Advocates of routine circumcision say it is a safe procedure, with a negligible rate of mistakes and things that go wrong, and in a relative sense (compared with brain or heart surgery) this may be true. Even so, the rate of immediate complications in the USA is between 3 and 9 per cent, meaning (tens of thousands of boys each year), with a further 5 per cent experiencing problems later. Outside the sterile wards of US hospitals, in tribal initiation settings as in Africa, circumcision may infect boys with tuberculosis, tetanus and possibly AIDS, as well as causing crippling injury to the penis. Between 60 and 80 boys die each year in southern Africa alone. Even in developed countries, such as Canada, the United States and Australia, in hygienic conditions and with all the paraphernalia of modern medicine, deaths occur regularly.
Even if the rate of complications in western countries is low in a statistical sense, the result for the unlucky few can be a personal disaster, as the tragic cases recorded on this page show.
|1919||Tuberculosis contracted during circumcision.||Webster, MJA, 27 May 1939, 796-8|
|1943||Gangrene following circumcision.||Barrett, MJA, 11 Dec 1943, 490|
|1953||Begg noted that figures for deaths from circumcision were not available, but reported Gairdner’s observation (1949) of 16 deaths annually in England and Wales for period 1942 to 1947 and commented: “There was every reason to believe that a proportionate mortality would prevail in Australia.”||Begg, MJA,25 April 1953, 603-4|
|1965||“Dr R. Southby mentioned two neonatal deaths which had resulted from infection after circumcision in the last year, and other instances of surgical complications leading to litigation.”||MJA, 28 August 1965, 393|
|1966||Two deaths from haemorrhage.||Schlicht and Aberdeen, MJA, 27 August 1966, 436|
|1967||Report of one death in 1963 and one in 1964 as recorded by Commonwealth Statistician, who commented: “Figures of deaths from complications of circumcision for other reasons [other than ritual or preventive] are not available.”||Wright, MJA, 27 May 1967, 1084|
|1969||Fredman noted that official statistics reported two deaths from 1959 to 1969, but added: “There is probably no adequate record of morbidity.”||Fredman, MJA, 18 Jan 1969, 117-20|
|1977||Death from meningitis.||Scurlock and Pemberton, MJA, 5 March 1977, 332-4|
|1993||Death from anaesthetic overdose, Brisbane. Reported by Queensland Law Reform Commission, Circumcision of Male Infants Research Paper, Brisbane 1993, p. 32||Qld Law Reform Commission|
|1920||Tuberculosis following circumcision||MJA, 24 June 1939, 942-3|
|1965||Two cases of infection, one with septicaemia and pneumonia, the other with Staphlycoccus||Birrell, MJA, 28 August 1965, 393|
|1966||Infection leading to loss of a third of penis.||See reference 6 below|
|1970||Leitch reported the incidence of complications at 15.5 per cent.||Aust Paediatric Journal, 6, 1970, 59-65|
|1972||“Examining large numbers of children at school medical inspections over the last few years I am appalled at the phallic mutilations exhibited by many of these children, some of whom have even been subjected to a subsequent “tidying up” procedure after being badly mauled in infancy.”||A. Clements, letter, MJA, 29 April 1972, 946|
|1977||Four cases of meningitis: one OK, one mildly retarded, one seriously retarded, one fatal.||Scurlock and Pemberton, MJA, 5 March 1977, 332-4|
|1982||Meningitis: subsequent history unknown||Procopius and Kewley, MJA, 9 January 1982, 15|
|1997||Two babies in Sydney suffer severe blood oxygen deprivation (hypoxaemia and methaemoglobinaemia) after administration of prilocaine as local anaesthetic during circumcision; authors of report note that both EMLA cream and prilocaine are not safe for use on very young babies.||Prineas, Wilkins and Halliday, MJA, 2 June 1997, 615|
|1997||Shane Peterson in Perth successfully sues doctor who circumcised him as an infant for excessive tissue removal, leading to erectile difficulties and constant pain.||See reference 7 below.|
Baby “nearly bleeds to death” after circumcision by Dr Aladdin Mattar, later deregistered. Details at www.nswmb.org.au/download.pl?param=143.
Daily Telegraph, 14 June and 17 Sept. 2000
|2002||RACP unable to give firm estimate of complications, but notes that reported incidence ranged from 2 to 10 per cent.||RACP, Position statement on circumcision, September 2002|
|2006||Dr Suman Sood deregistered for ten years by NSW Medical Board for misconduct in relation to both abortion and circumcision, including an excessive incidence of circumcision complications. Details at www.nswmb.org.au/ system/files/f10/f20/o585//SOOD.pdf||NSW Medical Board determination 774 of 2005, 6 October 2006.|
|2010||Melbourne Doctor Mohammed Mateen Ui Jabbar suspended for three months after incompetent circumcision of 2-year old boy using Plastibell device, resulting in severe injury to penis and and need for plastic surgery.||See News Page|
Unlike in underdeveloped countries, such as Turkey, Iran or Nigeria, where the incidence of serious adverse outcomes from circumcision runs as high as 20 per cent,  it is clear that deaths or serious complications from circumcision are not common in developed countries. Australia has an enviable record with respect to deaths from circumcision, none having been reported since 1993. There is, however, no room for complacency. As well as good medical practice, the absence of such reports is as much a consequence of the declining and now low incidence of infant circumcision and the difficulty of attributing deaths to circumcision when they are the result of later complications, such as infection, or of long term sequelae, such as depression and suicide. As shown on the above table, several authorities agree that there is no reliable record of mortality, and the Australian Institute of Health and Welfare has admitted that their statistics cannot identify deaths due indirectly to circumcision:
“We have information on circumcision and there are external cause codes for complications of medical and surgical care. However, it is not possible to tell if the complication was a result of the circumcision. For example, the circumcision may have been undertaken in a previous admission, and the patient readmitted with a complication. If this was the case, we couldn’t tell that it was the same patient and we wouldn’t know for sure that the complication was due to the circumcision.” 
