Sunday Life! (Melbourne) [Sunday Age magazine section], 23 July, 2000

It's a snip

Circumcision used to be regarded as routine. But as debate rages over its benefits, the majority of new parents are now saying no thanks.

by Rosemarie Milsom

When Debbie Huybers gave birth to baby Lachlan earlier this year, she planned to have him circumcised, just like his five-year-old brother Liam. "I've worked in the health system for years and I never forget seeing an elderly man with a serious infection. I decided then that if I ever had boys, I'd get them circumcised." Debbie and her husband, Brett, thought their request would be considered routine but nothing prepared the couple for the reaction of hospital staff. "I was treated like a barbarian. I just couldn't believe it," says Debbie.

The anxious mother was told the hospital had stopped circumcising newborns because demand for the service had declined. "There's a lot of politics behind it," says Debbie, still simmering about having to have her son circumcised privately five weeks after his birth (the procedure is usually carried out in the first few days of life). "I was really upset. I had a hell of a time trying to find a doctor who would do it. I believe that if there's a procedure there that can prevent an infection then use it."

At its peak in the 1960s, neonatal circumcision was one of the most frequently performed surgical procedures in Australia. For generations, the operation was so commonplace it was regarded as simply a routine of childbirth -- like cutting a newborn's umbilical cord. But as the Huybers found, times have changed. Demand for the procedure has declined in recent years as its benefits continue to be hotly debated. According to the Australian College of Paediatrics, less than 15% of boys are being circumcised nationally -- about 20,000 circumcisions were performed in 1997-98.

The Australian Medical Association (AMA) sees several reasons for the decline. "I think part of the reason is that when something went wrong, it gained a lot of publicity in an era when people were starting to question the procedure," says the Perth-based federal executive of the AMA, Dr Rosanna Capolingua.

Parents choose circumcision for religious, cultural and social reasons. Many, like Debbie Huybers, are also influenced by the view that the procedure prevents urinary tract infections and penile cancers. But recent research suggests otherwise.

The results of a United States study, which were issued in January, show the benefits of circumcision were not as significant as previously believed. The findings came from a review of more than 350,000 boys born in hospitals throughout Washington state from 1987 to 1996. Researchers found that for every complication from circumcision, only six urinary tract infections were prevented and for every two complications, only case of penile cancer was prevented. Complications include damage to the shaft and urethra, haemorrhage, infections, amputation and even death.

"The benefits do not outweigh the risks," says Capolingua. "Good hygiene in an uncircumcised boy is effective in preventing infection. In only a few cases is it necessary to perform the surgery for medical reasons."

As well as considering the risks of the procedure, barrister Neville Turner believes parents should give weight to the legal implications of their decision to proceed with the operation. "The whole concept of a child suing the doctor and parents later in life is a real possibility," says Turner. "Many people feel that it is the parents who have the rights but very few consider the rights of the child who is being subjected to an irreversible procedure."

In March, Turner joined three other legal and health professionals in calling for circumcision of baby boys to be outlawed. Writing in the Journal of Law and Medicine, they questioned whether parental consent to a routine circumcision had ever been truly informed. "The reality of the situation is that I think a lot of parents are never really confronted with the hard facts," says Turner. "It is an extremely painful process that can go horribly wrong."

The conflicting reports of the pros and cons doesn't make the decision any easier for parents. Both Turner and Capolingua agree that parents should consider all the facts before consenting to the operation. "Be prepared to ask questions because there is a lot of misinformation out there," adds Turner.

However, Debbie Huybers believes she made the right decision for her two sons. "I can see why people choose not to have it done and I'm not that narrow-minded to think everyone should do it," she says. "I've got nephews who aren't 'circed' and I respect my sister's decision. In the end, you've got to do what you're comfortable with."

Letter in Sunday Life!  30 July, 2000

Sunday Life! reported the case of a woman who against medical advice had her healthy child subjected to amputative surgery. (23/7)

In any other instance, this woman would have been brought up on charges, but because the procedure was called circumcision, she had the opportunity to report her opinions and justifications in Sunday Life!

Circumcision is the only operation in which parents assume the role of doctor and make a medical decision about surgery. Often, as in the case of Debbie Huybers, going against accepted medical practice.

Ms Huybers' justification for her son's genital reduction surgery was that she once saw an elderly man with 'a serious infection' in hospital. Infections can be cured with antibiotics. What kind of logic is it to subject a healthy person to surgery because someone else once had an infection?

Medicine is a science and should therefore be ruled by empirical evidence -- not the whims of parents.

Storm Schumacher
Circumcision Information Resource Centre Australia

Cite as:
(File revised 25 September 2000)

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