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Circumcision in boys and girls: why the double standard?

BMJ 2011; 342 doi: (Published 16 February 2011) Cite this as: BMJ 2011;342:d978

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Ritualised child abuse

Evans courageously questions the ethical justification for male circumcision. As a GP I have often seen the raw lesions left by the surgery, the infections sometimes caused, the clear distress, and, on more than one occasion, a worrying mutilation of the penis whereby more than the foreskin had been removed. I find it odd that this practice is permitted in countries where there are no significant clinical benefits to the procedure. People cite the reduced risk of cervical cancer, but this has been addressed with the introduction of the HPV vaccine, or they cite the higher incidence of rare diseases, such as penile cancer. HIV protection is not relevant in developed countries with low incidence. But even, if for the sake of argument, it were to provide significant protection to some diseases, do we conduct other elective procedures, such as appendicectomy, on children, in case they later on develop appendicitis (the risk of appendicitis in the USA is cited as being 0.25%)? The site of the wound is also relevant: an area that is particularly sensitive, exposed to urine and faeces, and in the context of an infant who cannot make sense of his distress and who cannot give consent.

Evans is quite right to refer to the fact that many men seek to restore their foreskins by drastic means in order to enjoy more satisfying sexual lives or simply to restore their bodily integrity. Googling 'Restoring foreskin' yields 703,000 entries. The issue is sensitive because of the religious context, but arguably we need to consider the differences in hygiene and medicine as well as attitudes to children that existed at the time of the religious injunction as compared to the modern day, when we now have (finally!) the Convention of the Rights of the Child. The great religions promote compassion as a fundamental tenet - where is compassion in all of this? At least it should be done when the individual is autonomous and can make the choice authentically and freely, even if the surgery is more complicated. Some fathers justify it on the grounds of wanting their sons to be 'like them'. But do we insist that our children have to have the same anatomical defects that we have? And finally is the issue of cleanliness and purity not something to do with a disgust towards our 'animal' bodies rather than being based on sound scientific evidence?

Competing interests: None declared

Competing interests: No competing interests

24 February 2011
Paquita C.B. de Zulueta
GP, Hon Senior clinical lecturer
Imperial College