It is a similar picture with respect to complications, the incidence of which is the subject of wide disagreement. In 1970 Leitch suggested a rate of 15.5 per cent,  while more recently the Royal Australasian College of Physicians cites estimates ranging from an implausible 0.06 per cent to an equally unlikely 55 per cent, depending on definition. It seems to regard a likely incidence as falling within the range of 2 to 10 per cent, and it warns that “serious complications, such as bleeding, septicaemia and meningitis may occasionally cause death”.  If the rate of complications is 15, 10 or even only 2 per cent, it is apparent that the small number of cases that get publicly reported represent only the tip of the iceberg; this under-reporting contributes to the illusion that circumcision is a safe and “harmless” operation. 
Whatever the figure – and it seems unlikely that definitive statistics will ever emerge – it will readily be agreed that there must be a lower threshold of tolerance for adverse outcomes from unnecessary or cosmetic surgical procedures than from those which are genuinely required for a person’s health. This principle is all the more important when the person does not choose the surgery for himself.References:
Each year in the United States more than 100 newborn baby boys die as a result of circumcision and circumcision complications. This is the alarming conclusion of a study, published in the journal Thymos, which examined hospital discharge and mortality statistics in order to answer two questions: (1) How many baby boys dies as a result of circumcision in the neonatal period (within 28 days of birth)? (2) Why are so few of these deaths officially recorded as due to circumcision?
The study, by researcher Dan Bollinger, concluded that approximately 117 neonatal deaths due directly or indirectly to circumcision occur annually in the United States, or one out of every 77 male neonatal deaths. This compares with 44 neonatal deaths from suffocation, 8 in automobile accidents and 115 from Sudden Infant Death Syndrome, all of which losses have aroused deep concern among child health authorities and stimulated special programs to reduce mortality. Why, the study asks, has the even greater number of deaths from circumcision not aroused the same response?
A large scale, comprehensive study has found that circumcised boys have a far higher incidence of urethral problems such as meatal stenosis than boys who are left genitally intact (uncircumcised). The nationwide study of over 4 million males in Denmark found that meatal stenosis (narrowing and ulceration of the urinary opening of the penis) affected as many as 20 per cent of circumcised boys, about five times the incidence of such problems in uncircumcised boys. They also experience a far higher incidence of other urethral problems. Among other observations, the authors of the article criticise the American Academy of Pediatrics for its uncritical reliance on a flawed study on circumcision complications by El Bcheraoui et al which claimed to find a negligible incidence of urethral disease among boys circumcised in American hospitals. They point out that the data in this study actually show a high relative risk for such problems. The AAP should have paid attention to a warning it published in 1984: “The foreskin shields the glans; with circumcision this protection is lost. In such cases, the glans and especially the urinary opening (meatus) may become irritated or infected, causing ulcers, meatitis (inflammation of the meatus), and meatal stenosis (a narrowing of the urinary opening). Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life”.** The present study is further evidence that the AAP’s 2012 claim that the “benefits” of circumcision exceed the “risks” is fundamentally false.
** This text was included in the 1984 edition of a leaflet for parents on care of the normal (uncircumcised) penis. When the leaflet was reissued in 1990 the paragraph was deleted, for reasons never explained. Relevant correspondence and a copy of the original leaflet available from Circumcision Resource Center.
The abstract of the paper follows.
Background: Meatal stenosis is markedly more common in circumcised than genitally intact
males, affecting 5-20 per cent of circumcised boys. However, no population-based study
has estimated the relative risk of meatal stenosis and other urethral stricture diseases
(USDs) or the population attributable fraction (AFp) associated with non-therapeutic
Methods: In two nationwide cohort studies (comprising 4.0 million males of all ages and
810 719 non-Muslim males aged 0e36 years, respectively), we compared hospital contact
rates for USD during 1977e2013 between circumcised and intact Danish males.Hazard ratios
(HRs) were obtained using Cox proportional hazards regression, and the AFp estimated the
proportion of USD cases in <10 year-old boys that is due to non-therapeutic circumcision.
Results: Muslim males had higher rates of meatal stenosis than ethnic Danish males,
particularly in <10 year-old boys (HR 3.44, 95 per cent confidence interval 2.42e4.88). HRs
linking circumcision to meatal stenosis (10.3, 4.53e23.4) or other USDs (5.14, 3.48e7.60)
were high, and attempts to reduce potential misclassification and confounding further
strengthened the association, particularly in <10 year-old boys (meatal stenosis: 26.3, 9.37
e73.9; other USDs: 14.0, 6.86e28.6). Conservative calculations revealed that at least 18, 41,
78, and 81 per cent of USD cases in <10 year-old boys from countries with circumcision
prevalences as in Denmark, the United Kingdom, the United States and Israel, respectively,
may be attributable to non-therapeutic circumcision.
Conclusion: Our study provides population-based epidemiological evidence that circumcision
removes the natural protection against meatal stenosis and, possibly, other USDs as well.
Frisch M, Simonsen J. Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease: Two nationwide register-based cohort studies in Denmark 1977-2013, The Surgeon, on-line first, 22 December 2016.
A study in Melbourne has found a disturbingly high incidence of circumcision complications requiring emergency treatment. Over a period of 29 months 167 boys were brought to the Royal Children’s Hospital casualty department suffering from circumcision-related injuries. The principal problems were: bleeding (53.9%), pain (38.3%), swelling (37.1%), redness (25.7%), decreased urine output (13.8%), fever (7.2%) and infection (6%). In addition, 29.9% were brought in because parents were shocked at the ugly post-circumcision appearance of the boy’s penis. About half the circumcisions (54%) had been performed for religious/cultural reasons, 30% for so-called medical reasons, and the remainder for reasons unknown. There was some difference in the incidence of complications between hospital-performed operations (40%) and those performed in the community, presumably by GPs and “specialist” clinics (60%), but not enough to justify the common assumption that hospital-performed operations are completely safe. The mean age of the boys was 3 years, but the boys circumcised by community operators were much younger and had the highest incidence of complications.
The authors of a study circumcision complications issue a particular warning against the Plastibell circumcision device, used on nearly 60% of the boys in their survey who required emergency treatment, pointing out that is not as safe as claimed by the circumcision providers and “specialist circumcision clinics” that commonly use it. They identify 4 recent studies detailing complications arising from the device and comment: “While it is reported to be a quick and simple method preferred by many providers, these studies have revealed method-dependent concerns. This includes concern about what is the appropriate length of time for the device to be retained, an increase in infection and increase in analgesia requirement post-operatively. We identified that 54 boys (58.7%) were circumcised by this method in the community. There was particular concern and poor understanding about the appropriate length of time the Plastibell ring should remain in situ, which could be addressed in improved information for parents.”
