What is circumcision?
Circumcision is a surgical operation that removes some skin or tissue from the genitals of a boy or girl. All forms of female circumcision are illegal in Australia. This article refers only to the circumcision of boys.
At birth, most boys have a sleeve of skin covering the end of the penis. This protective sleeve is called the foreskin. During a circumcision, this sleeve of skin is cut away, exposing the glans (head) of the penis.
Circumcision is sometimes done a few days after birth under local anaesthetic or with no anaesthetic. Alternatively, it can be done at several months of age in hospital with a local or general anaesthetic, or even later on in life.
If a boy is uncircumcised
At birth, the foreskin is joined to the underlying glans of the penis, so the foreskin can’t be pulled back. During childhood, the foreskin continues to cover and protect the sensitive glans. At some time during childhood for most boys, the foreskin separates from the glans and can be pulled back to expose the glans.
Once the foreskin can be easily pulled back, boys can wash underneath it while in the bath or shower. Generally, the foreskin is designed to look after itself. No special care is needed for an uncircumcised penis.
If a boy is circumcised
After the circumcision scar has healed, the glans will be permanently exposed. The appearance of the penis will depend on how much skin has been removed and where the cuts into the foreskin have been made. No special care is required for a circumcised penis.
Lots of parents worry about their boy’s penis, circumcised or uncircumcised. They worry that their son will feel or look different from other boys, or that his circumcision – or lack of it – is untidy or unusual. But boys themselves usually aren’t so bothered. An uncircumcised boy might ask a circumcised friend why he looks different, or vice versa, but it’s very unlikely to be a big issue for either of them.
The circumcision debate
Reasons for leaving your boy uncircumcised
Many parents and doctors are against circumcision because the foreskin is a natural part of a boy’s body. It’s rich in nerve endings, and plays an important role in sexual sensation and functions as boys grow older.
Things can go wrong with circumcisions, even when the most experienced of doctors does the operation. Short-term problems are mainly minor, such as bleeding after the operation. In very rare cases, problems can lead to damage to the urethra, gangrene and loss of the penis, or sometimes death. Long-term problems can include restricted urine outflow (meatal stenosis) and concerns about the appearance of the penis, particularly if too much skin has been removed, or if it’s uneven.
Many people argue that infant circumcision is unacceptable because the benefits don’t outweigh the possible harms. Also, a baby boy can’t consent to it. Circumcision in adolescence or early adulthood allows the boy to make his own decisions about it.
Some people argue that it doesn’t make sense to make all forms of female circumcision illegal but still allow male circumcision. They say that parents shouldn’t be allowed to authorise routine circumcision.
Reasons for having your boy circumcised
Being circumcised significantly reduces the risk that a baby boy will get a urinary tract infection. It also completely prevents the problem of having a foreskin that is inflamed or too tight – about 4% of older boys have this. Circumcision isn’t known to have any other benefits for boys before puberty.
A 2007 World Health Organisation study found that men who are circumcised, either as adults or as children, have been shown to be partly protected from catching HIV (AIDS) in high-risk countries in Africa. They also have a lower risk of catching genital warts in countries where there’s no vaccination against genital warts (Australia does vaccinate). Circumcision also offers considerable protection against the uncommon condition of cancer of the penis, which mainly occurs in older men who have tight foreskins that can’t be pulled back.
Some people see these benefits as very good reasons to circumcise all boys.
The circumcision debate is extremely passionate. Both sides focus on information that supports their view and ignore other information. You can trust evidence published by official medical organisations such as the Royal Australasian College of Physicians. It can be a good idea to treat other opinions with caution.
What experts recommend
Medical experts at the Royal Australasian College of Physicians (RACP) regularly review all the available evidence and have developed a circumcision policy for parents.
The most recent policy update from 2010 states that the RACP does not recommend routine neonatal circumcision for boys in Australia. But the RACP makes it clear that different parents might weigh up the risks and benefits differently and might choose to circumcise their son.
Whatever you decide, your boy is likely to have a normal childhood and adult life, without significant concerns about his penis.
If you accept the advice of the RACP, or you’re not sure what to do, you can leave your boy with his foreskin. If he disagrees with your choice later, he can make the decision for himself as a teenager or adult.
If you review the evidence yourself and you disagree with how the RACP policy balances risks and benefits, you should feel comfortable proceeding with circumcision. Some parents might also choose to have it done for strong cultural reasons (for example, their Jewish or Islamic customs).
Planning in advance
If you decide to have your son circumcised, you can take some steps to make sure the operation is done safely. Start by ensuring that whoever is circumcising your son is experienced. Ask how many procedures the doctor has done and how many complications have occurred. All doctors are required to give you balanced information and to respect your decision.
Try also to ensure that your son receives adequate pain relief during and after the procedure. Check that you have good access to the doctor for follow-up after the surgery. Also ask about any costs to you.
Note that some Australian states won’t allow circumcisions to be done in public hospitals without a medical reason.
Around the world, most Muslim and Jewish parents circumcise their boys for religious reasons. Among other families around the world, about 85% of boys aren’t circumcised. The only major western countries where circumcision is very common are the US and Canada. Circumcision is uncommon in Britain, most of Europe and Asia, South America and Central America.
The history of circumcision in Australia is unique. From 1920-1950, circumcision was actively promoted. The vast majority of boys born in Australia around 1950 were circumcised. Since then, there has been a big move away from circumcision. Now the majority of Australian boys aren’t circumcised.