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Dutch medical alliance moves to change thinking on male circumcision

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c2987 (Published 07 June 2010) Cite this as: BMJ 2010;340:c2987
  1. Tony Sheldon
  1. 1Utrecht

    A broad alliance of medical organisations in the Netherlands has officially adopted the view that circumcision of underage boys without a medical reason violates children’s human rights and contravenes the Dutch constitution.

    The Dutch Medical Association has spearheaded the move, arguing that the medical benefits of circumcision are unproved whereas complications are underestimated, and urging “a strong policy of deterrence.” Doctors should “actively and insistently” inform parents seeking to have their child circumcised about the association’s stance.

    It is estimated that up to15 000 circumcisions of boys under 16 are carried out each year in the Netherlands—largely for religious or cultural reasons—among Jewish, Muslim, and African Christian communities.

    The association thinks there are good reasons to ban the practice—female circumcision was outlawed in 2004—but fears that this might force it underground, leading to a greater number of complications.

    Instead, it calls for a dialogue between doctors and religious leaders, in recognition of the “deep religious, symbolic, and cultural sensitivity” surrounding circumcision.

    The Dutch Medical Association’s stance was taken on the basis of the argument that “non-therapeutic circumcision” of underage boys amounts to a violation of a child’s physical integrity, and so contravenes article 8 of the European Convention on Human Rights and article 11 of the Dutch constitution.

    It believes circumcision can lead to complications, including haemorrhage, infection, urethral stricture, and panic attacks. There are also reported cases of amputation of part, or all, of the penis as a result of complications involving necrosis.

    Dr Tom de Jong, head of paediatric urology at Wilhelmina Children’s Hospital, Utrecht, sees around 50 cases of complications after circumcision every year. Although there is no systematic registration of complications in the Netherlands, his belief, on the basis of published research, is that long term complications can occur in between 8% to 20% of cases, whereas complications arise in 3% to 5% of cases immediately after surgery

    The association believes that studies that suggest that circumcision reduces the risk of urinary tract infections or HIV/AIDS are inconclusive. Any preventive benefits should be balanced against less invasive forms of prevention, such as good personal hygiene, antibiotics, condom use, and information on safer sex, it argues. The possible medical advantages are insufficient “to justify circumcision on grounds of prevention.”

    The Dutch Medical Association’s chair, Dr Arie Nieuwenhuijzen Kruseman, said: “With every surgical procedure there is a risk of complications. The rule is not to operate on a healthy child. Children should only be exposed to medical intervention if there is an illness, abnormality, or it can be shown that it is in the interests of the child, such as vaccination.”

    Director of the Dutch Centre for Circumcision and general practitioner Lex Klein wrote on the centre’s website that non-therapeutic circumcision of boys is not medically necessary but “very important” for many people on religious and cultural grounds. The centre’s doctors have carried out 30 000 circumcisions on boys since 2001, adhering to strict protocols, and no serious complications have arisen, he said.

    A survey by the association, carried out to coincide with the new stance, found that two thirds (65%) of a representative sample of 1500 members believe that non-therapeutic circumcision violates physical integrity.

    The Dutch associations of paediatric medicine, paediatric surgery, surgery, and the college of general practitioners are backing the Dutch Medical Association’s stance.

    Notes

    Cite this as: BMJ 2010;340:c2987