A Challenging Choice: The Pros and Cons of Circumcision It’s possibly one of the toughest decisions new parents of infant boys may have to make in the first few months of their life – to circumcise or not? Here is the case for and against by a paediatrician. Children ’s Health Parents delivering a new baby may consider the procedure of circumcision for their boys. They may have preconceived beliefs in regards to the benefits and risks and they may have strong cultural drives to act in a particular way in making this decision. There is a responsibility of new parents to consider the available information and recommendations of authoritative bodies. Historically, circumcisions have been performed for thousands of years. The origins of the practice are not completely known; in the Victorian era, the practice increased in Britain and then later in America, New Zealand, Australia and Canada. In the 1950s the practice increased in Korea, but in other parts of the world it was rarely common practice. During the 1950s the practice declined significantly in England and then in New Zealand in the 60s and in Australia in the 70s. Currently, in Australia, between 10 and 20% of male infants are circumcised and in New Zealand less than 10% have this procedure performed. So what ar e th e benefits of circ umc ision? The infant may be born into a religious/cultural group that encourages the practice for a better ‘sense of belonging’. There may be a reduction in the frequency of some diseases including urinary tract infections: if 110 circumcisions are performed there may be avoidance of one urinary tract infection. These infections are not common in males but the relevance may be higher if the child has underlying risks for frequent infections. The incidence of cancer of the penis may be reduced but this is a very rare malignancy in males with an incidence of about 1 in 250,000. There may be less spread of HIV between heterosexual partners. The relevance of circumcision in Australia is different when compared to international locations because of the differences in the incidence of certain diseases. Then what ar e th e disad vantag es of circ umc ision? Any medical procedure that is performed may be associated with complications and that is the same for this procedure. Minor complications, such as bleeding, can occur. More serious complications such as infection, heavy bleeding or damage to the head of the penis can occur. Very severe complications requiring hospitalisation or management in intensive care can occur. These are procedural complications. These are not the only concerns that the medical fraternity has. The foreskin has a real function as a very sensitive tissue with many nerve endings. It provides protection for the head of the penis. Bioethicists and others are concerned that the removal of normal functioning tissue from a minor who is not able to autonomously consent to the procedure should not be performed. There are strong suggestions that a child should be allowed to make their own decision at a mature age if they are to have this elective procedure. What does a par ent need to do for th e car e of a foresk in? There is minimal attention needed. It is normal for the foreskin to not be able to be retracted over the head of the penis at birth and parents/caretakers should never forcibly try to do this. With advancing age, the foreskin will normally stretch and, often by about eight years of age, the head of the penis can be seen more easily. Then, gentle washing at bath times can occur. A phimosis is an uncommon complication of foreskins that are excessively tight and not able to stretch appropriately over time. These may be managed by applying a special cream and a circumcision is not usually required. What do the official medical bodies recommend to Australian parents? The Paediatrics & Child Health Division of the Royal Australian College of Physicians has updated its policy on this topic in recent years. It advises against routine circumcision for Australian children. It does not believe that circumcisions should be performed for newborn males and infants unless there is a medical reason to do so. Educational brochures for new parents are available, should you wish to access these resources. If you are considering circumcision for your child, it is advisable that you fully educate yourself about the procedure and any possible complications. Your family GP or paediatrician will be able to discuss your options with you. pm Pindara Magazine 56 Autumn - Winter | 2014
Pindara Private Hospital Magazine - Issue Two
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