Non-therapeutic Male Circumcision Research Articles

Commentary on "Circumcision".

This commentary draws upon the author's experience in bioethics and as a physician, ordained Rabbi, and certified Mohel (a Jewish professional qualified to perform infant male circumcisions (MC)). People's identity and adherence to a religious belief are frequently cited reasons for deciding whether to circumcise their male children. For Jewish and Muslim males, circumcision is considered essential. In this commentary, the author uses his medical, religious, and bioethical knowledge, expertise, and experience to address common arguments used in opposing nontherapeutic male circumcision of minors. In these narratives, half of the parents agreed with circumcision, and half did not. The parents against circumcision cite human rights violations, security, privacy, and bodily integrity issues and refer to circumcision as genital mutilation, while those who agree argue that circumcision should be done for religious reasons to prevent health issues, promote hygiene and cleanness, avoid cancer, or for later sexual enjoyment. After evaluating the evidence, the author states that parents should be free to either consent or decline MC for a son. Though a reoccurring theme in these narratives was for mothers to leave the circumcision decision up to their male partners, the author concludes that women have considerable power regarding the decision.

Helping midwives support families who require non-therapeutic infant male circumcision

In the UK, the majority of non-therapeutic infant male circumcisions for religious or cultural reasons are performed by private providers in community settings. There have been reports of unsafe practices by some unregulated private providers. The implementation of a voluntary quality assurance process in one region in northwest England has been associated with a decrease in paediatric surgical admissions of infant boys admitted following complications of circumcision in the community. Voluntary quality assurance is a feasible option to implement quality improvement for services outside clinical governance systems. The quality assurance process provides a valuable resource for midwives to signpost families to safely practising providers, potentially reducing the risk of harm to children resulting from families using unqualified providers and safeguarding infant boys from harm becuase of poor practice.

Non-therapeutic male circumcision in infancy or childhood and risk of human immunodeficiency virus and other sexually transmitted infections: national cohort study in Denmark

Whether male circumcision in infancy or childhood provides protection against the acquisition of human immunodeficiency virus (HIV) or other sexually transmitted infections (STIs) in adulthood remains to be established. In the first national cohort study to address this issue, we identified 810,719 non-Muslim males born in Denmark between 1977 and 2003 and followed them over the age span 0–36 years between 1977 and 2013. We obtained information about cohort members’ non-therapeutic circumcisions, HIV diagnoses and other STI outcomes from national health registers and used Cox proportional hazards regression analyses to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) associated with foreskin status (i.e., circumcised v. genitally intact). During a mean of 22 years of follow-up, amounting to a total observation period of 17.7 million person-years, 3375 cohort members (0.42%) underwent non-therapeutic circumcision, and 8531 (1.05%) received hospital care for HIV or other STIs. Compared with genitally intact males, rates among circumcised males were not statistically significantly reduced for any specific STI. Indeed, circumcised males had a 53% higher rate of STIs overall (HR = 1.53, 95% CI: 1.24–1.89), and rates were statistically significantly increased for anogenital warts (74 cases in circumcised males v. 7151 cases in intact males, HR = 1.51; 95% CI: 1.20–1.90) and syphilis (four cases in circumcised males v. 197 cases in intact males, HR = 3.32; 95% CI: 1.23–8.95). In this national cohort study spanning more than three decades of observation, non-therapeutic circumcision in infancy or childhood did not appear to provide protection against HIV or other STIs in males up to the age of 36 years. Rather, non-therapeutic circumcision was associated with higher STI rates overall, particularly for anogenital warts and syphilis.

Non-therapeutic male circumcision

Abstract Recent guidance on nontherapeutic male circumcision (NTMC) from the UK focuses on ethical and legal issues, addressing in particular religious NTMC. The guidance is generally negative, especially regarding NTMC of minors. This contrasts to guidance provided in other countries where a wider range of literature has been reviewed. There is strong medical data showing that NTMC protects against urinary tract and sexually transmitted infections, dermatological problems, and genital cancers. A risk-benefit analysis of infant NTMC for the UK shows that benefits exceed risks by 200 to one, and that more than half of uncircumcised males may experience a foreskin-related adverse medical condition over their lifetime. Infancy presents a window of opportunity for NTMC, because the procedure is simpler, adverse event risk is low, convenience, quicker healing, good cosmetic outcome, lower costs, and provides immediate and lifelong benefits. This article reviews the evidence for possible benefit and offers a global perspective on NTMC which may be helpful in considering the merits and demerits of NTMC by families.

