LISTENER (N.Z.), November 17, 2001.


The First Cut

As circumcision rates drop, several generations of Kiwi males now look slightly different to their dads. But will we follow some countries and legislate?


On June 1, the Swedish parliament passed a groundbreaking new law. The legislation was aimed at Sweden's burgeoning Muslim population, to whom the practice of circumcision is a holy writ, and too many of whom were presenting their mutilated infants at hospital emergency wards after botched backyard operations. Now circumcision in Sweden can only be carried out on boys under the age two months, and a registered nurse or doctor must give local anaesthesia. Male who have reached the age of consent can also decide to have it done. The reaction was immediate and vocal. The loudest response came from the Jewish community, for whom the practice is also part of a holy covenant with God. "People have compared the regulation to those of Nazi Germany implemented against the Jews," complained the chairwoman of Stockholm's Jewish community. "I think the backlash will be tremendous around the world said Stockholm's Rabbi. It is indicative of the heat of the debate that such comments are made about a simple medical safeguard for a minor operation. Circumcision, a process widely derided by many surgeons and GPs as of no benefit and of negative effect, yet fiercely defended as a vital part of cultural and religious identity by others, is the anachronism that refuses to die.

Hard figures are difficult to come by on the local circumcision scene. The New Zealand Medical Association's best guess is that around 10% of baby boys are circumcised. Other research indicates a wide cultural and racial split, with only about 1% of caucasian boys, but nearly 100% of Tongan, Samoan, and Jewish boys, currently having the operation done. Australia has similar figures to us, but in the US nearly 63% of babies are circumcised and in the UK somewhat less than 4%. It is relatively unknown in continental Europe, South America and non-Muslim Asia.

The origins of the practice are older than all major religions and recorded history. No one can remember why we do it. Outside of the wishes of a deity, or as rite of passage, there have been a number of medical justifications put forward, including- a cure to masturbation, epilepsy, eczema, idiocy, and headaches. Recently, it has been touted as preventing urinary tract infections, penile cancer and Aids. "Rubbish," says senior lecturer in pathology at Auckland University of Technology and anti-circumcision campaigner Ken McGrath. "The urinary tract justification is one of the worse studies I have seen in terms of bad design bias, incompetence in structuring the study and iatrogenic effects [investigators causing the infections]. They have been rubbished and never duplicated. I don't think anyone with any scientific discrimination would accept them.

Similarly, the penile cancer myth "That has been debunked since it came out, again it has never been replicated and there have been consistent reports of cancer in the circumcised male. There are four times more incidence of breast cancer in males than penile cancer anyway, but no one is suggesting you cut off men's nipples, even though you would do four times as much good if you did that to every boy rather than mucking about with their penis." And Aids? "That study really is silly - it has a truck driven through it. It has a serious set of statistical biases. Also, it suggests that the foreskin is at risk because it contains Langerhans cells. The cells are found in all skin. I predict that Aids will disappear as a reason, too, within five years they will have to find another reason for justifying circumcision - apart from money and cultural imperialism."

Money is certainly a factor. Southern Cross Healthcare's median payment for the operation was $1445 in 1999. A limited US study found that the the median charge was $US121. Circumcision opponents in that country estimate the total cost at up to $US2billion a year (McGrath says $US200million is more believable), and at least one US doctor dines out on the line that "Every American boy is born with a $100 bill under his foreskin. All you have to do to get it is take it off."

Reduced sexual pleasure is another cost in the circumcised male. Sixty percent of the skin of the foreskin is removed during circumcision and with it goes most of the penis' epicritical sensory system - complex transducers with very high resolution in sensitivity equivalent in sensitivity to the fingertip. What is left on the glans itself are the protopathic pathways, a very simple system of free nerve endings equivalent to in sensitivity to the heel of the foot.

Some research suggests disruption of circulation, bad hygiene and even neurological damage are a possibility, even after a successful operation. Curvature of the penis is also present in about 70 percent of circumcised males, and almost non-existent among the uncircumcised, but most medical complications stem from a botched procedure.

