Dharmaling

Against the Routine Infant Circumcision

Legal, medical, religious and other reasons against this out-of-date custom

The purpose of this paper is to refute the legal, religious, social and other arguments listed in favour of the routine infant circumcision and show that there are only some rare medical cases in which it could be justified (although even in these cases – like phimosis – probably avoidable).

1. Routine Infant Circumcision[1]

a) Basic facts

Routine circumcision of girls (usually between the age of 4 and 8 years) is still present mainly in some Muslim states in Africa and parts of Arabia and Asia (together in 28 states) and is usually performed in unhygienic environment and often without anesthesia. It is considered to be a traditional cultural rite of passage. 10 years ago Amnesty International estimated that 135 million girls have undergone various forms of genital mutilation, which ranges from a clitoridectomy (removal of the clitoris) to stitching the entire vaginal area closed except for a small opening for urination. According to the new information 2 million girls are at risk of female genital mutilation each year. Only 9 countries have specific legislation outlawing female genital mutilation, not long ago Eritrea joined the list, the country in which 89% of all women are circumcised.[2]

Elder women usually cut out the genitalia of a small girl sometimes even with a direct intent to enhance the sexual pleasure of her future male partners. This cruel and brutal custom resulting in significant mutilation, reproductive problems and sometimes death has been criticized for years by the Western countries, in which it is forbidden. But these same countries allow routine circumcision of boys despite the lack of arguments in its favour (male prepuce is identical to the female prepuce in its embryological development, cell structure, and nerve and blood supply).[3] Routine circumcision of boys is a bloody and a very painful procedure, in which the prepuce is cut from an infant’s/boy’s penis (in the case of adults, 5–8 cm of prepuce in length is cut away).[4]

b) Circumcision of male infants in numbers

Not long ago, the entire world population was 5 billion, 700 million. Out of those, 2 billion, 647 million were males. 18% of them (487 million) were circumcised and 2 billion 160 million were intact (the newest numbers are 665 million circumcised men, or 30% of the male population). Of the world’s male population, the circumcised were: 79 million American infants, 9 million American children or adults, 13 million infants in Canada, UK, New Zealand and Australia, 27 million infants in the rest of the world, 44 million children or adults in other parts of the world, and 315 (?!) million Muslim children/adolescents. Out of the worldwide total of 487 million circumcised men: 65% occurred as Muslim cultural circumcisions, 15% occurred in other countries, 3% occurred in other English-speaking countries, and 17% occurred in the U.S.

Just 30 years ago, as many as 90% of boys in the United States, 70% of those in Australia, 48% in Canada and 24% in the United Kingdom were circumcised (often without any anesthesia).[5] The practice was introduced to the U.S. through England, but they abandoned it nearly 50 years ago, practicing it now at the rate of only 1%. The rate is 3% in New Zealand, 10% in Australia and 20–25% in Canada.[6] The decrease in numbers is also due to the rise in awareness of doctors asked to perform the circumcision.

c) History of male circumcision

Male circumcision is depicted in Egyptian tombs 5,000 years ago.[7] It seems to have its origin in snake worship. The Egyptians believed that when the snake shed its skin, and emerged shiny and new again, it was undergoing rebirth. They reasoned that if, by shedding skin, the snake could become apparently immortal, then humans should follow suit. They made the simple equation: snake skin = foreskin, and the operation began. From there it spread to many Semitic peoples, both Arabs and Jews adopting it and converting it into an act of religious faith. As the centuries passed, it became popular in other regions of the world for other reasons such as moral, medical, or hygienic.[8]

Non-religious circumcision began in England in the late 1800s and it became extremely popular in English-speaking countries between 1920 and 1950. England introduced the practice to the U.S. At the time, it was believed that masturbation caused a host of different illnesses. Masturbation was considered extremely immoral and many children, both male and female, were circumcised through the years because parents discovered them “in the act.” To this day, who doesn’t remember the threat associated with masturbation that “you’ll go blind?”[9]

2. Legal and social aspects of circumcision

a) Legal theory, Convention on the Rights of the Child, Slovene Constitution

The question of circumcision of children poses a legal dilemma – i.e. a collision between two rights: on the one hand the right of a child as a unique human being to make essential decisions regarding his own body, and on the other hand the right of the parents (or guardians) to bring up their child as they want. The right of the parents is here a bit different than in the case of education – here a body of a child is in question and a change of it that circumcision causes can only be partially “repaired” in the future (as explained below under medical reasons), while doctrines and beliefs can be changed much more easily once a child matures. Also, in most cases there is no valid medical reason to hurry with such a delicate operation, while education is a non-stop ongoing process, which cannot be “frozen.”