Gender and cultural understandings in medical nonindicated interventions: A critical discussion of attitudes toward nontherapeutic male circumcision and hymen (re)construction

Hymen (re)construction and nontherapeutic male circumcision are medical nonindicated interventions that give rise to specific ethical concerns. In Europe, hymen (re)construction is generally more contested among medical professionals than male circumcision. Yet, from a standard biomedical framework, guided by the principles of autonomy, beneficence, nonmaleficence, and justice, circumcision of boys is, as this article explains, more problematic than hymen (re-) construction. While there is a growing debate on the acceptability of infant circumcision, in the case of competent minors and adults the surgery is not questioned. In the case of hymenoplasty, usually requested by a competent patient, it is recommended to only perform the operation after extensive counseling and if there are compelling conditions. The article further explores why attitudes of medical professionals toward both surgeries diverge and seeks to explain how this is largely informed by gendered and socio-cultural understandings. The article further raises critical questions on medical paternalism and the role of counseling.

From sameness to difference: Swedish Somalis’ post-migration perceptions of the circumcision of girls and boys

In every society where non-therapeutic female circumcision (FC) occurs, so too does non-therapeutic male circumcision (MC). In the past few decades, the norm in Euro-American societies has been to distinguish between the practices: FC is banned, while MC is condoned or encouraged. We explored Somalis’ post-migration perceptions of FC and MC, while considering that they once lived in a society where both practices were widely accepted and now live in a society where there is a legal ban on FC alongside acceptance of MC. Eighteen individual interviews and seven focus group discussions were conducted with Somali men and women in three Swedish cities. There seemed to be a continuity of values across male and female forms of genital cutting concerning being a good Muslim, not inflicting harm and upholding respectability. Following migration, however, a renegotiation of how these values relate to MC and FC resulted in a conceptual split between the two: MC was perceived as an unquestionably required practice, but FC was viewed as a practice that can be adapted or abandoned. In a new cultural context after migration, perceptions of ideal male and female genitals, and what kinds of inscriptions on the body are desired, seem to have changed.

The Ethics of Non-Therapeutic Male Circumcision Under Islamic Law

Abstract This qualitative research is a philosophical review about analyzing how circumcision can (cannot) be morally justified. It is typically assumed among Muslims that circumcision is mandatory according to Islamic law (Sharia). However, in this paper, I will argue that this is not clear in Islamic texts. Because firstly there is no textual evidence in the Quran about this matter and secondly permissibility of circumcision is not an agreed topic among Muslim scholars. This entails that circumcision is not a necessary part of being a Muslim. Although this idea seems idiosyncratic according to the majority of Muslims, I’m inclined to emphasize that we should not marginalize this idea, rather we have to support it for educational prosperity in Muslim communities. But perhaps more importantly this paper helps to introduce new Muslim intellectuals’ argument that moral reasoning is independent from (and even superior to) Islamic law. Since we do not have ultimate and decisive secular reason (e.g., medical reason) against male circumcision in every occasion, therefore, morally speaking, I believe it is not reasonable to say that male circumcision is always wrong. Muslims who support male circumcision still can find some secular reasons to defend this from their cultural identity. Abstrak Penelitian kualitatif ini merupakan tinjauan filosofis yang bertujuan menganalisis bagaimana sunat dapat atau tidak dapat dibenarkan secara moral. Ummat Muslim beranggapan bahwa hukum sunat adalah wajib menurut hukum Islam (Syariah). Akan tetapi, dalam tulisan ini, saya akan berargumen bahwa belum ada penjabaran yang pasti perihal asal hukum wajib pada sunat ini dalam Islam. Argumen ini memiliki dua alasan. Alasan pertama adalah tidak ada bukti tertulis dalam Al Qur'an tentang asal hukum wajib sunat ini dan alasan kedua adalah pembolehan sunat bukanlah topik yang disepakati di antara para cendikia Muslim. Atas dasar tersebut, keadaan yang mensyaratkan seseorang untuk sunat bukanlah hal yang wajib untuk menjadi seorang Muslim. Meskipun gagasan ini tampaknya idiosynkratik menurut mayoritas umat Muslim, saya menekankan bahwa kita tidak boleh menyisihkan gagasan ini, tetapi kita harus mendukungnya untuk kemakmuran pendidikan di komunitas Muslim. Kendati demikian mungkin yang lebih penting lagi bahwa tulisan ini membantu untuk memperkenalkan argumen intelektual Muslim yang baru bahwa penalaran moral adalah independen dari (dan bahkan lebih tinggi dari) hukum Islam. Karena kita tidak memiliki alasan kuat dan alasan sekuler (seperti alasan medis) terhadap sunat pada laki-laki didalam setiap keadaan. Kendati demikian, secara moral, saya percaya bahwa tidak beralasan untuk mengatakan bahwa sunat laki-laki itu selalu salah. Muslim yang mendukung sunat pada laki-laki masih dapat dilakukan dengan menemukan beberapa alasan sekuler untuk mempertahankan kegiatan sunat dari identitas budaya ummat muslim. How to Cite : Dabbagh, H. (2017). The Ethics Of Non-Therapeutic Male Circumcision Under Islamic Law: A Lesson For Educational Prosperity In Muslim Communities . TARBIYA: Journal of Education in Muslim Society, 4(2), 216-223. doi:10.15408/tjems.v4i2.6017. Permalink/DOI: http://dx.doi.org/10.15408/tjems.v4i2.6017