Dr Percy Pease has been a consulting paediatric surgeon with a specialty in pediatric urology for 27 years. He sees about one botched circumcision a month. "It is usually when too much skin has been taken off, generally people from the Pacific Island community." He has noted a drop in the number of people having the procedure done. "Even some European and New Zealand Jewish people are not having their kids circumcised. People question what the validity of it is when it is botched and have a hard time dealing with the guilt. I'll do them if people insist, only because I can do them properly." Currently the New Zealand Medical Association recognizes no preventative medical health benefits from circumcision. The British Medical Association considers it a radical invasive procedure and states that unless conservative treatments are tried first a therapeutic circumcision would be unethical.

"Even some European and New Zealand Jewish people are not having their kids circumcised. People question the validity of it when it is botched and have a hard time dealing with the guilt."

In New Zealand, the debate is just getting under way and seems likely to focus on human rights. As a signatory to the binding International Covenant on the Rights of the Child, we have agreed to "...take all effective and appropriate measures with a view to abolishing traditional procedures prejudicial to the health of children". Which some see as a warrant to ban the practice of ritual male circumcision. "The religious and cultural thing can be solved by letting the 16-year-old make his own decision," says McGrath.

The heat in the local argument indeed lies with those who seek to outlaw the process rather than those who seek to maintain the status quo. Orthodox Jewish Rabbi Jeremy Lawrence is relaxed about the new Swedish law. "There is every legitimate right for a government to make sure religious practice can be done within suitable medical paradigms," he says, but adds that a spiritual dimension may be lost by interfering with the ministrations of the Mohel, the person in Jewish culture who traditionally performs the circumcision.

Rabbi Lawrence objects to delaying the process until the child is of an age where he can legally consent. "Certainly it is much harder for someone who is older or sexually active to contemplate having that procedure. Deferring consent until it becomes more informed means you are creating a psychological barrier to changing who you are. If you say that a person is more able to weigh up the pros and cons when they are older, that may be true, if that is your sole value and criterion. If you say a child has a right to be brought up with a its heritage [another part of the International Covenant], to bring up a child alienated from what God has set out for them is a fundamental breach of the human right to spiritual and national identity."

Similar views exist with in Pacific Island society. Traditional Pacific Island Circumcision practice is different for European, a "dorsal slit" or supercision is usually performed on boys between nine and 15. This practice is not as damaging to the foreskin, although it also has the effect of toughening the glans and making it less sensitive.

Dr Sitaleki Finau is a senior lecturer at Auckland Medical School and Professor of Public Health at the Fiji School of Medicine. He dismisses anti-circumcision views on penile cancer and Aids. "Those who argue are those who don't understand the literature," he says. The practice was well established in the islands even before Christianity endorsed it. "If you're not circumcised, you are not a man, you haven't gone through the rites of passage and you are considered dirty." There are three Pacific-run clinics in Auckland that perform the operation for a break-even fee of $150. The clinics provide a check-up service as part of that fee. "We find hepatitis B, anemia, worms, that type of thing and treat them, too, and some of these kids haven't seen a doctor for a long while. About 280 kids have been done in the last couple of years and the practice of backyard circumcisions is starting to disappear." And the question of rights? "To whom does the child belong?" says Finau. "My stance is that if parents are responsible for children, they should be responsible for the decision made on behalf of children. Why is the penis different from the ear or ear piercing? It is less dangerous than liposuction or a facelift or any of those other things people do for fun."

The Swedish model would be a particularly good thing but is not applicable in the current hostile climate. "If circumcision was accepted in New Zealand we could develop a guideline, but there isn't one. If the medical profession doesn't accept it and it's becoming a lost skill."

The Commissioner for Children, Roger McClay, will be in the thick of the emerging debate. "If I was a newborn baby tonight and I could speak, I would say, 'Can you hold off a bit until I can make up my own mind.' But, by the same token, would a child want to grow up in a culture or with a religious belief of its parents and be different from everybody else?" The difficulty is in deciding it. But we should be talking about it." It is a very hard one. I would like to see a debate. It would be worth raising and it needs to be.

Cite as:
(File prepared 28 November 2001)