In legal theory and practice, two main approaches developed with regard to the collision between the right of a child and the right of his parents (guardians). One sees a child as a sort of extension of the identity of his parents (guardians), giving them virtually unabridged right (control) to treat the child as they think best (here it is worth noting that the most common social reason for circumcision is the wish of the parents to make the sons look like the father). The other one sees a child as an individual in charge of his own life, who makes his own decisions but is cared for by the parents, who can direct him (yet not force him) along the line they find appropriate.

Historically, legal solutions transcended the reactionary view of a child as an extension of the parents’ identity. If even the right of ownership (over a thing, not a living being!) cannot be abused nowadays, how much more can this be asserted in the case of a child. The Convention on the Rights of the Child – entry into force 2 September 1990 (Act on ratification of the Convention of the United Nations on the Rights of the Child; Official Gazette of SFRJ, No. 15/1990 – International Treaties, Official Gazette of RS, No. 9/1992 – International Treaties), which is used directly in Slovenia, is apparently “on the side of the child.” Regarding a child’s religious freedom, it determines that parents provide direction to the child in the exercise of his or her right in a manner consistent with the evolving capacities of the child. Freedom to manifest one’s religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health or morals, or the fundamental rights and freedoms of others (second and third paragraph of Article 14). Furthermore, the Convention states: “States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health” (first paragraph of Article 24), and: “States Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children” (third paragraph of Article 24). The Convention sets “the best interest of the child” as a primary consideration for the State Parties in all their activities concerning children (first paragraph of Article 3).

The Constitution of the Republic of Slovenia (Official Gazette of RS, No. 33/91, 42/97, 66/00, 24/03, 69/04, 68/06) also addresses the fact that “the religious and moral guidance given to children must be appropriate to their age and maturity, and be consistent with their free conscience and religious and other beliefs or convictions” (third paragraph of Article 41). No one may be subjected to torture, inhuman or degrading punishment or treatment. The conducting of medical or other scientific experiments on any person without their free consent is prohibited (Article 18).

Circumcision of children opens other legal and ethical questions as well: is a child later on entitled to monetary compensation for suffering caused without their consent? Aren’t doctors supposed to heal medical disorders and sicknesses instead of performing operations that don’t benefit an individual’s health? Can circumcision be performed by others than doctors – such as so-called mohels in the Jewish community? Some have called for legal responsibility to be placed on medical organizations (like national organizations of doctors) that support circumcision or fail to warn against its dangers (see chapter 4a – Opinion of the Medical Organizations).

b) Swedish regulation

Perhaps the most “progressive” countries in the field of legal regulation of the circumcision of male infants are the Scandinavian ones. Sweden was heavily criticized by some groups of Jews and Muslims after it enforced a law restricting medically unnecessary circumcision on 1 October 2001. The law was accepted with a vast majority in parliament after a Muslim boy died while being circumcised. The Jewish community claimed that in the mentioned case the circumcision was performed by a registered physician and that the cause of death was an overdose of anaesthetic. Every year about 3,000 Jewish and Muslim boys are circumcised in Sweden for religious reasons.