Source: Grace Gold, Simon Young, Mike O’Brien, Franz E Babl. Complications following circumcision: Presentations to the emergency department. Journal of Paediatrics and Child Health 51 (December 2015): 1158–1163.
OTTAWA — A one-week-old Ontario infant died from complications after undergoing a circumcision in a provincial hospital.
Information about the case was published in the April 2007 edition of Paediatric Child Health. The baby, whose name has been withheld by the parents, passed away after his kidneys [no, bladder] became enlarged to seven times their [its] normal size.
The child was born at an unidentified Ontario hospital “sometime in the last three years,” said Dr. Jim Cairns, Ontario's deputy chief coroner. “The family wants to keep this anonymous.” No charges were ever laid and no legal action was ever taken in the case.
According to the Paediatric Child Health article, the boy was “bottlefed and was reported to be doing well when he was circum[cis]ed.”
Five hours later, the parents returned to their family doctor with the infant, who had become “irritable and had blue discolouration” below the belly button. Doctors noticed the discolouration and slight swelling of the penis, but sent the child home. Fourteen hours after the circumcision, according to Cairns, the child was brought to another hospital where doctors noted he was extremely irritable with marked swelling of the penis and bruising to the scrotum.
The child was then transferred to a paediatric centre, where his bladder was diagnosed, Cairns said, to “seven or eight times its normal size.”
The PlastiBell ring, which is used to hold back the foreskin after circumcision, was removed and drained and the child went into shock.
“If the PlastiBell had been taken off five hours after he got there, he would be alive,” said Cairns
[Perhaps. If the PlastiBell had never been used in the first he would certainly be alive.]
The child's death was attributed to septic shock — “an overwhelming infection, leading to multi-organ failure,” Cairns said. “Death is rare after circumcision,” said Cairns. “But complications can happen.” The case was brought to Cairns' attention because the circumstances of every death of an Ontario child under five years of age must be reviewed by the provincial coroner's office.
Mark Brennae, CanWest News Service, Published: Wednesday, June 13, 2007
DETECTIVES are investigating the death of a seven-day-old baby after he was circumcised. Stunned relatives at the Jewish ceremony saw the toddler experience breathing difficulties. He was taken to hospital but died eight days later. A post mortem found the infant died from cardiac arrest and oxygen starvation.
Police are to interview family members and the senior rabbi who performed the operation at Golders Green Synagogue in North London. Concerns raised by doctors treating the baby have led to the probe being led by Scotland Yard’s child abuse investigators. Police and Home Office sources said the investigation was “highly unusual”. A Scotland Yard spokesman stated: “The death is being treated as unexplained at this early stage.”
The baby died two weeks ago at University College Hospital, Central London.
Circumcision of boys is an operation in which the foreskin is removed from the penis. With small babies, local anaesthetic is often sufficient and avoids the risks of a general anaesthetic. Some people believe the skin is redundant and gets in the way of hygiene. Others say it is a vital part of the male anatomy and should not be removed. Judaism considers circumcision to be an important ritual. The operation is usually performed by a mohel - a specialist in the procedure and its rituals. Many British mohels are doctors, rabbis or both. All have received appropriate medical and religious training.
A spokesman for The United Synagogue, a membership of 35 orthodox synagogues in Greater London, said: “We are awaiting the results of the police enquiry and until then it would not be appropriate for us to comment further."
The Mirror (London), 15 February 2007, Exclusive by Stephen Moyes
The following letter was sent by Circumcision Information Australia to the medical board in each state and territory in Australia, and to state health departments in South Australia, New South Wales and Queensland in March 2004.
Risks associated with circumcision of male infants and children
A recent Coroner's report from the province of British Columbia in Canada indicates that the risks inherent in the circumcision of male infants are greater than commonly appreciated. We enclose a copy of the Coroner's report for your information.
The report shows that the baby, Ryleigh Roman Bryan McWillis, aged one month, was circumcised in the Penticton Regional Hospital on 20 August 2002. He was released from the hospital into the care of his parents; suffered extensive bleeding from the wound; was returned to Penticton Hospital; and was subsequently transferred to the B.C. Children's Hospital, where he died less than 48 hours after the operation. The Coroner concluded that the death was due to "multiorgan hypoxic/ischemic injury due to hypovolemic shock as a result of massive hemorrhage from a circumcision site." Tragic though it is, there is nothing extraordinary in this outcome: bleeding and death are well-known complications of circumcision. [1-3] A similar case was reported by the Miami Herald in 1993,  a case occurred in Ireland in 2003,  and cases have also been recorded in Australia. (See below and Attachment 1.)
Since the prepuce is highly vascularized, it is likely to haemorrhage when cut, and severing of the frenular artery is also possible during circumcision procedures.  Infants have a very small volume of blood in their bodies, and they can tolerate only about a 20 per cent blood loss before hypovolemia and hypovolemic shock set in, followed quickly by death. A 4000 gram male newborn has only 11.5 oz (340 ml) of total blood volume at birth, 85 ml per kilogram of weight.  Blood loss of only 2.3 oz (68 ml) - about a quarter of a cup - represents 20 per cent of total blood volume at birth, and is sufficient to cause hypovolemia.  The quantity of blood loss that might kill an infant - 85 ml - is easily concealed in today's highly absorbent diapers: Ryleigh's parents were quoted by the Canadian Broadcasting Corporation as stating that they had no way to know that their baby boy was bleeding to death.  Circumcision of infants, even in optimum conditions, thus carries an inherent danger of hypovolemic shock and death.
The Coroner further shows that the doctor at Penticton Hospital performed the circumcision in the absence of any medical indication or need, but at the request of his parents. This practice - needless circumcision at parental request - is thus shown to be hazardous to children's lives. As Watters and Carroll have shown in their study of parental attitudes in rural New South Wales, parents rarely appreciate the risks associated with the excision of an infant's prepuce, and are ill-equipped to make decisions that should properly be made after expert paediatric advice or left to the boy himself. 
