News about circumcision from Australia

and around the world : 2018



High risk of circumcision complications demands hospital-only operations


A Scandinavian study of complications arising from circumcision concludes that the risk of serious harm is great enough to require that circumcision always be performed in hospitals with 24-hour emergency departments. The key points of the paper: (1) This study reviewed factors associated with complications of circumcision in infant boys in Scandinavia over the last two decades. (2) We found that 32 cases had been reported to the health authorities, with a total of 74 complications, including severe bleeding, circulatory shock and one death. (3) Based on our analyses of the severe cases, we argue that circumcision should only be performed at hospitals with a 24-hour emergency department.

This conclusion is confirmed by a study of boys brought to the emergency department of the Royal Children’s Hospital, Melbourne, which found that circumcision complications were more common when performed by GPs or in “specialist” circumcision clinics. Details on this site.

Gertrud Edler et al. Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital-based procedure. Acta Paediatrica 105 (2016): 842-850.

Pain study finds baby boys show signs of extreme distress during circumcision

A study based on videotapes of baby boys being circumcised identified 40 types of distress behaviour and reaches the obvious conclusion that circumcision is acutely painful and causes the infant extreme distress. One paragraph deserves quotation in full:

There were 24 common distress behaviors during circumcision. These 24 behaviors also occurred during diaper change and restraint application; however, they occurred either more frequently or for longer duration during circumcision. Neonates spent 76% of the 3-min circumcision crying, but we noted an increased variation in the pitch, tempo and urgency of the cry compared to the restraint event. Within a space of a few seconds—and especially when the surgeon inserted the probe to separate the glans—cry shifted from hoarse and strained to exhausted and weak-sounding, and from abrupt and explosive to loud or rapidly repeating. For about 63% of circumcision, neonates positioned their heads midline and their upper limbs appeared very tense, whether crying or not. They also extended their hands (fisted or palm exposed) and positioned them side or front facing, and they frequently exhibited very strained neck hyperextensions, which co-occurred with cry and handling.

How on earth was ethics approval granted for this ghoulish experiment? Did we really need videotape evidence to prove that circumcision is baby torture?

Fay Warnock & Dilma Sandrin. Comprehensive description of newborn distress behavior in response to acute pain (newborn male circumcision). Pain 107 (2004): 242-255.

As human rights advance …

… circumcision advocates have nowhere left to hide


The terms of the debate about non-therapeutic circumcision of minors have changed. The issue is no longer whether the so-called “benefits” outweigh the risks, or even whether the benefits outweigh the risks and harms. (As for the troglodytes who still mutter about pros and cons …) Coming on top of the judgement of a German court that circumcision is bodily harm and that it violates the child’s right to religious freedom, a leading legal philosopher now argues that boys have an inherent right not to be circumcised without medical need. In a paper forthcoming in Health Matrix, Stephen Munzer argues that current norms of autonomy and bodily integrity give male minors “a moral, anticipatory right-in-trust not to be circumcised without a medical indication.” Even more remarkably, it is now conceded by a prominent defender of religious/cultural circumcision that the practise is harmful and does violate the rights of the child. Writing in the Journal of Applied Philosophy, Joseph Mazor acknowledges the physical and moral harms of circumcision and admits that the child has “a right of moderate strength” not to be subjected to “presumably harmful circumcision”.

Both Munzer and Mazor go on to argue that, given the importance of circumcision within the cultural/religious communities that follow this tradition, the practice should not be criminalised. This is a fair point, far less important than the vital concession that circumcision is harmful and does violate the rights of the child to bodily integrity, personal autonomy and an open future. The argument about these points is over; the debate now is whether non-therapeutic circumcision is or should be illegal.

Stephen Munzer. Examining nontherapeutic circumcision. Health Matrix 28 (1) 2018: 1-77 (in press). Full text at SSRN.

Joseph Mazor. On the Strength of Children's Right to Bodily Integrity: The Case of Circumcision. Journal of Applied Philosophy, on-line first, 24 May 2018.

Further details on the human rights page


New data on deaths from infant circumcision


Death is recognised as a “rare complication” of circumcision in clinical settings in developed countries, but deaths nonetheless occur regularly. A new study finds that in the United States approximately 20 neonatal deaths per year can be attributed to circumcision. Neonatal here means within the first 30 days of life, so the study does not count deaths that occur after the first month. This might seem a small figure in relation to the overall number of births, but what death rate would be acceptable for a medically unnecessary operation performed without the consent of the subject? The abstract of the paper follows.