Unfortunately, the law was greatly watered down from when it was first introduced, despite protest from Swedish pediatricians, who claimed that circumcision of boys is an abuse which contravenes the UN Convention on the Rights of the Child and should be abolished. The initial text said that no one could be circumcised before the age of 18 and then only with full disclosure. Following negotiations with the Jewish community, the act made an exemption for the first two months, during which a mohel can obtain a license from the government to circumcise a baby. Perhaps this was done with an (un)conscious traditional and (untrue) belief that small children don’t suffer any long-term consequences from this kind of procedure. A mohel living in Sweden even stated publicly that a week-old baby doesn’t feel any pain during circumcision.[10]

The Swedish Circumcision Act determines that a boy under the age of two months old may be circumcised by a person who is not a registered physician, provided that person has obtained special authorization from the National Board of Health and Welfare. No boy may be circumcised without an anaesthetic, which must be administered either by a registered physician or by a registered nurse. The Jewish community fears it will not be able to find nurses or doctors to help perform the ceremony, because many health professionals in Sweden view circumcision as a form of mutilation.

3. Religious aspects of circumcision

In the Judeo-Christian tradition, the reason for circumcision is mainly derived from an excerpt in the Old Testament in which God instructs Abraham that every male child of his line shall be circumcised as a sign of the covenant (Genesis 17:9–11). There are many other parts of the Bible referring to circumcision (including Jesus’ own – Luke 2:21), some in favour of it, others not (including from Jesus himself, questioning why he should be judged for healing on the Sabbath when circumcision on the Sabbath is permitted – John 7:23–24). Some ask: didn’t God stop the sacrifice of Abraham’s son (Genesis 22)? So why would he demand circumcision of believers’ sons? The main objection frames circumcision as a sacrifice to God – a renouncing of the flesh (body) with its sins; Augustine thought circumcision signified cleansing, even in infants, of original sin, much like baptism (On Marriage and Concupiscence, II, 24). Others argue that Jesus was circumcised so that Christians would no longer need circumcision, as a form of redemption. Paul rejected circumcision, probably for pragmatic reasons, since it could impede the spread of Christianity (especially among Greeks and Romans); see Romans 2:25–28 and Galatians.

Quite a few Christians and Jews list arguments against circumcision:[11] for example, why hurry with the procedure instead of waiting until adulthood; didn’t God create man in his own image (Genesis 1:26) – meaning God is not circumcised, so doesn’t circumcision represent a violation of the integrity of what God has created? Historically, circumcision originates in snake worship in ancient Egypt (animals represented Egyptian gods and goddesses), and Jews and Arabs only transferred this ritual to their own god. In fact, the theological debate on the subject seems never-ending.

Apparently a significant part of the “sacrifice in the form of circumcision” is the shedding of blood, and circumcision is a notoriously bloody operation; even in modern surgical conditions, hemorrhage (significant blood loss) can be a problem. A rate of up to 2% is supposedly requiring blood transfusion.[12]

It is often argued that the real reason behind the listed religious arguments in favour of circumcision is an attempt to establish control over (male) sexuality and consequently over the human race. One of the direct consequences of circumcision is a greatly reduced possibility of pleasurable sensations for a circumcised man during sexual intercourse.[13] This is said to “raise the value of the sacrifice to God,” since the prepuce is by itself just “a piece of skin.” It was also believed to help stop masturbation, since in the past it was thought masturbation caused blindness, mental illness, alcoholism, epilepsy and a host of other ills. It therefore made sense to some physicians that genital surgery would stop masturbation and prevent the onset of these illnesses.[14] Again, this argument could be interpreted as an ideological disguise covering the real reason: control over male sexuality, and the human race.

In Jewish tradition, the child is usually circumcised at the age of 8 days. Although circumcision is considered a tradition, many Jews argue that other “traditions” prescribed by the Torah are not followed nowadays (e.g. a death penalty for various offenses), and that other practices recognized by Judaism in the past (slavery, animal and human sacrifice, divorce for men only, female subservience to men) have likewise been abandoned.[15]