It is a widely accepted principle that the primary duty of doctors is to consider the well-being of their patient above all else.  Medically unnecessary circumcisions at parental request are inconsistent with that paramount duty. Doctors must comply with ethical guidelines issued by the Australian Medical Association to "practise the science and art of medicine to the best of your ability."  Circumcision of male infants in the absence of any medical indication or need carries serious risks, offers no significant therapeutic benefit, and is inconsistent with those duties.
Parents have a duty to protect their children and to act in their best interests.  Non-therapeutic circumcision of children infringes children's legal right to bodily integrity and their rights as human beings to life and security of person.  Election of medically unnecessary circumcision is inconsistent with parents' responsibilities to the child; indeed, it is debatable whether it is legally possible for them to give valid consent to the non-therapeutic circumcision of an incompetent minor. 
We do not suggest that deaths or serious complications from circumcision are common in developed countries: Australia has an enviable record with respect to deaths from circumcision, none having been reported since 1993. There is, however, no room for complacency. As well as good medical practice, the absence of such reports is as much a consequence of the declining and now low incidence of infant circumcision (see Attachment 2) and the difficulty of attributing deaths to circumcision when they are the result of later complications, such as infection, or of long term sequelae, such as suicide. Several authorities agree that there is no reliable record of mortality (see Attachment 1), and the Australian Institute of Health and Welfare has admitted that their statistics cannot identify deaths due indirectly to circumcision:
"We have information on circumcision and there are external cause codes for complications of medical and surgical care. However, it is not possible to tell if the complication was a result of the circumcision. For example, the circumcision may have been undertaken in a previous admission, and the patient readmitted with a complication. If this was the case, we couldn't tell that it was the same patient and we wouldn't know for sure that the complication was due to the circumcision." 
It is a similar picture with respect to complications, the incidence of which is the subject of wide disagreement. In 1970 Leitch suggested a rate of 15.5 per cent,  while more recently the Royal Australasian College of Physicians cites estimates ranging from an implausible 0.06 per cent to an equally unlikely 55 per cent, depending on definition. It seems to regard a likely incidence as falling within the range of 2 to 10 per cent, and it warns that "serious complications, such as bleeding, septicaemia and meningitis may occasionally cause death".  If the rate of complications is 15, 10 or even only 2 per cent, it is apparent that the small number of cases that get publicly reported represent only the tip of the iceberg; this understatement contributes to the impression that circumcision is a safe operation.
Whatever the figure - and it seems unlikely that definitive statistics will ever emerge - it will readily be agreed that there must be a lower threshold of tolerance for adverse outcomes from unnecessary or cosmetic surgical procedures than from those which are required for a person's health. This principle is all the more important when the person does not choose the surgery for himself. Although the incidence of circumcision in Australia is low by historic standards (around 12 per cent, compared with about 50 per cent in the early 1970s), there has been a gradual increase since 1993, and it is still disturbingly prevalent in New South Wales, South Australia and Queensland. If the frequency of the operation continues to increase, complications and adverse outcomes will become more common. It is clear that the surest way to avoid both complications and death from circumcision is by not performing the operation in the first place.
Your attention is particularly drawn to the disturbingly high and increasing incidence of circumcision in New South Wales. Its frequency has risen by about 30 per cent over the past ten years and is now double that found in Victoria, the ACT, Tasmania, Western Australia and the Northern Territory.
We suggest that the Canadian tragedy makes it timely to remind medical practitioners of the unavoidable risks of surgery and of their duty to protect infants and children from procedures that are not needed for, and which may well harm, their health and happiness. By ratifying the United Nations Convention on the Rights of the Child, Australia has pledged itself to protect children from "traditional procedures prejudicial to the health of children",  and it is hard to see how non-therapeutic male circumcision would not fall into that category.
We seek your advice on how you propose to ensure that tragedies like the McWillis case do not occur in your state. We also ask you to advise us on whether you would be willing to adopt measures in order to:
We believe that such reminders would go far towards minimising the danger of exsanguination, hypovolemic shock and death as a consequence of non- therapeutic circumcision and greatly reduce the risk of adverse outcomes from therapeutically or otherwise justified circumcision. We urge that you take appropriate action and thereby continue to fulfil your board's obligation to protect the public,  especially its smallest and weakest members.
Circumcision Information Australia
22 March 2004
A pdf copy of the Coroner's report is available here. http://www.cirp.org/library/death/
1. Williams N, Kapila L. Complications of circumcision. Brit J Surg 1993; 80: 1231-6
2. Fetus and Newborn Committee, Canadian Paediatric Society (CPS). Neonatal circumcision revisited. Can Med Assoc J 1996; 154(6):769-80.
3. Beasley S, Darlow B, Craig J, et al. Position statement on circumcision. Sydney: Royal Australasian College of Physicians, 2002
4. Baby bleeds to death after circumcision. Miami Herald, June 26, 1993. http://www.cirp.org/news/1993.06.21_death/
5. Neans McSweeney. Baby dies after botched circumcision. Irish Examiner, Cork, Thursday, 21 August 2003
6. Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83 Suppl. 1:34-44. http://www.cirporg/library/anatomy/cold-taylor/
7. Paediatric Handbook, editors J Smart, T Nolan, Sixth Edition, Blackwell Science Asia, Carlton South, Victoria, Australia, 2000, page 82.
8. Glancy GL. Shock in children warrants special considerations. Ski Patrol Magazine 1997, Summer
9. Canadian Broadcasting Corporation, Wednesday, 11 February 2004. Circumcision under attack.
10. Greg Watters and John Carroll, Just like dad: Maternal attitudes to neonatal circumcision in an Anglo-Celtic society, paper given to Urological Society of Australasia, Scientific Meeting, Queenstown, NZ, 6 March 2003
11. Australian Medical Association. Code of Ethics (1996).
14. Articles 3 and 5. Universal Declaration of Human Rights, G.A. res. 217A (III), U.N. Doc A/810 at 71 (1948).
15. Gregory J Boyle, J Steven Svoboda, Christopher P Price, J Neville Turner. Circumcision of Healthy Boys: Criminal Assault? 7 J Law Med 301 (2000). http://www.cirp.org/library/legal/boyle1/
16. Narelle Grayson, Hospitals and Mental Health Services Unit, AIHW, email message to Shane Peterson, 14 January 2004
17. I.O.W. Leitch, "Circumcision: A continuing enigma", Australian Paediatric Journal, Vol. 6,1970, 60 http://www.cirp.org/library/general/leitch1/
18. RACP Policy statement on circumcision, 2002
19. Article 24.3, U.N. Convention on the Rights of the Child (1989). UN General Assembly Document A/RES/44/25.
20. Committee on Medical Ethics. The law & ethics of male circumcision - guidance for doctors. London: British Medical Association, 2003.
