumcision, used to justify the practice of infant male circumcision, are tenuous at best, and considered against the risks and the harms arising from infant male circumcision fade into insignificance. If individuals wish to be circumcised when they are old enough to provide informed consent, understanding potential risks and benefits, then so be it. Research suggests that this group will overwhelmingly chose circumcision for social or cultural reasons, as the vast majority of (rare) issues arising from pathologies of the foreskin are easily treated medically rather than surgically.

My feelings about religious imperatives towards circumcision (such as in some Australian indigenous groups, Judaism and Islam) is that this is a cultural practice, which if it continues should be practiced as humanely as possible, and with as little harm to the one circumcised. It is striking, for example, that circumcision has become much more radical in Judaism over time – more of the foreskin is amputated now than in the past. In Islam the imperative to circumcise arises out of culture appended to religious practice, rather than a religious command in holy text. Similarly, circumcision as an initiatory rite (as in some Australian indigenous groups) is a cultural imperative, which I believe should be rethought, and alternatives developed.

To continue this lengthy preamble, I’m aware of recent research arising out of Sub-Saharan Africa suggesting that circumcision exerts a protective effect against the transmission of HIV. I’m also aware of many critiques of the research, not the least of which is the observation that because circumcision affects sexual behaviours, and many sexual behaviours are strongly culturally influenced, it is impossible to make broad generalisations about the effect that circumcision would have in other cultures. Certainly, it bears stating that one of the cultures that circumcised the vast majority of their infants experienced the highest rates of HIV transmission – the United States.

In future blogs I’ll plan to deal with:
• Social influences on circumcision
• Why circumcision became prevalent
• Health costs and health benefits of circumcision
• Construction of discourses about circumcision
• Sexual aspects of circumcision, including how circumcision affects sensitivity of the penis

A final statement – I don’t intend any of this to apply to the mutilatory practices known euphemistically as ‘female genital mutilation’. There is a great deal of information on the internet about this issue, which I’d encourage you to read if you’re interested (and everyone should be).

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