Evidence suggests, US doctors have concluded, that it is the kindest cut: Circumcision can reduce the risk of urinary tract infections in infants, cut the risk of penile cancer and lower the risk of HIV and the human papillomavirus, which causes cervical and other cancers. So why is the removal of a tiny flap of skin at birth, both an ancient religious ritual and an apparently pragmatic hygienic practice, causing controversy around the world?
While the American Academy of Pediatrics (AAP) has concluded that the health benefits of circumcision outweigh the risks and the procedure is a matter of parental choice, outraged opponents call it male genital mutilation, or child abuse. Many parts of Europe concur.
A court in Cologne this summer ruled that circumcision contravened the rights of a child to decide later in life on his religious beliefs. A German doctor has now filed charges against a rabbi for performing circumcisions on two infant boys, causing outrage in Jewish and Muslim communities and a delicate debate about intolerance, religious freedom and children’s rights in Germany.
Circumcision is an ancient ritual in Judaism and Islam, but there is no ritual circumcision in Hinduism and other religions that arose outside the Middle East. Aboriginal societies in desert areas of Australia also traditionally practiced circumcision and historians believe the procedure was originally an early public health measure to prevent balanitis, a swelling of the penis that can be caused by the accumulation of sand under the foreskin.
Until the 1950s, British men were routinely circumcised for health and hygiene (balanitis, easily cured and prevented with basic hygiene, occurs in about one in 20 infants, and is more common in uncircumcised boys). Circumcision is still legal with parental consent in the UK, but barely 5 percent of British men are circumcised now for medical reasons, although some religious circumcisions may be unrecorded if undertaken outside mainstream medicine.
The difference in statistics between Europe — in Scandinavia rates are as low as 1 percent — and the US, where most men are circumcised, is striking, and the attitudes of medical opinion in Europe and the US seem poles apart. Recent US research has added weight to the pro-circumcision case, but the number of newborn circumcisions is falling largely because of how much they cost — the public Medicaid program no longer pays for it in more than a dozen states.
In Europe, there is far less consensus on the medical benefits of the removal of a piece of skin filled with nerve endings.
“The medical harms or benefits have not been unequivocally proven,” the British Medical Association says in its guidance for doctors. “It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child.”
The main principle of surgery is that no operation should be undertaken if there is no disease and the risk of the procedure cannot be justified without the risk of a disease, Australian general surgeon John Hutson said in a symposium on circumcision in the Journal of Medical Ethics.
“The surgical argument for circumcision of all neonatal males at present is very weak,” he said. “And with rising public health standards in the developed world, is likely to remain weak.”