Risks of circumcision Further information For 1 in 500 circumcisions there may be either a little may be obtained from the following web sites. bleeding• – easily stopped by pressure or, less commonly, http://www.circinfo.net requiring stitches (1 in 1000), the need for repeat surgery http://www.gilgalsoc.org Circumcision: (1 in 1000), or a generalized infection that will require http://www.medicirc.org antibiotics (1 in 4000). Although there can be a local http://www.aboutcirc.info infection, often what seems like a local infection is actually http://www.circumcision.com.au A guide part of the normal healing process. http://www.circumcisioninfo.com Serious complications (requiring hospitalization) are rare • The author wishes to thank the various international medical for parents – approximately 1 in 5000. experts who helped in formulation of this Guide. Mutilation or loss of the penis, and death, is virtually by Professor Brian Morris unheard• of with circumcisions performed by a competent Copyright clearance is hereby given for this Guide to medical practitioner. Ensure your doctor is experienced. be reproduced unchanged and in its entirety for free distribution. If a bleeding disorder such as haemophilia runs in the family,• then the doctor needs to be advised as circumcision may require special preoperative treatment. Brian Morris Anaesthetic is imperative, preferably a local, since a is a Professor in the School of Medical Sciences at the general• anaesthetic carries risks, and is unnecessary. For , where he has taught medicine and age 0-4 months a local, not general, and for older children or science students since 1978. teenagers a mild sedative might be considered in addition After graduating from the , he to the local. Young children who wriggle can be gently conducted research for doctoral studies in the departments restrained. For pain after the anaesthetic wears off , an oral of medicine of the and Monash analgaesic medication is often prescribed. University, at the Austin and Prince Henry hospitals, Delay means stitches being used for circumcision of respectively, from 1972. This was followed in 1975 by older• children, teenagers and men. further reasearch as a C J Martin Fellow of the National Health & Medical Research Council of , in • So if circumcision is delayed past 4 months, total cost will the School of Medicine of the University of Missouri in become increasingly greater. Columbia, and the University of California in San Francisco. In 1993 he was awarded a DSc based on his published work, In conclusion which currently extends to over 230 research articles on molecular biology and genetics, hypertension, and cervical Circumcision confers a lifetime of medical benefi ts. 1 in 3 screening. It is the latter topic that fostered his interest in uncircumcised boys will develop a condition requiring medical circumcision. attention. This means various degrees of suff ering and, in rare cases, death. In contrast, risk of an easily-treatable condition He is not aligned with any religious, political, medical is 1 in 500, and of a true complication is 1 in 5000. A successful or other group that may have any infl uence on the circumcision is very unlikely to have any long-term adverse topic of circumcision. The views he expresses arise from ircumcision is a simple surgical procedure that consequences. independent research published in medical jounals. removes the foreskin – a sleeve of skin covering Cthe tip of the penis. Parents have the legal right to authorize circumcision. In order to make an informed Thus, benefi ts exceed ©2006 Brian Morris & decision, they must carefully consider the benefi ts and risks. The Gilgal Society Since the foreskin traps bacteria and other infectious moderate risks by over Published in England by agents, as well as accumulating malodorous smegma, The Gilgal Society its removal improves genital hygiene and reduces risk of a hundred to one! PO Box 53515 diseases and other conditions over the lifetime for the boy

London SE19 2TX 0604-1 GFP-EN and his future sexual partners. Uncircumcised penis Section through an Uncircumcised penis with foreskin retracted Circumcised penis with foreskin intact uncircumcised penis From above From below From above From the side

Coronal sulcus Shaft

Urethra Coronal rim Frenulum*

Frenulum Glans Glans

Foreskin Foreskin Urethral opening Urethral opening Preputial or Meatus or Meatus opening * The frenulum may or may not be removed by a circumcision

History Circumcision has been performed for thousands of Over 10-fold decrease in risk of urinary tract infection. Circumcision also aff ords substantial protection against years as part of the culture of indigenous people who Whereas• risk of this is only 1 in 500 for a circumcised sexually• transmitted infections such as papilloma (wart) live in hot environments such as in Australia, the Pacifi c boy; 1 in 50 uncircumcised male infants will get a urinary virus, syphilis and chancroid. Islands, equatorial countries, the Middle East, Africa and tract infection. This very painful condition is particularly Circumcision reduces by up to 5 times the risk of the Americas. In Australia all newborn boys were once dangerous in infancy, and in 40% of cases can lead to the• man’s female partner being infected by chlamydia circumcised routinely. Circumcision then decreased in the kidney infl ammation and disease; sepsis and meningitis can or getting cervical cancer (which is caused by human mid-1970s, but is now rising again, in line with research. also result. papilloma virus). The load of infectious bacteria and viruses Over 60% of Australian men are circumcised. • Over 20-fold decrease in risk of invasive penile cancer, that accumulate under the foreskin is delivered into the which has a high fatality rate. One in 600 uncircumcised female genital tract during sex. Chlamydia has more than Benefi ts of circumcision men get penile cancer, which often requires penile doubled over the past 5 years in Australia and can cause Eliminates the risk of phimosis, which aff ects 1 in 10 older amputation. infertility (in both sexes), pelvic infl ammatory disease, and • ectopic pregnancy. boys and men. This condition refers to a tight foreskin that • Uncircumcised men have 1½ – 2 times the risk of cannot be pulled back fully, so making cleaning under it, prostate cancer, which aff ects 1 in 6 men. If not circumcised soon after birth, up to 10% will later and passing urine, diffi cult. Phimosis also greatly increases require• one anyway for medical reasons. the risk of penile cancer, and is the cause of foreskin and • Reduces by approximately 3-fold the risk of getting catheter problems in nursing homes. HIV (AIDS), during sex with an infected woman. HIV enters Credible research shows that most women prefer the via the vulnerable inner lining of the foreskin of a healthy appearance• of the circumcised penis. They also prefer it for • Reduces by 3-fold the risk of infl ammation and infection penis, but can also infect via sores anywhere on the penis sexual activity. Hygiene is one reason. of the skin of the penis. One in 10 uncircumcised men get (caused for example by genital herpes). In countries such infl ammation of the head of the penis, which is covered by as Australia that have a low prevalence of HIV the risk of • There is no signifi cant diff erence in sensitivity of a the foreskin. This rises to 1 in 3 if the uncircumcised man is a heterosexual man being infected with HIV sexually is circumcised and uncircumcised penis. diabetic. (Diabetic men also have other severe problems.) In generally low. His risk, especially if uncircumcised, will be In general, sexual function is the same or better. contrast only 2% of circumcised men get this condition. much greater if he engages in unsafe sex with people of • countries in which HIV abounds.