We sought to quantify early deaths following neonatal circumcision (same hospital admission) and to identify factors associated with such mortality. We performed a retrospective analysis of all patients who underwent circumcision while hospitalized during the first 30 days of life from 2001-2010 using the National Inpatient Sample (NIS). Over 10 years, 200 early deaths were recorded among 9,899,110 subjects (1 death per 49,166 circumcisions). Note: this figure should not be interpreted as causal but correlational: it may include both under-counting and over-counting of deaths attributable to circumcision. Compared to survivors, subjects who died following newborn circumcision were more likely to have associated co-morbid conditions, such as cardiac disease (OR: 697.8 [378.5-1286.6] p<0.001), coagulopathy (OR: 159.6 [95.6-266.2] p<0.001), fluid and electrolyte disorders (OR: 68.2 [49.1-94.6] p<0.001), or pulmonary circulatory disorders (OR: 169.5 [69.7-412.5] p<0.001). Recognizing these factors could inform clinical and parental decisions, potentially reducing associated risks.

Earp, B. D., Allareddy, V., Allareddy, V., & Rotta, A. T. (in press). Factors associated with early deaths following neonatal circumcision in the United States, 2001-2010. Clinical Pediatrics, July 2018, in press.

More Muslim thinkers questioning circumcision

While it is clear that increasing numbers Jewish people in both Israel and the United States are abandoning circumcision and opting for peaceful naming ceremonies instead, there has been only slight evidence of questioning attitudes among Muslims. This situation now appears to be changing, with scholars and thinkers now beginning to come forward with critiques of what they argue is an outdated and harmful custom. Writing in the Indonesian journal Tarbiya, Hossein Dabbagh argues that circumcision is not a necessary part of being a Muslim and further that ethical reasoning is separate from or even superior to religious law. Meanwhile, writing in Medium, Dr Arif Akhtar argues that the objections to female genital mutilation raised by World Health Organisation and anti-FGM activists are just as applicable to circumcision of boys: “It may not be as surgically extreme as the female version but it is still an unnecessary medical procedure, carried out without consent on children, who are usually too young to complain about.” In a personal comment, the author makes clear that although he was circumcised as a child, he would prefer not to have been and regards it as a harm.


In South Korea the US-sponsored custom of circumcision, introduced after the Korean War in the early 1950s, is now fading as people gain access to alternative information sources, such as the internet. A similar process of learning and consciousness-raising will eventually lead to the decline of circumcision among the world’s Jewish and Muslim communities.

Hossein Dabbagh. The Ethics of Non-Therapeutic Male Circumcision Under Islamic Law: A Lesson for Educational Prosperity in Muslim Communities. TARBIYA: Journal of Education in Muslim Society 4 (2), December 2017. (Abstract only; contact if you would like a copy of the full paper.)

Arif Akhtar. Female Genital Mutilation is bad, so why is Male Circumcision for non-medical reasons OK? Medium, 9 May 2018.

Other sources

Riad Sattouf’s account of forced circumcision in Syria

Iranian human rights activist criticises circumcision

The forgotten critics: Jewish arguments for and against circumcision have a long history

Sydney “Genital autonomy” conference supports children’s rights


The Australasian Institute for Genital Autonomy (AIGA) seminar was held on 20 November 2017 in Sydney, Australia. As an inaugural event, the AIGA seminar was held on International Children’s Day, commemorating the anniversary of the UN General Assembly’s adoption of the Convention on the Rights of the Child in 1989. AIGA is a not-for-profit organisation loosely affiliated with the genital autonomy movement in various countries. AIGA advocates for global recognition of children’s right to genital autonomy to safeguard all children from medically unnecessary genital modification procedures regardless of a child’s sex characteristics. AIGA condemns all forms of medically unnecessary modification of children’s sex characteristics as genital mutilation.