Circumcision is not mentioned in the Quran, yet the divine law of sharia is based not only on the Quran but also on the hadith (the sayings of the Prophet Muhammad) and the sunnah (the Prophet’s tradition – teachings and acts). Circumcision has the status of sunnah. Only the Shafi’i school of law regards circumcision as obligatory, while others regard it as merely recommended. Even those who consider circumcision an obligatory duty for themselves do not see it as an essential requirement for others to become Muslim. Yet the procedure is very commonly practiced and is seen as an important external symbol of submission to God’s will.[16] The usual age for circumcision of a Muslim boy is around 7 years, but in practice it may be performed anywhere from a few days after birth up to puberty. Adult converts to Islam have traditionally been expected to undergo the operation, though this is not universally considered essential, especially where there is a health risk.[17]

Circumcision is also a business: doctors, mohels and others derive income from performing it, and there are various medical, religious and tribal instruments used during the procedure that can be purchased. There is even talk of a “circumcision industry.” It is estimated that 1.2 million newborn males are circumcised in the United States annually, at a cost of between $150 million and $270 million.[18] In the West, biotissue companies use amputated newborn foreskins to create profitable artificial skin products.[19] So religious reasons are sometimes viewed as an ideological justification supporting the survival of the “circumcision industry.”

4. Medical and psychological aspects of circumcision

a) Opinions of medical organizations

Medical aspects of circumcision are most often cited in the pro-and-con debate about the procedure, yet they tend to speak much more against it than in favour. No national medical organization in the world recommends routine circumcision of male infants, and a number are quite critical of the procedure, including (to name but a few from English-speaking countries): the 2003 British Medical Association, the 2002 Royal Australasian College of Physicians, the 2002 Canadian Paediatric Society (reaffirming its 1996 position), the 2000 American Medical Association, the 1999 American Academy of Pediatrics, the 1996 Australian College of Paediatrics, and the 1996 Australasian Association of Paediatric Surgeons.[20]

The Canadian Paediatric Society, for example, concluded that “the overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns.”[21] The American Academy of Pediatrics (AAP) issued a more reserved policy statement in 1999, especially compared to some of its earlier statements, in which it had claimed, for instance, that there were no valid medical indications for circumcision in the neonatal period (1971).[22] In its 1999 opinion, the AAP concluded that existing evidence points to potential medical benefits but is not sufficient to recommend routine neonatal circumcision, and that where the procedure is not essential to a child’s current well-being, parents should be given accurate, unbiased information and the opportunity to discuss the decision, with procedural analgesia provided if circumcision is chosen.[23]

The AAP policy statement may be revisited in the future, since it has been heavily criticized. Some commentators have argued that the AAP did not cite all relevant research and that some cited research was misquoted, going so far as to suggest the evidence does not now support, and never has supported, the continued routine performance of circumcision on infant males, and that the AAP and the American College of Obstetricians and Gynecologists (ACOG) should fully disclose the profession’s history of erroneous rationalizations for the practice.[24]

b) Medical and psychological pros and cons of circumcision

Defenders of circumcision claim that a circumcised penis is cleaner. But, as most men know, hygiene of the genitals is simpler and less time-consuming than brushing or flossing teeth, so this argument hardly calls for routine circumcision of infants.[25][26]

Circumcision is extremely painful and bloody. Excessive bleeding can require a blood transfusion, with the attendant risks of transmitting HIV and other disease organisms. Pain can also be experienced in the days after the operation, and even later in the case of complications.

Modern psychology knows much more about a child’s ability to feel pain and remember traumatic experiences than it used to.[27] An experiment designed to measure fetal and neonatal memory for speech sounds found that infants who had been read a target story in utero later, as neonates, responded preferentially to that story over similar-sounding ones, regardless of who recited it.

Researchers also found a significantly higher percentage of adolescent suicides among subjects who had experienced respiratory distress at birth compared to those who had not, and a pattern of distressed behaviors similar to those of “infants born at risk” during the trauma of circumcision. A separate Swedish epidemiological study found a correlation between suicide method and the type of birth complications experienced. In both cases, researchers were careful to note the correlational, rather than causal, nature of their findings.

One study demonstrated that three-month-old infants can remember a picture for weeks after brief exposure, and research recording brain activity in infants during memory experiments concluded that infants have “covert” long-term memory even without overt evidence of it.

