Brexit. Gun control. Who’s better out of Cristiano Ronaldo or Lionel Messi?
Some arguments are doomed to rage for eternity with supporters on both sides refusing to give an inch.
That’s definitely the case with male circumcision, a subject that ignites a tinderbox full of hot-button issues.
Religion, sex, medicine, and human rights all jostle for attention within this controversial subject that continues to divide medical opinion.
But it didn’t used to be this way. Most men who were born before 1980 in Australia were routinely circumcised. Gradually, however, the popularity of the procedure has plummeted.
By 2018, Professor Paul Colditz, President of the Royal Australasian College of Physicians paediatrics and child health division, estimated that only four per cent of newborn males were currently circumcised.
What does it involve?
Circumcision is the removal of a simple fold of skin commonly known as the foreskin that covers the head of the flaccid penis. It is an extremely common procedure.
In a 2010 report, the World Health Organisation estimated that one in three males worldwide were circumcised. The report also showed that most still undergo the procedure for religious reasons with Muslim and Jewish men accounting for almost 70 per cent of cases worldwide.
The purpose of the foreskin
The biological purpose of the foreskin is debated. Some believe that it originally evolved to protect the head of the penis back in the early days of man when we all wandered about stark naked.
Viewed from this perspective, the foreskin’s role is now redundant given that public nudity is largely frowned upon and underpants have really caught on.
Yet others argue the foreskin still plays an important role for infants. In the early years of life when a child is not yet toilet-trained, the foreskin completely covers the head of the penis, thereby helping to avoid infection by protecting it from coming into contact with the contents of a dirty nappy.
Already the fault-lines are being drawn on this loaded issue in which the results of practically every study are loudly debated.
The arguments for circumcision
Circumcision prevents the spread of HPV and certain cancers
HPV is a common virus that is transmitted through sexual contact. According to the Centres for Disease Control and Prevention, 90 per cent of HPV infections go away on their own within two years.
But HPV can also cause a range of cancers including cervical, genital, head, neck and throat.
“High-quality studies have established unequivocally that male circumcision protects against cancer-causing HPV genotypes in men,” says Professor Emeritus Brian Morris from the School of Medical Sciences and Bosch Institute, at the University of Sydney.
He also point out that studies show that female partners of uncircumcised men have a 5.6-fold higher risk of cervical cancer than women with circumcised partners. In addition Professor Morris says, “Penile cancer is confined almost exclusively to uncircumcised men.”
Circumcision lessens the spread of STIs
A range of studies also show that male circumcision helps protect against HIV infection with circumcised males between two to eight times less likely to contract the virus.
In fact, circumcision is shown to lessen your chances of catching a host of sexually transmitted infections, ranging from syphilis to gonorrhoea. One theory to explain this is that the foreskin offers a greater available surface area and therefore more cells that are susceptible to infection.
Circumcised men get fewer UTIs
Urinary tract infections are relatively common in small children. One study showed that up to the age of five, six per cent of boys in Sydney had experienced one.
But an Australian meta-analysis of published data on the effects of circumcision suggests the procedure could help, concluding that “circumcision was associated with a significantly reduced risk of UTI”.
Women may prefer it
Another circumcision study involving Professor Morris suggests that women may also prefer men who’ve made the cut. “Recent systematic reviews have found an overwhelming preference by women for a circumcised male partner because of hygiene, appearance, sexual pleasure and disease prevention,” Professor Morris says.
The arguments against circumcision
"It's an unnecessary procedure"
The aforementioned studies appear to present an overwhelming case for the benefits of circumcision. What confuses the issue is that many respected medical bodies counter this by maintaining that it’s an unnecessary procedure.
The Royal Australasian College of Physicians (RACP), the Royal Australasian College of Surgeons, the Urological Society of Australia and New Zealand and state health departments have all concluded the risks of circumcision performed for non-medical reasons outweigh the potential benefits.
The RACP released a position statement on the issue: “After reviewing the currently available evidence, the RACP believes that 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.”
The RACP, for example, concedes that circumcision virtually eliminates the risk of developing penile cancer. But they also point this rare condition only affects one in 250,000 Australian men.
Things can (occasionally) go wrong
Circumcision isn’t a complex procedure but, as with any form of medical intervention, things can still go wrong. One US study that reviewed more than 6000 circumcisions in Utah found the rate of complications was much higher than expected at 11.5 per cent.
Problems can range from blood infections to surgical mishaps. But on rare occasions, the complications prove more serious. A 2010 study estimated that each year in America there will be 117 neo-natal deaths related to circumcision. “Because infant circumcision is elective, all of these deaths are avoidable,” concluded study author, Dan Bollinger.
Cutting off a piece of skin from one of an areas of the male anatomy densely packed with nerves is a painful experience that requires the use of anaesthetics. In addition, the procedure is typically carried out on small babies who are not the most physically robust.
The vast majority of circumcisions do proceed smoothly. But even then, some parents will question whether they really want to put their baby through the procedure and subsequent recovery.
Circumcision may reduce pleasure
The wrinkly skin at the end of the foreskin is packed with nerve endings that are stimulated during sexual activity. Some believe that circumcised men may therefore miss out on extra sensitivity.
A 2007 study that measured response to light touch found that "the glans [or the head] of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis". In addition, a Belgian study found that circumcised men report less intense sexual pleasure and orgasm.
Yet these results were challenged by a 2016 study published in the Journal of Urology that found circumcision did not reduce penile sensitivity. As with practically everything in the wildly contentious issue, the debate rages on and on.
Should you get your son circumcised?
Ultimately, the issue of circumcision boils down to making a personal decision on behalf of your son.
To help you navigate the process, ask your GP or paediatrician to talk you through the potential benefits and risks in order to make a properly informed call on whether or not to make the cut.