The seminar’s theme, “Genital Autonomy and the Rights of the Child” explored modification of children’s sex characteristics and international human rights law in the context of male and female genital cutting and intersex genital modification. The seminar featured five speakers to explore these practices in social, medical, and legal contexts. Dr Olayide Ogunsiji, Lecturer in Nursing and Midwifery at Western Sydney University, explored the complexities of caring and living with female genital mutilation through the voices of Australian midwives and circumcised women. Dr Juliet Richters, social epidemiologist and Honorary Professor at the Kirby Institute for Infection and Immunity in Society, University of New South Wales, presented her paper, “Circumcision: What We Can and Can’t Measure,” which explored the incommensurability of pro- and anti-circumcision arguments. Michael Glass, retired teacher and private researcher, explored Medicare funding for female genital cutting in Australia. Paul Mason, Family Law Barrister and Former Children’s Commissioner in Tasmania, explored international human rights law and children’s right to genital autonomy. Travis Wisdom, PhD Candidate in the Adelaide Law School at the University of Adelaide, presented the paper, “The Impact of a Physical and Mental Integrity Approach in the Family Court’s “Special Medical Procedures” Cases Concerning Intersex Minors.” The Family Court does not adopt a human rights framework in its intersex cases, but instead assumes an assimilationist approach to justify medically unnecessary genital modification on the understanding that adherence to socio-cultural norms is in children’s best interests. In this paper, Travis explored the impact of a physical and mental integrity approach in these cases in light of global human rights developments to safeguard intersex children. He argued that the Family Court should adopt a nuanced human rights framework for intersex cases, which incorporates the mosaic of human rights standards which are breached by intersex genital modification.

Full report by Travis Wisdom in Attorney’s for the Rights of the Child Newsletter, Winter 2017/18.

Circumcision and parental authority


Advocates and defenders of non-therapeutic circumcision of children commonly assert that a decision to circumcise a child is a reasonable exercise of parental discretion, and that to regulate or restrict it in any way is to interfere with parental rights. There have been many replies to this contention (such as this paper at Sage Open and these comments on consent), and in a recent discussion Kai Moller, Associate Professor of Law at the London School of Economics & Political Science, argues that non-therapeutic circumcision of children lies outside the scope of parental authority because it involves permanent physical changes to the child’s body and thus violates his right to an open future. The abstract of the paper follows:

A recent judgment by a lower court in Germany brought the problem of ritual male circumcision to the consciousness of the wider public and legal academia. This essay weighs in on this emerging discussion and argues that ritual male circumcision is not covered by parental authority because it violates the human rights of the boy on whom it is imposed. It first considers and dismisses the best interest test of parental authority which, by focusing on the well-being of the child as opposed to his (future) autonomy, fails to take the boy’s human rights sufficiently into account. Instead, the essay proposes what it terms the autonomy conception of parental authority, according to which parental authority must be exercised such as to ensure that the child will become an autonomous adult. While parents may raise their child in line with their ethical, including religious, convictions, respect for his autonomy requires that this be done in a way that allows the child to later distance himself from these values; this implies, among other things, that irreversible physical changes are impermissible. This conclusion holds even if it could be assumed that the child would later come to endorse his circumcision: a proper understanding of autonomy implies that the religious sacrifice of a body part can only be authorised by the person whose body it is. Thus, ritual male circumcision is outside the scope of parental authority because it usurps the child’s right and responsibility to become the author of his own life.

Kai Moller. Ritual male circumcision and parental authority. LSE Legal Studies Working Paper, June 2017.

Published as Kai Moller. Ritual male circumcision and parental authority. Jurisprudence: An International Journal of Legal and Political Thought 8 (3) 2017: 461-79.

Should circumcision of boys be banned? The need for dialogue

In a related discussion the same author considers the controversial question of whether medically unnecessary circumcision of boys should be legally prohibited in the same way as circumcision of girls (FGM). With reference to current proposals in Iceland, Denmark and other European countries to outlaw circumcision, Professor Moller calls for respectful dialogue among the various parties, the avoidance of name-calling and abuse. He writes:

My work has led me to be strongly … opposed to male circumcision. Yet there is nothing antisemitic or Islamophobic about my argument: on the contrary, it takes Jews and Muslims who are in favour of circumcision seriously as moral agents by providing moral reasons that try to convince them that their position is wrong. This attitude is not only theoretically preferable, it also works in practice. I have recently published a scholarly article criticising circumcision as a human rights violation, and over the last couple of years I have presented my arguments at various academic conferences and events, with many Jewish and Muslim participants. The discussions were controversial but almost always respectful. They revealed that there is considerable debate among Jews and Muslims about the pros and cons of circumcision. Some are opposed to circumcision or curious and open-minded about it. … People came up to me and talked, often very movingly, about their personal struggles with the question, or the disagreements within their families. When we leave identity politics aside, refrain from lazily accusing each other of prejudice or bigotry, and begin to actually talk to each other in an honest and straightforward way, such encounters can happen. We may not be able to reach agreement, and sharp divisions may remain. But we display the courage to look each other in the eye, go through the hassle of trying to develop the best possible argument for our view, and bring up the patience to listen to the other side’s views, trying to reach some common ground. In short, we treat each other as moral agents. It’s a very democratic thing to do.