Health-Related and Sexual Consequences of Non-Therapeutic Male Circumcision in Childhood

Health-Related and Sexual Consequences of Non-Therapeutic Male Circumcision in Childhood

Long-term adverse outcomes from neonatal circumcision reported in a survey of 1,008 men: an overview of health and human rights implications

ABSTRACTAmid growing bioethical and human rights concerns over non-therapeutic infant male circumcision, calls have been made to investigate long-term impacts on the men these infants eventually become. The present inquiry attempts to identify factors contributing to concerns of men claiming dissatisfaction with or ascribing harm from neonatal circumcision. This large sample size survey involved an online questionnaire with opportunities to upload photographic evidence. Respondents revealed wide-ranging unhealthy outcomes attributed to newborn circumcision. Survey results establish the existence of a considerable subset of circumcised men adversely affected by their circumcisions that warrants further controlled study. Empirical investigations alone, however, may be insufficient to definitively identify long-term effects of infant circumcision. As with non-therapeutic genital modifications of non-consenting female and intersex minors, responses are highly individualistic and cannot be predicted at the time they are imposed on children. Findings highlight important health and human rights implications resulting from infringements on the bodily integrity and future autonomy rights of boys, which may aid health care and human rights professionals in understanding this emerging vanguard of men who report suffering from circumcision. We recommend further research avenues, offer solutions to assist affected men, and suggest responses to reduce the future incidence of this problem.

Non-therapeutic infant male circumcision. Evidence, ethics, and international law perspectives.

Objectives:To review the evidence of the benefits and harms of infant male circumcision, and the legal and ethical perspectives of infant male circumcision.Methods:We conducted a systematic search of the literature using PubMed, EMBASE, and the Cochrane library up to June 2015. We searched the medical law literature using the Westlaw and Lexis Library law literature resources up to June 2015.Results:Male circumcision significantly reduced the risk of urinary tract infections by 87%. It also significantly reduced transmission of human immunodeficiency virus among circumcised men by 70%. Childhood and adolescent circumcision is associated with a 66% reduction in the risk of penile cancer. Circumcision was associated with 43% reduction of human papilloma virus infection, and 58% reduction in the risk of cervical cancer among women with circumcised partners compared with women with uncircumcised partners. Male infant circumcision reduced the risk of foreskin inflammation by 68%.Conclusion:Infant male circumcision should continue to be allowed all over the world, as long as it is approved by both parents, and performed in facilities that can provide appropriate sterilization, wound care, and anesthesia. Under these conditions, the benefits of infant male circumcision outweigh the rare and generally minor potential harms of the procedure.

