CIRCUMCISION

Circumcision, or removal of the foreskin, is an operation of great antiquity. As a magical or initiation rite it was introduced independently by aboriginal tribes in Australia, Africa and the Americas. Circumcision was practised by the Egyptians of 3,000 B.C., at first as a privilege of the nobility, but it later became the custom for all males. Presumably what started as a religious rite was found to be a useful hygienic measure in a hot climate. The Jews learned from the Egyptians and incorporated ritual circumcision into their religion and later the Moslem faith adopted the same custom. In more recent history there are records of the operation being performed for abnormalities of the foreskin which interfered with passing water or sexual intercourse.

What is the status of circumcision at the present day? Although it may originally have been a non-medical rite it is now a standard surgical operation which, rightly or wrongly, is performed to prevent or cure certain genital troubles. One would have thought that after performing the operation for several thousand years there would now be general agreement about the merits of circumcision. Most doctors agree about circumcision to cure certain diseases of the foreskin but there is a sharp division of opinion about the advisability of routine circumcision of the newborn as a preventative measure. Preventative medicine always seems to be controversial whether it be circumcision, immunization or fluoridation but in this instance doctors who usually show a strictly scientific approach to the prevention and treatment of disease seem to attach an importance to the preservation of the foreskin which they do not accord to other parts of the body. Consequently one sees articles in the medical and lay press which discuss the topic in highly emotional terms with selected facts presented so as to confirm the pro or anti-circumcision views of the writer. My aim in this booklet is to present the available information in an unemotional way so that in a situation where doctors differ you can make up your own mind whether to have yourself and/or your sons circumcised.

The current policy in the United Kingdom was established in 1949 by Gairdner's paper 'The Fate of the Foreskin' in which he stated that many infants had anatomically unnecessary circumcisions and the operation caused at least 16 deaths a year. He concluded that the hazard to life outweighed any possible advantages from the operation. Since then, within the N.H.S., circumcision has only been done for a narrow range of indications and routine operation at birth is strongly discouraged. At the same time as Gairdner published his article doctors in the rest of the English-speaking world were encouraging circumcision at birth as a safe and beneficial procedure. The explanation of these conflicting views is that the deaths in Gairdner's series were due to anaesthesia and not the operation itself, while the other reports concerned newborn babies circumcised without anaesthesia.

Millions of circumcisions in the U.S.A. and elsewhere in the last quarter century have confirmed that operation without anaesthesia soon after birth is devoid of serious complications. The advent of an anaesthetic agent called 'Ketalar' has taken away the risks of general anaesthesia in infants and young children if circumcision is not done at birth.