Source: Let’s talk about circumcision. LSE Politics Blog, 6 March 2018.

Foreskins rule! Australians rush to abandon circumcision


According to a report on SBS, Australia’s circumcision rate has fallen by over two thirds over the past decade. According to Medicare figures, there were only 6309 boys (under 6 months) circumcised in the 2016/17 financial year, compared with 19,663 in 2007/08. SBS quotes Professor Paul Colditz, head of the Paediatrics and Child Health Division of the Royal Australasian College of Physicians, as saying that only about 4 per cent of baby boys are being circumcised these days, “so I guess parents are really making up their own minds on the basis of the available evidence.” He added that there could be some procedures not captured by the Medicare data if performed by religious figures such as Mohels, but that would be a fairly small number in relation to the 6000 or so babies circumcised in the past year. Professor Colditz attributed the sharp decline to two main factors - better informed parents and more fathers not being circumcised themselves. The number of new fathers (many born in the 1980s and early 90s) who were themselves not circumcised is increasing, and they are deciding that there is no reason why they should circumcise their own sons. Parents were also making up their own minds by researching available evidence. “We've entered an era where everyone is looking at the evidence and asking, ‘Is this operation worthwhile, will it be effective, what are the risks?'" Professor Colditz said. Parents are assessing the balance between the potential for any benefits against the potential for harm and damage. “I think the whole of society is getting more sophisticated in the way they do this.”

In other words, the more people learn about circumcision, the more they are against it.

Source: Circumstitions News

Genital autonomy and sexual wellbeing


All children - male, female and intersex - have an interest in “genital autonomy”. In a wide-ranging, deply-researched essay, Brian Earp and Rebecca Steinfeld argue that this means all children should be protected from medically unnecessary alterations to their genitals, but that adults should be free to undergo such surgeries if they have given informed consent. These rules are necessary not merely because surgical operations such as circumcision, female genital cutting (FGM) and intersex genital cutting (”normalisation surgery”) violate accepted principles of bioethics and human rights, particularly the child’s right to an open future; but also because such surgeries harm the child by removing erogenous tissue that makes a major contribution to sexual function. The authors point out that a person’s genitals are a particularly significant and uniquely intimate part of his/her body, and thus that in normal circumstances any unwanted touching in that area may constitute sexual assault. The various “health” and “cultural” justifications that have been offered for such procedures are the focus of intense controversy, but even if there was consensus on the “benefits” they would not outweigh the risks involved, nor the long term harms arising from the loss of significant bodily tissues.

Abstract. Purpose of review: To survey recent arguments in favor of preserving the genital autonomy of children—female, male, and intersex—by protecting them from medically unnecessary genital cutting practices. Recent findings: Nontherapeutic female, male, and intersex genital cutting practices each fall on a wide spectrum, with far more in common than is generally understood. When looking across cultures and comparing like cases, one finds physical, psychosexual, and symbolic overlaps among the three types of cutting, suggesting that a shared ethical framework is needed. Summary: All children have an interest in genital autonomy, regardless of their sex or gender.

The authors conclude: “Western societies, if they wish to be consistent, may soon face a choice between two courses of action. Either they must consider tolerating at least some relatively mild forms of “culturally motivated” nontherapeutic female genital cutting (FGC) performed on minors—so long as they do not cross an arbitrary threshold of presumed harmfulness—or they must consider a less tolerant attitude toward “cosmetic” female and intersex surgeries as well as medically unnecessary male circumcision performed before an age of consent. Although each approach has advantages and disadvantages, a benefit of the latter approach is that it would prioritize the genital autonomy of all vulnerable children, regardless of their race, religion, sex, or gender, thus eliminating concerns about fair treatment and equal protection.”

Brian Earp and Rebecca Steinfeld. Genital autonomy and sexual well being. Current Sexual Health Reports, in press. Full text available here.