In defence of genital autonomy for children

Arora and Jacobs (2016) assume that liberal societies should tolerate non-therapeutic infant male circumcision, and argue that it follows from this that they should similarly tolerate—or even encourage—what the authors...

Between Moral Relativism and Moral Hypocrisy: Reframing the Debate on "FGM".

The spectrum of practices termed "Female Genital Mutilation" (or FGM) by the World Health Organization is sometimes held up as a counterexample to moral relativism. Those who advance this line of thought suggest the practices are so harmful in terms of their physical and emotional consequences, as well as so problematic in terms of their sexist or oppressive implications, that they provide sufficient, rational grounds for the assertion of a universal moral claim--namely, that all forms of FGM are wrong, regardless of the cultural context. However, others point to cultural bias and moral double standards on the part of those who espouse this argument, and have begun to question the received interpretation of the relevant empirical data on FGM as well. In this article I assess the merits of these competing perspectives. I argue that each of them involves valid moral concerns that should be taken seriously in order to move the discussion forward. In doing so, I draw on the biomedical "enhancement" literature in order to develop a novel ethical framework for evaluating FGM (and related interventions--such as female genital "cosmetic" surgery and nontherapeutic male circumcision) that takes into account the genuine harms that are at stake in these procedures, but which does not suffer from being based on cultural or moral double standards.

Circumcision of Infants and Children: Short-Term Trauma and Long-Term Psychosexual Harm

Non-therapeutic infant male circumcision is a permanent surgical alteration to the penis that may cause significant physical, sexual and psychological harm. Physical harms include unintended adverse effects of the surgery itself (e.g., complications such as bleeding, infection, excessive removal of foreskin leaving insufficient shaft skin to accommodate erections, etc.), as well as the inherent loss of healthy, functional tissue. Sexual harms that necessarily follow from circumcision include the loss of all sensation in the foreskin itself, and the loss of all sexual functions that involve the physical manipulation of the foreskin. Additional sexual harms that may follow circumcision include reduced sexual sensation in the remaining penile structures, difficulty with masturbation, increased chafing in both the circumcised man and his sexual partner, as well as reduced overall psychosexual/psychological tension relief and subjective satisfaction. Psychological harms include short-term trauma as well as the potential for long-term emotional disturbances, including sadness, frustration, distress, and anger—akin to post-traumatic stress disorder (PTSD). In this paper, the extent and severity of these various harms are considered and it is argued that they are more serious and more widespread than is commonly believed.

Can Culture Justify Infant Circumcision?

The paper addresses arguments in the recent philosophical and bioethical literature claiming that social and cultural benefits can justify non-therapeutic male infant circumcision. It rejects these claims by referring to the open future argument, according to which infant circumcision is morally unjustifiable because it violates the child’s right to an open future. The paper also addresses an important objection to the open future argument and examines the strength of the objection to refute the application of the argument to the circumcision case.

Non-therapeutic male circumcision performed on immigrant children from Africa in Spain

To study the frequency, characteristics, and complications of non-therapeutic male circumcision on immigrant children from Africa in Spain. This descriptive study focused on primary care consultations conducted at 21 Aragon health centres during 2010 and 2011. The data were gathered through interviewer-administered questionnaires to the parents of African children. Sociodemographic variables were studied, along with others related to the practice of circumcision. 283 questionnaires were obtained. 98.93 % of the children had undergone or were planning to undergo circumcision. 68.2 % were circumcised. Circumcisions were most frequently performed during a vacation to the country of origin (67.04 %), especially so for the Maghreb population. The remaining circumcisions had been performed in Spain. Half of the circumcisions practiced in Spain were performed at home, and 84 % of these were performed on Gambian children. The current study demonstrates that, in Aragon, Spain, almost all immigrant children from Africa have been or will be circumcised and that a considerable proportion has been circumcised at home by unqualified individuals. Gambians are particularly at risk of performing unsafe circumcision.

