Sunday, 26 June 2011

Radio 4 on male circumcision

Antony Lempert, head of the Secular Medical Forum, spoke on Broadcasting House this morning on Radio 4 (listen right at end of programme). The programme broadcast the cries of a 8 day old infant being circumcised (under anaesthetic).  
A Muslim boy cries as a doctor performs a circumcision on him. Photograph: Stoyan Nenov/Reuters. Picture from guardian.co.uk detailing the charity Norm-UK who, addressing a conference on the physical and psychological consequences of male circumcision at Keele University, encouraged parents to wait to circumcise their children until they were old enough to give consent.
Over 30,000 male circumcisions are performed in the UK each year (in a ritual ceremony 8 days after birth for children of Jewish parents, and at approximately 7 years of age for children of Muslim parents) with complications ranging from severe bleeding, urethral scarring, infection, and in rare cases, death (see Williams, N & Kapila L. Complications of circumcision British Journal of Surgery Volume 80, Issue 10, pages 1231–1236, October 1993 DOI: 10.1002/bjs.1800801005).

Dr. Lempert spoke on the programme about this study in the BJU International which shows that 'circumcision ablates the most sensitive parts of the penis'; indeed, in circumcised males, the circumcision scar is the most sensitive part left of the penis.

The programme noted that the procedure does not have to be carried out by a doctor, or indeed with any anaesthetic. I blog here about a research paper in the Journal of Public Health which found that 13 of 32 genital mutilations ('circumcisions') carried out for religious reasons on teenage boys by the Oxford Islamic community led to complications, including infections, urethral scarring and severe bleeding. They were conducted by non-doctors (local religious leaders and others) in the library of a faith school.

The BMA still refuses to tackle this issue. There is going to be a demonstration Monday 27th June 2011 outside the BMA Annual Representatives Meeting who refuse to debate Motion 310 and encourage representatives to choose it as one of five additional motions for debate. Motion 310 asks the BMA to endorse the 2010 position of the Royal Dutch Medical Association which calls non-therapeutic genital surgery on male minors a violation of the boy's rights to autonomy and to physical integrity.

I find our differential attitudes to male circumcision and female genital mutilation peculiar, as if the less severe injury to males somehow makes us ignore the fact we are still cutting a child's genitals. Mutilating the genitals of non-consenting children as a result of their parent's faith is not something with which doctors should collude.

5 comments:

  1. Let those males able to consent for themselves decide if they want to have their genitals cut to help prevent HPV/cervical cancer, rather than foisting the decision upon them. Would female genital mutilation be justified if it could be shown to have incidental benefits to sexual health? Clearly, no.

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  2. Ahhh, the cervical cancer alleged "benefit" of circumcision rares its head again. It's like retro clothing coming back into fashion. The pro-circ phreaks who did these "studies" must think that we have short memories.
    If circumcision had a significant impact on HPV and cervical cancer, the US would have significantly lower rates of both. We do not. These assertions are utter nonsense.
    A far more worthy use of time, money and scientific talent is to find out why most folks who have a tete-a-tete with HPV clear it and it does not make a problem, while a few go on to develop genital cancers. Genetic predisposition and other health criteria do seem to be involved. We need more genetic information, not more genital mutilation.

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  3. No good study has shown a direct connnection between circumcision and cervical cancer, only, like the one armouris cites (by people with an agenda to make circumcision acceptable), a slight tendency towards lower HPV, a very common virus that the body readily rids itself of.

    If you look at the sorry history of circumcision, a "cure" in search of a disease, and more generally an intrusion in search of an excuse, you will demand something much more convincing than this to justify cutting a normal, healthy, non-regrowing, functional body part off a baby.

    Contrary to that link, there is no dotted line, and hence no "right" amount of skin to cut, so the outcome in the adult is highly variable - and sometimes disastrous.

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  4. I’m in the U.S. and trying to get a handle on things in the UK as far as how much religion encroaches into medicine there. I happened upon the following BMA statements:

    http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp

    >Circumcision for medical purposes
    >Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available.

    And yet...

    >Non-therapeutic male circumcision
    >Male circumcision that is performed for any reason other than physical clinical need is termed non-therapeutic (or sometimes “ritual”) circumcision. … The Association has no policy on these issues.

    It very much stuns me that having a medical reason, but no medical necessity would constitute an “unethical” circumcision, but having no medical reason/need whatsoever is perfectly ethical, so long as religion is your excuse for acting in a way that would otherwise be condemned as unethical.

    Meanwhile, as far as “benefits” of circumcision, one of the best statements I ever saw on this subject was a comment response to this article from a Canadian physician:
    http://www.cirp.org/library/legal/Canada/kluge1/

    “Even if further investigation corroborated the results of studies Jones cites on the risk of HIV infection among uncircumcised men, the very mention of this issue in this context is disturbing. Because condoms are good protection against HIV infection the transmission rates among circumcised and uncircumcised men using condoms should be the same. Therefore, Jones must be talking about transmission rates among men who do not use condoms. It is universally agreed that unprotected sexual intercourse is inappropriate. The sexual transmission of HIV will be retarded or stopped not by circumcising males but, rather, by appropriate sexual behaviour. To suggest that all men be circumcised so that some who engage in inappropriate sexual behaviour will have a lower rate of HIV transmission runs the risk of encouraging such behaviour among circumcised men. Is that appropriate?”

    According to BMA, it doesn’t matter if there are benefits. All that matters is whether those same benefits can be achieved by a less invasive approach; and I have yet to hear of any STD-related “benefit” that isn’t far better addressed with a simple condom.

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