21. New South Wales, Medical Practice Act 1992. Section 2A (1)
If you type “botched circumcision” into the Google search engine you will get over 2 million hits (web pages) and thousands of images - if you have the stomach for them. Number of times the term botched circumcision occurs in the circumcision policy statement of the American Academy of Pediatrics: zero.
The following sites also contain graphic images: proceed at own risk.
Two careful studies published in the world's leading jounral of urology, BJU International, demonstrate that circumcision damages the penis and cuts both sexual capacity and sexual satisfaction.
Two Korean researchers, DaiSik Kim and Myung-Geol Pang, studied 373 sexually active men, of whom 255 were circumcised and 118 were not. They found that circumcision reduced sexual pleasure in most cases and that a significant minority of men reported major injury to their penis, causing bleeding, scarring and chronic pain. Summarizing their results, the authors write:
"There were no significant differences in sexual drive, erection, ejaculation, and ejaculation latency time between circumcised and uncircumcised men. Masturbatory pleasure decreased after circumcision in 48% of the respondents, while 8% reported increased pleasure. Masturbatory difficulty increased after circumcision in 63% of the respondents but was easier in 37%. About 6% answered that their sex lives improved, while 20% reported a worse sex life after circumcision."
Conclusion: There was a decrease in masturbatory pleasure and sexual enjoyment after circumcision, indicating that adult circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings.
DaiSik Kim and Myung-Geol Pang, The effect of male circumcision on sexuality. BJU Int 99(3):619-22
Meanwhile, researchers in the United States have found that circumcision removes the most sensitive part of the penis.
Researcher Dr Morris Sorrells and others enlisted 159 men from the San Francisco Bay area, 91 of them circumcised, and conducted touch-sensitivity tests, using an instrument that presses with calibrated hairs, on 17-19 different places on their penises. The men could not see where they were being touched.
It was found that the most sensitive part of a circumcised penis was on the scar in the middle underneath. But several places on the foreskin were more sensitive than that while the glans of the uncircumcised penis was more sensitive than in the circumcised.
The paper is summarised here:
Objective: To map the fine-touch pressure thresholds of the adult penis in circumcised and uncircumcised men, and to compare the two populations.
Subjects and methods: Adult male volunteers with no history of penile pathology or diabetes were evaluated with a Semmes-Weinstein monofilament touch-test to map the fine-touch pressure thresholds of the penis. Circumcised and uncircumcised men were compared using mixed models for repeated data, controlling for age, type of underwear worn, time since last ejaculation, ethnicity, country of birth, and level of education.
Results: The glans of the uncircumcised men had significantly lower mean ( SEM ) pressure thresholds than that of the circumcised men, at 0.161 (0.078) g ( P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity. There were significant differences in pressure thresholds by location on the penis ( P < 0.001). The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds than the ventral scar of the circumcised penis.
Conclusions: The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.
Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU International 2007;99:864-9
See also a revealing article by Paul Festa in Nerve magazine, How insensitive: A new study confirms a long-time fear: Circumcised men are missing out
In a paper given at the Keel conference on genital integrity in 2008, Dr John Warren shows how the harm of circumcision arises from the operation itself, when all goes well and as planned, not merely when there are complications.
Abstract: Male circumcision results in permanent changes in the appearance and functions of the penis. These include artificial exposure of the glans, resulting in its keratinization and altered appearance. Additionally, circumcision results in loss of 30–50% of the penile skin, loss of at least 10,000–20,000 specialized erotogenic nerve endings, loss of reciprocal stimulation of foreskin and glans, and loss of the natural coital gliding mechanism, etc. From the point of view of sensation and function, the most important effect is caused by the tissue loss itself. The most sensitive part of the penis is removed, and the normal mechanisms of intercourse and erogenous stimulation are disturbed.
On 29 October 2005 the British Guardian ran a major feature article, “Sore Point”, on the resentment felt by men who had been circumcised as children:
Circumcision – beloved by the Victorians … can be a cause of great anguish. Richard Johnson meets men finding ways to reverse a cut they wish they’d never had.
In response to a letter agreeing that circumcision was immoral but questioning the comparison with female genital mutilation, the Guardian published the following letter from John Dalton.
As a victim of male circumcision and a subject of Richard Johnson’s article (Sore Point, October 29), I have no wish to belittle the suffering of circumcised girls. I would, however, like to respond to Catherine Long’s objection to male circumcision being compared to female genital mutilation (Letters, November 5). Male and female circumcision both remove normal tissue from normal children without therapeutic need or personal consent. The time has come for children to be protected from non-therapeutic circumcision without prejudice in respect of race, religion or gender.
John D Dalton
The following letter signed by twenty English men was published in the British Medical Journal in 1996.
Circumcision of children
EDITOR, We are all adult men who believe that we have been harmed by circumcision carried out in childhood by doctors in Britain. We are concerned about the ethics of this surgery on children and that it is commonly carried out when it is not essential. We have read the BMA’s ethical guidelines, which give no guidance to practitioners who are faced with a boy who has been referred for circumcision.  The possible future wishes of the patient should be considered.
Although it was shown 28 years ago that preputial development continues to the age of 17 and that only three of 1968 boys needed surgery,  many British doctors still seem to be ignorant of this research.  The European charter for children in hospital states that every child must be protected from unnecessary medical treatment. The United Nations Convention on the Rights of the Child states that children have rights to self determination, dignity, respect, integrity, and non-interference and the right to make informed personal decisions. Unnecessary circumcision of boys violates these rights.