Researchers Anna Taddio and colleagues demonstrated that neonatal circumcision increased infants’ pain response to vaccination at four and six months, a result that held even for boys given EMLA cream (a topical anesthetic) during their neonatal circumcision – evidence that neonatal circumcision has long-term behavioral effects.[28]

Many parents believe their child can be safely anesthetized during circumcision, but this carries real risk. In a Canadian case from August 1994, a baby developed significant methaemoglobinaemia a few hours after circumcision – a blood disorder in which hemoglobin is unable to carry oxygen to cells, which can cause brain damage and death in small infants. Two further cases linked to Prilocaine occurred in British Columbia, and Lidocaine has been associated with similar outcomes.[29]

The injection of local anesthesia into the penis carries its own risks, including permanent vascular and nerve damage, and the injection itself can be very painful. Even when anesthesia is attempted, it is not always effective.

Some men who were circumcised as children later regret it and pursue foreskin restoration, which can be achieved surgically or through non-surgical tissue expansion techniques. The unique structure of the inner lining of the prepuce can never be fully recreated, though most who undergo restoration report satisfaction with the results.[30]

A study found that 29.7% of circumcised boys under three years of age develop adhesions (scar tissue) or skin bridges[31] – complications that form when the raw remnant where the foreskin was cut attaches to the raw surface of the glans, interfering with hygiene.

According to research, balanitis (inflammation of the glans) is more common in circumcised boys, perhaps because some parents mistakenly believe a circumcised penis needs no maintenance and neglect penile hygiene. The foreskin’s protective functions are, of course, absent once it is removed.

A circumcised boy needs the skin overlaying the glans pulled back and cleaned regularly until 15–18 months of age to prevent adhesions from reforming and debris from accumulating. There is a strong association between coronal adhesions and subpreputial debris, though most such adhesions resolve by 24 months once parents are instructed in gentle retraction. By contrast, the intact penis is protected by the preputial sphincter and cleaned naturally by urine flow, requiring no special care.[32]

Infection occurs after circumcision in up to 10% of patients.[33] Repeated infections can result in meatal stenosis (narrowing of the urinary opening), which may require surgery.

Some parents feel not enough skin was removed and that their son looks uncircumcised, leading to children being subjected to “redone” circumcisions[34] – though this appearance is sometimes simply due to a fat pad in the pubic area that resolves as the child grows. Conversely, too much tissue is sometimes removed, which may not become apparent until later and can cause painful erections and curvature of the penis.

Many parents are led to believe circumcision is safer than leaving the penis intact. One pediatric reference reports one serious complication for every 500 circumcisions,[35] while a pediatrician cited elsewhere puts the complication rate at roughly three in 100 cases.[36] One study that followed circumcised boys beyond the immediate post-operative period found complications at a rate of 55%.[37] Other estimates place realistic complication rates between 2% and 10%,[38] or cite a 4% immediate and 13% late complication rate.[39] Reported complications include hemorrhage, infection, and damage to the penis, with much of the harm not becoming apparent until adulthood.

The assumption that circumcision is inevitable at some later time is a myth: there is less than a 1% chance it will ever become medically necessary.

Parents who choose circumcision for cosmetic reasons often don’t realize it cannot accurately be described as purely cosmetic. Cosmetic surgery, by definition, improves appearance without affecting function – yet the foreskin, commonly assumed to serve no purpose, in fact has several functions, all of which are eliminated when it is removed:

  • It is itself sensitive, due to nerve endings on its inner surface that become exposed during sexual arousal.
  • It protects the glans, which stays soft, moist and sensitive throughout life when protected, whereas an exposed glans becomes increasingly thickened and desensitized over time.
  • Its mobile sheath of skin allows the prepuce to slide back and forth.
  • Slack skin on the shaft of the erect penis allows it to glide within its own sheath.

