“Is there any other point to which you would wish to draw my attention?”
“To the curious incident of the dog in the night-time.”
“The dog did nothing in the night-time.”
“That was the curious incident,” remarked Sherlock Holmes.
— “Silver Blaze”
In its report, The Health of Australian Males, issued in July 2011, the Australian Institute of Health and Welfare outlined the important health issues facing men and boys in this country. A significant feature of the report is the absence of any references to circumcision. The fact that the word does not appear at all is good evidence – proof, in fact – that Australia’s leading health research and advisory body considers that circumcision is irrelevant to male health outcomes. Indeed, none of the health problems and issued discussed in the report have the slightest connection with circumcision (or even “lack of circumcision”).
This conclusion is something of a slap in the face for those few circumcision promoters and advocates (who shall remain nameless) who have, for the past decade or so, been uttering dire warnings about the public health catastrophe that is sure to lie “just around the corner” as a consequence of Australia’s low and declining incidence of circumcision. Really? Well, as it happens, we have turned many corners over the past decade, and the catastrophe somehow keeps failing to arrive.
1. Nutrition: They don’t eat enough fruit and vegetables. The report found that 54% of men 18 years and over don’t eat enough fruit, that 92% don’t eat enough vegetables, and only 5% get enough of both. The figures for boys 5 to 17 are better (22% eat enough – obviously they have conscientious mothers who make them eat their greens), but are still far from satisfactory. Not much scope for circumcision here: even Brian Morris would be hard-pressed to argue that circumcised men eat more broccoli.
2. Exercise: Men don’t get enough physical exercise, especially after age 24.
3. Weight: Men tend to be overweight: 42% of men 18-plus are overweight, and 26% are regarded as obese. (These figures may be somewhat exaggerated, as the definitions of overweight and obese are rather broad; but even if the figures were halved there would still be cause for concern.)
4. Smoking: As every schoolboy knows, smoking is the most serious preventable cause of poor health and disease, including many cancers (not just lung cancer). The good news is that only 18% of men 14 years and older are daily smokers, and the number is in decline.
5. Violence: Contrary to popular opinion, men are far more likely than women to be victims of violence (other than domestic or sexual violence). Men aged 18 to 24 were especially likely to be victims of violence, usually from other males in public places.**
The leading causes of all male deaths in Australia are as follows: heart disease (17%), lung cancer, stroke, respiratory disease, prostate cancer (4%). For males 15 to 44 years, however, the leading cause of death is “intentional self-harm” (i.e. suicide). The report does not give reasons for this, but it probably arises from psychological issues, such as depression.
This is confirmed by the list of the most serious diseases affecting men (in descending order of importance): heart disease, diabetes, anxiety and depression, lung cancer, stroke, other respiratory diseases, hearing loss, self-inflicted injuries, prostate cancer. Speaking of cancers specifically, the report names cancer of the prostate, bowel, lung and testes in that order. Another slap in the face for circumcision advocates is the absence of cancer of the penis from this list: it is simply too rare to rate a mention.
Some circumcision advocates (notably Brian Morris) have claimed that uncircumcised men are more vulnerable to prostate cancer and have urged circumcision of infants as a precaution against this risk. When the Royal Australasian College of Physicians investigated this claim, however, they found the only evidence in its favour to be the speculative ramblings of an American crank called Abraham Ravich, way back in the 1940s. In its policy statement on circumcision the RACP comments: “This association [between lack of circumcision and prostate cancer] has not been consistent, and more recent reviews have failed to confirm it.” [1] This is a polite way of saying that the claim of a connection is bullshit.