A non-retractile foreskin in a boy can be managed conservatively. [4, 5] Circumcision should therefore rarely be necessary. It would be helpful if paediatric urologists could produce guidelines to advise doctors how foreskin problems in boys can be managed. Preferably, circumcision should not be done until the patient is adult or at least old enough to understand what is intended; then he has a right to a full, illustrated explanation of the nature of the operation and the reasons for it in advance, with the opportunity to ask questions, and help in coming to terms with the alteration of his anatomy afterwards. If the patient is not satisfied with the explanations his views should be taken into consideration.
It cannot be ethical for a doctor to amputate normal tissue from a normal child. In the case of disease, circumcision should be used only when there is evidence that conservative treatment is unlikely to be effective or when it has failed. Avoiding surgery may even be cheaper for purchasers of health care. Doctors should approach the child's foreskin with a combination of good ethics, a recognition of the rights of children, and advice based on evidence.
John P Warren, P David Smith, John D Dalton, Graham R Edwards, Marc Foden, Robert Preston, Philip Stewart, Adam Roberts, Philip C Cookson, Joseph Elliott, J S Phillips, James Williams, Matthew Mallinson-Read, Ian Morris, John Bowring, Rob Warburton, James Blazeby, Tony Peters, John Moore, John Stevens
1. BMA. Medical ethics today: its practice and philosophy. London: BMJ Publishing Group, 1993.
[Note: This has now been superseded by British Medical Association, Medical Ethics Committee, The law & ethics of male circumcision: Guidance for doctors, 4 April 2003]
2. Oster J. Further fate of the foreskin. Arch Dis Child 1968;43:200-3.
3. Griffiths D, Frank JD. Inappropriate circumcision referrals by GPs. J R Soc Med 1992;85:324-5.
4. Wright JE. The treatment of childhood phimosis with topical steroid. Aust NZ J Surg 1994;64:327-8.
5. Cuckow PM, Rix G, Mouriquand PDE. Preputial plasty: a good alternative to circumcision. J Pediatr Surg 1994;29:561-3.
UI [University of Iowa] freshman Neil Peterson grew up convinced that he was no different from other boys even though he spent much of those years in excruciating pain.
The Missouri native experienced uncomfortable erections from early childhood until two years ago, when the 24-year-old anthropology student discovered that he suffered from a rare complication after being circumcised too tightly. Since then, he's spoken out about the procedure and formed a local chapter of Students for Genital Integrity, a nationwide support group. "I had to recognize that I was unhappy the way I was," he said. "[Forming the group] was a very un-American thing for me to do, because society normalcy calls for circumcision in men. It has healed me to talk about it."
Peterson said his complication was healed after he learned to stretch his foreskin out to alleviate his condition. Although he no longer experiences pain, he is dedicated to speaking out against genital mutilation. Circumcision and other types of bodily mutilation are crimes against human rights, Peterson said. His group contends that children should not be forcibly circumcised, as they now are as infants at their parents' request. The group is dedicated to educating the public and doctors that circumcision is not necessary, in addition to highlighting the dangers of sex-reassignment surgery to distinguish hermaphrodites as male or female.
The group will be formally recognized as a UI student organization next week, Peterson said. Peterson is planning to hold fund-raisers and host speakers at the university and write to representatives, expressing the need for a law barring circumcision in the United States.
The Circumcision Information and Resource Pages reports that approximately 60 percent of American males are circumcised, down from nearly 90 percent in the 1960s.
Edward Bell, a UI professor of pediatrics, said complications such as Peterson's are rare. The American Academy of Pediatrics says 0.2 to 0.6 percent of circumcisions end with complications. Bleeding and infection are two problems that can occur when a boy is circumcised, as well as scarring if the doctor removes too much foreskin. Bell said that circumcision has become an unnecessary procedure for most males. "Circumcision is more of a cultural issue than a medical one," he said. "It would be nice if parents didn't insist upon having their boys circumcised." Many parents don't want their boys to look different from their brothers, peers, or fathers, Bell said. "Circumcision has become cosmetic surgery, and it's really just a matter of personal preference," Bell said.
By Paula Mavroudis - The Daily Iowan (USA) 12/5/02
"Yes, we had it done"
"We decided to have our son, Jonas, circumcised, because my husband, Conrad, wanted to. He's circumcised, so it's a case of like father like son. We researched it before we had it done, and nothing really bothered me for or against it. However, Conrad's family are doctors and nurses, and they all encouraged us to have it done.
"If I had another boy, I would have to have him circumcised too, because you can't have one boy done and not the other. But it was a horrible experience. Jonas was three weeks old when we took him to a doctor's surgery for the procedure. Apparently that's all this doctor does and all you could hear in the surgery was babies screaming. Now, I hear that doctors are doing it later, but I wouldn't have it done that way. At three weeks, Jonas screamed for about 20 minutes -- if they're older, they're more aware that it's hurting. I would recommend having it done earlier.
"After the circumcision, his penis was wrapped in gauze while it healed, and it was just so painful for me. We had to bath him in salt water to help the healing process and slowly pull the gauze away. As we were unwrapping it, some of the gauze was stuck to the skin and it was just horrible - hard and heartbreaking. Unless you've got the guts for it, I wouldn't do it. But I don't regret it.
"There are a lot of people saying to me now that less children are now being circumcised, so I don't know how that's going to effect Jonas as he's growing up. It's starting to worry me that he won't be like everybody else."
-- Juliette Van Outen
"No, we didn't have it done"
"I always thought I would circumcise any sons I had, because I think a circumcised penis looks nicer, and because my husband, Anton, is circumcised. But when I had Saxon, I realised there was no way I was going to inflict unnecessary pain on my little boy. "Every time I thought about the actual procedure, I'd feel physically sick. When my husband brought up the subject -- he wanted Saxon to be done -- I'd say let's wait until he's six months, which is when babies can be anaesthetised. It was my way of buying time.
"Saxon turned six months and the subject was casually broached again. I said I didn't want to do it; that I couldn't see the pros outweighing the cons. Anton still said he wanted it done. We left it at that. Just before Saxon turned one, I read an article that confirmed my feelings against getting it done. The article described the pain of the procedure and the fact that uncircumcised men experience greater pleasure during sex. I told my husband that now I was adamantly against circumcision. He just said 'Well, I figured out pretty quickly that, when we didn't do it straight away, we wouldn't do it at all.' It wasn't a big issue between us, thankfully."