These characteristics facilitate intercourse and help avoid problems with vaginal dryness.[40]

It is notable that doctors in Western countries will not permit female circumcision – involving removal of some or all of the erogenous tissue from the vulva for reasons other than major pathology – yet will permit, and in some cases encourage, removal of the male prepuce, which is identical to the female prepuce in its embryological development, cell structure, and nerve and blood supply.[41]

Avoidance of penile problems is sometimes cited as a reason for routine infant circumcision. However, the incidence of bleeding, erosion of the glans and stenosis of the urethral meatus has been reported to be higher in circumcised male infants than in intact ones, and meatitis and meatal ulcers occur almost exclusively in circumcised boys.[42]

A study published in the New England Journal of Medicine found an increased risk of cervical cancer in women whose partners were not circumcised, reasoning that uncircumcised men are more likely to transmit human papillomavirus (HPV), which may be responsible for up to 99% of cervical cancers worldwide.[43] Yet another study found no correlation between an uncircumcised partner and cervical cancer.[44] A good screening program and vaccine appear to be far more effective weapons against cervical cancer than circumcision.[45]

Penile cancer is extremely rare – roughly two cases per 100,000 men annually, almost never presenting before age 50. One calculation found that circumcising 100,000 male infants, at a cost of $3.8 million, would prevent only two cases of penile cancer[46] – and neonatally circumcised men are not immune to the disease; at least some cases occur in circumcised men as well.[47] Hygiene alone also appears to lower the risk of penile cancer.

Some claim circumcision reduces the incidence of HIV transmission, though there is inadequate evidence to recommend it as a public health measure for that purpose.[48] Some African studies suggested circumcision could reduce the spread of HIV and other sexually transmitted diseases,[49] while a Western study among heterosexual men found no significant effect on the incidence of common sexually transmitted diseases.[50] Critics argue the older African studies used flawed methodology and outdated data; one study even found a higher rate of chlamydia among circumcised men, with no higher STD rates among intact men.[51] Proponents of the newer African studies argue they are more accurate, attributing any increased infection risk to the foreskin’s susceptibility to scratches and tears during intercourse, and to its high density of Langerhans cells, which are especially vulnerable to HIV.

Health experts warn that men might mistakenly believe circumcision offers complete protection from AIDS, leading them to take greater risks in their sex lives.[52] Circumcision also brings its own risks, especially when not performed in a hospital by a doctor, and there are other proven ways to prevent the spread of HIV, such as condom use, which is both safer and less painful. Health experts stress that nothing substitutes for consistent prevention, as demonstrated in more medically developed countries.

There are some medical cases in which circumcision of infants is more defensible, such as true phimosis – though quite a few medical experts believe it is avoidable even then.[53]

Phimosis refers to any condition in which the foreskin cannot be retracted. Most infants are born with a non-retractable foreskin, and this is entirely normal. “True phimosis,” or preputial stenosis, occurs in fewer than 2% of intact males; of those, 85–95% respond to topical steroids, and of the remainder, at least 75% respond to stretching under local anesthesia. In practice, at most seven boys in 10,000 may ever need surgery for preputial stenosis.

A boy’s foreskin may remain tight until after puberty; this is an entirely normal condition, not phimosis, and rarely requires treatment in cultures where circumcision is uncommon. Spontaneous loosening typically occurs with increasing maturity: roughly 50% of ten-year-old boys, 90% of 16-year-olds, and 98–99% of 18-year-olds have a fully retractable foreskin, and some estimates put the figure as high as 90% of uncircumcised infants by age five.[54] If treatment is ever necessary, it should wait until after puberty, when the male himself can weigh the options and give informed consent.

Importantly, an immature foreskin must never be forcibly retracted for “cleaning” or any other reason, as this damages developing tissue; children should be told their foreskin will eventually retract on its own, and the first person to retract it should be the child himself.

A number of reports indicate that many doctors are not trained to distinguish normal developmental tightness from pathological phimosis, leading to frequent misdiagnosis.[55]

Since the 1990s, topical steroidal and non-steroidal medications have become the treatment of choice for phimosis in boys, given their low morbidity, lack of pain or trauma, and low cost – considered the most cost-effective option, with circumcision the least.[56] Steroid ointment accelerates the foreskin’s normal growth and expansion, typically leading to spontaneous relief of the non-retractile condition; narrow foreskins usually widen over time even without treatment. Gentle stretching over a period of time can achieve a similar effect non-surgically, without trauma or surgical risk, and can be combined with steroid treatment if needed.