More important than gender neutral language:

A gender-neutral policy on child genital cutting

In an earlier paper prepared for the European Parliament the same authors argue that the old genital cutting paradigm - circumcision good or OK, FGM bad and unacceptable - is outmoded, and should be replaced by a new paradigm based on gender neutrality. Under the new paradigm, all children - male, female and intersex - should be protected from medically unnecessary alterations to their private parts. This would not necessarily mean heavy-handed attempts to criminalise or otherwise legally prohibit circumcision and other forms of genital cutting, as such efforts are likely to fail in the teeth of popular resistance. In countries where FGM is entrenched as a cultural practice, laws against it have had little impact. Far more effective are efforts to discourage such practices through community education programs and the elimination of financial and other incentives, such as health insurance rebates.

The abstract reads as follows: “Moral and legal opposition to the non-therapeutic cutting of children’s genitals has traditionally focused on female children. In recent years, however, a growing movement of scholars, activists, and individuals affected by childhood genital cutting have argued that all children, regardless of sex or gender, should be protected from such intimate violations. By drawing attention to the overlapping harms to which female, male, and intersex children may be exposed as a result of having their genitals cut, this movement posits a sex and gender neutral—that is, human—right to bodily integrity and genital autonomy. This article introduces and outlines some of the main arguments supporting this perspective.”

Conclusion: Policy Implications

What are the implications of the foregoing discussion for policy? At a recent WHO-sponsored conference on female NGC held at Geneva University Hospitals, we argued that a gender-inclusive approach—based on an individual’s capacity to provide informed consent to NGC—is not only better supported by the available evidence, as explained above, but also carries several practical advantages:

  1. It neutralizes accusations of cultural imperialism by applying the same standards to medically unnecessary genital cutting practices primarily affecting white minors in North America, Australasia and Europe (i.e., medicalized routine or religious male circumcision, intersex genital normalization surgery, adolescent female cosmetic genital surgery) as it does to such practices primarily affecting minors of color in Africa, the Middle East, and Southeast Asia (i.e., male and female peripubertal initiation ceremonies and other customary forms of childhood NGC).
  2. It clarifies the moral confusion that is introduced by Western-led efforts to eliminate only the female “half” of childhood NGC practices in communities that practice both male and female NGC in parallel.
  3. It weakens accusations of sexism by recognizing that boys and intersex children are also vulnerable to non-therapeutic genital alterations that they may later come to seriously resent.

Adopting such an approach, however, does not necessarily entail “banning” all pre-consensual NGCs. History shows that the enactment of strict legal prohibitions prior to cultural readiness can backfire, creating intense resistance among those who are dedicated to the practice, often driving it underground. Prohibition of childhood female NGC, for example, has been largely unsuccessful in many countries, and recent attempts to criminalize childhood male NGC have either been blocked or overturned. There are many “levers” society can pull to discourage harmful practices: the law is only one among them, and not necessarily the most desirable or effective. Some authors have proposed step-wise regulation of childhood NGCs, along with community engagement and education, as alternatives and/or supplements to formal prohibition. Whatever specific policies are implemented, however, what is clear is that fundamentally different treatment of female, male, and intersex children—with respect to the preservation of their bodily integrity—will become increasingly difficult to justify in the coming years.

Brian Earp and Rebecca Steinfeld. Gender and Genital Cutting: A New Paradigm.

Circumcision “not justified”: Canadian urologists


In a major statement based on a comprehensive survey of the medical literature, the Canadian Urological Association has concluded that routine prophylactic circumcision of male infants and boys is not justified as a preventive health measure. The statement is of particular interest because it reaches this conclusion on the basis of a very narrow calculation of medical benefits, costs and risks, pays little attention to the harms of circumcision (such as effect on male sexuality, moral harm of denying choice etc) and largely ignores bioethical and human rights issues. The statement emphasises that the results of clinical studies in underdeveloped regions with acute health and social problems cannot be mapped onto developed nations with quite different epidemiological and social environments, and point out that “The effect of MC has to be analyzed at the individual and societal level.” The statement is at pains to point out that the evidence as to the benefits and risks of circumcision is contradictory and inconclusive, and that much of it is of poor quality, especially studies claiming to show that circumcision has little impact on sexual sensation and function. The final conclusion is that while circumcision does offer some advantages, they are small, can be achieved by other, non-surgical means, and are outweighed by the risks and harms. This being the case, routine circumcision is not justified as a health measure and cannot be recommended.

Source: Sumit Dave, Kourosh Afshar, Luis H. Braga, Peter Anderson. CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants. Canadian Urological Association Journal 2017 Dec. 1; Epub ahead of print.


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