Implementation of a quality assurance process for non-therapeutic infant male circumcision providers in North West England

Infant male circumcision is practised by many groups for religious and cultural reasons. Prompted by a desire to minimize the complication rate and to help parents identify good quality providers, a quality assurance (QA) process for infant male circumcision providers has been developed in Greater Manchester. Local stakeholders agreed a set of minimum standards, and providers were invited to submit evidence of their practice in relation to these standards. In participation with parents, community groups, faith groups, healthcare staff and safeguarding partners, an information leaflet for parents was produced. Engagement work with local community groups, faith groups, providers and healthcare staff was vital to ensure that the resources are accessible to parents and that providers continue to engage in the process. Providers that met the QA standards have been listed on a local website. Details of the website are included in the information leaflet distributed by maternity services, health visitors, primary care and community and faith groups. The leaflet is available in seven languages. Local QA processes can be used to encourage and identify good practice and to support parents who need to access services outside the remit of the National Health Service.

Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision

The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non-US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.

Cultural Bias and Circumcision: The AAP Task Force on Circumcision Responds

The members of the American Academy of Pediatrics (AAP) Task Force on Circumcision appreciate the opportunity to respond to the concerns raised by Frisch et al in their commentary, “Cultural Bias in AAP’s 2012 Technical Report and Policy Statement on Male Circumcision.” The central claim of these authors is that the conclusions of the task force report are culturally biased, leading the task force to a flawed understanding of what constitutes trustworthy evidence and to conclusions that are far from those reached by physicians in most other Western countries. The “obvious” cultural bias to which they refer apparently has its genesis in “the normality of non-therapeutic male circumcision in the US.” All of the commentary authors hail from Europe, where the vast majority of men are uncircumcised and the cultural norm clearly favors the uncircumcised penis. In contrast, approximately half of US males are circumcised, and half are not.1 Although that heterogeneity may lead to a more tolerant view toward circumcision in the United States than in Europe, the cultural “bias” in the United States is much more likely to be a neutral one than that found in Europe, where there is a clear bias against circumcision. Yet, the commentary’s authors have, at no point, recognized that their own cultural bias may exist in equal, if not greater, measure than any cultural bias that might exist among the members of the AAP Task Force on Circumcision. If cultural bias influences the review of available evidence, then a culture that is comfortable with both the circumcised penis and the uncircumcised penis would seem predisposed to a more dispassionate analysis of the scientific literature than a culture with a bias that is either strongly opposed to circumcision or strongly in favor of it. The task force’s process was systematic, objective, comprehensive, … Address correspondence to Douglas S. Diekema, MD, MPH, Seattle Children’s Research Institute, C9S-6, 1900 Ninth Ave, Seattle, WA 98101. E-mail: diek{at}u.washington.edu

Safety and Efficacy of Nontherapeutic Male Circumcision: A Systematic Review

We wanted to assess the safety and efficacy of nontherapeutic male circumcision through a systematic review of the literature. We systematically searched The York Centre for Reviews and Disseminations, Cochrane Library, PubMed, and EMBASE databases for randomized controlled trials published between January 1997 and August 2008. Studies reporting on circumcision in an operative setting in males of any age with no contraindications to or medical indications for circumcision were eligible for inclusion. The main comparator was intact genitalia. From 73 retrieved studies, 8 randomized controlled trials were ultimately included for analysis. Severe complications were uncommon. Analgesia/anesthesia during circumcision was promoted. The prevalence of self-reported genital ulcers was significantly lower in circumcised men than uncircumcised men (3.1% vs 5.8%; prevalence risk ratio 0.53; 95% confidence interval [CI], 0.43-0.64; P<.001). Circumcised sub-Saharan African men were at significantly lower risk of acquiring human immunodeficiency virus/acquired immune deficiency syndrome than were uncircumcised men (random effects odds ratio = 0.44, 95% CI, 0.32-0.59; P <.001). The evidence suggests that adult circumcision does not affect sexual satisfaction and function. Strong evidence suggests circumcision can prevent human immunodeficiency virus/acquired immune deficiency syndrome acquisition in sub-Saharan African men. These findings remain uncertain in men residing in other countries. The role of adult nontherapeutic male circumcision in preventing sexually transmitted infections, urinary tract infections, and penile cancer remains unclear. Current evidence fails to recommend widespread neonatal circumcision for these purposes.

Comment 1: Dual parental consent

Comment on doi 10.1308/003588409X359394 R Robinson, E Makin, R Wheeler. Consent for non-therapeutic male circumcision on non-religious grounds. Ann R Coll Surg Engl 2009; 91: 152–4