Preputioplasty – plastic surgery of the prepuce – is a more conservative alternative to traditional circumcision or dorsal slit for treating preputial stenosis or phimosis, proposed by many doctors as a way to avoid the risks and complications inherent in circumcision. Its claimed advantages include a faster, less painful recovery, significantly less morbidity, and preservation of the foreskin’s protective, erogenous and sexual functions.[57]

5. Conclusion

This paper shows that there are virtually no valid reasons for the routine circumcision (cutting of the prepuce) of boys. Religious reasons are either superstitious (redemption for original sin), incoherent within the very religious tradition from which they originate (if God created humans in his image, why violate the integrity of that creation?), or simply ideological justifications used to establish control over male sexuality – and, by extension, the human race – since involuntary circumcision reduces the possibility of pleasurable sexual sensation.

The UN Convention on the Rights of the Child calls on State Parties to abolish traditional practices prejudicial to children’s health and to always act in the child’s best interest. It transcends the old view of children as mere extensions of their parents’ identity, instead treating a child as a unique individual who makes major decisions about their own life once mature enough, with parents restricted to a guidance and counseling role. On this basis, a parent’s wish to make a son resemble his father cannot justify circumcision.

Slovenia should follow the initial text of the Swedish circumcision act, under which medically unnecessary circumcision was permitted only for adults. This would give legal effect to the professional opinion of the many medical organizations that speak against routine infant circumcision – none of which recommend the procedure.

The Slovene medical profession should take a firm stand against the circumcision of children, or risk legal liability should complications arise in a concrete case of infant circumcision in the future.

There are many serious medical and psychological reasons against the circumcision of children, and virtually none in favour. Even those who claim benefits (reduced risk of penile problems, sexually transmitted diseases, urinary tract infections, penile cancer, cervical cancer) acknowledge that circumcision is not the best solution to these problems and that they can be avoided through other means – and that the studies claiming a protective correlation are themselves methodologically disputed, with other studies showing the opposite.

Even phimosis – more precisely, preputial stenosis – can be successfully treated by less invasive means: topical steroids, stretching, or preputioplasty.

Given these arguments, a clear stand against routine infant circumcision is needed at both the national and international level.

