Male circumcision is a simple procedure but a complex and emotive health issue that continues to generate great debate in the community and the medical profession. The child's welfare is foremost. The current prevailing public policy in Australia suggests there is no medical reason for routine circumcision in newborns. However, recent research has found a higher risk of some health problems in uncircumcised males. Ultimately, it is the parents' decision, which should be respected and based on balanced, well-informed, comprehensive information. If you do decide to have your son circumcised, ensure it is done by an appropriate and experienced practitioner.
Circumcision is an operation to remove the foreskin from the penis. Although circumcision is done more often on babies and young boys, it can be performed on men of any age.
Circumcision is usually a safe and straightforward operation but there are risks, mainly of minor complications such as bleeding and wound infection and only rarely, serious complications including meningitis (an infection of part of the brain) and septicaemia (an infection in the bloodstream). An anaesthetic is required, which may be local or general.
Only a small number of males will need circumcision for medical reasons, which may include:
Circumcision may also be done for cosmetic, religious or social reasons. This is called non-therapeutic or ritual circumcision.
Circumcision may reduce the risk of the following conditions:
Circumcision has a complication rate of one to four percent that includes local infection, bleeding and damage to the penis.
When performed on healthy newborn male infants as an elective procedure, the incidence of serious complications from circumcision is extremely low. Serious complications such as uncontrolled bleeding, meningitis and septicaemia are rare but may result in death.
Circumcision has been around for religious and cultural reasons for thousands of years, and is still an important ritual in some religious groups. Circumcision for medical reasons became popular in the UK and United States in the late 19th century, while in Australia and New Zealand the practice of circumcision was adopted later. In the 1950s around 85 percent of Australian boys were circumcised. It has since become uncommon in Europe and is declining in Australia and New Zealand but is still practised widely in the US.
Circumcision does have some possible medical benefits, as mentioned above. It does not prevent diseases, however, and good hygiene and safe sex practices are still just as necessary. Circumcision also carries some risks and there is debate over whether these outweigh the potential benefits. Some people argue against circumcision saying that the foreskin does have a functional purpose – primarily to protect the glans, which is highly sensory tissue.
Circumcision of male infants is a deeply personal matter, and includes medical, ethical, cultural and social considerations. Parents may need to consider how the child might respond, opinions of family and friends, pressure to conform with dad, medical risks and benefits, and whether they should be making such a decision without the consent of the child.
Ultimately, parents have the right and obligation to make the decision of whether or not to circumcise their sons. The decision, like all medical procedures, should be based on the principle of weighing up the risks and benefits for the long-term wellbeing of the child. It’s important to have access to accurate information so you can make an informed decision. Talking to informed people you trust, such as your GP, can also help with the decision-making process.
In recent years the rate of circumcision in Australia has fallen and it is now estimated that around 32 percent of Australian men under 30 are circumcised.
The Royal Australasian College of Physicians (RACP) issued an updated policy statement on male circumcision in September 2010. It includes an analysis of the risks and benefits and states, “After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand. However it is reasonable for parents to weigh the benefits and risks of circumcision and to make the decision whether or not to circumcise their sons.”
Circumcision should always be performed in a safe, family-friendly environment by an appropriately trained, competent practitioner. It is important that the person carrying out the circumcision is capable of dealing with any complications that may arise, no matter how rare they may be, and is knowledgeable in using appropriate analgesia.
In Australia circumcision for non-therapeutic reasons is no longer carried out in public hospitals. However, they will continue to provide circumcision where there is an identified need for surgery to improve the patient's physical health.
It is normal for the inner surface of the foreskin to be fused to the glans in newborn males. Separation of the foreskin from the glans usually occurs spontaneously during childhood. By five years of age most boys are able to retract their foreskin. A small percentage of boys are unable to retract their foreskin fully until puberty.
The foreskin requires no special care during infancy and should be left alone. Attempts to retract it forcibly are painful, often injure the foreskin, and can lead to scarring and phimosis (difficulty in retracting the foreskin).
Later in childhood, the boy may be able to retract his foreskin gently to the point where resistance is met and the end of the penis and the urethral opening become visible. Only the boy should attempt to retract his foreskin - no one else. He can be shown how to clean the glans and the inner-surface of the foreskin once separation has occurred and the foreskin is fully retractable.
At puberty, all uncircumcised boys should be able to retract their foreskin and clean underneath it with water in the bath or shower. It is important that they always return the foreskin to its original position after they have finished. If the foreskin is left retracted behind the glans, it may swell up and become painful (paraphimosis).
As the foreskin separates from the glans, dead skin cells will collect between the two layers. These dead cells appear as white crumbly or cheesy material and have been termed smegma. Smegma may produce a noticeable (and often asymmetrical) swelling beneath the foreskin. This material rarely causes problems and usually discharges spontaneously. Accumulation of smegma assists the normal process of separation of the inner surface of the foreskin to the glans of the penis in the young boy.
The Children’s Hospital at Westmead. Male infant circumcision
http://www.schn.health.nsw.gov.au/files/factsheets/male_infant_circumcision-en.pdf (PDF 510.24KB)
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Last updated: 9 June 2015
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