-- Vicky Redlich
"I said no, but doctors changed my mind."
"Jon was circumcised when he was four. I deliberately chose not to have him (and my other boys) done as babies, but then when he was nearly four, Jon started to scream when he went to the toilet and I knew something was wrong. It turned out that his foreskin wouldn't retract and this was causing him pain when he did a wee. Our doctor convinced me that circumcision was the best option.
Jon had a general anaesthetic for the operation and came out of it quite quickly, but he was in lots of pain for weeks after. He screamed whenever he did a wee and he screamed the first time I put him in the bath after the operation. After that he wouldn't go near the bath for two weeks. His penis got infected and he needed antibiotics to clear it up.
He kept crying and saying, "I wish I had my old willy back". It was really rough on Jon and created several weeks, if not a couple of months, of crying and pain, but we've had no problems since."
- Ginny Anderson
Source: "Circumcision: Fore(skin) and against" , Practical Parenting, June 2002
NOTE: It is not unusual for boys to go through a phase during which the foreskin balloons out when they urinate. This is nothing to worry about: it can actually help gently stretch the foreskin and detach it from the glans. Phimosis can now nearly always be successfully treated with steroid cream. It's pretty obvious that the parents who got their boys circumcised inflicted needless suffering and harm: the first case for no good reason at all, the third on the basis of bad medical advice. If your GP tells you that your boy "needs" to be circumcised, make sure you get a second opinion, preferably from a competent paediatrician, before you agree.
"I am an English atheist and my husband is an Egyptian Muslim. My son was born with undescended testicles and at the age of two and a half had an operation to bring them down permanently. Even though I was completely against it as a form of mutilation, my husband was adamant that our son would be circumcised one day - definitely in Egypt when he was older and without anaesthetic. As I thought it would be safer for him in England, under anaesthetic, and to avoid any further family conflict in the future, I thought it better to get it over and done with while he was having his other operation.
Not a day has passed since (it's been five years now) that I have not regretted giving in to my dominant husband. The pain my little boy went through with his penis weeping and covered in stitches for days afterwards, the thoughts of how it would affect him psychologically, how he would feel about being different from other boys, how it would affect his sexual pleasure when he grows up, how he might hate me one day for agreeing to this barbaric mutilation, and all these thoughts and more haunt me every day since. To have it done when there was no medical reason, no reason whatsoever for it having to be done - I just cannot live with my conscience without knowing there is any advantage whatsoever. If only I had said no, wait until he's older and can decide for himself - of course he never would have decided 'yes', who would agree to having the most sensitive part of their body mutilated? "
New York engineer Jonathan Friedman writes that he became aware of the damaged condition of his penis from an early age: “The unsightly scar around the shaft of my penis, halfway along its length. The discolored flesh above the scar which used to be the inside of my foreskin. The scar tissue where my frenulum used to attach to my glans. When I reached puberty, my erections were tight and painful. When I started masturbating, I didn’t understand that I needed to use lubrication, and as a consequence I seriously damaged my penis. The skin was bleeding, chaffed and flaking off. I was in pain. At this point I realized that the skin should be gliding back and forth over the shaft, but this was very difficult to do because my circumcision was so tight. I could only move the skin up towards my glans, pulling more hair-baring skin from my groin up onto my shaft. I couldn’t move my shaft skin downward at all. When I became sexually active, I realized I had virtually no touch-sensitivity. I felt devastated. Not much has changed since.
“I also frequently experience lymphedema, where the top of my penis above my circumcision scar fills up with fluid and swells. This happens spontaneously and during arousal. Recently I experienced a lymphedema episode where my penis didn't return to its normal size for over twelve hours. Due to all my issues with pain and swelling, I can only masturbate once or twice per month. Even with copious lubrication, my shaft skin becomes chaffed and bleeds. If I had the choice, I would not be circumcised.”
Source: Jonathan Friedman, On Circumcision, Authority and the Perpetuation of Abuse
by Elwyn Moir
I was in kindergarten when I first realised parts of my penis were missing - and it felt horrible. My parents were forthright in explaining my body to me as a child; I have clear early memories of bathing with my Dad and I can’t recall a time when I didn’t know I was circumcised. However, when I saw other preschool boys who had “the whole package” I was taken aback by the contrasts – their penises had interesting parts mine lacked, and the glans (head) of an intact penis looked glossier, smoother, moister and far healthier than mine.
Excessive removal of skin and mucosa is one of the most common results of neonatal circumcision, yet the true frequency of this injury and its adverse effects on physical and psychological development have never been adequately documented. In this account, Shane Peterson tells his own story of the lifelong trauma he has suffered as a result of the “routine neonatal circumcision” to which he was subjected soon after birth – an operation in which nearly all the skin of the penis shaft was removed in addition to the skin and mucosa of the foreskin.
The horrific results and damaging long term sequelae of this iatrogenic injury distorted Shane’s physical and psychological development, his sexuality, his perceived place in society, and his career. Doctors and psychiatrists were unsympathetic when he complained of pain and disfigurement. Reconstructive surgery to resolve the physical injury yielded such disappointing results that he attempted suicide. Eventually, Shane was able to achieve partial resolution of the psychological trauma through a combination of ongoing counselling, successful litigation against the operator, and an active commitment to public education about the detrimental effects of circumcision.
Alex was circumcised at 25 during an operation to correct a bend in his penis. The surgeon decided - without Alex's consent - to remove the foreskin, an action that other surgeons have subsequently confirmed as unnecessary. "There was a huge reduction in erogenous tissue," says Alex, now 29, a systems analyst from Oxfordshire. "The feeling of pleasure has changed so much that I haven't been able to achieve orgasm since the operation. It had a disastrous effect on my relationship: my partner wondered whether it was her fault, and that contributed to the end of our relationship. Since then I've found it hard to get into a new relationship. I am conscious of how I look, and girlfriends have given me quizzical looks. They are not used to seeing circumcised men. I haven't had the confidence to go into a public changing room since the operation."