Notes

  1. Sometimes referred to also as Male (or Female) Genital Mutilation. ↩
  2. Desiree Cooper, “Circumcision traditions challenged,” Detroit Free Press, March 8, 1999; Isabel Mbugua, “Ending the Mutilation,” People & the Planet, Vol. 6, No. 1, 1997; “Facts and Figures Report 2006,” Amnesty International, 23 May 2006; “Eritrea bans female circumcision,” BBC News, 4 April 2007. ↩
  3. Wallerstein E., Circumcision: an American Health Fallacy, New York: Springer Publishing Company, 1980. ↩
  4. John P. Warren, Jim Bigelow, “The Case against Circumcision,” British Journal of Sexual Medicine, pp. 6–8, September/October 1994. ↩
  5. “Neonatal circumcision revisited,” Canadian Medical Association Journal, 1996; 154(6): 769–780; Jackie Smith, “The growing consensus against circumcision,” National Post, 30 August 2002; WHO/UNAIDS, recommendations from expert meeting on male circumcision for HIV prevention, Paris, 28 March 2007. ↩
  6. Mary G. Ray, 1997. ↩
  7. See note 4. ↩
  8. Desmond Morris, Babywatching, as quoted in the source listed in note 6. ↩
  9. Ibid. ↩
  10. “Sweden restricts circumcisions,” BBC News, 1 October 2001; “Circumcision in Sweden and its regulation.” ↩
  11. See e.g. Catholics Against Circumcision; Jews Against Circumcision. ↩
  12. See note 4. ↩
  13. Ibid. ↩
  14. See note 6. ↩
  15. See note 11. ↩
  16. Dr. John Dean, “Circumcision,” netdoctor.co.uk, last updated 12 September 2005. ↩
  17. “Traditional Muslim Male Circumcision,” circlist.com. ↩
  18. American Academy of Pediatrics, Task Force on Circumcision, “Circumcision Policy Statement,” Pediatrics, Vol. 103, No. 3, pp. 686–693, March 1, 1999. ↩
  19. “Instruments Used in the Circumcision Industry,” noharmm.org. ↩
  20. “Position Statements of Medical Societies in English-Speaking Countries”; “Circumcision: Medical Organization Official Policy Statements,” last updated 20 February 2007; see also Canadian Children’s Rights Council. ↩
  21. See note 5. ↩
  22. American Academy of Pediatrics, Committee on Fetus and Newborn, Standards and Recommendations for Hospital Care of Newborn Infants, 5th ed., Evanston, IL: AAP, 1971. ↩
  23. See note 18. ↩
  24. Matthew R. Giannetti, “Circumcision and the American Academy of Pediatrics: Should Scientific Misconduct Result in Trade Association Liability,” Iowa Law Review, Vol. 85, No. 4, pp. 1507–1568, May 2000. ↩
  25. Mostly derived from note 6. ↩
  26. Circumcision can hardly be called “a routine procedure” from the standpoint of the stress experienced by the child. ↩
  27. Quoted from the article cited in note 24. ↩
  28. Lander J, Brady-Freyer B, Metcalfe JB, et al., “Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision,” JAMA, 1997; 278: 2158–2162; Howard J. Stang et al., “Beyond Dorsal Penile Nerve Block: A More Humane Circumcision,” Pediatrics, Vol. 100, No. 2, August 1997. ↩
  29. Canadian Nurse, August 1994, pp. 5–6. ↩
  30. See note 4. ↩
  31. See note 6. ↩
  32. Dr. Robert Van Howe, British Journal of Urology, Vol. 80: pp. 776–782, November 1997. ↩
  33. Williams and Kapila, “Complications of Circumcision,” British Journal of Surgery, Vol. 80, October 1993, pp. 1231–1236. ↩
  34. See note 6. ↩
  35. Schmitt, Barton D., Your Child’s Health, Bantam Books, Revised Ed., 1991. ↩
  36. “Circumcision,” reporter Jonica Newby, ABC Catalyst, 20 June 2005. ↩
  37. Patel, H., “The Problem of Routine Circumcision,” Canadian Medical Association Journal, 95: 576–81, 1966. ↩
  38. See note 5. ↩
  39. See note 24. ↩
  40. See note 4. ↩
  41. See notes 3 and 4. ↩
  42. See note 5. ↩
  43. See note 36. ↩
  44. Kessler II, “Etiological concepts in cervical carcinogenesis,” Gynecologic Oncology, 1981; 12 (suppl 2): S7–S24. ↩
  45. See note 35; see also Gostout, Bobbie, M.D., “Cervical cancer vaccine: Who needs it, how it works,” Mayo Clinic, 22 January 2007. ↩
  46. Hartunian NS, Smart CN, Thompson MS, “The incidence and economic costs of cancer, motor vehicle injuries, coronary heart disease and stroke: a comparative analysis,” American Journal of Public Health, 1980; 70: 1249–1260. ↩
  47. See note 24. ↩
  48. See note 5. ↩
  49. Lovgren, Stefan, “Circumcision Can Reduce AIDS Risk, Study Says,” National Geographic News, 27 July 2005; New Scientist, 25 November 2006, p. 8; WHO/UNAIDS recommendations (see note 5); “Male circumcision to fight HIV poses risk to women,” New Scientist, 7 March 2007. ↩
  50. Donovan B, Bassett I, Bodsworth NJ, “Male circumcision and common sexually transmissible diseases in a developed nation,” Genitourinary Medicine, 1994; 70: 317–320. ↩
  51. See note 24. ↩
  52. See note 49. ↩
  53. “Conservative Contemporary Treatment of Phimosis: Alternatives to Radical Circumcision,” last updated 12 July 2006. ↩
  54. See note 18. ↩
  55. See note 5. ↩
  56. See note 24. ↩
  57. See note 53. ↩

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