Is infant male circumcision an abuse of the rights of the child?

December 7, 2007

Circumcision is one of the commonest surgical procedures performed on males. Opponents argue that infant circumcision can cause both physical and psychological harm, while recent evidence shows that circumcision is medically beneficial. Two doctors debate the issue in this week’s BMJ.

There is now rarely a therapeutic indication for infant circumcision, yet ritual (non-therapeutic) male circumcision continues unchecked throughout the world, long after female circumcision, facial scarification, and other ritual forms of infant abuse have been made illegal, writes Geoff Hinchley, a consultant at Barnet & Chase Farm NHS Trust.

The law and principles pertaining to child protection should apply equally to both sexes, so why do society and the medical profession collude with this unnecessary mutilating practise, he asks"

In addition to religious justification, there have been many spurious and now unsupported claims for circumcision including the prevention of penile cancer, masturbation, blindness, and insanity, most of which relate to adult sexual behaviour and not to the genital anatomy or best interest of a child, he adds.

There may be a case that male circumcision reduces HIV risk in sexually active adults, however the decision on whether an individual wishes to have this procedure should be left until they are old enough to make their own informed health care choices.

Male genital mutilation is not a risk-free procedure, he adds. Far from being a harmless traditional practice, circumcision damages young boys.

And in terms of legal protection, he argues that both the US and the UK legal systems discriminate between the sexes when it comes to protecting boys and girls from damaging ritual genital mutilation.

The unpalatable truth is that logic and the rights of the child play little part in determining the acceptability of male genital mutilation in our society, he writes. The profession needs to recognise this and champion the argument on behalf of boys that was so successful for girls.

But Kirsten Patrick of the BMJ argues that, if competently performed, circumcision carries little risk and cannot be compared with female circumcision.

Although any surgical operation can be painful and do harm, the pain of circumcision, if done under local anaesthesia, is comparable to that from an injection for immunisation, she writes.

In terms of evidence of benefit, male circumcision has been associated with a reduced risk of sexually transmitted infections, such as human papilloma virus, chancroid and syphilis. Robust research has also shown that circumcision can reduce the spread of HIV.

And although the complication rate for infant circumcision is essentially unknown (because most operations are unregistered) data suggest that it is between 0.2% and 3%, with most complications being minor. Furthermore, she says, no robust research exists examining the long term psychological effects of male infant circumcision.

Despite the fact that no medical body advocates routine male infant circumcision, most agree that it is safe and acceptable and recommend that the procedure is carried out by a competent operator using adequate anaesthesia.

Male circumcision is not illegal anywhere in the world. It is a choice that parents will make on behalf of their male children, for cultural or other reasons, and regulating its provision is the wisest course of action, she concludes.

An accompanying clinical review concludes that medical indications for male circumcision in both childhood and adulthood are rare, but that complications can be drastic.

Source: British Medical Journal

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8 comments

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codesuidae
2.3 / 5 (4) Dec 07, 2007
"Why do society and the medical profession collude with this unnecessary mutilating practice"

People do not think much about things that are societal routine, and doctors make a good bit of money doing something that is relatively quick and easy (though certainly not painless, the procedure is normally performed without anesthetic of any sort).

This is an elective and cosmetic procedure and should not be performed on anyone who is unable to give their own informed consent.
Doug_Huffman
1 / 5 (1) Dec 07, 2007
Considering the prevalence, now and 'then', of HIV and the effects of circumcision on its acquisition, circumcision should be included with any number of other infant-prophylactics.
ThomastheGardener
5 / 5 (1) Dec 07, 2007
I watched my son being born, I watched his circumcision, and I can tell you that he though his circumcision (that did include a local anesthetic) was a walk in the park compared to pushing him though a small tube until his bones deform.

Should we then consider vaginal birth too harmful for a child?