Source: Simon Crompton, "The unkindest of cuts", Times (London), 13 January 2003
Dr David Nunn - Worst mistake of my life"
I was circumcised when I was 19 because I wanted to be "normal" like other young men. I am now many years down the track from 19 and I consider it to be the biggest and worst mistake of my whole life. The first time I masturbated after being circumcised it was an absolute let-down because the feeling was about one third the intensity of my pre-circumcision and has been ever since. By removal of the prepuce (foreskin) quite a large amount of nerve tissue is destroyed, and hence the wonderful feeling associated with the glans moving in and out of the prepuce. All doctors should be compelled to explain to the parents of innocent baby boys and to adults seeking circumcision the destructive effects of such a mutilation.
Sent to Canadian site offering special underwear to help protect penis and restore sensitivity in circumcised men
David Louis, a 37 year old Aussie man living on the Gold Coast, got the idea that circumcision would improve his sex life. He had the operation, but the result was a disaster: "I had disgust with the surgeon for failing to warn me, and disgust with myself for letting this happen, and an overall feeling of bitter bitter disappointment of the loss of sexual feeling. Now, 30 months on, the foreskin removal is a horrendous loss to me and my sexual enjoyment."
I’m a 24-year-old man, originally from the former Soviet Union (Ukraine), where circumcision was not practiced (and was discouraged for that matter). When I was a toddler, I had a severe case of phimosis. My mother asked Soviet surgeons to remove my foreskin to cure the condition, but they refused, insisting on topical treatments. Eventually, treatments helped. And so the foreskin stayed.
But he got circumcised in his twenties, after he had moved to the United States, and soon realised that it was the biggest mistake of his life.
In medical circles, neonatal male circumcision was long assumed to be psychologically and emotionally benign. It was believed that newborn infants had "poorly developed" neurologic systems; that newborns could not feel pain; or, if they did feel the pain, they would not remember it. According to that orthodoxy, the experience of neonatal circumcision could never have any lasting effect on a child and could not traumatize a child. These claims were gross assumptions, not evidence-based statements, since the circumcision promoters had done no research on the question and were merely giving the assurances best calculated to reduce opposition to their plans. There was, in fact, published evidence that boys could be traumatised by circumcision as early as the 1920s, and way back in the 1890s it was pointed out that most would prefer not to be circumcised and were thus likely to be resentful and unhappy if it was done to them.
Just how sensitive even very young boys can be to interference with their penis was revealed in a paper by David Levy published in 1945. He was a psychiatrist who treated children with psychological and behavioural problems. In many cases he found that their difficulties could be traced to an operation in early childhood or infancy, and that operations on the penis were especially likely to leave psychological and emotional, as well as physical, scars.
In summary, the old belief that children do not remember, or don't care about, medical interventions carried out when they are very young, and that infants cannot feel pain, is now outmoded and discredited. Further information on pain of circumcision and pain control
It was also a common belief that the foreskin had no particular structure and no useful function; and that the patient would never later regret its loss.
The idea that the foreskin is a "useless flap of skin" is contradicted by a modern understanding of anatomy.
The assumption that no patient would ever regret being circumcised was not (and was never) justified.
Enough evidence now exists to say with confidence that male circumcision causes psychological changes. The trauma of the experience is injurious. It can have long-term deleterious effects later in life. However, the specific neurological, psychological, and behavioural changes resulting from early genital trauma have never been carefully investigated. Much more study is needed to further elaborate these changes.
The study of the psychology of circumcision can be divided into several interrelated areas:
In a study published in the August 2013 issue of the Canadian Urological Association Journal, urologists report a disturbingly high incidence of complications and other adverse outcomes from circumcisions performed on infants by surgeons in Ontario hospitals. The authors found that “most physicians performing neonatal circumcisions in our community have received informal and unstructured training. This lack of formal instruction may explain the complications and unsatisfactory results witnessed in our pediatric urology practice. Many practitioners are not aware of the contraindications to neonatal circumcision and most non-surgeons perform the procedure without being able to handle common post-surgical complications.” In other words, even under the most favourable conditions - qualified medical personnel, modern hospitals and the latest equipment, an advanced Western society - circumcision of infants still cannot be safely performed.
Although they are not aware of it, the authors confirm the conclusion of Hugh Young, in a study of circumcision techniques, that no fully satisfactory and entirely safe method has ever been devised and - given the complex and variable anatomy of the foreskin - none is ever likely to be. Unlike a finger, an arm, the gall bladder, or the appendix, the foreskin is not a discrete or self-contained member or organ that can easily be detached from the rest of the body. Since it is an extension of the penile skin system, there is no agreed point at which the “foreskin” ends and the rest of the penis skin begins, and thus no clearly-defined point at which the operator should start (or stop) cutting. As Young concludes, the structure of the foreskin does not lend it self to neat amputation, but is highly vulnerable to complications and messy cosmetic outcomes.
Abstract A survey of circumcision methods and instruments is presented from an evolutionary perspective. Instruments for circumcising have evolved, but not in any coherent or consistent manner. Nor, after more than 4,000 years, has any consistent (“best”) method emerged for circumcising. This underlines fundamental problems with the operation. The instruments have been fetishized along with the operation.
The article concludes: Unlike the hurricane lantern, they did not find the best method and stick with it; unlike the scissors, there was no great leap forward; unlike the car door handle, there was no smooth progression, from linear to annular to disposable, Instead, inventors have jumped back and forth, apparently having some nostalgia for the linear barzel, and perhaps some dislike of the necrosis of the Plastibell. It took the designers of the devices thousands of years to work out how to compress in a circle. They still have not accommodated the frenulum because the frenulum intractably complicates the cutting. And though it is common knowledge that the frenulum, the last remnant of Taylor’s ridged band, is the male G-spot, circumcisers have not yet formulated a consistent policy towards it and hence their devices do not treat it consistently. What this exposes is that no way of circumcising is without problems because the foreskin has not evolved in a way that lends itself to being removed.
Source: Hugh Young. Evolution of Circumcision Methods: Not “Just a Snip”, in G.C. Denniston et al (eds), Genital Cutting: Protecting Children from Medical, Cultural, and Religious Infringements. Dordrecht: Springer 2013.
Full text of Hugh Young’s article may be download as PDF here: Young-CircumcisionMethods
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