HEALTH: Apr 05, AU Edition

The circumcision debate has reignited, with a Melbourne doctor calling the controversial cut a lifesaver. But is it really?
What do you call the useless bit of skin at the end of a penis? The man. Sorry, that just popped out. And while it may be funny, it’s also just as inaccurate an answer as any, since the human foreskin is actually not particularly useless; it protects the penis underneath.
It also harbours the Human Papilloma Virus, which causes penile and cervical cancer. Oh yeah, and it is also said to facilitate the transmission of HIV.
On second thought, it’s worse than useless – it’s an absolute death trap! Off with their…anyway.
Somewhere between 80 and 90 per cent of Australian boys are, like my own two sons, uncircumcised. The Royal Australasian College of Physicians sees no reason to support routine newborn circumcision, so it is not regularly performed in Australia or New Zealand except for religious or medical reasons.
Ah, but wait. The aptly-named Professor Roger Short of Melbourne University and the Royal Women’s Hospital’s obstetrics department, has recently suggested that we reconsider our attitudes. Short’s research has shown that because the HIV virus enters the body via the foreskin, circumcised men have 7 times less chance of contracting HIV than uncircumcised men.

The Human Papilloma Virus, or HPV (a nasty little bug that causes cervical cancer in women and the much rarer penile cancer in men), also lives under the foreskin, so women with an uncircumcised partner have twice the risk of developing cervical cancer.
This research is actually in line with previous research on the subject, so I’m going to go along with the man and presume he’s correct in his research findings. It’s the conclusions that follow on from these findings that I have trouble with. Let’s walk through this: you live in a western democracy which has soap, running water and condoms widely available. Rates of HIV are low in your community. The spread of both HIV and HPV viruses can be nearly entirely stopped by the use of the aforementioned condoms. So you conclude that to prevent your tiny baby from ever contracting HIV or HPV, you should go messing about with his penis.
I’m not saying the science is faulty: I’m saying that if my boys can’t think of a better way to avoid contracting HIV than surgery, then we have a whole other set of problems on our hands.
The value in Prof. Short’s research mayfc be found in countries with endemic HIV. Encouraging routine circumcision of newborns in countries which already support the practise may have implications for reducing the spread of AIDS in conjunction with public health teaching about safer sex practices. (Less happily, it may also fuel the belief that condoms aren’t necessary). Unfortunately, countries with high HIV rates don’t tend to have large clean modern obstetric units or much in the way of local anaesthetics and sterile equipment, so one would have to assume that the complication rates of circumcision would be higher than in Western countries.
Of course, there are other reasons for circumcision, religion being chief among them. Jewish and Muslim babies are circumcised in the first week or so of life, rapidly (as one would hope), and generally with local anaesthesia.
That’s all very well and good, but my bigger concern is with the pursuit of circumcision for “socio-cultural reasons” (“so that the boy matches his dad” is a surprisingly common justification). Parents wishing their child to be circumcised for these sorts of aesthetic reasons are advised to wait until the child is