And how can anyone compare male circumcision with female circumcision? Female circumcision is not the removal of the clitoral hood, it's the removal of the clitoris its self. The equivalent would removing the head of the penis.
CactusCritter
not rated yet Dec 08, 2007
There is a condition, whose name eludes me, which can occur in young males in which the urinary opening in the foreskin can grow closed. Circumcision seems to be the only way of correcting this before the condition causes, I assume, urinary retention problems.

I know because it happened to me. Prior to circumcision, physicians stretched the foreskin opening which was a painful process.
HarryStottle
5 / 5 (2) Dec 08, 2007
To start with, I was circumcised within a few days of being born. I remember nothing about it at all. It most certainly has not caused me any problems whatsoever. If anything, the indications are of mild benefits.

Were my rights infringed? If they were, then they were infringed to a much more obvious extent on the numerous occasions when I was forced, as a child, to have vaccinations or attend a dentist when I made it very clear that this coercion was against my wishes.

"Ah but these interventions were clearly for your benefit" I hear you say. Does that make the coercion OK? If so - presumably on the basis that I was a kid and not yet able to make such decisions for myself - then the debate is clearly nothing to do with "rights" at all, but only whether or not the circumcision is beneficial, like a vaccination, or not and that is a medical issue, not an ethical one.
Destor
not rated yet Dec 08, 2007
The difference, Harry, between being forced to go to the dentist or receive a vaccination, is that neither of those permanently remove a vital part of the body without your consent. You can't reclaim your foreskin after it's been removed, once it's gone it's gone, although there is a market out there for Foreskin Restoration for those men that wish to attempt to restore what was stolen from them.

My father was circumcised as a child, and he was adamant that it not be done to me, and I cherish his decision to leave me intact to this day. He gave me the choice to make the decision myself, and if I had a single problem with my foreskin throughout my 22 years of life, I wouldn't hesitate to have it removed, at least it would be MY informed decision.

FYI, there are multiple forms of female circumcision, and clitoral removal is one of the most extreme. Removal of the clitoral hood at birth which is the female equivalent of the prepuce, is just as illegal as clitoral removal, this is the double-standard.

No boy of mine will ever have his genitals mutilated at birth, if he wants it done for aesthetic reasons when he's older then he'll always have that option, but aesthetics is the only true benefit, it's considered plastic surgery by many people.

About the HIV aspect, maybe if you're having unprotected sex with a HIV positive person, you should be re-evaluating your decision making abilities instead of falling back on circumcision, just a thought. Safe sex is the answer to HIV, not removal of the foreskin which may have benefits in third world countries but, not anywhere else.
HarryStottle
5 / 5 (1) Dec 09, 2007
The issue of whether the circumcision causes permanent "damage" is itself part of the medical issue. Clearly in my own case, it did not. However, I concede that it is irreversible. But then, vaccinations can sometimes go wrong and kill or produce permanent damage themselves, so I would still argue that they're on an ethical par. It still comes down to whether it is medically justifiable.

Of course, the strongest argument against that is that billions of men remain healthily uncircumcised and live just as long and healthily as we circumcised ones, which does raise the dubious nature of the medical claims...
roguetrekker
1.5 / 5 (2) Dec 09, 2007
I can't understand why this is an issue at all. If there is medical need for it, as in it would directly benefit those that receive it, then it should be continued. If it has a chance of avoiding medical complications later, then I say it is up to the parents to make the choice for their offspring. It's not for the self proclaimed board of ethics to determine whether or not a parent has the right to try to help their child or take care of their child in the best manner they see fit. Of course, if a parent believes that daily beating are beneficial to the child, that might need some looking into, but circumcision is a different matter entirly.

My questions is, why not just take off part of the foreskin and not the whole thing? The male still gets the pleasurable advantages of it and the women still get the aesthetic nature. It would prevent the condition CactusCritter refers to and still leave the male relatively intact to make the decision later in life to have it all removed. (I might be biased. My husband had a bizarre circumcision that only took a small protion off. Personally, I rather like it.)

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