In Australia, reports by the Australian Institute of Health and Welfare
in 2004 and 2009 found substantial improvements in child health in the 20 years from 1983 to 2003. This was the very period during which circumcision all but disappeared, falling from around 40% of boys in the early 1980s to less than 10% in the mid-1990s. If circumcision was as essential to health as its promoters claim, you would expect to find evidence of worsening child health in these surveys. In fact, the opposite occurred: as circumcision declined, child health improved.
To take another example, a report by the Organisation for Economic Cooperation and Development
in 2009 on child health outcomes found that on many measures the United States scored so badly that it was on a par with Turkey and Mexico. Since circumcision is almost universal in Turkey, rare in Mexico, and in the United States is still imposed on about 50% of boys, it is plainly irrelevant to child health outcomes. The countries that scored best were northern Europe and Japan, where circumcision is practically unknown.
These studies did not specifically cover the particular diseases that circumcision is supposed to prevent. But a recent article in Annals of Family Medicine
subjected the claims of the circumcision lobby to an exhaustive review, and concluded that its value for child health is close to zero.
When the literature is considered as a whole (rather than cherry picked for papers supporting a particular thesis) there is no proof that circumcision provides any significant protection against urinary tract infections, sexually transmitted infections or cancer of the penis.
The only evidence for prophylactic efficacy was African data suggesting that adult males who got circumcised had a slightly lower risk of contracting HIV through unprotected intercourse with an infected female partner. But as the authors of the paper comment, Africa has unique health problems. Since the circumcision trials were on adult men the results cannot be applied to children, nor can the World Health Organisation recommendations for the underdeveloped world be transposed to developed countries. In Australia, unlike Africa, AIDS is not a heterosexual epidemic, but a relatively rare disease confined to specific sub-cultures – homosexual men and injecting drug users. These groups can derive no protection from circumcision at all. In any case, because it is a disease of promiscuous adults, children are not at any risk of infection with HIV or any other STIs – unless, of course, by surgery. When they become sexually active boys are old enough to understand the issues and make their own decisions about how to manage the risks of sexual activity with others.
The Australian Federation of AIDS Organisations
has stated that circumcision has no relevance to Australia's HIV problem, and their conclusion has been endorsed by a paper in the Australian and New Zealand Journal of Public Health
, which argues that circumcision is not a surgical vaccine and is not appropriate as an HIV control tactic in Australia.
Nonetheless, task forces set up by medical authorities
in countries where routine circumcision became established (Britain, the USA, Australia and Canada) have attempted to sift through the piles of mullock and reach an overall conclusion as to whether it is good, bad or indifferent. They have all concluded that that circumcision as a precaution is ethically questionable and medically unnecessary, and that it should not be performed unless there is an injury, deformity or disease that cannot be treated in any other way.
The most recent statement from the British Medical Association
"There is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research. …
"Doctors should ensure that any parents seeking circumcision for their son in the belief that it confers health benefits are fully informed of the lack of consensus amongst the profession over such benefits, and how great any potential benefits and harms are. The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it."
The current policy (October 2010) of the Royal Australasian College of Physicians states
"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."
Summing up the pros and cons of circumcision, the statement continues: "The decision to circumcise or not to circumcise involves weighing up potential harms and potential benefits. The potential benefits include connectedness for particular socio-cultural groups and decreased risk of some diseases. The potential harms include contravention of individual rights, loss of choice, loss of function, procedural and psychological complications."
Since the harms appear to outweigh the potential benefits, and many adult men resent having been circumcised
, it follows that the only person entitled to make the decision is the one who must bear the lifelong consequences. The statement agrees with the Royal Dutch Medical Association
that leaving the circumcision decision to be made by the boy when he is old enough to make an informed choice has the merit of respecting individual autonomy, preserving everybody's options and respecting the "open future" principle
Their bottom line is that (routine) preventive circumcision of minors offers no significant health benefit, carries significant risks, has an adverse effect on sexual sensation, is an affront to personal autonomy, is a violation of the right to bodily integrity, and should not be performed.