There is, however, evidence that circumcision can increase the risk of other prostate problems and urinary symptoms, such as enlargement of the prostate. Research on Australian men by McCredie et al concluded that “being circumcised, or not currently living as married, were associated with increased prevalence of urinary symptoms.” [2] These findings are important because urinary symptoms are often an indication of benign prostatic hyperplasia (BPH). Enlargement of the prostate is a common male ailment, often requiring surgery such as transurethral resection of the prostate (TURP) to improve the sufferer's quality of life. In about 80% of cases, TURP results in infertility (because the semen goes into the bladder rather than being ejaculated) and in 5% to 8% of cases, TURP results in impotence. About 400,000 TURPs are performed annually in the United States. If being circumcised increases a man’s risk of BPH by 50% (as found in the study above), then if 60% of the at risk population in the USA have been circumcised, almost 100,000 of the 400,000 TURPs (25%) were the result of circumcision. Quite apart from the loss of function, think what a waste of surgical resources this represents.
There was no media coverage of this paper, but you can be sure that if the study had, on the contrary, shown that being circumcised was associated with reduced prevalence of urinary symptoms, there would have been newspaper headlines, and the circumfanatics would have been crowing about yet another reason to circumcise baby boys.
Further information on (the lack of a link between) circumcision and prostate cancer
This is looking more promising: surely the report is going to say something about circumcision in relation to male sexual and reproductive health. After all, many circumcision advocates insist that circumcision is an essential component of male sexual health. Bad luck: the report makes no mention of circumcision at all. The principal problems facing males in this area are: low testosterone, erectile dysfunction, urinary tract symptoms and prostate disease (both of which, as suggested above, may be worsened by circumcision).
The report does not find sexually transmitted infections to be a serious problem among Australian males. As you would expect, nearly all (94%) of HIV cases are male, the vast majority of which are homosexual men. As we have pointed out elsewhere on this site, there is no heterosexual HIV problem in Australia, and even among gay men, HIV infections are steady or in decline. [3] The most common STI experienced by Australian men is chlamydia (234 per 100,000); but there is no evidence from Australia that uncircumcised men are at greater risk of this or any other STI, [4] and even if they were, most STIs are easily cured with antibiotics. (In the case of chlamydia, a single pill does the job.)
The inescapable conclusion is that circumcision is not relevant to the health of Australian males. As Sherlock Holmes would say, we draw your attention to the significant remarks of the AIHW on circumcision and male health. “But Holmes, the AIHW says nothing about circumcision and male health.” That silence, Watson, is what is so significant.
** Though many would argue that circumcision without informed consent is in itself sexual violence. In other parts of the world, notably underdeveloped countries and regions of war and conflict, men and boys are certainly victims of sexual violence on a large scale.
References
[1.] RACP, Policy statement on circumcision, October 2010, p. 13.
[2.] McCredie M; Staples M; Johnson W; English DR; Giles GG. Prevalence of urinary symptoms in urban Australian men aged 40-69. J Epidemiol Biostat 2001;6(2):211-8.
[3.] See the analysis by ACON - which again makes no mention of circumcision.
[4.] See study by Ferris et al 2010.
There is increasing awareness that males and females have distinct health needs and concerns related to their biology and roles in society. This is illustrated by different rates of injury, illness and mortality; different attitudes towards health and risks; and the way each group uses, or does not use, health services. In this context, in May 2010 the Australian Government launched the National Male Health Policy, which provides a framework for improving the health of Australia’s males (DoHA 2010a). This report is the first in a series funded under the Policy. Drawing on a range of data sources, this report presents a snapshot of the health and wellbeing of Australia’s males. It is not intended to be exhaustive, but to provide a summary for policymakers, researchers and others interested in male health issues, and set the scene for future reporting and research.
Australia’s males at a glance
In June 2010, there were 11.1 million males living in Australia –just under half of the total population (ABS 2010a). The median age was 36 years; 20% of males were aged under 15 years and 12% were aged 65 years and over. The male population is continuing to age, associated with increasing life expectancy.
Some males make healthy lifestyle choices and have positive health outcomes:
But many males are still at risk of poor health:
And many males are already experiencing poor health:
With under-use of some health services and over-representation in others:
The full report, The Health of Australian Males, is available from the Australian Institute of Health and Welfare.